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Sample records for adjusted medical loss

  1. 45 CFR 158.330 - Criteria for assessing request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... the State's insurance commissioner, superintendent, or comparable official may exercise with respect... the medical loss ratio. 158.330 Section 158.330 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS ISSUER USE OF PREMIUM REVENUE: REPORTING AND REBATE...

  2. 45 CFR 158.330 - Criteria for assessing request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... the State's insurance commissioner, superintendent, or comparable official may exercise with respect... the medical loss ratio. 158.330 Section 158.330 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS ISSUER USE OF PREMIUM REVENUE: REPORTING AND REBATE...

  3. 45 CFR 158.330 - Criteria for assessing request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the medical loss ratio. 158.330 Section 158.330 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... factors such as surplus level, risked-based capital ratio, net income, and operating or underwriting gain... business, as measured by their risk based capital ratios; (4) The mechanisms, such as guaranteed...

  4. 45 CFR 158.330 - Criteria for assessing request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... the medical loss ratio. 158.330 Section 158.330 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... factors such as surplus level, risked-based capital ratio, net income, and operating or underwriting gain... business, as measured by their risk based capital ratios; (4) The mechanisms, such as guaranteed...

  5. Medications for Memory Loss

    MedlinePlus

    ... memory loss, confusion, and problems with thinking and reasoning) of Alzheimer's disease. As Alzheimer’s progresses, brain cells ... the latest Alzheimer's medications available today, and the clinical trials that may bring us closer to new ...

  6. 45 CFR 800.203 - Medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 3 2013-10-01 2013-10-01 false Medical loss ratio. 800.203 Section 800.203 Public... PROGRAM Premiums, Rating Factors, Medical Loss Ratios, and Risk Adjustment § 800.203 Medical loss ratio. (a) Required medical loss ratio. An MSPP issuer must attain: (1) The medical loss ratio...

  7. 45 CFR 800.203 - Medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 3 2014-10-01 2014-10-01 false Medical loss ratio. 800.203 Section 800.203 Public... PROGRAM Premiums, Rating Factors, Medical Loss Ratios, and Risk Adjustment § 800.203 Medical loss ratio. (a) Required medical loss ratio. An MSPP issuer must attain: (1) The medical loss ratio...

  8. 45 CFR 1160.10 - Loss adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 3 2014-10-01 2014-10-01 false Loss adjustment. 1160.10 Section 1160.10 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE ARTS AND THE... sustained, the claimant shall file a Proof of Loss or Damage on forms provided by the Council. Failure...

  9. 45 CFR 1160.10 - Loss adjustment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Loss adjustment. 1160.10 Section 1160.10 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES FEDERAL COUNCIL ON THE ARTS AND THE HUMANITIES INDEMNITIES UNDER THE ARTS AND ARTIFACTS...

  10. 45 CFR 1160.10 - Loss adjustment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 3 2011-10-01 2011-10-01 false Loss adjustment. 1160.10 Section 1160.10 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES FEDERAL COUNCIL ON THE ARTS AND THE HUMANITIES INDEMNITIES UNDER THE ARTS AND ARTIFACTS...

  11. 45 CFR 1160.10 - Loss adjustment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 3 2012-10-01 2012-10-01 false Loss adjustment. 1160.10 Section 1160.10 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES FEDERAL COUNCIL ON THE ARTS AND THE HUMANITIES INDEMNITIES UNDER THE ARTS AND ARTIFACTS...

  12. 45 CFR 1160.10 - Loss adjustment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 3 2013-10-01 2013-10-01 false Loss adjustment. 1160.10 Section 1160.10 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES FEDERAL COUNCIL ON THE ARTS AND THE HUMANITIES INDEMNITIES UNDER THE ARTS AND ARTIFACTS...

  13. Weight-loss medications

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000346.htm Weight-loss medicines To use the sharing features on this page, please enable JavaScript. Several weight-loss medicines are available. Ask your health care provider ...

  14. Revenge and psychological adjustment after homicidal loss.

    PubMed

    van Denderen, Mariëtte; de Keijser, Jos; Gerlsma, Coby; Huisman, Mark; Boelen, Paul A

    2014-01-01

    Feelings of revenge are a common human response to being hurt by others. Among crime victims of severe sexual or physical violence, significant correlations have been reported between revenge and Posttraumatic Stress Disorder (PTSD). Homicide is one of the most severe forms of interpersonal violence. It is therefore likely that individuals bereaved by homicide experience high levels of revenge, which may hamper efforts to cope with traumatic loss. The relationship between revenge and psychological adjustment following homicidal loss has not yet been empirically examined. In the current cross-sectional study, we used self-report data from 331 spouses, family members and friends of homicide victims to examine the relationships between dispositional revenge and situational revenge on the one hand and symptom-levels of PTSD and complicated grief, as well as indices of positive functioning, on the other hand. Furthermore, the association between revenge and socio-demographic and offense-related factors was examined. Participants were recruited from a governmental support organization, a website with information for homicidally bereaved individuals, and members of support groups. Levels of both dispositional and situational revenge were positively associated with symptoms of PTSD and complicated grief, and negatively with positive functioning. Participants reported significantly less situational revenge in cases where the perpetrator was a direct family member than cases where the perpetrator was an indirect family member, friend, or someone unknown. Homicidally bereaved individuals reported more situational revenge, but not more dispositional revenge than a sample of students who had experienced relatively mild interpersonal transgressions. PMID:24910007

  15. Revenge and psychological adjustment after homicidal loss.

    PubMed

    van Denderen, Mariëtte; de Keijser, Jos; Gerlsma, Coby; Huisman, Mark; Boelen, Paul A

    2014-01-01

    Feelings of revenge are a common human response to being hurt by others. Among crime victims of severe sexual or physical violence, significant correlations have been reported between revenge and Posttraumatic Stress Disorder (PTSD). Homicide is one of the most severe forms of interpersonal violence. It is therefore likely that individuals bereaved by homicide experience high levels of revenge, which may hamper efforts to cope with traumatic loss. The relationship between revenge and psychological adjustment following homicidal loss has not yet been empirically examined. In the current cross-sectional study, we used self-report data from 331 spouses, family members and friends of homicide victims to examine the relationships between dispositional revenge and situational revenge on the one hand and symptom-levels of PTSD and complicated grief, as well as indices of positive functioning, on the other hand. Furthermore, the association between revenge and socio-demographic and offense-related factors was examined. Participants were recruited from a governmental support organization, a website with information for homicidally bereaved individuals, and members of support groups. Levels of both dispositional and situational revenge were positively associated with symptoms of PTSD and complicated grief, and negatively with positive functioning. Participants reported significantly less situational revenge in cases where the perpetrator was a direct family member than cases where the perpetrator was an indirect family member, friend, or someone unknown. Homicidally bereaved individuals reported more situational revenge, but not more dispositional revenge than a sample of students who had experienced relatively mild interpersonal transgressions.

  16. Recovering from Loss: A Qualitative Study Examining Student Loss While in Medical School

    ERIC Educational Resources Information Center

    Yokota, Mitsue

    2011-01-01

    Recovering from the loss of a loved one can be difficult for anyone, but it can be especially trying for individuals already dealing with elevated levels of stress. Various studies have looked at the causes of stress in medical school students, but little has been done to understand the adjustments these students undergo after experiencing the…

  17. 48 CFR 49.203 - Adjustment for loss.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Adjustment for loss. 49.203 Section 49.203 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TERMINATION OF CONTRACTS Additional Principles for Fixed-Price Contracts Terminated...

  18. Role loss and emotional adjustment in chronic pain.

    PubMed

    Harris, Samantha; Morley, Stephen; Barton, Stephen B

    2003-09-01

    Chronic pain interrupts behaviour, interferes with functioning, and may affect a person's identity: their sense of self. We tested whether loss of role and personal attributes and current and past self-concept differentiation, predicted adjustment as indexed by measures of depression. Chronic pain patients (n=80) completed measures of pain (MPQ), disability (PDI), depression and anxiety (BDI, HADS). Measures of role and attribute loss and self-concept differentiation were derived from a Role-Attribute Test in which participants identified four social roles in four domains (friendship, occupation, leisure, family) and nominated two personal attributes in each role prior to pain onset and current. Participants reported mean losses of 3.38 roles, and 6.97 attributes. Greater losses were observed in friendship, occupation and leisure domains compared with the family domain. Multiple regression analyses revealed that after controlling for demographic and clinical differences, role and attribute loss predicted depression scores. There was no evidence that depression was associated with past self-concept differentiation. The results are discussed with reference to the methodology used and the relevance of self-identity to understand adjustment to chronic pain. PMID:14499455

  19. Low-loss polymer films with adjustable refractive index.

    PubMed

    Ramaswamy, V; Weber, H P

    1973-07-01

    Solution-deposited polymer films with continuously adjustable refractive index (1.489-1.563) are made by blending in solution two polymers: polymethyl methacrylate (PMMA) and styrene-acrylonitrile copolymer (SAN). The dependence of index of refraction on composition was found to be linear, indicating the compatibility of the two polymers on a molecular basis. In films ~2 microm thick losses less than 0.2 dB/cm were measured. For thicker films (3.5 microm) an increased scattering loss was observed in high SAN content films.

  20. Sleep loss and fatigue in medical training.

    PubMed

    Owens, J A

    2001-11-01

    The effects of sleep loss and fatigue in the context of medical training is a topic that has generated considerable interest, as well as controversy, over the past two decades. The sleep deprived state in medical trainees potentially impacts on a variety of domains relevant to medical care, including performance on neurobehavioral and work-related tasks, mood and affect, learning, risk for and commission of medical errors, and the health and well-being of medical students and residents. The following review provides a summary of research conducted on this topic in the past decade, including the relation of sleep loss and fatigue to medical errors and the quality of patient care. Those few studies that have analyzed the use of operational alertness management strategies, countermeasures, and educational interventions to address and mitigate the effects of sleep loss and fatigue are also reviewed. There is clearly a need for additional research to further explore the complex interaction between sleep and fatigue and medical care, and to support the development and implementation of regulatory policies based on sound science. PMID:11706318

  1. [Medical image automatic adjusting window and segmentation].

    PubMed

    Zhou, Zhenhuan; Chen, Siping; Tao, Duchun; Chen, Xinhai

    2005-04-01

    Image guided surgical navigation system is the most advanced surgical apparatus, which develops most rapidly and has great application prospects in neurosurgery, orthopaedics, E.N.T. department etc. In current surgical navigation systems, windowing, segmenting and registration of medical images all depend on manual operation, and automation of image processing is urgently needed. This paper proposes the algorithm which realizes very well automatic windowing and segmentation of medical images: first, we analyze a lot of MRI and CT images and propose corresponding windowing algorithm according to their common features of intensity distribution. Experiments show that the effects of windowing of most MRI and CT images are optimized. Second, we propose the seed growing algorithm based on intensity connectivity,which can segment tumor and its boundary exactly by simply clicking the mouse, and control dynamically the results in real time. If computer memory permits, the algorithm can segment 3D images directly. Tests show that this function is able to shorten the time of surgical planning, lower the complexity, and improve the efficiency in navigation surgery. PMID:15884547

  2. Medical loss ratio regulation under the Affordable Care Act.

    PubMed

    Harrington, Scott E

    2013-01-01

    The minimum medical loss ratio (MLR) regulations in the Affordable Care Act guarantee that a specific percentage of health insurance premiums is spent on medical care and specified activities to improve health care quality. This paper analyzes the regulations' potential unintended consequences and incentive effects, including: higher medical costs and premiums for some insurers; less innovation to align consumer, provider, and health plan incentives, less consumer choice and increased market concentration; and the risk that insurers will pay rebates if claim costs are lower than projected when premiums are established, despite the regulations' permitted "credibility adjustments." The paper discusses modifications and alternatives to the MLR regulations to help achieve their stated goals with less potential for adverse effects. PMID:23720876

  3. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data....

  4. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data....

  5. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data....

  6. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data....

  7. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data....

  8. Nonlinear optical losses in medical fibers

    NASA Astrophysics Data System (ADS)

    Ozols, Andris O.; Ivanovs, Girts; Coders, Guntars

    1997-02-01

    Attenuation intensity dependences of 1064 nm and 532 nm picosecond pulses in multimode optical fibers produced for medical purposes by 'Anda' factory in Livani, Latvia are experimentally studied. A strong linear growth of inverse transmittance with intensity is found. The possible mechanism of nonlinear losses are analyzed and the conclusion is made that the observed effect is mainly due to the two-photon absorption involving defects levels. Strong attenuation intensity dependence can be used to make such fiber optical devices as light power limiters, optically driven light modulators and dynamic holographic frequency filters.

  9. 45 CFR 158.210 - Minimum medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Minimum medical loss ratio. 158.210 Section 158.210 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS... § 158.210 Minimum medical loss ratio. Subject to the provisions of § 158.211 of this subpart: (a)...

  10. 45 CFR 158.210 - Minimum medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Minimum medical loss ratio. 158.210 Section 158.210 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS... § 158.210 Minimum medical loss ratio. Subject to the provisions of § 158.211 of this subpart: (a)...

  11. Pattern hair loss in men: diagnosis and medical treatment.

    PubMed

    Banka, Nusrat; Bunagan, M J Kristine; Shapiro, Jerry

    2013-01-01

    Androgenetic alopecia is a common cause of hair loss in both men and women. The exact pathogenesis of androgenetic alopecia is not well understood. As the name implies, the role of androgens and genetic susceptibility predisposes to pattern hair loss due to gradual conversion of terminal hair into vellus hair. Male and female pattern hair loss are clinically distinct entities but histologically indistinguishable. The role of sex hormones in females is less understood. This article discusses current understanding of the etiopathogenesis of hair loss in men, diagnostic tests available, and its medical management. PMID:23159182

  12. Loss of chance: a new development in medical negligence law.

    PubMed

    Tibballs, James

    2007-08-20

    The concept of "loss of chance" as an alternative cause of action in cases of medical negligence has succeeded in recent cases where actions based on causation have failed. The plaintiff must prove negligence and loss of a chance of a better outcome. The quantity of loss of chance must be more than "speculative" (1%). Damages are awarded as a proportion of the total injury commensurate with the loss of chance. More claims may be expected, although damages will generally be less than those awarded under causation. Doctors' insurance premiums may rise.

  13. Denial and External Locus of Control as Mechanisms of Adjustment in Chronic Medical Illness

    ERIC Educational Resources Information Center

    Goldstein, Alan M.

    1976-01-01

    Adjustment of patients with a serious medical condition to psychological stress accompanying their disorder was investigated. Long-term hemodialysis patients (N=22) and 24 patients in recovery stages of minor medical problems were experimental and control subjects. A significant relationship was found between denial and external locus of control…

  14. Sleep Loss in Resident Physicians: The Cause of Medical Errors?

    PubMed Central

    Kramer, Milton

    2010-01-01

    This review begins with the history of the events starting with the death of Libby Zion that lead to the Bell Commission, that the studied her death and made recommendations for improvement that were codified into law in New York state as the 405 law that the ACGME essentially adopted in putting a cap on work hours and establishing the level of staff supervision that must be available to residents in clinical situations particularly the emergency room and acute care units. A summary is then provided of the findings of the laboratory effects of total sleep deprivation including acute total sleep loss and the consequent widespread physiologic alterations, and of the effects of selective and chronic sleep loss. Generally the sequence of responses to increasing sleep loss goes from mood changes to cognitive effects to performance deficits. In the laboratory situation, deficits resulting from sleep deprivation are clearly and definitively demonstrable. Sleep loss in the clinical situation is usually sleep deprivation superimposed on chronic sleep loss. An examination of questionnaire studies, the literature on reports of sleep loss, studies of the reduction of work hours on performance as well as observational and a few interventional studies have yielded contradictory and often equivocal results. The residents generally find they feel better working fewer hours but improvements in patient care are often not reported or do not occur. A change in the attitude of the resident toward his role and his patient has not been salutary. Decreasing sleep loss should have had a positive effect on patient care in reducing medical error, but this remains to be unequivocally demonstrated. PMID:21188260

  15. Pesticide residues in eggs of wild birds: Adjustment for loss of moisture and lipid

    USGS Publications Warehouse

    Stickel, L.F.; Wiemeyer, Stanley N.; Blus, L.J.

    1973-01-01

    Eggs of wild birds collected for the purpose of measuring concentrations of pesticides or other pollutants vary from nearly fresh to nearly dry so that objective comparisons cannot be made on the basis of weight of the contents at the time of collection. Residue concentrations in the nearly dry eggs can be greatly exaggerated by this artifact. Valid interpretation of residue data depends upon compensation for these losses. A method is presented for making adjustments on the basis of volume of the egg, and formulas are derived for estimating the volume of eggs of eagles, ospreys, and pelicans from egg measurements. The possibility of adjustments on the basis of percentage of moisture, solids, or fat in fresh eggs is discussed also.

  16. Adjusting to Hearing Loss during High School: Preparing Students for Successful Transition to Postsecondary Education or Training. Tipsheet

    ERIC Educational Resources Information Center

    Brooks, Dianne

    2009-01-01

    Completion of postsecondary education frequently builds upon a student's successful academic and personal experience during high school. For students with hearing loss, healthy adjustment to hearing loss is a key lifelong developmental process. The vast majority (94%) of approximately 1.1 million K-12 students with hearing loss are educated in…

  17. 75 FR 82277 - Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-30

    ... HUMAN SERVICES 45 CFR Part 158 RIN 0950-AA06 Health Insurance Issuers Implementing Medical Loss Ratio... ``Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient Protection... Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements accurately states...

  18. Masculinity, Femininity, and Psychosocial Adjustment in Medical Students: Two-Year Follow-Up.

    ERIC Educational Resources Information Center

    Zeldow, Peter B.; And Others

    Although research on masculinity and femininity has increased over the past decade, longitudinal studies addressing predictive elements are lacking. The Rush Medical College Longitudinal Study examines the correlation between masculinity and femininity on the one hand and adjustment, interpersonal functioning, and impairment on the other. During…

  19. Dietary and medication adjustments to improve seizure control in patients treated with the ketogenic diet

    PubMed Central

    Selter, Jessica H.; Turner, Zahava; Doerrer, Sarah C.; Kossoff, Eric H.

    2014-01-01

    Unlike anticonvulsant drugs and vagus nerve stimulation, there are no guidelines regarding adjustments to ketogenic diet regimens to improve seizure efficacy once the diet has been started. A retrospective chart review was performed of 200 consecutive patients treated with the ketogenic diet at Johns Hopkins Hospital from 2007-2013. Ten dietary and supplement changes were identified, along with anticonvulsant adjustments. A total of 391 distinct interventions occurred, of which 265 were made specifically to improve seizure control. Adjustments lead to >50% further seizure reduction in-18%, but only 3% became seizure-free. The benefits of interventions did not decrease over time. There was a trend towards medication adjustments being more successful than dietary modifications (24% vs. 15%, p = 0.08). No single dietary change stood out as the most effective, but calorie changes were largely unhelpful (10% with additional benefit). PMID:24859788

  20. Do Afterlife Beliefs Affect Psychological Adjustment to Late-Life Spousal Loss?

    PubMed Central

    2014-01-01

    Objectives. We explore whether beliefs about the existence and nature of an afterlife affect 5 psychological symptoms (anxiety, anger, depression, intrusive thoughts, and yearning) among recently bereaved older spouses. Method. We conduct multivariate regression analyses using data from the Changing Lives of Older Couples (CLOC), a prospective study of spousal loss. The CLOC obtained data from bereaved persons prior to loss and both 6 and 18 months postloss. All analyses are adjusted for health, sociodemographic characteristics, and preloss marital quality. Results. Bleak or uncertain views about the afterlife are associated with multiple aspects of distress postloss. Uncertainty about the existence of an afterlife is associated with elevated intrusive thoughts, a symptom similar to posttraumatic distress. Widowed persons who do not expect to be reunited with loved ones in the afterlife report significantly more depressive symptoms, anger, and intrusive thoughts at both 6 and 18 months postloss. Discussion. Beliefs in an afterlife may be maladaptive for coping with late-life spousal loss, particularly if one is uncertain about its existence or holds a pessimistic view of what the afterlife entails. Our findings are broadly consistent with recent work suggesting that “continuing bonds” with the decedent may not be adaptive for older bereaved spouses. PMID:23811692

  1. Sweet taste preferences before and after an intensive medical weight loss intervention

    PubMed Central

    Rothberg, A. E.; Arcori, L.; Kaur, M.; Fowler, C. E.; Herman, W. H.

    2016-01-01

    Summary Objective Medical weight loss could change sweet taste threshold and preferences. The decrease in sweet taste preferences may, in turn, help in the maintenance of weight loss. This study examined the association between sweet taste preferences at baseline and weight change during a medical weight management programme and the impact of diet‐induced weight loss on sweet taste preferences. Methods Adult patients with body mass index ≥32 kg m−2 were recruited from a medical weight management clinic. Sweet taste preference was assessed using a forced‐choice, paired‐comparison tracking method before and after a very‐low‐calorie diet (VLCD). Results Twenty participants were included in the analysis: mean age was 53.1 (standard deviation [SD]: 11.4) years, and 14 were female. The mean body mass index was 41.4 (SD: 7.5) kg m−2. The median preferred sucrose concentration before VLCD was 0.45 M. Following VLCD, mean change in weight was −13.3 (SD: 6.6) kg, and percentage weight change was −11.3% (SD: 5.9%). Based on mixed models with and without adjustment for demographic factors, diabetes status and smoking history, preferred sucrose concentration at baseline did not predict change in longer‐term body weight. The change of preferred sucrose concentration following 12 weeks of VLCD was not significant (P‐value 0.95). Conclusions Change in weight during and after VLCD was not associated with sweet taste preferences at baseline. After diet‐induced weight loss, sweet taste preferences did not change. PMID:27812384

  2. Tropical cyclone losses in the USA and the impact of climate change - A trend analysis based on data from a new approach to adjusting storm losses

    SciTech Connect

    Schmidt, Silvio; Hoeppe, Peter

    2009-11-15

    Economic losses caused by tropical cyclones have increased dramatically. Historical changes in losses are a result of meteorological factors (changes in the incidence of severe cyclones, whether due to natural climate variability or as a result of human activity) and socio-economic factors (increased prosperity and a greater tendency for people to settle in exposed areas). This paper aims to isolate the socio-economic effects and ascertain the potential impact of climate change on this trend. Storm losses for the period 1950-2005 have been adjusted to the value of capital stock in 2005 so that any remaining trend cannot be ascribed to socio-economic developments. For this, we introduce a new approach to adjusting losses based on the change in capital stock at risk. Storm losses are mainly determined by the intensity of the storm and the material assets, such as property and infrastructure, located in the region affected. We therefore adjust the losses to exclude increases in the capital stock of the affected region. No trend is found for the period 1950-2005 as a whole. In the period 1971-2005, since the beginning of a trend towards increased intense cyclone activity, losses excluding socio-economic effects show an annual increase of 4% per annum. This increase must therefore be at least due to the impact of natural climate variability but, more likely than not, also due to anthropogenic forcings.

  3. Indirect Medical Education and Disproportionate Share Adjustments to Medicare Inpatient Payment Rates

    PubMed Central

    Nguyen, Nguyen Xuan; Sheingold, Steven H.

    2011-01-01

    The indirect medical education (IME) and disproportionate share hospital (DSH) adjustments to Medicare's prospective payment rates for inpatient services are generally intended to compensate hospitals for patient care costs related to teaching activities and care of low income populations. These adjustments were originally established based on the statistical relationships between IME and DSH and hospital costs. Due to a variety of policy considerations, the legislated levels of these adjustments may have deviated over time from these “empirically justified levels,” or simply, “empirical levels.” In this paper, we estimate the empirical levels of IME and DSH using 2006 hospital data and 2009 Medicare final payment rules. Our analyses suggest that the empirical level for IME would be much smaller than under current law— about one-third to one-half. Our analyses also support the DSH adjustment prescribed by the Affordable Care Act of 2010 (ACA)—about one-quarter of the pre-ACA level. For IME, the estimates imply an increase in costs of 1.88% for each 10% increase in teaching intensity. For DSH, the estimates imply that costs would rise by 0.52% for each 10% increase in the low-income patient share for large urban hospitals. PMID:22340777

  4. 26 CFR 1.833-1 - Medical Loss Ratio under section 833(c)(5).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 8 2014-04-01 2014-04-01 false Medical Loss Ratio under section 833(c)(5). 1.833-1 Section 1.833-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Other Insurance Companies § 1.833-1 Medical Loss Ratio under section 833(c)(5). (a) In...

  5. 77 FR 28788 - Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Under the Patient Protection and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-16

    ... HUMAN SERVICES 45 CFR Part 158 Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Under the... Federal Register on December 1, 2010, entitled ``Health Insurance Issuers Implementing Medical Loss Ratio... published in the Federal Register on December 30, 2010, entitled ``Health Insurance Issuers...

  6. The Effect of Undergraduate GPA Selectivity Adjustment on Pre-interview Ranking of Rural Medical School Applicants.

    ERIC Educational Resources Information Center

    Gilbert, Gregory Eastham; Blue, Amy Victoria; Basco, William Thomas, Jr.

    2003-01-01

    Almost all U.S. medical schools adjust applicants' GPAs based on the selectivity of applicants' undergraduate institutions. Analysis of data from 2,033 in-state applicants to the Medical University of South Carolina, 1996-99, found that this practice did not adversely affect the number of rural applicants offered admission interviews. (SV)

  7. 38 CFR 10.2 - Evidence required of loss, destruction or mutilation of adjusted service certificate.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... receipt, as the case may be. The evidence must be sufficient to establish to the satisfaction of the... behalf, received the adjusted service certificate, or that at the time of its receipt it was mutilated...

  8. 38 CFR 10.2 - Evidence required of loss, destruction or mutilation of adjusted service certificate.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... receipt, as the case may be. The evidence must be sufficient to establish to the satisfaction of the... behalf, received the adjusted service certificate, or that at the time of its receipt it was mutilated...

  9. Disaster-Driven Evacuation and Medication Loss: a Systematic Literature Review

    PubMed Central

    Ochi, Sae; Hodgson, Susan; Landeg, Owen; Mayner, Lidia; Murray, Virginia

    2014-01-01

    AIM: The aim of this systematic literature review was to identify the extent and implications of medication loss and the burden of prescription refill on medical relief teams following extreme weather events and other natural hazards. METHOD: The search strategy followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Key health journal databases (Medline, Embase, PsycINFO, Maternity and Infant Care, and Health Management Information Consortium (HMIC)) were searched via the OvidSP search engine. Search terms were identified by consulting MeSH terms. The inclusion criteria comprised articles published from January 2003 to August 2013, written in English and containing an abstract. The exclusion criteria included abstracts for conferences or dissertations, book chapters and articles written in a language other than English. A total of 70 articles which fulfilled the inclusion criteria were included in this systematic review. RESULTS: All relevant information was collated regarding medication loss, prescription loss and refills, and medical aids loss which indicated a significant burden on the medical relief teams. Data also showed the difficulty in filling prescriptions due to lack of information from the evacuees. People with chronic conditions are most at risk when their medication is not available. This systematic review also showed that medical aids such as eye glasses, hearing aids as well as dental treatment are a high necessity among evacuees. DISCUSSION: This systematic review revealed that a considerable number of patients lose their medication during evacuation, many lose essential medical aids such as insulin pens and many do not bring prescriptions with them when evacuated.. Since medication loss is partly a responsibility of evacuees, understanding the impact of medication loss may lead to raising awareness and better preparations among the patients and health care professionals. People who are not prepared could have

  10. Adjustable Gastric Band Surgery or Medical Management in Patients With Type 2 Diabetes: A Randomized Clinical Trial

    PubMed Central

    Ding, Su-Ann; Simonson, Donald C.; Wewalka, Marlene; Halperin, Florencia; Foster, Kathleen; Goebel-Fabbri, Ann; Hamdy, Osama; Clancy, Kerri; Lautz, David; Vernon, Ashley

    2015-01-01

    Context: Recommendations for surgical, compared with lifestyle and pharmacologically based, approaches for type 2 diabetes (T2D) management remain controversial. Objective: The objective was to compare laparoscopic adjustable gastric band (LAGB) to an intensive medical diabetes and weight management (IMWM) program for T2D. Design: This was designed as a prospective, randomized clinical trial. Setting: The setting was two Harvard Medical School-affiliated academic institutions. Interventions and Participants: A 12-month randomized trial comparing LAGB (n = 23) vs IMWM (n = 22) in persons aged 21–65 years with body mass index of 30–45 kg/m2, T2D diagnosed more than 1 year earlier, and glycated hemoglobin (HbA1c) ≥ 6.5% on antihyperglycemic medication(s). Main Outcome Measure: The proportion meeting the prespecified primary glycemic endpoint, defined as HbA1c < 6.5% and fasting glucose < 7.0 mmol/L at 12 months, on or off medication. Results: After randomization, five participants did not undergo the surgical intervention. Of the 40 initiating intervention (22 males/18 females; age, 51 ± 10 y; body mass index, 36.5 ± 3.7 kg/m2; diabetes duration, 9 ± 5 y; HbA1c, 8.2 ± 1.2%; 40% on insulin), the proportion meeting the primary glycemic endpoint was achieved in 33% of the LAGB patients and 23% of the IMWM patients (P = .457). HbA1c reduction was similar between groups at both 3 and 12 months (−1.2 ± 0.3 vs −1.0 ± 0.3%; P = .496). Weight loss was similar at 3 months but greater 12 months after LAGB (−13.5 ± 1.7 vs −8.5 ± 1.6 kg; P = .027). Systolic blood pressure reduction was greater after IMWM than LAGB, whereas changes in diastolic blood pressure, lipids, fitness, and cardiovascular risk scores were similar between groups. Patient-reported health status, assessed using the Short Form-36, Impact of Weight on Quality of Life, and Problem Areas in Diabetes, all improved similarly between groups. Conclusions: LAGB and a multidisciplinary IMWM program

  11. Optical sensors for therapeutic drug monitoring of antidepressants for a better medication adjustment

    NASA Astrophysics Data System (ADS)

    Krieg, Anne K.; Hess, Stefan; Gauglitz, Günter

    2013-05-01

    Therapeutic drug monitoring provides the attending physicians with detailed information on a patient's individual serum level especially during long-term medication. Due to the fact that each patient tolerates drugs or their metabolites differently a medication adjustment can reduce the number and intensity of noticeable side-effects. In particular, psychotropic drugs can cause unpleasant side-effects that affect a patient's life almost as much as the mental disease itself. The tricyclic antidepressants amitriptyline is commonly used for treatment of depressions and was selected for the development of an immunoassay using the direct optical sensor technique Reflectometric Interference Spectroscopy (RIfS). RIfS is a simple, robust and label-free method for direct monitoring of binding events on glass surfaces. Binding to the surface causes a shift of the interference spectrum by a change of the refractive index or physical thickness. This technique can be used for time-resolved observation of association and dissociation of amitriptyline (antigen) and a specific antibody using the binding inhibition test format. An amitriptyline derivative is immobilized on the sensor surface and a specific amount of antibodies can bind to the surface unless the binding is inhibited by free amitriptyline in a sample. No fluorescent label is needed making the whole assay less expensive than label-based methods. With this recently developed immunoassay amitriptyline concentrations in buffer (PBS) can easily be detected down to 500 ng/L.

  12. 42 CFR 31.15 - Continuance of medical relief after loss of status.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., PUBLIC HEALTH SERVICE, AND FORMER LIGHTHOUSE SERVICE Provisions Applicable to Personnel of Former Lighthouse Service § 31.15 Continuance of medical relief after loss of status. If a person is separated...

  13. 42 CFR 31.15 - Continuance of medical relief after loss of status.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., PUBLIC HEALTH SERVICE, AND FORMER LIGHTHOUSE SERVICE Provisions Applicable to Personnel of Former Lighthouse Service § 31.15 Continuance of medical relief after loss of status. If a person is separated...

  14. 42 CFR 31.15 - Continuance of medical relief after loss of status.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., PUBLIC HEALTH SERVICE, AND FORMER LIGHTHOUSE SERVICE Provisions Applicable to Personnel of Former Lighthouse Service § 31.15 Continuance of medical relief after loss of status. If a person is separated...

  15. 42 CFR 31.15 - Continuance of medical relief after loss of status.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., PUBLIC HEALTH SERVICE, AND FORMER LIGHTHOUSE SERVICE Provisions Applicable to Personnel of Former Lighthouse Service § 31.15 Continuance of medical relief after loss of status. If a person is separated...

  16. 42 CFR 31.15 - Continuance of medical relief after loss of status.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., PUBLIC HEALTH SERVICE, AND FORMER LIGHTHOUSE SERVICE Provisions Applicable to Personnel of Former Lighthouse Service § 31.15 Continuance of medical relief after loss of status. If a person is separated...

  17. Use and abuse of the medical loss ratio to measure health plan performance.

    PubMed

    Robinson, J C

    1997-01-01

    This paper examines the use and abuse of the medical loss ratio in the contemporary health care system and health policy debate. It begins with a survey of the ways in which the medical loss ratio has been interpreted to be something it is not, such as a measure of quality or efficiency. It then analyzes key organizational features of the emerging health care system that complicate measures of financial performance, including integration between payers and providers, diversification of payers across multiple products and distribution channels, and geographic expansion across metropolitan and state lines. These issues are illustrated using medical loss ratios from a range of nonprofit and for-profit health plans. The paper then sketches a strategy for improving the public's understanding of health plan performance as an alternative to continued reliance on the flawed medical loss ratio. This strategy incorporates data on structure and process, service quality, and financial performance.

  18. 78 FR 53702 - Computation of, and Rules Relating to, Medical Loss Ratio; Hearing Cancellation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-30

    ... 13, 2013 (78 FR 27873) announced that a public hearing was scheduled for September 17, 2013, at 10 a... health care organizations, on computing and applying the medical loss ratio added to the Internal...

  19. Surviving Job Loss: Motivation among Second Year Trade Adjustment Assistance (TAA) Students

    ERIC Educational Resources Information Center

    Karnes, Sandra Lee

    2012-01-01

    This ethnographic case study investigated second year college students who participated in the Trade Adjustment Assistance (TAA) program at a technical college in northeastern Pennsylvania. In order to understand how learners stayed motivated in a college setting, I selected participants who were in their second year of the TAA program. A total of…

  20. Modeling Quality-Adjusted Life Expectancy Loss Resulting from Tobacco Use in the United States

    ERIC Educational Resources Information Center

    Kaplan, Robert M.; Anderson, John P.; Kaplan, Cameron M.

    2007-01-01

    Purpose: To describe the development of a model for estimating the effects of tobacco use upon Quality Adjusted Life Years (QALYs) and to estimate the impact of tobacco use on health outcomes for the United States (US) population using the model. Method: We obtained estimates of tobacco consumption from 6 years of the National Health Interview…

  1. Retrospective: Adjusting contaminant concentrations in bird eggs to account for moisture and lipid Loss during their incubation

    USGS Publications Warehouse

    Rattner, Barnett A.; Wiemeyer, Stanley N.; Blus, Lawrence J.

    2016-01-01

    By the 1960s, research and monitoring efforts on chlorinated pesticide residues in tissues of wildlife were well underway in North America and Europe. Conservationists and natural resource managers were attempting to resolve whether pesticide exposure and accumulated residues were related to population declines in several species of predatory and scavenging birds (e.g., bald eagle Haliaeetus leucocephalus, peregrine falcon Falco peregrinus, brown pelican Pelecanus occidentalis and osprey Pandion haliaetus). The avian egg was a favored sampling matrix even before the realization that eggshell thinning was linked to population declines (Ratcliffe 1967; Hickey and Anderson 1968) and that the concentration of p,p’-DDE in an egg was associated with the shell thinning phenomenon (e.g., Blus et al. 1972; Wiemeyer et al. 1988). The necessity for making wet-weight concentration adjustments to account for natural moisture loss during incubation of viable eggs was realized. Correction for the more dramatic moisture loss in non-viable decaying eggs was recognized as being paramount. For example, the ∑DDT residues in osprey eggs were reported to vary by as much as eightfold without accounting for moisture loss adjustments (Stickel et al. 1965). In the absence of adjusting concentrations to the fresh wet-weight that was present at the time of egg laying, the uncorrected values exaggerated contaminant concentrations, yielding artifactual results and ultimately incorrect conclusions. The adjustment to fresh wet-weight concentration is equally important for many other persistent contaminants including PCBs, dioxins, furans, and brominated diphenyl ethers.

  2. Adjusting Measured Weight Loss of Aged Graphite Fabric/PMR-15 Composites

    NASA Technical Reports Server (NTRS)

    Bowles, Kenneth J.

    1998-01-01

    The purposes of this study were to evaluate the growth of the surface damage layer in polymer matrix composites (PMC's) fabricated with graphite fabric reinforcement and to determine the effects of the cut-surface degradation on the overall thermo-oxidative (TOS) stability of these materials. Four important conclusions were made about the TOS behavior of T650-35/PNIR- 15 fabric-reinforced composites: (1) Three stages of composite weight loss were seen on the plot of weight loss versus aging time; (2) the depth of the cut-edge damage is related to the composite thickness; (3) the actual weight loss realized by a mechanical test specimen that has had all the aging-induced cut-edge damage removed during the preparation process is significantly less than the weight loss measured using specimens with a high percentage of cut edges exposed to the damaging environment; and (4) an extrapolation of a section of the weight loss curve can be used to obtain a more correct estimate of the actual weight loss after extended periods of aging at elevated temperatures.

  3. 20 CFR 404.1562 - Medical-vocational profiles showing an inability to make an adjustment to other work.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Medical-vocational profiles showing an inability to make an adjustment to other work. 404.1562 Section 404.1562 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and...

  4. 20 CFR 404.1562 - Medical-vocational profiles showing an inability to make an adjustment to other work.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Medical-vocational profiles showing an inability to make an adjustment to other work. 404.1562 Section 404.1562 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and...

  5. 20 CFR 404.1562 - Medical-vocational profiles showing an inability to make an adjustment to other work.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Medical-vocational profiles showing an inability to make an adjustment to other work. 404.1562 Section 404.1562 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and...

  6. 20 CFR 404.1562 - Medical-vocational profiles showing an inability to make an adjustment to other work.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Medical-vocational profiles showing an inability to make an adjustment to other work. 404.1562 Section 404.1562 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and...

  7. 20 CFR 404.1562 - Medical-vocational profiles showing an inability to make an adjustment to other work.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Medical-vocational profiles showing an inability to make an adjustment to other work. 404.1562 Section 404.1562 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and...

  8. 45 CFR 158.322 - Proposal for adjusted medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... practicable; (c) An estimate of the rebates that would be paid if the issuers offering coverage in the... estimate of the rebates that would be paid if the issuers offering coverage in the individual market in...

  9. 45 CFR 158.322 - Proposal for adjusted medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... practicable; (c) An estimate of the rebates that would be paid if the issuers offering coverage in the... estimate of the rebates that would be paid if the issuers offering coverage in the individual market in...

  10. Impact of medical loss regulation on the financial performance of health insurers.

    PubMed

    McCue, Michael; Hall, Mark; Liu, Xinliang

    2013-09-01

    The Affordable Care Act's regulation of medical loss ratios requires health insurers to use at least 80-85 percent of the premiums they collect for direct medical expenses (care delivery) or for efforts to improve the quality of care. To gauge this rule's effect on insurers' financial performance, we measured changes between 2010 and 2011 in key financial ratios reflecting insurers' operating profits, administrative costs, and medical claims. We found that the largest changes occurred in the individual market, where for-profit insurers reduced their median administrative cost ratio and operating margin by more than two percentage points each, resulting in a seven-percentage-point increase in their median medical loss ratio. Financial ratios changed much less for insurers in the small- and large-group markets.

  11. Attitude and knowledge of hearing loss among medical doctors selected to initiate a residency in Mexico.

    PubMed

    López-Vázquez, M; Berruecos, P; Lopez, L E; Cacho, J

    2009-03-01

    Early diagnosis and intervention of hearing loss are directly influenced by the knowledge and attitude towards this condition among medical personnel, particularly in countries where screening is not performed routinely. The objective of this paper was to evaluate the attitude and knowledge of hearing loss in a group of physicians. A questionnaire with five Likert-type items and five multiple choice and fill-in-the-blank items was completed by 2727 physicians selected to start a medical residency. Results suggested that physicians' knowledge level on the matter is deficient and their attitude is far from the ideal; however, physicians selected for a residency in audiology showed slightly better results. PMID:19283581

  12. Progress on Antarctic Glacial Isostatic Adjustment and GRACE constraints on ice loss (Invited)

    NASA Astrophysics Data System (ADS)

    Ivins, E. R.; James, T. S.; Wahr, J. M.; Schrama, E. J.; Simon, K. M.; Landerer, F. W.; Watkins, M. M.; Wiese, D. N.

    2013-12-01

    Preparations for the Intergovermental Panel on Climate Change: Assessment Report 5 (IPCC AR5) has placed pressure on various research groups to accelerate the pace of their work in order to meet the Report deadlines. While this stimulates both positive and negative bi-products, it helped to focus attention to irreconcilable mass balance determinations for the Antarctic Ice Sheet (AIS) using space and airborne data. A glaring ';sore-thumb' for determining AIS trends from Gravity Recovery and Climate Experiment (GRACE) satellite data is the large signal of glacial isostatic adjustment (GIA) that is poorly constrained and possibly of the same magnitude as the present-day mass change. The report published in Science (vol. 338, pp. 1183-89) by S13 [Shepherd et al. 2013] met this challenge head-on by investing heavily in improving the GIA models with new GPS data, and new chronological constraints on ice sheet evolution across the Antarctic continent. This new data has emerged only within the last five years, and it came at a fortuitous time for advancing the IPCC AR5 goals. In this presentation we speak to the improvements developed in a recent JGR Solid Earth publication (14 June 2013). We extend the analysis using all of the official 05 releases of the analysis centers, including the JPL-mascon fields. The total error budgets of GIA correction are poorly determined, in spite of the great model improvements witnessed in the past 5 years. S12 reported the uncertainty for space-based sea level sourcing during 1992-2011 to Antarctica at roughly 0.23 mm/yr. Although GRACE 2002-2013 estimates vary, the uncertainly is about half this value. Here we examine how much of that uncertainty is still caused by GIA models and discuss how new classes of GIA models, and the collection of yet new GPS and ice constraint data for Antarctica, will enhance the value of a GRACE Follow-On mission. However, there will be a limit to constraining GIA, and a limit, therefore, to GIA error due to

  13. A master curve analysis of F82H using statistical and constraint loss size adjustments of small specimen data

    NASA Astrophysics Data System (ADS)

    Odette, G. R.; Yamamoto, T.; Kishimoto, H.; Sokolov, M.; Spätig, P.; Yang, W. J.; Rensman, J.-W.; Lucas, G. E.

    2004-08-01

    We assembled a fracture toughness database for the IEA heat of F82H based on a variety of specimen sizes with a nominal ASTM E1921 master curve (MC) reference temperature T0=-119±3 °C. However, the data are not well represented by a MC. T0 decreases systematically with a decreasing deformation limit Mlim starting at ≈200, which is much higher than the E1921 censoring limit of 30, indicating large constraint loss in small specimens. The small scale yielding T0 at high Mlim is ≈98±5 °C. While, the scatter was somewhat larger than predicted, after model-based adjustments for the effects of constraint loss, the data are in reasonably good agreement with a MC with T0=-98 °C. This supports to use of MC methods to characterize irradiation embrittlement, as long as both constraint loss and statistical size effects are properly accounted for. Finally, we note various issues, including sources of the possible excess scatter, which remain to be fully assessed.

  14. 'Miscarriage or abortion?' Understanding the medical language of pregnancy loss in Britain; a historical perspective.

    PubMed

    Moscrop, Andrew

    2013-12-01

    Clinical language applied to early pregnancy loss changed in late twentieth century Britain when doctors consciously began using the term 'miscarriage' instead of 'abortion' to refer to this subject. Medical professionals at the time and since have claimed this change as an intuitive empathic response to women's experiences. However, a reading of medical journals and textbooks from the era reveals how the change in clinical language reflected legal, technological, professional and social developments. The shift in language is better understood in the context of these historical developments, rather than as the consequence of more empathic medical care for women who experience miscarriage.

  15. Computation of, and rules relating to, medical loss ratio. Final regulations.

    PubMed

    2014-01-01

    This document contains final regulations that provide guidance to Blue Cross and Blue Shield organizations, and certain other qualifying health care organizations, on computing and applying the medical loss ratio added to the Internal Revenue Code by the Patient Protection and Affordable Care Act.

  16. 78 FR 27873 - Computation of, and Rules Relating to, Medical Loss Ratio

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-13

    ... Cross and Blue Shield organizations, and certain other health care organizations, on computing and... 2718(b)(1)(B)(ii) provides that beginning on January 1, 2014, the medical loss ratio computed under..., of its unearned premiums for purposes of computing premiums earned on insurance contracts...

  17. 76 FR 76573 - Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-07

    ... group markets. DATES: Effective date. This rule is effective on January 3, 2012. Comment date. We will... individual markets. A request for information relating to the medical loss ratio (MLR) provisions of PHS Act section 2718 was published in the Federal Register on April 14, 2010 (75 FR 19297). On December 1,...

  18. The federal medical loss ratio rule: implications for consumers in year 3.

    PubMed

    McCue, Michael J; Hall, Mark A

    2015-03-01

    For the past three years, the Affordable Care Act has required health insurers to pay out a minimum percentage of premiums in medical claims or quality improvement expenses--known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2013 were $325 million, less than one-third the amount paid out in 2011, indicating much greater compliance with the MLR rule. Insurers' spending on quality improvement remained low, at less than 1 percent of premiums. Insurers' administrative and sales costs, such as brokers' fees, and profit margins have reduced slightly but remain fairly steady. In the first three years under this regulation, total consumer benefits related to the medical loss ratio--both rebates and reduced overhead--amounted to over $5 billion. This was achieved without a great exodus of insurers from the market.

  19. The federal medical loss ratio rule: implications for consumers in year 2.

    PubMed

    McCue, Michael J; Hall, Mark A

    2014-05-01

    For the past two years, the Affordable Care Act has required health insurers to pay out a minimum percentage of premiums in the form of medical claims or quality improvement expenses--known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2012 were $513 million, half the amount paid out in 2011, indicating greater compliance with the MLR rule. Spending on quality improvement remained low, at less than 1 percent of premiums. Insurers continued to reduce their administrative and sales costs, such as brokers' fees, without increasing profit margins, for a total reduction in overhead of $1.4 billion. In the first two years under this regulation, total consumer benefits related to the medical loss ratio--both rebates and reduced overhead--amounted to more than $3 billion. PMID:24881098

  20. The federal medical loss ratio rule: implications for consumers in year 3.

    PubMed

    McCue, Michael J; Hall, Mark A

    2015-03-01

    For the past three years, the Affordable Care Act has required health insurers to pay out a minimum percentage of premiums in medical claims or quality improvement expenses--known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2013 were $325 million, less than one-third the amount paid out in 2011, indicating much greater compliance with the MLR rule. Insurers' spending on quality improvement remained low, at less than 1 percent of premiums. Insurers' administrative and sales costs, such as brokers' fees, and profit margins have reduced slightly but remain fairly steady. In the first three years under this regulation, total consumer benefits related to the medical loss ratio--both rebates and reduced overhead--amounted to over $5 billion. This was achieved without a great exodus of insurers from the market. PMID:25890979

  1. Estimated Lifetime Medical and Work-Loss Costs of Fatal Injuries--United States, 2013.

    PubMed

    Florence, Curtis; Simon, Thomas; Haegerich, Tamara; Luo, Feijun; Zhou, Chao

    2015-10-01

    Injury-associated deaths have substantial economic consequences. In 2013, unintentional injury was the fourth leading cause of death, suicide was the tenth, and homicide was the sixteenth; these three causes accounted for approximately 187,000 deaths in the United States. To assess the economic impact of fatal injuries, CDC analyzed death data from the National Vital Statistics System for 2013, along with cost of injury data using the Web-Based Injury Statistics Query and Reporting System. This report updates a previous study that analyzed death data from the year 2000, and employs recently revised methodology for determining the costs of injury outcomes, which uses the most current economic data and incorporates improvements for estimating medical costs associated with injury. Number of deaths, crude and age-specific death rates, and total lifetime work-loss costs and medical costs were calculated for fatal injuries by sex, age group, intent (intentional versus unintentional), and mechanism of injury. During 2013, the rate of fatal injury was 61.0 per 100,000 population, with combined medical and work-loss costs exceeding $214 billion. Costs from fatal injuries represent approximately one third of the total $671 billion medical and work-loss costs associated with all injuries in 2013. The magnitude of the economic burden associated with injury-associated deaths underscores the need for effective prevention.

  2. Survey of Keyword Adjustment of Published Articles Medical Subject Headings in Journal of Mazandaran University of Medical Sciences (2009-2010)

    PubMed Central

    Kabirzadeh, Azar; Abadi, Ebrahim Bagherian Farah; Saravi, Benyamin Mohseni

    2013-01-01

    CONFLICT OF INTEREST: NONE DECLARED Introduction Keywords are the most important tools for Information retrieval. They are usually used for retrieval of articles based on contents of information reserved from printed and electronic resources. Retrieval of appropriate keywords from Medical Subject Headings (MeSH) can impact with exact, correctness and short time on information retrieval. Regarding the above mentioned matters, this study was done to compare the Latin keywords was in the articles published in the Journal of Mazandaran University of Medical Sciences. Method This is a descriptive study. The data were extracted from the key words of Englsih abstracts of articles published in the years 2009–2010 in the Journal of Mazandaran University of Medical Sciences by census method. Checklist of data collection is designed, based on research objectives and literature review which has face validity. Compliance rate in this study was to determine if the keywords cited in this article as a full subject of the main subject headings in a MeSH (Bold and the selected word) is a perfect adjustment. If keywords were cited in the article but the main heading is not discussed in the following main topics to be discussed with reference to See and See related it has considered has partial adjustment. Results Out of 148 articles published in 12 issues in proposed time of studying, 72 research papers were analyzed. The average numbers of authors in each article were 4 ± 1. Results showed that most of specialty papers 42 (58. 4%), belonging to the (Department of Clinical Sciences) School of Medicine, 11 (15.3%) Basic Science, 6(8.4%) Pharmacy, Nursing and Midwifery 5(6.9%), 4(5.5%) Health, paramedical Sciences 3(4.2%), and non medical article 1(1.3%) school of medicine. In general, results showed that 80 (30%) of key words have been used to complete the adjustment. Also, only 1(1.4%) had complete adjustment with all the MeSH key words and in 8 articles(11.4%) key words of had no

  3. Changes in body temperature in king penguins at sea: the result of fine adjustments in peripheral heat loss?

    PubMed

    Schmidt, Alexander; Alard, Frank; Handrich, Yves

    2006-09-01

    To investigate thermoregulatory adjustments at sea, body temperatures (the pectoral muscle and the brood patch) and diving behavior were monitored during a foraging trip of several days at sea in six breeding king penguins Aptenodytes patagonicus. During inactive phases at sea (water temperature: 4-7 degrees C), all tissues measured were maintained at normothermic temperatures. The brood patch temperature was maintained at the same values as those measured when brooding on shore (38 degrees C). This high temperature difference causes a significant loss of heat. We hypothesize that high-energy expenditure associated with elevated peripheral temperature when resting at sea is the thermoregulatory cost that a postabsorptive penguin has to face for the restoration of its subcutaneous body fat. During diving, mean pectoral temperature was 37.6 +/- 1.6 degrees C. While being almost normothermic on average, the temperature of the pectoral muscle was still significantly lower than during inactivity in five out of the six birds and underwent temperature drops of up to 5.5 degrees C. Mean brood patch temperature was 29.6 +/- 2.5 degrees C during diving, and temperature decreases of up to 21.6 degrees C were recorded. Interestingly, we observed episodes of brood patch warming during the descent to depth, suggesting that, in some cases, king penguins may perform active thermolysis using the brood patch. It is hypothesized that functional pectoral temperature may be regulated through peripheral adjustments in blood perfusion. These two paradoxical features, i.e., lower temperature of deep tissues during activity and normothermic peripheral tissues while inactive, may highlight the key to the energetics of this diving endotherm while foraging at sea. PMID:16627689

  4. Primary and Secondary Control among Children Undergoing Medical Procedures: Adjustment as a Function of Coping Style.

    ERIC Educational Resources Information Center

    Weisz, John R.; And Others

    1994-01-01

    Obtained reports of coping and goals from 33 children being treated for leukemia. Coping strategies were classified as primary control coping (attempts to alter objective conditions), secondary control coping (attempts to adjust to objective conditions), or relinquished control (no attempt to cope). Secondary control coping was positively…

  5. A systematic review of targeted outcomes associated with a medically supervised commercial weight-loss program.

    PubMed

    Furlow, Emily A; Anderson, James W

    2009-08-01

    Accurate information about weight loss is not available for most commercial weight-loss programs. Our objective was to obtain accurate assessments of weight outcomes, behavioral data, and side effects for an intensive behavioral weight-loss program using low-energy diets. Weights, behavioral data, and side effects for 173 consecutive patients were assessed. Treatment options were Medically Supervised, using a minimum of five meal replacements per day, and Healthy Solutions, using meal replacements, fruits, and vegetables. Both options included weekly classes, daily records, midweek phone calls, and a minimum physical activity goal of 2,000 kcal/week. The primary outcome was change in body weight with secondary outcomes related to behavioral changes and side effects. Intention-to-treat (ITT) and completer analyses (completed 9 weeks of treatment) were performed. During 13 months, 173 patients met criteria for analysis. They selected either Healthy Solutions: 56 patients (ITT) and 37 completers; or Medically Supervised: 117 patients (ITT) and 93 completers. Mean (+/-standard error) weight losses were: Healthy Solutions: ITT=12.8+/-1.3 kg in 13 weeks and completers=17.0+/-1.4 kg in 18 weeks; Medically Supervised: ITT=16.6+/-1.0 kg in 16 weeks and completers=19.7+/-1.0 kg in 19 weeks. Mean use of meal replacements, fruits, and vegetables exceeded goals. Most side effects were mild and did not affect program continuation. An intensive behavioral weight-loss program using low-energy diets, including five meal replacements daily, is safe and effective.

  6. Loss of appetite in acutely ill medical inpatients: physiological response or therapeutic target?

    PubMed

    Schütz, Philipp; Bally, Martina; Stanga, Zeno; Keller, Ulrich

    2014-01-01

    Loss of appetite and ensuing weight loss is a key feature of severe illnesses. Protein-energy malnutrition (PEM) contributes significantly to the adverse outcome of these conditions. Pharmacological interventions to target appetite stimulation have little efficacy but considerable side effects. Therefore nutritional therapy appears to be the logical step to combat inadequate nutrition. However, clinical trial data demonstrating benefits are sparse and there is no current established standard algorithm for use of nutritional support in malnourished, acutely ill medical inpatients. Recent high-quality evidence from critical care demonstrating harmful effects when parenteral nutritional support is used indiscriminately has led to speculation that loss of appetite in the acute phase of illness is indeed an adaptive, protective response that improves cell recycling (autophagy) and detoxification. Outside critical care, there is an important gap in high quality clinical trial data shedding further light on these important issues. The selection, timing, and doses of nutrition should be evaluated as carefully as with any other therapeutic intervention, with the aim of maximising efficacy and minimising adverse effects and costs. In light of the current controversy, a reappraisal of how nutritional support should be used in acutely ill medical inpatients outside critical care is urgently required. The aim of this review is to discuss current pathophysiological concepts of PEM and to review the current evidence for the efficacy of nutritional support regarding patient outcomes when used in an acutely ill medical patient population outside critical care. PMID:24782139

  7. Medical and Genetic Differences in the Adverse Impact of Sleep Loss on Performance: Ethical Considerations for the Medical Profession

    PubMed Central

    Czeisler, Charles A.

    2009-01-01

    The Institute of Medicine recently concluded that-on average-medical residents make more serious medical errors and have more motor vehicle crashes when they are deprived of sleep. In the interest of public safety, society has required limitations on work hours in many other safety sensitive occupations, including transportation and nuclear power generation. Those who argue in favor of traditional extended duration resident work hours often suggest that there are inter- individual differences in response to acute sleep loss or chronic sleep deprivation, implying that physicians may be more resistant than the average person to the detrimental effects of sleep deprivation on performance, although there is no evidence that physicians are particularly resistant to such effects. Indeed, recent investigations have identified genetic polymorphisms that may convey a relative resistance to the effects of prolonged wakefulness on a subset of the healthy population, although there is no evidence that physicians are over-represented in this cohort. Conversely, there are also genetic polymorphisms, sleep disorders and other inter-individual differences that appear to convey an increased vulnerability to the performance-impairing effects of 24 hours of wakefulness. Given the magnitude of inter-individual differences in the effect of sleep loss on cognitive performance, and the sizeable proportion of the population affected by sleep disorders, hospitals face a number of ethical dilemmas. How should the work hours of physicians be limited to protect patient safety optimally? For example, some have argued that, in contrast to other professions, work schedules that repeatedly induce acute and chronic sleep loss are uniquely essential to the training of physicians. If evidence were to prove this premise to be correct, how should such training be ethically accomplished in the quartile of physicians and surgeons who are most vulnerable to the effects of sleep loss on performance

  8. Weight Maintenance Following the STRIDE Weight Loss and Lifestyle Intervention for Individuals taking Antipsychotic Medications

    PubMed Central

    Green, Carla A.; Yarborough, Bobbi Jo H.; Leo, Michael C.; Stumbo, Scott P.; Perrin, Nancy A.; Nichols, Gregory A.; Stevens, Victor J.

    2015-01-01

    Objective Individuals taking antipsychotic medications have increased risk of obesity-related early morbidity/mortality. This report presents weight maintenance results from a successful weight loss and behavioral lifestyle change program developed for people taking antipsychotic medications. Design and Methods STRIDE was a 2-arm, randomized controlled trial. Intervention participants attended weekly group meetings for 6 months, then monthly group meetings for 6 months. Assessments were completed at baseline, 6, 12, and 24 months. Results At 24-months, intervention participants lost 3.7% of baseline weight and control participants 2.1%, a non-significant difference. Fasting glucose results followed a similar pattern. There was a statistically significant difference, however, for fasting insulin—the intervention group’s levels decreased between the end of the intensive intervention (at 6 months) and 24 months (10.1 to 7.91μU/mL); control participants’ levels increased (11.66 to 12.92μU/mL) during this period. There were also fewer medical hospitalizations among intervention participants (5.7%) than controls (21.1%; Χ2=8.47, p=0.004) during the 12 to 24-month post-intervention maintenance period. Conclusions Weight-change differences between arms diminished following the intervention period, though fasting insulin levels continued to improve. Reduced hospitalizations suggest that weight loss, even with regain, may have long-term positive benefits for people taking antipsychotic medications and may reduce costs. PMID:26334929

  9. Update on the pathogenesis, genetics and medical treatment of patterned hair loss.

    PubMed

    Schweiger, Eric S; Boychenko, Olga; Bernstein, Robert M

    2010-11-01

    Androgenic alopecia (AGA), or pattern hair loss, is a common condition that affects both men and women has been gradually increasing. The discovery of the androgen receptor (AR) gene and related genes has expanded the knowledge on the genetics of hair loss. These basic science studies, combined with more recent clinical studies, have led to a better understanding of the pathogenesis of AGA in both men and women. These genetic advances have also led to the development of a new screening test for AGA. Recently, in addition to the two currently approved U.S. Food and Drug Administration (FDA) medications (minoxidil and finasteride), a novel device was FDA-approved for the treatment of hair loss, the laser hair comb. Further studies are needed to verify the accuracy and validity of the genetic screening test and the efficacy of the laser hair comb. PMID:21061765

  10. Fostering Student Adjustment to Medical School: Evaluation of One Innovative Curricular Approach.

    ERIC Educational Resources Information Center

    Dennis, Kay S.

    This study evaluated an innovative curriculum for first-year medical students which was designed to render the undergraduate curriculum more humanistic in socializing students into medicine. The Personal, Professional, and Leadership (PPL) development program provides guided, semi-structured opportunities to create "communities of learning" by…

  11. Attitude adjustment: shaping medical students' perceptions of older patients with a geriatrics curriculum.

    PubMed

    Bensadon, Benjamin A; Teasdale, Thomas A; Odenheimer, Germaine L

    2013-11-01

    For more than half a century, scientific research has documented widespread avoidance and even denial of aging. Though nothing new, aversive reactions to the elderly are not only unfortunate but dangerous today, as increasing life expectancy and consequent demand for specialized geriatric medical care vastly outpace the supply of qualified clinicians equipped to provide it. This discrepancy has led to a crisis that is not easily resolved. At the same time, geriatrics reports the highest level of physician satisfaction among medical specialties. How can this apparent disconnect be explained, and what can be done about it? Citing evidence from medicine and other health care disciplines, the authors address these questions by emphasizing the role of aging-related attitudes, a complex but theoretically modifiable construct. Successful educational interventions are described, including the authors' experience at the helm of a monthlong geriatrics clerkship for fourth-year medical students. Novel suggestions are provided to combat the daunting challenges to achieving a workforce that is sufficient both in number and training to effectively meet the needs of the fastest-growing segment of the U.S. population. As patients continue to age across most medical specialties, the importance of geriatric curricula, particularly those sensitizing learners to the need for a systems-based, biopsychosocial (i.e., interdisciplinary) model of care, cannot be overemphasized. Such training, it is argued, should be a standard component of medical education, and future research should focus on identifying specific curricular content and teaching methods that most effectively achieve this end. PMID:24072114

  12. Medicare program; medical loss ratio requirements for the Medicare Advantage and the Medicare Prescription Drug Benefit Programs.

    PubMed

    2013-05-23

    This final rule implements new medical loss ratio (MLR) requirements for the Medicare Advantage Program and the Medicare Prescription Drug Benefit Program established under the Patient Protection and Affordable Care Act.

  13. Continuous monitoring of haemoglobin concentration after in-vivo adjustment in patients undergoing surgery with blood loss.

    PubMed

    Frasca, D; Mounios, H; Giraud, B; Boisson, M; Debaene, B; Mimoz, O

    2015-07-01

    Non-invasive monitoring of haemoglobin concentration provides real-time measurement of haemoglobin concentration (SpHb) using multi-wavelength pulse co-oximetry. We hypothesised that in-vivo adjustment using the mean of three haemoglobinometer (HemoCue®) measurements from an arterial blood sample at the first SpHb measurement (HCueART) would increase the accuracy of the monitor. The study included 41 adults for a total of 173 measurements of haemoglobin concentration. In-vivo adjusted SpHb was automatically calculated by the following formula: in-vivo adjusted SpHb = unadjusted SpHb - (SpHb - HCueART). The accuracy of in-vivo adjusted SpHb was compared with SpHb retrospectively adjusted using the same formula, except for haemoglobin level which was assessed at the central laboratory and then compared with all other available invasive methods of haemoglobin measurement (co-oximetry, HbSAT; arterial HemoCue, HCueART; capillary HemoCue, HCueCAP). Compared with laboratory measurement of haemoglobin concentration, bias (precision) for unadjusted SpHb, in-vivo adjusted SpHb, retrospectively adjusted SpHb, HbSAT, HCueART and HCueCAP were -0.4 (1.4), -0.3 (1.1), -0.3 (1.1), -0.6 (0.7), 0.0 (0.4) and -0.5 (1.2) g.dl(-1) , respectively. In-vivo adjustment of SpHb values using the mean of three arterial HemoCue measurements improved the accuracy of the device similar to those observed after a retrospective adjustment using central laboratory haemoglobin level. PMID:25676902

  14. Continuous monitoring of haemoglobin concentration after in-vivo adjustment in patients undergoing surgery with blood loss.

    PubMed

    Frasca, D; Mounios, H; Giraud, B; Boisson, M; Debaene, B; Mimoz, O

    2015-07-01

    Non-invasive monitoring of haemoglobin concentration provides real-time measurement of haemoglobin concentration (SpHb) using multi-wavelength pulse co-oximetry. We hypothesised that in-vivo adjustment using the mean of three haemoglobinometer (HemoCue®) measurements from an arterial blood sample at the first SpHb measurement (HCueART) would increase the accuracy of the monitor. The study included 41 adults for a total of 173 measurements of haemoglobin concentration. In-vivo adjusted SpHb was automatically calculated by the following formula: in-vivo adjusted SpHb = unadjusted SpHb - (SpHb - HCueART). The accuracy of in-vivo adjusted SpHb was compared with SpHb retrospectively adjusted using the same formula, except for haemoglobin level which was assessed at the central laboratory and then compared with all other available invasive methods of haemoglobin measurement (co-oximetry, HbSAT; arterial HemoCue, HCueART; capillary HemoCue, HCueCAP). Compared with laboratory measurement of haemoglobin concentration, bias (precision) for unadjusted SpHb, in-vivo adjusted SpHb, retrospectively adjusted SpHb, HbSAT, HCueART and HCueCAP were -0.4 (1.4), -0.3 (1.1), -0.3 (1.1), -0.6 (0.7), 0.0 (0.4) and -0.5 (1.2) g.dl(-1) , respectively. In-vivo adjustment of SpHb values using the mean of three arterial HemoCue measurements improved the accuracy of the device similar to those observed after a retrospective adjustment using central laboratory haemoglobin level.

  15. [Continuity--adjustment--autonomy--physician--patient--an overview of medical cultural philosophy in former East Germany].

    PubMed

    Belau, D

    1991-12-01

    The author probes into the "culture" of medical thinking in the former GDR in respect of the interlinking of socialisation of the doctor, within the framework of socialism, with the fate of the patient; the fundamentals of the development of science and of the pattern of cultural life; and the development of moral consciousness and health policy under the influence of Marxist-Leninist teachings. (One should not neglect the difference made by the author between "official Marxism-Leninism as decreed by the state" and "Marxist theory" as well as "public level of consciousness".) Errors of judgment, illusions, so-called "noble" ideals of the medical profession such as ambitiousness, engagedness, and readiness to shoulder responsibilities, were interwoven with the trend to functionalism, to keep the party bureaucracy of the SED in power. One of the thematic points of emphasis was the "changing of paradigms in medicine", such as the hostility to psychology as a feature of GDR socialism, or the sociopolitically dictated condemnation of non-institutional or "alternative" medicine. The author sees a basic trend to technocracy in GDR medicine. He shows up trends to "moral remote control" of the doctor, to a deliberately practised illusionment, a systematically engineered demounting of decisions based on moral constraints--such demounting being promoted both in the doctor's mind and in actual practice--and to eliminating emotional obstacles officially construed as "interfering" with a strictly objectified doctor-patient relationship. Nothing in this context can be soft-pedalled and excused. The author points specifically to the officially promoted vision of a "successful repair and construction of a New Man". Within the context of socialist ideal views and actual socialisation of the doctor there are similarities between the balance-sheets of 1945 and 1989 in Germany without attempting to suggest that this amounts to a comparison on the same level with the genocide and war

  16. [Continuity--adjustment--autonomy--physician--patient--an overview of medical cultural philosophy in former East Germany].

    PubMed

    Belau, D

    1991-12-01

    The author probes into the "culture" of medical thinking in the former GDR in respect of the interlinking of socialisation of the doctor, within the framework of socialism, with the fate of the patient; the fundamentals of the development of science and of the pattern of cultural life; and the development of moral consciousness and health policy under the influence of Marxist-Leninist teachings. (One should not neglect the difference made by the author between "official Marxism-Leninism as decreed by the state" and "Marxist theory" as well as "public level of consciousness".) Errors of judgment, illusions, so-called "noble" ideals of the medical profession such as ambitiousness, engagedness, and readiness to shoulder responsibilities, were interwoven with the trend to functionalism, to keep the party bureaucracy of the SED in power. One of the thematic points of emphasis was the "changing of paradigms in medicine", such as the hostility to psychology as a feature of GDR socialism, or the sociopolitically dictated condemnation of non-institutional or "alternative" medicine. The author sees a basic trend to technocracy in GDR medicine. He shows up trends to "moral remote control" of the doctor, to a deliberately practised illusionment, a systematically engineered demounting of decisions based on moral constraints--such demounting being promoted both in the doctor's mind and in actual practice--and to eliminating emotional obstacles officially construed as "interfering" with a strictly objectified doctor-patient relationship. Nothing in this context can be soft-pedalled and excused. The author points specifically to the officially promoted vision of a "successful repair and construction of a New Man". Within the context of socialist ideal views and actual socialisation of the doctor there are similarities between the balance-sheets of 1945 and 1989 in Germany without attempting to suggest that this amounts to a comparison on the same level with the genocide and war

  17. Colon Ischemia After Weight-Loss Medication in a 36-Year-Old Woman.

    PubMed

    Sharma, Prabin; Krishnamoorthy, Parasuram

    2016-04-01

    Weight-loss medications have been associated with many conditions, including valvular heart disease, ischemic colitis, and pulmonary hypertension. There is a constant increase in the use of these drugs, especially new medications with better efficacy. Phentermine is one such drug, approved for short-term use to lose weight. We report a case of ischemic colitis in a female patient linked to inappropriate phentermine intake. The patient presented with symptoms of severe abdominal pain and repeated bowel movement associated with rectal bleeding for two weeks. Initial blood work was unremarkable for infectious and inflammatory causes. A CT scan was performed which revealed findings of ischemic colitis extending from transverse to descending colon. A biopsy study confirmed the same. Upon further questioning, the patient admitted to taking 37.5 mg of phentermine for two years beyond her prescribed period of 12 weeks. Hence, we propose that inappropriate use of phentermine caused ischemic colitis. With the widespread use of these medications, there is a need for heightened awareness among clinicians regarding adverse effects of phentermine. PMID:27265924

  18. End-of-Life Communication and Adjustment: Pre-Loss Communication as a Predictor of Bereavement-Related Outcomes

    ERIC Educational Resources Information Center

    Metzger, Patricia L.; Gray, Matt J.

    2008-01-01

    Although bereavement-related emotional distress usually remits on its own over time, approximately 20% of bereaved individuals experience chronic emotional difficulties following the loss (Prigerson & Jacobs, 2001). Although several factors have been shown to be associated with poor outcomes post-loss, few studies have examined the relationship…

  19. Rehabilitation of a patient with an elusive medical history and loss of occlusal vertical dimension.

    PubMed

    Wong, Angela T T; Nguyen, Caroline T

    2013-01-01

    In this clinical report, we describe the medical history, diagnosis and prosthodontic treatment of a 61-year-old man with a previous history of oral cancer. Loss of a full upper denture and severe erosion of his teeth prompted the patient to seek treatment at the dental clinic at the British Columbia Cancer Agency. Although he stated that he was being treated for a sleeping disorder, hospital records revealed multiple recent admissions for alcoholism and depression. The patient's limited finances prevented complex restoration of worn lower dentition; thus, definitive treatment consisted of extraction of teeth with a poor prognosis, removal of a glandular odontogenic cyst and fabrication of a full maxillary prosthesis and a removable mandibular cast-metal overlay.

  20. THE AFFORDABLE CARE ACT AND MEDICAL LOSS RATIOS: NO IMPACT IN FIRST THREE YEARS.

    PubMed

    Day, Benjamin; Himmelstein, David U; Broder, Michael; Woolhandler, Steffie

    2015-01-01

    The Patient Protection and Affordable Care Act (ACA) set limits on insurers' overhead, mandating a medical loss ratio (MLR) of at least 80 percent in the individual and small-group markets and 85 percent in the large-group market starting in 2011. In implementing the law, the Obama administration introduced new rules that changed (and inflated) how insurers calculate MLRs, distorting time trends. We used insurers' filings with the U.S. Securities and Exchange Commission to calculate the largest insurers' MLRs before and after the ACA regulations took effect, using a constant definition of MLR. MLRs averaged 83.04 percent in the three years before reform and 83.05 percent in the three years after reform. We conclude that the ACA had no impact on insurance industry overhead spending. PMID:26460451

  1. Predicting economic and medical outcomes based on risk adjustment for congenital heart surgery classification of pediatric cardiovascular surgical admissions.

    PubMed

    Raucci, Frank J; Hoke, Tracey R; Gutgesell, Howard P

    2014-12-01

    The Risk Adjustment for Congenital Heart Surgery (RACHS-1) classification is an established method for predicting mortality for congenital heart disease surgery. It is unknown if this extends to the cost of hospitalization or if differences in economic and medical outcomes exist in certain subpopulations. Using data obtained from the University HealthSystem Consortium, we examined inpatient resource use by patients with International Classification of Diseases, Ninth Revision, procedure codes representative of RACHS-1 classifications 1 through 5 and 6 from 2006 to 2012. A total of 15,453 pediatric congenital heart disease surgical admissions were analyzed, with overall mortality of 4.5% (n = 689). As RACHS-1 classification increased, the total cost of hospitalization, hospital charges, total length of stay, length of intensive care unit stay, and mortality increased. Even when controlled for RACHS-1 classification, black patients (n = 2034) had higher total costs ($96,884 ± $3,392, p = 0.003), higher charges ($318,313 ± $12,018, p <0.001), and longer length of stay (20.4 ± 0.7 days, p <0.001) compared with white patients ($85,396 ± $1,382, $285,622 ± $5,090, and 18.0 ± 0.3 days, respectively). Hispanic patients had similarly disparate outcomes ($104,292 ± $2,759, $351,371 ± $10,627, and 23.0 ± 0.6 days, respectively) and also spent longer in the intensive care unit (14.9 ± 0.5 days, p <0.001). In conclusion, medical and economic measures increased predictably with increased procedure risk, and admissions for black and Hispanic patients were longer and more expensive than those of their white counterparts but without increased mortality.

  2. Trends, productivity losses, and associated medical conditions among toxoplasmosis deaths in the United States, 2000-2010.

    PubMed

    Cummings, Patricia L; Kuo, Tony; Javanbakht, Marjan; Sorvillo, Frank

    2014-11-01

    Few studies have quantified toxoplasmosis mortality, associated medical conditions, and productivity losses in the United States. We examined national multiple cause of death data and estimated productivity losses caused by toxoplasmosis during 2000-2010. A matched case-control analysis examined associations between comorbid medical conditions and toxoplasmosis deaths. In total, 789 toxoplasmosis deaths were identified during the 11-year study period. Blacks and Hispanics had the highest toxoplasmosis mortality compared with whites. Several medical conditions were associated with toxoplasmosis deaths, including human immunodeficiency virus (HIV), lymphoma, leukemia, and connective tissue disorders. The number of toxoplasmosis deaths with an HIV codiagnosis declined from 2000 to 2010; the numbers without such a codiagnosis remained static. Cumulative disease-related productivity losses for the 11-year period were nearly $815 million. Although toxoplasmosis mortality has declined in the last decade, the infection remains costly and is an important cause of preventable death among non-HIV subgroups.

  3. Comparing Maternal Services Utilization and Expense Reimbursement before and after the Adjustment of the New Rural Cooperative Medical Scheme Policy in Rural China

    PubMed Central

    You, Hua; Gu, Hai; Ning, Weiqing; Zhou, Hua; Dong, Hengjin

    2016-01-01

    Background The New Rural Cooperative Medical Scheme (NCMS) includes a maternal care benefits package that is associated with increasing maternal health services. The local compensation policies have been frequently adjusted in recent years. This study examined the association between the NCMS maternal-services policy adjustment and expense reimbursement in Yuyao, China. Methods Two household surveys were conducted in Yuyao in 2008 and 2011 (before and after the NCMS policy adjustment, respectively). Local women (N = 154) who had delivery history in the past three years were recruited. A questionnaire was used to collect information about delivery history, maternal health services utilization (prenatal care, postnatal care, and the grade of delivery institutions), NCMS participation, and reimbursement status. Logistic regression analyses were used to predict the association between policy adjustment and maternal health utilization and the association between policy adjustment and out-of-pocket proportion. Next, t-tests and covariance analyses adjusting for household income were used to compare the out-of-pocket proportion between 2008 and 2011. Results Results revealed that compensation policy adjustment was associated with an increase in postnatal visits (adjusted OR = 3.32, p = 0.009) and the use of second level or above institutions for delivery (adjusted OR = 2.32, p = 0.03) among participants. In 2008, only 9.1% of pregnant women received reimbursement from the NCMS; however, this rate increased to 36.8% in 2011. After policy adjustment, there were no significant changes in the proportion of out-of-pocket expenses shared in delivery fee (F = 0.24, p = 0.63) and in household income (F = 0.46, p = 0.50). Conclusions Financial compensation increase improved maternal health services utilization; however, this effect was limited. Although the reimbursement rate was raised, the out-of-pocket proportion was not significant changed; therefore, the compensation design

  4. An intervention to maximize medication management by caregivers of persons with memory loss: Intervention overview and two-month outcomes.

    PubMed

    Lingler, Jennifer H; Sereika, Susan M; Amspaugh, Carolyn M; Arida, Janet A; Happ, Mary E; Houze, Martin P; Kaufman, Robert R; Knox, Melissa L; Tamres, Lisa K; Tang, Fengyan; Erlen, Judith A

    2016-01-01

    Overseeing medication-taking is a critical aspect of dementia caregiving. This trial examined a tailored, problem-solving intervention designed to maximize medication management practices among caregivers of persons with memory loss. Eighty-three community-dwelling dyads (patient + informal caregiver) with a baseline average of 3 medication deficiencies participated. Home- and telephone-based sessions were delivered by nurse or social worker interventionists and addressed basics of managing medications, plus tailored problem solving for specific challenges. The outcome of medication management practices was assessed using the Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) and an investigator-developed Medication Deficiency Checklist (MDC). Linear mixed modeling showed both the intervention and usual care groups had fewer medication management problems as measured by the MedMaIDE (F = 6.91, p < .01) and MDC (F = 9.72, p < .01) at 2 months post-intervention. Reduced medication deficiencies in both groups suggests that when nurses or social workers merely raise awareness of the importance of medication adherence, there may be benefit.

  5. Loss of quality adjusted days as a trial endpoint: effect of early thrombolytic treatment in suspected myocardial infarction. Grampion Region Early Anistreplase Trial (GREAT).

    PubMed Central

    Rawles, J; Light, J

    1993-01-01

    STUDY OBJECTIVES--(1) To measure the quality of life and the loss of quality adjusted days (QADS) after suspected acute myocardial infarction in patients who received thrombolytic treatment either at home or in hospital. (2) To compare the loss of QADS as a trial endpoint with the conventional endpoints of mortality and Q-wave infarction. DESIGN--Randomised double blind parallel group trial of anistreplase (30 U given intravenously) and placebo given either at home or in hospital. SETTING--Rural practices in Grampian admitting patients to teaching hospitals in Aberdeen. PATIENTS--A total of 311 patients with suspected acute myocardial infarction and no contraindications to thrombolytic treatment seen at home within four hours of the onset of symptoms. MEASUREMENTS AND MAIN RESULTS--Loss of quality adjusted days (QADS) in the first 100 days after suspected myocardial infarction (365 QADS = 1 QALY) was the main outcome measure. Compared with later administration in hospital, anistreplase at home resulted in a relative reduction of mortality of 49% (95% confidence interval 3.95%, 2p = 0.04), and a relative reduction of 26% in the proportion of survivors with infarction who had Q-waves (95% CI 7.44%, 2p = 0.007). During the 100 day follow up, the median loss of QADS was 25 for all patients. This loss was significantly greater in those who died than in survivors (65 v 18, 2p < 0.001), and in survivors with infarction than in survivors without infarction (26 v 13, 2p < 0.01). However, there was no significant difference in loss of QADS in those with infarction with or without Q-waves (29 v 21, NS), and the median loss of QADS was not significantly different in those who had thrombolytic treatment at home or in hospital (median difference 0, 95% CI -5, +4 QADS). CONCLUSIONS--Loss of QADS had two serious limitations as an outcome measure: it was less sensitive than mortality and it failed to reflect physiological benefit. Palliative treatment with no physiological effect

  6. Distribution and medical impact of loss-of-function variants in the Finnish founder population.

    PubMed

    Lim, Elaine T; Würtz, Peter; Havulinna, Aki S; Palta, Priit; Tukiainen, Taru; Rehnström, Karola; Esko, Tõnu; Mägi, Reedik; Inouye, Michael; Lappalainen, Tuuli; Chan, Yingleong; Salem, Rany M; Lek, Monkol; Flannick, Jason; Sim, Xueling; Manning, Alisa; Ladenvall, Claes; Bumpstead, Suzannah; Hämäläinen, Eija; Aalto, Kristiina; Maksimow, Mikael; Salmi, Marko; Blankenberg, Stefan; Ardissino, Diego; Shah, Svati; Horne, Benjamin; McPherson, Ruth; Hovingh, Gerald K; Reilly, Muredach P; Watkins, Hugh; Goel, Anuj; Farrall, Martin; Girelli, Domenico; Reiner, Alex P; Stitziel, Nathan O; Kathiresan, Sekar; Gabriel, Stacey; Barrett, Jeffrey C; Lehtimäki, Terho; Laakso, Markku; Groop, Leif; Kaprio, Jaakko; Perola, Markus; McCarthy, Mark I; Boehnke, Michael; Altshuler, David M; Lindgren, Cecilia M; Hirschhorn, Joel N; Metspalu, Andres; Freimer, Nelson B; Zeller, Tanja; Jalkanen, Sirpa; Koskinen, Seppo; Raitakari, Olli; Durbin, Richard; MacArthur, Daniel G; Salomaa, Veikko; Ripatti, Samuli; Daly, Mark J; Palotie, Aarno

    2014-07-01

    Exome sequencing studies in complex diseases are challenged by the allelic heterogeneity, large number and modest effect sizes of associated variants on disease risk and the presence of large numbers of neutral variants, even in phenotypically relevant genes. Isolated populations with recent bottlenecks offer advantages for studying rare variants in complex diseases as they have deleterious variants that are present at higher frequencies as well as a substantial reduction in rare neutral variation. To explore the potential of the Finnish founder population for studying low-frequency (0.5-5%) variants in complex diseases, we compared exome sequence data on 3,000 Finns to the same number of non-Finnish Europeans and discovered that, despite having fewer variable sites overall, the average Finn has more low-frequency loss-of-function variants and complete gene knockouts. We then used several well-characterized Finnish population cohorts to study the phenotypic effects of 83 enriched loss-of-function variants across 60 phenotypes in 36,262 Finns. Using a deep set of quantitative traits collected on these cohorts, we show 5 associations (p<5×10⁻⁸) including splice variants in LPA that lowered plasma lipoprotein(a) levels (P = 1.5×10⁻¹¹⁷). Through accessing the national medical records of these participants, we evaluate the LPA finding via Mendelian randomization and confirm that these splice variants confer protection from cardiovascular disease (OR = 0.84, P = 3×10⁻⁴), demonstrating for the first time the correlation between very low levels of LPA in humans with potential therapeutic implications for cardiovascular diseases. More generally, this study articulates substantial advantages for studying the role of rare variation in complex phenotypes in founder populations like the Finns and by combining a unique population genetic history with data from large population cohorts and centralized research access to National Health Registers.

  7. Distribution and medical impact of loss-of-function variants in the Finnish founder population.

    PubMed

    Lim, Elaine T; Würtz, Peter; Havulinna, Aki S; Palta, Priit; Tukiainen, Taru; Rehnström, Karola; Esko, Tõnu; Mägi, Reedik; Inouye, Michael; Lappalainen, Tuuli; Chan, Yingleong; Salem, Rany M; Lek, Monkol; Flannick, Jason; Sim, Xueling; Manning, Alisa; Ladenvall, Claes; Bumpstead, Suzannah; Hämäläinen, Eija; Aalto, Kristiina; Maksimow, Mikael; Salmi, Marko; Blankenberg, Stefan; Ardissino, Diego; Shah, Svati; Horne, Benjamin; McPherson, Ruth; Hovingh, Gerald K; Reilly, Muredach P; Watkins, Hugh; Goel, Anuj; Farrall, Martin; Girelli, Domenico; Reiner, Alex P; Stitziel, Nathan O; Kathiresan, Sekar; Gabriel, Stacey; Barrett, Jeffrey C; Lehtimäki, Terho; Laakso, Markku; Groop, Leif; Kaprio, Jaakko; Perola, Markus; McCarthy, Mark I; Boehnke, Michael; Altshuler, David M; Lindgren, Cecilia M; Hirschhorn, Joel N; Metspalu, Andres; Freimer, Nelson B; Zeller, Tanja; Jalkanen, Sirpa; Koskinen, Seppo; Raitakari, Olli; Durbin, Richard; MacArthur, Daniel G; Salomaa, Veikko; Ripatti, Samuli; Daly, Mark J; Palotie, Aarno

    2014-07-01

    Exome sequencing studies in complex diseases are challenged by the allelic heterogeneity, large number and modest effect sizes of associated variants on disease risk and the presence of large numbers of neutral variants, even in phenotypically relevant genes. Isolated populations with recent bottlenecks offer advantages for studying rare variants in complex diseases as they have deleterious variants that are present at higher frequencies as well as a substantial reduction in rare neutral variation. To explore the potential of the Finnish founder population for studying low-frequency (0.5-5%) variants in complex diseases, we compared exome sequence data on 3,000 Finns to the same number of non-Finnish Europeans and discovered that, despite having fewer variable sites overall, the average Finn has more low-frequency loss-of-function variants and complete gene knockouts. We then used several well-characterized Finnish population cohorts to study the phenotypic effects of 83 enriched loss-of-function variants across 60 phenotypes in 36,262 Finns. Using a deep set of quantitative traits collected on these cohorts, we show 5 associations (p<5×10⁻⁸) including splice variants in LPA that lowered plasma lipoprotein(a) levels (P = 1.5×10⁻¹¹⁷). Through accessing the national medical records of these participants, we evaluate the LPA finding via Mendelian randomization and confirm that these splice variants confer protection from cardiovascular disease (OR = 0.84, P = 3×10⁻⁴), demonstrating for the first time the correlation between very low levels of LPA in humans with potential therapeutic implications for cardiovascular diseases. More generally, this study articulates substantial advantages for studying the role of rare variation in complex phenotypes in founder populations like the Finns and by combining a unique population genetic history with data from large population cohorts and centralized research access to National Health Registers. PMID

  8. Prediction of individual differences in adjustment to loss: Acceptance and valued-living as critical appraisal and coping strengths.

    PubMed

    Davis, Esther L; Deane, Frank P; Lyons, Geoffrey C B

    2016-01-01

    Our strengths-based model of coping with death and dying proposes acceptance and valued-living as key coping and appraisal strengths for the bereaved. These are core components of Acceptance and Commitment Therapy (ACT). The aim of this study was to provide an initial exploration of the theorized relationships via a survey of 97 bereaved university students. Using hierarchical regression analysis it was found that acceptance and valued-living were significant predictors of grief, while controlling for other model variables and loss characteristics. Results have implications for ACT-based approaches in supporting those bereaved who are struggling with their grief. PMID:26681151

  9. Resolving Trends in Antarctic Ice Sheet Mass Loss and Glacio-isostatic Adjustment Through Spatio-temporal Source-separation

    NASA Astrophysics Data System (ADS)

    Bamber, J. L.; Schoen, N.; Zammit-Mangion, A.; Rougier, J.; Flament, T.; Luthcke, S. B.; Petrie, E. J.; Rémy, F.

    2013-12-01

    There remains considerable inconsistency between different methods and approaches for determining ice mass trends for Antarctica from satellite observations. There are three approaches that can provide near global coverage for mass trends: altimetry, gravimetry and mass budget calculations. All three approaches suffer from a source separation problem where other geophysical processes limit the capability of the method to resolve the origin and magnitude of a mass change. A fourth approach, GPS vertical motion, provides localised estimates of mass change due to elastic uplift and an indirect estimate of GIA. Each approach has different source separation issues and different spatio-temporal error characteristics. In principle, it should be possible to combine the data and process covariances to minimize the uncertainty in the solution and to produce robust, posterior errors for the trends. In practice, this is a challenging problem in statistics because of the large number of degrees of freedom, the variable spatial and temporal sampling between the different observations and the fact that some processes remain under-sampled, such as firn compaction. Here, we present a novel solution to this problem using the latest methods in statistical modelling of spatio-temporal processes. We use Bayesian hierarchical modelling and employ stochastic partial differential equations to capture our physical understanding of the key processes that influence our observations. Due to the huge number of observations involved (> 10^8) methods are required to reduce the dimensionality of the problem and care is required in treatment of the observations as they are not independent. Here, we focus mainly on the results rather than the full suite of methods and we present time evolving fields of surface mass balance, ice dynamic-driven mass loss, and firn compaction for the period 2003-2009, derived from a combination of ICESat, ENVISAT, GRACE, InSAR, GPS and regional climate model output

  10. Two diets with different haemoglobin A1c and antiglycaemic medication effects despite similar weight loss in type 2 diabetes.

    PubMed

    Mayer, S B; Jeffreys, A S; Olsen, M K; McDuffie, J R; Feinglos, M N; Yancy, W S

    2014-01-01

    We analysed participants with type 2 diabetes (n = 46) within a larger weight loss trial (n = 146) who were randomized to 48 weeks of a low-carbohydrate diet (LCD; n = 22) or a low-fat diet + orlistat (LFD + O; n = 24). At baseline, mean body mass index (BMI) was 39.5 kg/m(2) (s.d. 6.5) and haemoglobin A1c (HbA1c) 7.6% (s.d. 1.3). Although the interventions reduced BMI similarly (LCD -2.4 kg/m(2) ; LFD + O -2.7 kg/m(2) , p = 0.7), LCD led to a relative improvement in HbA1c: -0.7% in LCD versus +0.2% in LFD + O [difference -0.8%, 95% confidence interval (CI) = -1.6, -0.02; p = 0.045]. LCD also led to a greater reduction in antiglycaemic medications using a novel medication effect score (MES) based on medication potency and total daily dose; 70.6% of LCD versus 30.4% LFD + O decreased their MES by ≥50% (p = 0.01). Lowering dietary carbohydrate intake demonstrated benefits on glycaemic control beyond its weight loss effects, while at the same time lowering antiglycaemic medication requirements.

  11. The Central Role of Meaning in Adjustment to the Loss of a Child to Cancer: Implications for the Development of Meaning-Centered Grief Therapy

    PubMed Central

    Lichtenthal, Wendy G.; Breitbart, William

    2015-01-01

    Purpose of review This review describes research on meaning and meaning-making in parents who lost a child to cancer, suggesting the need for a meaning-centered therapeutic approach to improve their sense of meaning, purpose, and identity and to help with management of prolonged grief symptoms. Recent findings Several studies have demonstrated that parents bereaved by cancer experience unique meaning related challenges associated with the caregiving and illness experience, including struggles with making sense of their loss, benefit-finding, their sense of identity and purpose, disconnection from sources of meaning, and sustaining a sense of meaning in their child’s life. Meaning-Centered Grief Therapy, adapted from Meaning-Centered Psychotherapy, directly addresses these issues, highlighting the choices parents have in how they face their pain, how they honor their child and his/her living legacy, the story they create, and how they live their lives. Summary Given the important role that meaning plays in adjustment to the loss of a child to cancer, a meaning-focused approach such as Meaning-Centered Grief Therapy, may help improve parents’ sense of meaning and grief symptoms. It seems particularly appropriate for parents who lost a child to cancer because it does not pathologize their struggles and directly targets issues they frequently face. PMID:25588204

  12. Impact of weight-loss medications on the cardiovascular system: focus on current and future anti-obesity drugs.

    PubMed

    Drolet, Benoit; Simard, Chantale; Poirier, Paul

    2007-01-01

    Overweight and obesity have been rising dramatically worldwide and are associated with numerous co-morbidities such as cardiovascular disease (CVD), type 2 diabetes mellitus, hypertension, certain cancers, and sleep apnea. In fact, obesity is an independent risk factor for CVD and CVD risks have also been documented in obese children. The majority of overweight and obese patients who achieve a significant short-term weight loss do not maintain their lower bodyweight in the long term. This may be due to a lack of intensive counseling and support from a facilitating environment including dedicated healthcare professionals such as nutritionists, kinesiologists, and behavior specialists. As a result, there has been a considerable focus on the role of adjunctive therapy such as pharmacotherapy for long-term weight loss and weight maintenance. Beyond an unfavorable risk factor profile, overweight and obesity also impact upon heart structure and function. Since the beginning, the quest for weight loss drugs has encountered warnings from regulatory agencies and the withdrawal from the market of efficient but unsafe medications. Fenfluramine was withdrawn from the market because of unacceptable pulmonary and cardiac adverse effects. Nevertheless, there is extensive research directed at the development of new anti-obesity compounds. The effect of these molecules on CVD risk factors has been studied and reported but information regarding their impact on the cardiovascular system is sparse. Thus, instead of looking at the benefit of weight loss on metabolism and risk factor management, this article discusses the impact of weight loss medications on the cardiovascular system. The potential interaction of available and potential new weight loss drugs with heart function and structure is reviewed. PMID:17696568

  13. 42 CFR 422.2420 - Calculation of the medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... meaningful use of certified electronic health records by qualifying MAOs, MA EPs and MA-affiliated eligible hospitals that are administered under 42 CFR part 495 subpart C. (B) EHR payment adjustments for a failure to meet meaningful use requirements that are administered under 42 CFR part 495 subpart C....

  14. 42 CFR 422.2420 - Calculation of the medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... meaningful use of certified electronic health records by qualifying MAOs, MA EPs and MA-affiliated eligible hospitals that are administered under 42 CFR part 495 subpart C. (B) EHR payment adjustments for a failure to meet meaningful use requirements that are administered under 42 CFR part 495 subpart C....

  15. Hospital-owned medical practices gaining the benefits without the losses.

    PubMed

    Halley, Marc D

    2014-04-01

    Hospitals can correct most of the causes of reduced performance in hospital-owned medical practices by setting appropriate performance expectations and implementing correct operating principles. Engaging employed physicians and executives as partners who provide principle-based direction and support to practice managers encourages performance improvement. A critical determinant of a hospital's ability to successfully own medical practices is understanding and implementing the principles for success in this unique ambulatory business. PMID:24757880

  16. Effects of meal composition on postprandial incretin, glucose and insulin responses after surgical and medical weight loss

    PubMed Central

    Brown, T. T.; Cheskin, L. J.; Choi, P.; Moran, T. H.; Peterson, L.; Matuk, R.; Steele, K. E.

    2015-01-01

    Summary Background Meal tolerance tests are frequently used to study dynamic incretin and insulin responses in the postprandial state; however, the optimal meal that is best tolerated and suited for hormonal response following surgical and medical weight loss has yet to be determined. Objective To evaluate the tolerability and effectiveness of different test meals in inducing detectable changes in markers of glucose metabolism in individuals who have undergone a weight loss intervention. Methods Six individuals who underwent surgical or medical weight loss (two Roux‐en‐Y gastric bypass, two sleeve gastrectomy and two medical weight loss) each completed three meal tolerance tests using liquid‐mixed, solid‐mixed and high‐fat test meals. The tolerability of each test meal, as determined by the total amount consumed and palatability, as well as fasting and meal‐stimulated glucagon‐like peptide, glucose‐dependent insulinotropic polypeptide, insulin and glucose were measured. Results Among the six individuals, the liquid‐mixed meal was better and more uniformly tolerated with a median meal completion rate of 99%. Among the four bariatric surgical patients, liquid‐mixed meal stimulated on average a higher glucagon‐like peptide (percent difference: 83.7, 89), insulin secretion (percent difference: 155.1, 158.7) and glucose‐dependent insulinotropic polypeptide (percent difference: 113.5, 34.3) compared with solid‐mixed and high‐fat meals. Conclusions The liquid‐mixed meal was better tolerated with higher incretin and insulin response compared with the high‐fat and solid‐mixed meals and is best suited for the evaluation of stimulated glucose homeostasis. PMID:27774253

  17. Estimated Lifetime Medical and Work-Loss Costs of Emergency Department-Treated Nonfatal Injuries--United States, 2013.

    PubMed

    Florence, Curtis; Haegerich, Tamara; Simon, Thomas; Zhou, Chao; Luo, Feijun

    2015-10-01

    A large number of nonfatal injuries are treated in U.S. emergency departments (EDs) every year. CDC's National Center for Health Statistics estimates that approximately 29% of all ED visits in 2010 were for injuries. To assess the economic impact of ED-treated injuries, CDC examined injury data from the National Electronic Injury Surveillance System--All Injury Program (NEISS-AIP) for 2013, as well as injury-related lifetime medical and work-loss costs from the Web-Based Injury Statistics Query and Reporting System (WISQARS). NEISS-AIP collects data from a nationally representative sample of EDs, using specific guidelines for recording the primary diagnosis and mechanism of injury. Number of injuries, crude- and age-specific injury rates, and total lifetime work-loss costs and medical costs were calculated for ED-treated injuries, stratified by sex, age groups, and intent and mechanism of injury. ED-treated injuries were further classified as those that were subsequently hospitalized or treated and released. The rate of hospitalized injuries was 950.8 per 100,000, and the rate of treated and released injuries was 8,549.8 per 100,000. Combined medical and work-loss costs for all ED-treated injuries (both hospitalized and treated and released) were $456.9 billion, or approximately 68% of the total costs of $671 billion associated with all fatal and ED-treated injuries. The substantial economic burden associated with nonfatal injuries underscores the need for effective prevention strategies.

  18. A Longitudinal Study on the Relationship between Weight Loss, Medical Expenditures, and Absenteeism among Overweight Employees in the WAY to Health Study

    PubMed Central

    Finkelstein, Eric A.; Linnan, Laura A.; Tate, Deborah F.; Leese, Peter J.

    2010-01-01

    Objective To quantify the extent to which successful weight loss among overweight/obese employees translates into subsequent savings in medical expenditures and absenteeism. Methods This analysis relied on medical claims and absenteeism data collected from overweight/obese employees at 17 community colleges in North Carolina. Results We find no evidence that participants achieving at least a 5% weight loss experienced reduced medical expenditures or lower absenteeism during the 12 month weight loss intervention or in the subsequent 2 years. Conclusions These results suggest that a quick return on investment from weight loss programs, even effective ones, is unlikely. However, as with other employee benefit decisions, the decision about whether to offer weight loss programs should take into account many factors, such as employee health, in addition to the potential for a quick return on investment. PMID:19952786

  19. Study of device use adjusted rates in health care-associated infections after implementation of "bundles" in a closed-model medical intensive care unit.

    PubMed

    Venkatram, Sindhaghatta; Rachmale, Sonal; Kanna, Balavenkatesh

    2010-03-01

    "Bundles" strategies improve health care-associated infection (HCAI) rates in medical intensive care units (MICUs). However, few studies have analyzed HCAI rates adjusted for the device removal component of the bundles. An observational study of adult MICU patients while using bundles to prevent HCAIs associated with endovascular catheters, mechanical ventilation, and urinary tract catheters was conducted. The HCAI rates, unadjusted and adjusted for device use, were calculated using incidence rate ratios (unadjusted IRRs [uIRR] and adjusted IRRs [aIRR], respectively). Among 4550 study patients, HCAIs declined from 47 in 2004 to 10 in 2005, 8 in 2006, and 3 in 2007. Catheter-related blood stream infection (CRBSI) rates decreased from 10.77 to 1.67 per 1000 central line days (uIRR, 0.155; 95% confidence interval [CI], 0.13-0.18; P < .0001). Foley-related urinary tract infections (CA-UTI) decreased from 6.23 to 0.63 per 1000 device days (uIRR, 0.1; 95% CI, 0.08-0.19; P < .0001). Ventilator-associated pneumonia (VAP) per 1000 ventilator days diminished from 2.17 to 0.62 (uIRR, 0.29; 95% CI, 0.21-0.38; P < .0001). After adjustment for device use, aIRRs of CRBSI (0.14; 95% CI, 0.11-0.18), UTI (0.09; 95% CI, 0.06-0.12), and VAP (0.33; 95% CI, 0.22-0.47) declined significantly (P < .00001). Implementing comprehensive bundle strategies reduces HCAI beyond the impact of device removal.

  20. Comparing Medical Costs and Use After Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass

    PubMed Central

    Lewis, Kristina H.; Zhang, Fang; Arterburn, David E.; Ross-Degnan, Dennis; Gillman, Matthew W.; Wharam, J. Frank

    2015-01-01

    IMPORTANCE There is conflicting evidence about how different bariatric procedures impact health care use. OBJECTIVE To compare the impact of laparoscopic adjustable gastric banding (AGB) and laparoscopic Roux-en-Y gastric bypass (RYGB) on health care use and costs. DESIGN, SETTING, AND PARTICIPANTS Retrospective interrupted time series with comparison series study using a national claims data set. The data analysis was initiated in September 2011 and completed in January 2015. We identified bariatric surgery patients aged 18 to 64 years who underwent a first AGB or RYGB between 2005 and 2011. We propensity score matched 4935 AGB to 4935 RYGB patients according to baseline age group, sex, race/ethnicity, socioeconomic variables, comorbidities, year of procedure and baseline costs, emergency department (ED) visits, and hospital days. Median postoperative follow-up time was 2.5 years. MAIN OUTCOMES AND MEASURES Quarterly and yearly total health care costs, ED visits, hospital days, and prescription drug costs. We used segmented regression to compare pre-to-post changes in level and trend of these measures in the AGB vs the RYGB groups and difference-in-differences analysis to estimate the magnitude of difference by year. RESULTS Both AGB and RYGB were associated with downward trends in costs; however, by year 3, AGB patients had total annual costs that were 16% higher than RYGB patients (P < .001; absolute change: $818; 95% CI, $278 to $1357). In postoperative years 1 and 2, AGB was associated with 27% to 29% fewer ED visits than RYGB (P < .001; absolute changes: −0.6; 95% CI, −0.9 to −0.4 and −0.4; 95% CI, −0.6 to −0.1 visits/person, respectively); however, by year 3, there were no detectable differences. Postoperative annual hospital days were not significantly different between the groups. Although both procedures lowered prescription costs, annual postoperative prescription costs were 17% to 32% higher for AGB patients than RYGB patients (P < .001

  1. Reach of Effective, Nationally-Available, Low-Cost, Nonprofit Weight Loss Program in Medically Underserved Areas (MUAs).

    PubMed

    Mitchell, Nia S; Nassel, Ariann F; Thomas, Deborah

    2015-12-01

    Obesity rates are higher for ethnic minority, low-income, and rural communities. Programs are needed to support these communities with weight management. We determined the reach of a low-cost, nationally-available weight loss program in Health Resources and Services Administration medically underserved areas (MUAs) and described the demographics of the communities with program locations. This is a cross-sectional analysis of Take Off Pounds Sensibly (TOPS) chapter locations. Geographic information systems technology was used to combine information about TOPS chapter locations, the geographic boundaries of MUAs, and socioeconomic data from the Decennial 2010 Census. TOPS is available in 30 % of MUAs. The typical TOPS chapter is in a Census Tract that is predominantly white, urban, with a median annual income between $25,000 and $50,000. However, there are TOPS chapters in Census Tracts that can be classified as predominantly black or predominantly Hispanic; predominantly rural; and as low or high income. TOPS provides weight management services in MUAs and across many types of communities. TOPS can help treat obesity in the medically underserved. Future research should determine the differential effectiveness among chapters in different types of communities. PMID:26072259

  2. [Structural adjustment, cultural adjustment?].

    PubMed

    Dujardin, B; Dujardin, M; Hermans, I

    2003-12-01

    Over the last two decades, multiple studies have been conducted and many articles published about Structural Adjustment Programmes (SAPs). These studies mainly describe the characteristics of SAPs and analyse their economic consequences as well as their effects upon a variety of sectors: health, education, agriculture and environment. However, very few focus on the sociological and cultural effects of SAPs. Following a summary of SAP's content and characteristics, the paper briefly discusses the historical course of SAPs and the different critiques which have been made. The cultural consequences of SAPs are introduced and are described on four different levels: political, community, familial, and individual. These levels are analysed through examples from the literature and individual testimonies from people in the Southern Hemisphere. The paper concludes that SAPs, alongside economic globalisation processes, are responsible for an acute breakdown of social and cultural structures in societies in the South. It should be a priority, not only to better understand the situation and its determining factors, but also to intervene and act with strategies that support and reinvest in the social and cultural sectors, which is vital in order to allow for individuals and communities in the South to strengthen their autonomy and identify.

  3. A prospective trial for laparoscopic adjustable gastric banding in morbidly obese adolescents: an interim report of weight loss, metabolic and quality of life outcomes.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The outcome of patients completing 12 months of follow-up in a prospective longitudinal trial of the safety/efficacy of laparoscopic adjustable gastric banding (LAGB), for morbidly obese adolescents aged 14 to 17 years using a Food and Drug Administration Institutional Device Exemption for the use o...

  4. Evaluation of medical stone amendment for the reduction of nitrogen loss and bioavailability of heavy metals during pig manure composting.

    PubMed

    Wang, Quan; Wang, Zhen; Awasthi, Mukesh Kumar; Jiang, Yahui; Li, Ronghua; Ren, Xiuna; Zhao, Junchao; Shen, Feng; Wang, Meijing; Zhang, Zengqiang

    2016-11-01

    The purpose of this research was to evaluate the effect of medical stone (MS) on nitrogen conservation and improving the compost quality during the pig manure (PM) composting. Five treatments were designed with different concentrations of MS0%, 2.5%, 5%, 7.5% and 10% (on dry weight of pig manure basis) mixed with initial feed stock and then composted for 60days. The results showed that MS amendment obviously (p<0.05) promoted the organic waste degradation and prolonged the thermophilic phase as well as enhanced the immobilization of heavy metals Cu and Zn. With increasing the amount of MS, the NH3 loss and N2O emission were significantly reduced by 27.9-48.8% and by 46.6-85.3%, respectively. Meanwhile, the MS amendment could reduce the NO2(-)-N formation and increase the NO3(-)-N content. Finally our results suggested that 10%MS addition could significantly reduce the nitrogen conservation as well as improve the quality of compost. PMID:27589824

  5. Is the medical loss ratio a good target measure for regulation in the individual market for health insurance?

    PubMed

    Karaca-Mandic, Pinar; Abraham, Jean M; Simon, Kosali

    2015-01-01

    Effective January 1, 2011, individual market health insurers must meet a minimum medical loss ratio (MLR) of 80%. This law aims to encourage 'productive' forms of competition by increasing the proportion of premium dollars spent on clinical benefits. To date, very little is known about the performance of firms in the individual health insurance market, including how MLRs are related to insurer and market characteristics. The MLR comprises one component of the price-cost margin, a traditional gauge of market power; the other component is percent of premiums spent on administrative expenses. We use data from the National Association of Insurance Commissioners (2001-2009) to evaluate whether the MLR is a good target measure for regulation by comparing the two components of the price-cost margin between markets that are more competitive versus those that are not, accounting for firm and market characteristics. We find that insurers with monopoly power have lower MLRs. Moreover, we find no evidence suggesting that insurers' administrative expenses are lower in more concentrated insurance markets. Thus, our results are largely consistent with the interpretation that the MLR could serve as a target measure of market power in regulating the individual market for health insurance but with notable limited ability to capture product and firm heterogeneity.

  6. Additional double-wall roof in single-wall, closed, convective incubators: Impact on body heat loss from premature infants and optimal adjustment of the incubator air temperature.

    PubMed

    Delanaud, Stéphane; Decima, Pauline; Pelletier, Amandine; Libert, Jean-Pierre; Stephan-Blanchard, Erwan; Bach, Véronique; Tourneux, Pierre

    2016-09-01

    Radiant heat loss is high in low-birth-weight (LBW) neonates. Double-wall or single-wall incubators with an additional double-wall roof panel that can be removed during phototherapy are used to reduce Radiant heat loss. There are no data on how the incubators should be used when this second roof panel is removed. The aim of the study was to assess the heat exchanges in LBW neonates in a single-wall incubator with and without an additional roof panel. To determine the optimal thermoneutral incubator air temperature. Influence of the additional double-wall roof was assessed by using a thermal mannequin simulating a LBW neonate. Then, we calculated the optimal incubator air temperature from a cohort of human LBW neonate in the absence of the additional roof panel. Twenty-three LBW neonates (birth weight: 750-1800g; gestational age: 28-32 weeks) were included. With the additional roof panel, R was lower but convective and evaporative skin heat losses were greater. This difference can be overcome by increasing the incubator air temperature by 0.15-0.20°C. The benefit of an additional roof panel was cancelled out by greater body heat losses through other routes. Understanding the heat transfers between the neonate and the environment is essential for optimizing incubators.

  7. Estimating the efficacy of an interstitial cystitis/painful bladder syndrome medication in a randomized trial with both non-adherence and loss to follow-up.

    PubMed

    Yang, Wei; Propert, Kathleen J; Landis, J Richard

    2014-09-10

    We are motivated by a randomized clinical trial evaluating the efficacy of amitriptyline for the treatment of interstitial cystitis and painful bladder syndrome in treatment-naïve patients. In the trial, both the non-adherence rate and the rate of loss to follow-up are fairly high. To estimate the effect of the treatment received on the outcome, we use the generalized structural mean model (GSMM), originally proposed to deal with non-adherence, to adjust for both non-adherence and loss to follow-up. In the model, loss to follow-up is handled by weighting the estimation equations for GSMM with one over the probability of not being lost to follow-up, estimated using a logistic regression model. We re-analyzed the data from the trial and found a possible benefit of amitriptyline when administered at a high-dose level. PMID:23225539

  8. Loss of a chance in medical malpractice litigation: expanding liability of health professionals versus providing justice to those who have lost.

    PubMed

    Meldrum, M A

    2001-11-01

    The loss of a chance doctrine in medical malpractice litigation is essentially based on the perceived unfairness of denying recovery to a patient when a health provider's malpractice has reduced the patient's chance of a better outcome. It is the thesis of the article that loss of a chance must the recognised at law, notwithstanding that the chance is less than even or not subject to the benefit of statistical and/or scientific proof and that each lost chance should be assessed according to the value of that chance. Varying approaches to allocating value to the chance lost are examined both historically and internationally. The author contends that the policy arguments--which include potential for increased medical malpractice litigation, tainted reputations and an increase in professional indemnity policies--are insignificant when compared to the value and quality of human life and therefore cannot be supported.

  9. Early Pregnancy Loss

    MedlinePlus

    ... is called early pregnancy loss , miscarriage , or spontaneous abortion . How common is early pregnancy loss? Early pregnancy ... testes that can fertilize a female egg. Spontaneous Abortion: The medical term for early pregnancy loss. Trimester: ...

  10. Seasonal affective disorder, grief reaction, and adjustment disorder.

    PubMed

    Osborn, Justin; Raetz, Jacqueline; Kost, Amanda

    2014-09-01

    Seasonal affective disorder is a subtype of other affective disorders. The most studied treatment is light therapy, although second-generation antidepressants are also an option. Grief reactions are normal for patients experiencing loss, and primary care providers (PCPs) should be aware of both the expected course of grief and the more severe symptoms that indicate complex grief. Adjustment disorder is a time-limited abnormal response to a stressor. PCPs can manage patients with adjustment disorder by arranging counseling, screening for suicidality, assessing for substance abuse, and ruling out other psychiatric diagnoses. At present there are no reliable data to suggest medication management.

  11. American College of Medical Genetics and Genomics guideline for the clinical evaluation and etiologic diagnosis of hearing loss.

    PubMed

    Alford, Raye L; Arnos, Kathleen S; Fox, Michelle; Lin, Jerry W; Palmer, Christina G; Pandya, Arti; Rehm, Heidi L; Robin, Nathaniel H; Scott, Daryl A; Yoshinaga-Itano, Christine

    2014-04-01

    Hearing loss is a common and complex condition that can occur at any age, can be inherited or acquired, and is associated with a remarkably wide array of etiologies. The diverse causes of hearing loss, combined with the highly variable and often overlapping presentations of different forms of hearing loss, challenge the ability of traditional clinical evaluations to arrive at an etiologic diagnosis for many deaf and hard-of-hearing individuals. However, identifying the etiology of a hearing loss may affect clinical management, improve prognostic accuracy, and refine genetic counseling and assessment of the likelihood of recurrence for relatives of deaf and hard-of-hearing individuals. Linguistic and cultural identities associated with being deaf or hard of hearing can complicate access to and the effectiveness of clinical care. These concerns can be minimized when genetic and other health-care services are provided in a linguistically and culturally sensitive manner. This guideline offers information about the frequency, causes, and presentations of hearing loss and suggests approaches to the clinical evaluation of deaf and hard-of-hearing individuals aimed at identifying an etiologic diagnosis and providing informative and effective patient education and genetic counseling.

  12. Shaft adjuster

    DOEpatents

    Harry, H.H.

    1988-03-11

    Abstract and method for the adjustment and alignment of shafts in high power devices. A plurality of adjacent rotatable angled cylinders are positioned between a base and the shaft to be aligned which when rotated introduce an axial offset. The apparatus is electrically conductive and constructed of a structurally rigid material. The angled cylinders allow the shaft such as the center conductor in a pulse line machine to be offset in any desired alignment position within the range of the apparatus. 3 figs.

  13. Shaft adjuster

    DOEpatents

    Harry, Herbert H.

    1989-01-01

    Apparatus and method for the adjustment and alignment of shafts in high power devices. A plurality of adjacent rotatable angled cylinders are positioned between a base and the shaft to be aligned which when rotated introduce an axial offset. The apparatus is electrically conductive and constructed of a structurally rigid material. The angled cylinders allow the shaft such as the center conductor in a pulse line machine to be offset in any desired alignment position within the range of the apparatus.

  14. Ways Children Adjust to Limb Loss

    MedlinePlus

    ... 2: Emotional Response and Early Management . http://www.amputee-coalition.org/inmotion/mar_apr_06/congenital_part2. ... 05/2009 Back to Top © Copyrighted by the Amputee Coalition . Local reproduction for use by Amputee Coalition ...

  15. Dissonant Role Perception and Paradoxical Adjustments: An Exploratory Study on Medical Residents' Collaboration with Senior Doctors and Head Nurses

    ERIC Educational Resources Information Center

    Fiordelli, Maddalena; Schulz, Peter J.; Caiata Zufferey, Maria

    2014-01-01

    A good collaboration between health professionals is considered to have benefits for patients, healthcare staff, and organizations. Nevertheless, effective interprofessional collaboration is difficult to achieve. This is particularly true for collaboration between Medical Residents (MRs) and the immediate colleagues they interact with, as Senior…

  16. Quantifying Morbidity Burdens and Medical Utilization of Children with Intellectual Disabilities in Taiwan: A Nationwide Study Using the ACG Case-Mix Adjustment System

    ERIC Educational Resources Information Center

    Lee, Wui-Chiang; Chen, Tzeng-Ji

    2012-01-01

    The purpose of this study was to quantify morbidity burdens of children with intellectual disability (ID) and to examine its association with total medical utilization and expenditure on a national basis in Taiwan. People under 18 years of age that had been continuously enrolled in the National Health Insurance (NHI) between year 2008 and 2010…

  17. Physiological adjustments of sand gazelles (Gazella subgutturosa) to a boom-or-bust economy: standard fasting metabolic rate, total evaporative water loss, and changes in the sizes of organs during food and water restriction.

    PubMed

    Ostrowski, Stephane; Mesochina, Pascal; Williams, Joseph B

    2006-01-01

    To test the hypothesis that desert ungulates adjust their physiology in response to long-term food and water restriction, we established three groups of sand gazelles (Gazella subgutturosa): one that was provided food and water (n = 6; CTRL) ad lib. for 4 mo, one that received ad lib. food and water for the same period but was deprived of food and water for the last 4.5 d (n = 6; EXPT(1)), and one that was exposed to 4 mo of progressive food and water restriction, an experimental regime designed to mimic conditions in a natural desert setting (n = 6; EXPT(2)). At the end of the 4-mo experiment, we measured standard fasting metabolic rate (SFMR) and total evaporative water loss (TEWL) of all sand gazelles and determined lean dry mass of organs of gazelles in CTRL and EXPT(2). Gazelles in CTRL had a mean SFMR of 2,524 +/- 194 kJ d(-1), whereas gazelles in EXPT(1) and EXPT(2) had SFMRs of 2,101+/- 232 and 1,365 +/- 182 kJ d(-1), respectively, values that differed significantly when we controlled for differences in body mass. Gazelles had TEWLs of 151.1 +/- 18.2, 138.5 +/- 17.53, and 98.4 +/- 27.2 g H(2)O d(-1) in CTRL, EXPT(1), and EXPT(2), respectively. For the latter group, mass-independent TEWL was 27.1% of the value for CTRL. We found that normally hydrated sand gazelles had a low mass-adjusted TEWL compared with other arid-zone ungulates: 13.6 g H(2)O kg(-0.898) d(-1), only 17.1% of allometric predictions, the lowest ever measured in an arid-zone ungulate. After 4 mo of progressive food and water restriction, dry lean mass of liver, heart, and muscle of gazelles in EXPT(2) was significantly less than that of these same organs in CTRL, even when we controlled for body mass decrease. Decreases in the dry lean mass of liver explained 70.4% of the variance of SFMR in food- and water-restricted gazelles. As oxygen demands decreased because of reduced organ sizes, gazelles lost less evaporative water, probably because of a decreased respiratory water loss. PMID

  18. Physiological adjustments of sand gazelles (Gazella subgutturosa) to a boom-or-bust economy: standard fasting metabolic rate, total evaporative water loss, and changes in the sizes of organs during food and water restriction.

    PubMed

    Ostrowski, Stephane; Mesochina, Pascal; Williams, Joseph B

    2006-01-01

    To test the hypothesis that desert ungulates adjust their physiology in response to long-term food and water restriction, we established three groups of sand gazelles (Gazella subgutturosa): one that was provided food and water (n = 6; CTRL) ad lib. for 4 mo, one that received ad lib. food and water for the same period but was deprived of food and water for the last 4.5 d (n = 6; EXPT(1)), and one that was exposed to 4 mo of progressive food and water restriction, an experimental regime designed to mimic conditions in a natural desert setting (n = 6; EXPT(2)). At the end of the 4-mo experiment, we measured standard fasting metabolic rate (SFMR) and total evaporative water loss (TEWL) of all sand gazelles and determined lean dry mass of organs of gazelles in CTRL and EXPT(2). Gazelles in CTRL had a mean SFMR of 2,524 +/- 194 kJ d(-1), whereas gazelles in EXPT(1) and EXPT(2) had SFMRs of 2,101+/- 232 and 1,365 +/- 182 kJ d(-1), respectively, values that differed significantly when we controlled for differences in body mass. Gazelles had TEWLs of 151.1 +/- 18.2, 138.5 +/- 17.53, and 98.4 +/- 27.2 g H(2)O d(-1) in CTRL, EXPT(1), and EXPT(2), respectively. For the latter group, mass-independent TEWL was 27.1% of the value for CTRL. We found that normally hydrated sand gazelles had a low mass-adjusted TEWL compared with other arid-zone ungulates: 13.6 g H(2)O kg(-0.898) d(-1), only 17.1% of allometric predictions, the lowest ever measured in an arid-zone ungulate. After 4 mo of progressive food and water restriction, dry lean mass of liver, heart, and muscle of gazelles in EXPT(2) was significantly less than that of these same organs in CTRL, even when we controlled for body mass decrease. Decreases in the dry lean mass of liver explained 70.4% of the variance of SFMR in food- and water-restricted gazelles. As oxygen demands decreased because of reduced organ sizes, gazelles lost less evaporative water, probably because of a decreased respiratory water loss.

  19. Estimating the Roles of Genetic Risk, Perinatal Risk, and Marital Hostility on Early Childhood Adjustment: Medical Records and Self-Reports.

    PubMed

    Neiderhiser, Jenae M; Marceau, Kristine; De Araujo-Greecher, Marielena; Ganiban, Jody M; Mayes, Linda C; Shaw, Daniel S; Reiss, David; Leve, Leslie D

    2016-05-01

    A wide variety of perinatal risk factors have been linked to later developmental outcomes in children. Much of this work has relied on either birth/medical records or mothers' self-reports collected after delivery, and there has been an ongoing debate about which strategy provides the most accurate and reliable data. This report uses a parent-offspring adoption design (N = 561 families) to (1) examine the correspondence between medical record data and self-report data, (2) examine how perinatal risk factors may influence child internalizing and externalizing behavior at age 4.5 years, and (3) explore interactions among genetic, perinatal risk, and rearing environment on child internalizing and externalizing behavior during early childhood. The agreement of self-reports and medical records data was relatively high (51-100 %), although there was some variation based on the construct. There were few main effects of perinatal risk on child outcomes; however, there were several 2- and 3-way interactions suggesting that the combined influences of genetic, perinatal, and rearing environmental risks are important, particularly for predicting whether children exhibit internalizing versus externalizing symptoms at age 4.5 years.

  20. Lost: loss of chance.

    PubMed

    Bird, Sara

    2010-09-01

    Loss of chance claims involve an allegation that a patient has lost the chance of a better medical outcome, in terms of treatment and/or prognosis, as a result of the negligence of the medical practitioner. A recent High Court of Australia judgment confirmed that monetary damages are not available for the loss of a chance of a better medical outcome. This article discusses the judgment and its implications for medical practitioners in Australia.

  1. Management of type 2 diabetes mellitus in self-motivated patients: optimized diet, exercise, and medication for weight loss and cardiometabolic fitness.

    PubMed

    Nadeau, Daniel A

    2014-11-01

    Type 2 diabetes mellitus (T2DM) is a growing public health problem with significant lifetime health care costs. The majority of Americans do not achieve minimal targets for exercise, and individuals with T2DM typically engage in less exercise than the general adult population. However, those patients with T2DM who are sufficiently self-motivated to manage their condition have the potential to reverse diabetes and prevent its complications through behavioral and pharmacologic interventions. Marked improvements are possible through increased awareness and selection of healthy eating options, a willingness to incorporate vigorous exercise into their lifestyle, and the use of newer medications that essentially eliminate the risk of hypoglycemia while facilitating weight loss and the achievement of ideal glucose targets. For self-motivated patients, daily aerobic activity of 45 to 60 minutes per day may be a suitable target. For those who have cardiovascular clearance, high-intensity interval training accomplishes high levels of cardiometabolic fitness with shorter training periods by alternating moderate and intense exertion. Suitable medications that have a low risk of hypoglycemia during exercise include metformin, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and sodium-glucose linked transporter-2 inhibitors. Specific daily caloric goals and incorporation of a mainly plant-based diet should be considered as a primary target for diabetes management. Self-management is important to achieving diabetes treatment goals, and mobile applications can be useful tools to support lifestyle changes in patients with T2DM.

  2. 29 CFR 785.42 - Adjusting grievances.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Adjusting grievances. 785.42 Section 785.42 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL... Adjusting Grievances, Medical Attention, Civic and Charitable Work, and Suggestion Systems §...

  3. Integrating with users is one thing, but living with them? A case study on loss of space from the Medical Center Library, University of California, San Diego.

    PubMed

    Haynes, Craig

    2010-01-01

    The University of California, San Diego (UCSD) Medical Center is the primary hospital for the UCSD School of Medicine. The UCSD Medical Center Library (MCL), a branch of the campus's biomedical library, is located on the medical center campus. In 2007, the medical center administration made a request to MCL for space in its facility to relocate pharmacy administration from the hospital tower. The university librarian brought together a team of library managers to deliberate and develop a proposal, which ultimately accommodated the medical center's request and enhanced some of MCL's public services.

  4. Integrating with users is one thing, but living with them? a case study on loss of space from the Medical Center Library, University of California, San Diego

    PubMed Central

    Haynes, Craig

    2010-01-01

    The University of California, San Diego (UCSD) Medical Center is the primary hospital for the UCSD School of Medicine. The UCSD Medical Center Library (MCL), a branch of the campus's biomedical library, is located on the medical center campus. In 2007, the medical center administration made a request to MCL for space in its facility to relocate pharmacy administration from the hospital tower. The university librarian brought together a team of library managers to deliberate and develop a proposal, which ultimately accommodated the medical center's request and enhanced some of MCL's public services. PMID:20098651

  5. Hearing Loss

    MedlinePlus

    ... version of this page please turn Javascript on. Hearing Loss What is Hearing Loss? Hearing loss is a common problem caused by ... sec Click to watch this video Types of Hearing Loss Hearing loss comes in many forms. It can ...

  6. Increasing revenue through fee review and adjustment.

    PubMed

    Wild, J; Cimerola, J

    1996-08-01

    Medical group practices are under increasing pressure to deliver care more cost-efficiently. To remain competitive, practices must find ways to increase their fee-for-service revenue. One way for medical group practices to increase revenue is to review fees in accordance with industry standards and to adjust them, as needed.

  7. 26 CFR 1.904(f)-1T - Overall foreign loss and the overall foreign loss account (temporary).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Without the United States § 1.904(f)-1T Overall foreign loss and the overall foreign loss account...) Adjustments for capital gains and losses. If a taxpayer has capital gains or losses, the taxpayer shall make adjustments to such capital gains and losses to the extent required under section 904(b)(2) and §...

  8. Medical Issues: Equipment

    MedlinePlus

    ... Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At School At Home ... Diagnosed Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life Grief & Loss Community & Local ...

  9. Case Study: Weight loss in a patient with type 2 diabetes: Challenges of diabetes management.

    PubMed

    Lotfi, Katayoun; Palmer, Kenya; Apovian, Caroline M

    2015-04-01

    This patient with BMI 36 kg/m² and T2DM on insulin glargine and glyburide as well as atenolol for HTN was able to lose 10% of his initial body weight with a low-carbohydrate diet and exercise and adjustment of medications in approximately a 36-week time frame. Insulin glargine and glyburide were reduced gradually with blood glucose monitoring and replaced by an increase in metformin, start of liraglutide, and eventually phentermine/topiramate and canagliflozin (Figure). Therefore, medications that can exacerbate weight gain were discontinued in place of medications which promote weight loss. PMID:25900868

  10. 21 CFR 880.5120 - Manual adjustable hospital bed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Manual adjustable hospital bed. 880.5120 Section... Therapeutic Devices § 880.5120 Manual adjustable hospital bed. (a) Identification. A manual adjustable hospital bed is a device intended for medical purposes that consists of a bed with a manual...

  11. ADJUSTABLE DOUBLE PULSE GENERATOR

    DOEpatents

    Gratian, J.W.; Gratian, A.C.

    1961-08-01

    >A modulator pulse source having adjustable pulse width and adjustable pulse spacing is described. The generator consists of a cross coupled multivibrator having adjustable time constant circuitry in each leg, an adjustable differentiating circuit in the output of each leg, a mixing and rectifying circuit for combining the differentiated pulses and generating in its output a resultant sequence of negative pulses, and a final amplifying circuit for inverting and square-topping the pulses. (AEC)

  12. 7 CFR 981.401 - Adjusted kernel weight.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... weight of delivery 10,000 10,000 2. Percent of edible kernel weight 53.0 84.0 3. Less weight loss in... 7 Agriculture 8 2014-01-01 2014-01-01 false Adjusted kernel weight. 981.401 Section 981.401... Administrative Rules and Regulations § 981.401 Adjusted kernel weight. (a) Definition. Adjusted kernel...

  13. 7 CFR 981.401 - Adjusted kernel weight.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... weight of delivery 10,000 10,000 2. Percent of edible kernel weight 53.0 84.0 3. Less weight loss in... 7 Agriculture 8 2012-01-01 2012-01-01 false Adjusted kernel weight. 981.401 Section 981.401... Administrative Rules and Regulations § 981.401 Adjusted kernel weight. (a) Definition. Adjusted kernel...

  14. 7 CFR 981.401 - Adjusted kernel weight.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... weight of delivery 10,000 10,000 2. Percent of edible kernel weight 53.0 84.0 3. Less weight loss in... 7 Agriculture 8 2013-01-01 2013-01-01 false Adjusted kernel weight. 981.401 Section 981.401... Administrative Rules and Regulations § 981.401 Adjusted kernel weight. (a) Definition. Adjusted kernel...

  15. 7 CFR 981.401 - Adjusted kernel weight.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... weight of delivery 10,000 10,000 2. Percent of edible kernel weight 53.0 84.0 3. Less weight loss in... 7 Agriculture 8 2011-01-01 2011-01-01 false Adjusted kernel weight. 981.401 Section 981.401... Administrative Rules and Regulations § 981.401 Adjusted kernel weight. (a) Definition. Adjusted kernel...

  16. 7 CFR 981.401 - Adjusted kernel weight.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... weight of delivery 10,000 10,000 2. Percent of edible kernel weight 53.0 84.0 3. Less weight loss in... 7 Agriculture 8 2010-01-01 2010-01-01 false Adjusted kernel weight. 981.401 Section 981.401... Administrative Rules and Regulations § 981.401 Adjusted kernel weight. (a) Definition. Adjusted kernel...

  17. A tale of loss of privilege, resilience and change: the impact of the economic crisis on physicians and medical services in Portugal.

    PubMed

    Russo, Giuliano; Rego, Inês; Perelman, Julian; Barros, Pedro Pita

    2016-09-01

    That the current economic crisis is having an impact on population health and healthcare utilisation across Europe is fairly established; how national health systems and markets are reacting is however still poorly understood. Drawing from the economic literature we conducted 21 interviews with physicians, policy-makers and healthcare managers in Portugal, to explore their perceptions on the impact of the crisis on the country's market medical services, on physicians' motivation, and the ensuing coping strategies. Interviews were recorded, transcribed and analysed using NVivo software. We show that despite the crisis, few physicians reported considering leaving the public sector and the country, and very diverse coping strategies are emerging, depending on the respective employment institutions and seniority. In spite of the changes in patient case-mix, demand for medical services may not have necessarily increased, having shifted from public to private, with many highlighting the contribution of the current crisis in consolidating the private sector. In order to maintain their pre-crisis living standards amidst deteriorating salaries and increasing controls, hospital physicians have resorted to strategies such as shifting hours to the private, and primary care ones to anticipating their retirement. Migration was reported to be an option only for the younger and older doctors. Our study suggests the existence of resilience among Portuguese physicians and in the country's market for medical services, which, if corroborated by further research, will need to be taken into account by national health policies.

  18. PreDictor Research in Obesity during Medical care - weight Loss in children and adolescents during an INpatient rehabilitation: rationale and design of the DROMLIN study

    PubMed Central

    2014-01-01

    Background Obesity in adults and children is increasing worldwide at alarming rates. Obese children and adolescents are likely to become obese adults with increased risk of a number of comorbidities. In addition to preventing the development of obesity at young age, it is necessary to individualize the therapy of already obese children and adolescents in order to increase the likelihood of weight loss and maintenance. Therefore, the aim of this study is to identify predictors which play a significant role in successful weight loss and weight loss maintenance in children and adolescents. Methods/Design Over a one year period, 60 obese children and adolescents between 9 to 17 years of age shall be recruited at an inpatient children rehabilitation facility in Germany. They will be investigated twice within a few days following admission and prior to discharge. The study will be an integrated component of an established inpatient weight-loss and in part psychosomatic therapy. The collected data can be grouped into four clusters: 1) demographic, sociometric and psychometric data, 2) objective and subjective parameters of body condition, 3) autonomic nervous system regulated functions and 4) objective and subjective parameters for eating behavior. Primary outcome is the change of the body mass index standard deviation score (BMI-SDS). In order to evaluate the data appropriately, all examinations will be also conducted in a normal-weight reference group, matched for age and gender. Discussion For some of the collected parameters the time span between measures may be too short. Therefore, a 6 months, 1 year and 2 year follow-up will be performed for evaluating the different predictors and their influence in regard to a successful intervention. Further middle- and long-term follow-up studies are planned. Trial Registration The study protocol was approved by the Ethics Committee of the University Hospital Tübingen, Germany. This study is registered at the German Clinical

  19. Medication Use Among Patients Prior to Bariatric Surgery

    PubMed Central

    Elliott, Jennifer Padden; Gray, Erica L.; Yu, Jessie

    2015-01-01

    Purpose: The aims of this study were to describe the most common medications reported by candidates for weight loss surgery and to consider the potential implications for patient care. Methods: A secondary data analysis of data from bariatric surgery patients enrolled in a randomized, controlled trial. At study entry, participants recorded their use of prescription medications they had taken in the previous 90 days. The Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) Index 2014 was used to classify medications. Results: Participants (n=265) were 85.7% female and 83.0% white. Mean body mass index was 47.9±6.5 kg/m2, and age was 45.1±11 years. The average number of medications was 4.4±4.1, and the median was 3. The top three anatomical main groups were the cardiovascular system, alimentary tract and metabolism, and nervous system (28.2%, 21.6%, and 21.3% of all medications, respectively). The top therapeutic subgroups were drugs used in diabetes, psychoanaleptics, and agents acting on the renin-angiotensin system (12%, 11.3%, and 8.2% of all medications, respectively). Conclusions: Candidates for weight loss surgery report taking medications associated with obesity-related comorbidities such as diabetes, depression, and hypertension. Although many may be able to eliminate these medications, others will require close monitoring and dosage adjustment after surgery. PMID:26421247

  20. Nonsyndromic hereditary hearing loss.

    PubMed

    Alford, Raye L

    2011-01-01

    The etiology of hereditary hearing loss is extraordinarily complex. More than 400 genetic syndromes are associated with hearing loss and more than 140 genetic loci associated with nonsyndromic hearing loss have been mapped, with more than 60 genes identified to date. Hereditary hearing loss can be inherited as an autosomal dominant, autosomal recessive, X-linked or mitochondrial (maternally inherited) condition. The overlapping audiologic phenotypes associated with many genes and the variability and/or reduced, sometimes age-related, penetrance of some phenotypic features of syndromic hearing loss can complicate the distinction between various genetic causes of nonsyndromic hearing loss and between nonsyndromic and syndromic hearing loss, especially in childhood. Testing for individual genes associated with nonsyndromic hearing loss, beyond GJB2 which encodes Connexin 26, can become expensive and, without specific phenotypic features to guide selection of genes for testing (such as enlarged vestibular aqueducts, low frequency hearing loss or auditory neuropathy), it is not likely to yield an etiology. Advances in DNA sequencing and the rapid decline in the cost of sequencing presage the availability of testing that can identify the etiology in the majority of cases of genetic hearing loss. However, until comprehensive genetic testing of hearing loss is clinically available and cost-effective, thorough phenotypic and audiologic evaluation and careful documentation of risk factors, infectious exposures and patient and family medical history will continue to be important to efforts directed toward etiologic diagnosis. The complexities associated with interpretation of genetic test results, genetic counseling and genetic risk assessment make consultation with medical geneticists important for many patients.

  1. Sudden sensorineural hearing loss.

    PubMed

    Stew, B T; Fishpool, S J C; Williams, H

    2012-02-01

    Sudden onset sensorineural hearing loss is a medical emergency that continues to be poorly understood despite being recognized in the literature since 1944 (De Kleyn, 1944). A commonly used criterion to qualify for this diagnosis is a sensorineural hearing loss over three contiguous pure-tone frequencies of 30 dB or more that develops within 72 hours. The vast majority of cases are unilateral and the estimated annual incidence is 20 per 100 000 persons (Nosrati-Zarenoe et al, 2007). A cause for the hearing loss is only identified in up to 10% of cases but 50% of patients will improve spontaneously (Penido et al, 2009).

  2. Sudden sensorineural hearing loss.

    PubMed

    Stew, B T; Fishpool, S J C; Williams, H

    2012-02-01

    Sudden onset sensorineural hearing loss is a medical emergency that continues to be poorly understood despite being recognized in the literature since 1944 (De Kleyn, 1944). A commonly used criterion to qualify for this diagnosis is a sensorineural hearing loss over three contiguous pure-tone frequencies of 30 dB or more that develops within 72 hours. The vast majority of cases are unilateral and the estimated annual incidence is 20 per 100 000 persons (Nosrati-Zarenoe et al, 2007). A cause for the hearing loss is only identified in up to 10% of cases but 50% of patients will improve spontaneously (Penido et al, 2009). PMID:22504750

  3. Personality, attrition and weight loss in treatment seeking women with obesity.

    PubMed

    Dalle Grave, R; Calugi, S; Compare, A; El Ghoch, M; Petroni, M L; Colombari, S; Minniti, A; Marchesini, G

    2015-10-01

    Studies on small samples or in single units applying specific treatment programmes found an association between some personality traits and attrition and weight loss in individuals treated for obesity. We aimed to investigate whether pre-treatment personality traits were associated with weight loss outcomes in the general population of women with obesity. Attrition and weight loss outcomes after 12 months were measured in 634 women with obesity (mean age, 48; body mass index (BMI), 37.8 kg m(-2)) seeking treatment at eight Italian medical centres, applying different medical/cognitive behavioural programmes. Personality traits were assessed with the Temperament and Character Inventory (TCI), eating disorder features with the Binge Eating Scale (BES) and Night Eating Questionnaire (NEQ). Within the 12-month observation period, 32.3% of cases were lost to follow-up. After adjustment for demographic confounders and the severity of eating disorders, no TCI personality traits were significantly associated with attrition, while low scores of the novelty seeking temperament scale remained significantly associated with weight loss ≥ 10% (odds ratio, 0.983; 95% confidence interval, 0.975-0.992). Additional adjustment for education and job did not change the results. We conclude that personality does not systematically influence attrition in women with obesity enrolled into weight loss programmes in the community, whereas an association is maintained between novelty seeking and weight loss outcome. Studies adapting obesity interventions on the basis of individual novelty seeking scores might be warranted to maximize the results on body weight.

  4. Mass loss

    NASA Technical Reports Server (NTRS)

    Goldberg, Leo

    1987-01-01

    Observational evidence for mass loss from cool stars is reviewed. Spectra line profiles are used for the derivation of mass-loss rates with the aid of the equation of continuity. This equation implies steady mass loss with spherical symmetry. Data from binary stars, Mira variables, and red giants in globular clusters are examined. Silicate emission is discussed as a useful indicator of mass loss in the middle infrared spectra. The use of thermal millimeter-wave radiation, Very Large Array (VLA) measurement of radio emission, and OH/IR masers are discussed as a tool for mass loss measurement. Evidence for nonsteady mass loss is also reviewed.

  5. Psychological impediments to weight loss.

    PubMed

    Strain, G W; Strain, J J

    1979-01-01

    An understanding of the possible psychologic impediments to weight loss can promote improved therapeutic intervention for the obese patient. Certain psychological tasks are imposed by chronic medical illness including obesity. The universal stresses that accompany medical illness, the basic threat to self-esteem and sense of intactness, the fear--of loss of love and approval, of loss of control of function, of injury to body parts, of pain, and of guilt--all become psychological impediments thwarting weight loss and its maintenance. The physician's awareness of these psychological stresses helps him identify areas of necessary support. PMID:528129

  6. SLIT ADJUSTMENT CLAMP

    DOEpatents

    McKenzie, K.R.

    1959-07-01

    An electrode support which permits accurate alignment and adjustment of the electrode in a plurality of planes and about a plurality of axes in a calutron is described. The support will align the slits in the electrode with the slits of an ionizing chamber so as to provide for the egress of ions. The support comprises an insulator, a leveling plate carried by the insulator and having diametrically opposed attaching screws screwed to the plate and the insulator and diametrically opposed adjusting screws for bearing against the insulator, and an electrode associated with the plate for adjustment therewith.

  7. Remotely Adjustable Hydraulic Pump

    NASA Technical Reports Server (NTRS)

    Kouns, H. H.; Gardner, L. D.

    1987-01-01

    Outlet pressure adjusted to match varying loads. Electrohydraulic servo has positioned sleeve in leftmost position, adjusting outlet pressure to maximum value. Sleeve in equilibrium position, with control land covering control port. For lowest pressure setting, sleeve shifted toward right by increased pressure on sleeve shoulder from servovalve. Pump used in aircraft and robots, where hydraulic actuators repeatedly turned on and off, changing pump load frequently and over wide range.

  8. Weighted triangulation adjustment

    USGS Publications Warehouse

    Anderson, Walter L.

    1969-01-01

    The variation of coordinates method is employed to perform a weighted least squares adjustment of horizontal survey networks. Geodetic coordinates are required for each fixed and adjustable station. A preliminary inverse geodetic position computation is made for each observed line. Weights associated with each observed equation for direction, azimuth, and distance are applied in the formation of the normal equations in-the least squares adjustment. The number of normal equations that may be solved is twice the number of new stations and less than 150. When the normal equations are solved, shifts are produced at adjustable stations. Previously computed correction factors are applied to the shifts and a most probable geodetic position is found for each adjustable station. Pinal azimuths and distances are computed. These may be written onto magnetic tape for subsequent computation of state plane or grid coordinates. Input consists of punch cards containing project identification, program options, and position and observation information. Results listed include preliminary and final positions, residuals, observation equations, solution of the normal equations showing magnitudes of shifts, and a plot of each adjusted and fixed station. During processing, data sets containing irrecoverable errors are rejected and the type of error is listed. The computer resumes processing of additional data sets.. Other conditions cause warning-errors to be issued, and processing continues with the current data set.

  9. When the library is located in prime real estate: a case study on the loss of space from the Duke University Medical Center Library and Archives.

    PubMed

    Thibodeau, Patricia L

    2010-01-01

    The Duke University Medical Center Library and Archives is located in the heart of the Duke Medicine campus, surrounded by Duke Hospital, ambulatory clinics, and numerous research facilities. Its location is considered prime real estate, given its adjacency to patient care, research, and educational activities. In 2005, the Duke University Library Space Planning Committee had recommended creating a learning center in the library that would support a variety of educational activities. However, the health system needed to convert the library's top floor into office space to make way for expansion of the hospital and cancer center. The library had only five months to plan the storage and consolidation of its journal and book collections, while working with the facilities design office and architect on the replacement of key user spaces on the top floor. Library staff worked together to develop plans for storing, weeding, and consolidating the collections and provided input into renovation plans for users spaces on its mezzanine level. The library lost 15,238 square feet (29%) of its net assignable square footage and a total of 16,897 (30%) gross square feet. This included 50% of the total space allotted to collections and over 15% of user spaces. The top-floor space now houses offices for Duke Medicine oncology faculty and staff. By storing a large portion of its collection off-site, the library was able to remove more stacks on the remaining stack level and convert them to user spaces, a long-term goal for the library. Additional space on the mezzanine level had to be converted to replace lost study and conference room spaces. While this project did not match the recommended space plans for the library, it underscored the need for the library to think creatively about the future of its facility and to work toward a more cohesive master plan.

  10. When the library is located in prime real estate: a case study on the loss of space from the Duke University Medical Center Library and Archives

    PubMed Central

    Thibodeau, Patricia L.

    2010-01-01

    The Duke University Medical Center Library and Archives is located in the heart of the Duke Medicine campus, surrounded by Duke Hospital, ambulatory clinics, and numerous research facilities. Its location is considered prime real estate, given its adjacency to patient care, research, and educational activities. In 2005, the Duke University Library Space Planning Committee had recommended creating a learning center in the library that would support a variety of educational activities. However, the health system needed to convert the library's top floor into office space to make way for expansion of the hospital and cancer center. The library had only five months to plan the storage and consolidation of its journal and book collections, while working with the facilities design office and architect on the replacement of key user spaces on the top floor. Library staff worked together to develop plans for storing, weeding, and consolidating the collections and provided input into renovation plans for users spaces on its mezzanine level. The library lost 15,238 square feet (29%) of its net assignable square footage and a total of 16,897 (30%) gross square feet. This included 50% of the total space allotted to collections and over 15% of user spaces. The top-floor space now houses offices for Duke Medicine oncology faculty and staff. By storing a large portion of its collection off-site, the library was able to remove more stacks on the remaining stack level and convert them to user spaces, a long-term goal for the library. Additional space on the mezzanine level had to be converted to replace lost study and conference room spaces. While this project did not match the recommended space plans for the library, it underscored the need for the library to think creatively about the future of its facility and to work toward a more cohesive master plan. PMID:20098649

  11. When the library is located in prime real estate: a case study on the loss of space from the Duke University Medical Center Library and Archives.

    PubMed

    Thibodeau, Patricia L

    2010-01-01

    The Duke University Medical Center Library and Archives is located in the heart of the Duke Medicine campus, surrounded by Duke Hospital, ambulatory clinics, and numerous research facilities. Its location is considered prime real estate, given its adjacency to patient care, research, and educational activities. In 2005, the Duke University Library Space Planning Committee had recommended creating a learning center in the library that would support a variety of educational activities. However, the health system needed to convert the library's top floor into office space to make way for expansion of the hospital and cancer center. The library had only five months to plan the storage and consolidation of its journal and book collections, while working with the facilities design office and architect on the replacement of key user spaces on the top floor. Library staff worked together to develop plans for storing, weeding, and consolidating the collections and provided input into renovation plans for users spaces on its mezzanine level. The library lost 15,238 square feet (29%) of its net assignable square footage and a total of 16,897 (30%) gross square feet. This included 50% of the total space allotted to collections and over 15% of user spaces. The top-floor space now houses offices for Duke Medicine oncology faculty and staff. By storing a large portion of its collection off-site, the library was able to remove more stacks on the remaining stack level and convert them to user spaces, a long-term goal for the library. Additional space on the mezzanine level had to be converted to replace lost study and conference room spaces. While this project did not match the recommended space plans for the library, it underscored the need for the library to think creatively about the future of its facility and to work toward a more cohesive master plan. PMID:20098649

  12. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hydraulic adjustable hospital bed. 880.5110... (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic...

  13. 21 CFR 880.5120 - Manual adjustable hospital bed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Manual adjustable hospital bed. 880.5120 Section... (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Therapeutic Devices § 880.5120 Manual adjustable hospital bed. (a) Identification. A manual...

  14. 7 CFR 400.405 - Agent and loss adjuster responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Regulations; Collection and Storage of Social Security Account Numbers and Employer Identification Numbers... eligibility for program participation; and (4) Collection of any amount which may be owed by the agent...

  15. 7 CFR 400.405 - Agent and loss adjuster responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... her correct SSN to FCIC or the insurance provider, whichever is applicable, to be eligible to participate in the crop insurance program. The SSN will be used by FCIC and the insurance provider in... the crop insurance program does not provide his or her correct SSN on forms or contracts where...

  16. 7 CFR 400.405 - Agent and loss adjuster responsibilities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... her correct SSN to FCIC or the insurance provider, whichever is applicable, to be eligible to participate in the crop insurance program. The SSN will be used by FCIC and the insurance provider in... the crop insurance program does not provide his or her correct SSN on forms or contracts where...

  17. 7 CFR 400.405 - Agent and loss adjuster responsibilities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... her correct SSN to FCIC or the insurance provider, whichever is applicable, to be eligible to participate in the crop insurance program. The SSN will be used by FCIC and the insurance provider in... the crop insurance program does not provide his or her correct SSN on forms or contracts where...

  18. 7 CFR 400.405 - Agent and loss adjuster responsibilities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... her correct SSN to FCIC or the insurance provider, whichever is applicable, to be eligible to participate in the crop insurance program. The SSN will be used by FCIC and the insurance provider in... the crop insurance program does not provide his or her correct SSN on forms or contracts where...

  19. African Refugees in Egypt: Trauma, Loss, and Cultural Adjustment

    ERIC Educational Resources Information Center

    Henry, Hani M.

    2012-01-01

    This study examined the influence of pre-immigration trauma on the acculturation process of refugees, as reflected in the manifestations of their continuing bonds with native cultures. Six African refugees who sought refuge in Egypt because of wars and political persecution were interviewed about the circumstances of their departure from their…

  20. The post-adjustable gastric band abdominoplasty.

    PubMed

    Wu, Allan Y; Coon, John L; Huerta, Sergio; Condé-Green, Alexandra; Morrow, David M

    2012-07-01

    Serious complications associated with post-laparoscopic adjustable gastric band (LAGB) abdominoplasty have been reported in the medical literature. Furthermore, others have noted aesthetic problems with closure of the umbilicus due to apparatus port proximity. Currently, no clinical protocol or formal industry guidance for LAGB apparatus management during abdominoplasty is available in the medical literature. In this article, the authors describe their procedure for safe LAGB apparatus management during abdominoplasty and illustrate key surgical principles by presenting unique cases from their series of 20 patients treated with this technique. PMID:22745453

  1. Simple, Internally Adjustable Valve

    NASA Technical Reports Server (NTRS)

    Burley, Richard K.

    1990-01-01

    Valve containing simple in-line, adjustable, flow-control orifice made from ordinary plumbing fitting and two allen setscrews. Construction of valve requires only simple drilling, tapping, and grinding. Orifice installed in existing fitting, avoiding changes in rest of plumbing.

  2. Self Adjusting Sunglasses

    NASA Technical Reports Server (NTRS)

    1986-01-01

    Corning Glass Works' Serengeti Driver sunglasses are unique in that their lenses self-adjust and filter light while suppressing glare. They eliminate more than 99% of the ultraviolet rays in sunlight. The frames are based on the NASA Anthropometric Source Book.

  3. Rural to Urban Adjustment

    ERIC Educational Resources Information Center

    Abramson, Jane A.

    Personal interviews with 100 former farm operators living in Saskatoon, Saskatchewan, were conducted in an attempt to understand the nature of the adjustment process caused by migration from rural to urban surroundings. Requirements for inclusion in the study were that respondents had owned or operated a farm for at least 3 years, had left their…

  4. Self adjusting inclinometer

    DOEpatents

    Hunter, Steven L.

    2002-01-01

    An inclinometer utilizing synchronous demodulation for high resolution and electronic offset adjustment provides a wide dynamic range without any moving components. A device encompassing a tiltmeter and accompanying electronic circuitry provides quasi-leveled tilt sensors that detect highly resolved tilt change without signal saturation.

  5. 26 CFR 1.904(f)-1T - Overall foreign loss and the overall foreign loss account (temporary).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... United States § 1.904(f)-1T Overall foreign loss and the overall foreign loss account (temporary). (a)(1... capital gains and losses. If a taxpayer has capital gains or losses, the taxpayer shall make adjustments to such capital gains and losses to the extent required under section 904(b)(2) and §...

  6. Hearing loss in older adults.

    PubMed

    Walling, Anne D; Dickson, Gretchen M

    2012-06-15

    Hearing loss affects approximately one-third of adults 61 to 70 years of age and more than 80 percent of those older than 85 years. Men usually experience greater hearing loss and have earlier onset compared with women. The most common type is age-related hearing loss; however, many conditions can interfere with the conduction of sound vibrations to the inner ear and their conversion to electrical impulses for conduction to the brain. Screening for hearing loss is recommended in adults older than 50 to 60 years. Office screening tests include the whispered voice test and audioscopy. Older patients who admit to having difficulty hearing may be referred directly for audiometry. The history can identify risk factors for hearing loss, especially noise exposure and use of ototoxic medications. Examination of the auditory canal and tympanic membrane can identify causes of conductive hearing loss. Audiometric testing is required to confirm hearing loss. Adults presenting with idiopathic sudden sensorineural hearing loss should be referred for urgent assessment. Management of hearing loss is based on addressing underlying causes, especially obstructions (including cerumen) and ototoxic medications. Residual hearing should be optimized by use of hearing aids, assistive listening devices, and rehabilitation programs. Surgical implants are indicated for selected patients. Major barriers to improved hearing in older adults include lack of recognition of hearing loss; perception that hearing loss is a normal part of aging or is not amenable to treatment; and patient nonadherence with hearing aids because of stigma, cost, inconvenience, disappointing initial results, or other factors.

  7. Abortion - medical

    MedlinePlus

    ... womb (uterus). There are different types of medical abortions: Therapeutic medical abortion is done because the woman has ... Therapeutic medical abortion; Elective medical abortion; Induced abortion; Nonsurgical abortion

  8. An adjustable RF coil loading device.

    PubMed

    Hayes, C E

    1993-01-01

    This paper describes an adjustable loading device that can substitute for the tissue losses of various sized patients in a whole-body MR imager. It resembles a lowpass birdcage resonator but with resistors replacing the capacitors on the cylindrical surface. Power dissipated is a monotonic function of the total surface conductance of the loader. The loader can be used in conjunction with a low loss water filled phantom to measure signal-to-noise ratios (SNR). The impact on measured SNR due to screening by the loader and changing the phantom size or composition are also briefly discussed.

  9. 26 CFR 1.1502-78 - Tentative carryback adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... respect to the consolidated net operating loss, X, the common parent, must file an application under section 6411. If a tentative carryback adjustment is desired with respect to Z's loss, X must file an... 1, X becomes a member of the Y consolidated group, which also files returns on a calendar year...

  10. Hair Loss

    MedlinePlus

    ... lupus. If you take certain medicines or have chemotherapy for cancer, you may also lose your hair. Other causes are stress, a low protein diet, a family history, or poor nutrition. Treatment for hair loss depends on the cause. ...

  11. Hair Loss

    MedlinePlus

    ... Common baldness" usually means male-pattern baldness, or permanent-pattern baldness. It is also called androgenetic alopecia. ... will grow back normally. However, scarring can cause permanent hair loss. Hot oil hair treatments or chemicals ...

  12. Memory loss

    MedlinePlus

    ... results in the loss of, or damage to brain tissue or nerve cells, such as Parkinson disease , Huntington disease , or multiple sclerosis Low levels of important nutrients or vitamins, such as low vitamin B1 or B12

  13. Precision adjustable stage

    DOEpatents

    Cutburth, Ronald W.; Silva, Leonard L.

    1988-01-01

    An improved mounting stage of the type used for the detection of laser beams is disclosed. A stage center block is mounted on each of two opposite sides by a pair of spaced ball bearing tracks which provide stability as well as simplicity. The use of the spaced ball bearing pairs in conjunction with an adjustment screw which also provides support eliminates extraneous stabilization components and permits maximization of the area of the center block laser transmission hole.

  14. Adjustable vane windmills

    SciTech Connect

    Ducker, W.L.

    1982-09-14

    A system of rotatably and pivotally mounted radially extended bent supports for radially extending windmill rotor vanes in combination with axially movable radially extended control struts connected to the vanes with semi-automatic and automatic torque and other sensing and servo units provide automatic adjustment of the windmill vanes relative to their axes of rotation to produce mechanical output at constant torque or at constant speed or electrical quantities dependent thereon.

  15. Adjustable vane windmills

    SciTech Connect

    Ducker, W.L.

    1980-01-15

    A system of rotatably and pivotally mounted radially extended bent supports for radially extending windmill rotor vanes in combination with axially movable radially extended control struts connected to the vanes with semi-automatic and automatic torque and other sensing and servo units provide automatic adjustment of the windmill vanes relative to their axes of rotation to produce mechanical output at constant torque or at constant speed or electrical quantities dependent thereon.

  16. Adjustable vane windmills

    SciTech Connect

    Ducker, W.L.

    1982-09-07

    A system of rotatably and pivotally mounted radially extended bent supports for radially extending windmill rotor vanes in combination with axially movable radially extended control struts connected to the vanes with semi-automatic and automatic torque and other sensing and servo units provide automatic adjustment of the windmill vanes relative to their axes of rotation to produce mechanical output at constant torque or at constant speed or electrical quantities dependent thereon.

  17. Adjustable Autonomy Testbed

    NASA Technical Reports Server (NTRS)

    Malin, Jane T.; Schrenkenghost, Debra K.

    2001-01-01

    The Adjustable Autonomy Testbed (AAT) is a simulation-based testbed located in the Intelligent Systems Laboratory in the Automation, Robotics and Simulation Division at NASA Johnson Space Center. The purpose of the testbed is to support evaluation and validation of prototypes of adjustable autonomous agent software for control and fault management for complex systems. The AA T project has developed prototype adjustable autonomous agent software and human interfaces for cooperative fault management. This software builds on current autonomous agent technology by altering the architecture, components and interfaces for effective teamwork between autonomous systems and human experts. Autonomous agents include a planner, flexible executive, low level control and deductive model-based fault isolation. Adjustable autonomy is intended to increase the flexibility and effectiveness of fault management with an autonomous system. The test domain for this work is control of advanced life support systems for habitats for planetary exploration. The CONFIG hybrid discrete event simulation environment provides flexible and dynamically reconfigurable models of the behavior of components and fluids in the life support systems. Both discrete event and continuous (discrete time) simulation are supported, and flows and pressures are computed globally. This provides fast dynamic simulations of interacting hardware systems in closed loops that can be reconfigured during operations scenarios, producing complex cascading effects of operations and failures. Current object-oriented model libraries support modeling of fluid systems, and models have been developed of physico-chemical and biological subsystems for processing advanced life support gases. In FY01, water recovery system models will be developed.

  18. Hearing Loss in HIV-Infected Children in Lilongwe, Malawi

    PubMed Central

    Hrapcak, Susan; Kuper, Hannah; Bartlett, Peter; Devendra, Akash; Makawa, Atupele; Kim, Maria; Kazembe, Peter; Ahmed, Saeed

    2016-01-01

    Introduction With improved access to antiretroviral therapy (ART), HIV infection is becoming a chronic illness. Preliminary data suggest that HIV-infected children have a higher risk of disabilities, including hearing impairment, although data are sparse. This study aimed to estimate the prevalence and types of hearing loss in HIV-infected children in Lilongwe, Malawi. Methods This was a cross-sectional survey of 380 HIV-infected children aged 4–14 years attending ART clinic in Lilongwe between December 2013-March 2014. Data was collected through pediatric quality of life and sociodemographic questionnaires, electronic medical record review, and detailed audiologic testing. Hearing loss was defined as >20 decibels hearing level (dBHL) in either ear. Predictors of hearing loss were explored by regression analysis generating age- and sex-adjusted odds ratios. Children with significant hearing loss were fitted with hearing aids. Results Of 380 patients, 24% had hearing loss: 82% conductive, 14% sensorineural, and 4% mixed. Twenty-one patients (23% of those with hearing loss) were referred for hearing aid fitting. There was a higher prevalence of hearing loss in children with history of frequent ear infections (OR 7.4, 4.2–13.0) and ear drainage (OR 6.4, 3.6–11.6). Hearing loss was linked to history of WHO Stage 3 (OR 2.4, 1.2–4.5) or Stage 4 (OR 6.4, 2.7–15.2) and history of malnutrition (OR 2.1, 1.3–3.5), but not to duration of ART or CD4. Only 40% of caregivers accurately perceived their child’s hearing loss. Children with hearing impairment were less likely to attend school and had poorer emotional (p = 0.02) and school functioning (p = 0.04). Conclusions There is an urgent need for improved screening tools, identification and treatment of hearing problems in HIV-infected children, as hearing loss was common in this group and affected school functioning and quality of life. Clear strategies were identified for prevention and treatment, since most

  19. 7 CFR 786.106 - Determination of losses incurred.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., dairy production losses incurred by producers under this part are determined on the established history... § 786.106(d) will be adjusted to account for pounds of production losses determined by the FSA...

  20. Adjustment and war bereavement - some considerations.

    PubMed

    Purisman, R; Maoz, B

    1977-03-01

    Forty-seven parents from 25 families who had lost a son in the War of Attrition of 1969-1970 were interviewed in the course of this study. The interviews took place 2-3 years after the bereavement. The purpose of the study was an assessment of personal adjustment of bereaved parents, and an examination of background and behavioural characteristics which might differentiate between parents making a better and less good adjustment to the loss of a son. To this end data were collected via semistructured interviews. Non-objective variables: religiosity, social interpersonal relationships and adjustment were rated by independent judges. Reliability of interjudge agreement ranged from 0-67 to 1-00. Hypotheses were tested using correlation matrices. The hypothesis stating a positive relationship of high religiosity and good adjustment was not confirmed. The results suggest a very significant relationship between good adjustment and level of education (r = 0-668, alpha less than 0-01). Level of education was responsible for most of the variance and thus made impossible an answer regarding the relationship between religiosity and recovery after bereavement. To elucidate religiosity's function in adjustment, control of education level would be necessary. While this was not done in the present study, a further research plan was suggested. The hypothesis stating a positive correlational relationship between adjustment and interpersonal skills as reflected in social contacts and marital relations was confirmed (r = 0-735, r = 0-573, alpha less than 0-01). The findings of this study suggest that individuals who have suffered a severe stress, may gain strength, encouragement and compensation when their life style includes higher educational level and satisfying interactions with other people.

  1. Catastrophic medical expenditure risk.

    PubMed

    Flores, Gabriela; O'Donnell, Owen

    2016-03-01

    We propose a measure of household exposure to particularly onerous medical expenses. The measure can be decomposed into the probability that medical expenditure exceeds a threshold, the loss due to predictably low consumption of other goods if it does and the further loss arising from the volatility of medical expenses above the threshold. Depending on the choice of threshold, the measure is consistent with a model of reference-dependent utility with loss aversion. Unlike the risk premium, the measure is only sensitive to particularly high expenses, and can identify households that expect to incur such expenses and would benefit from subsidised, but not actuarially fair, insurance. An empirical illustration using data from seven Asian countries demonstrates the importance of taking account of informal insurance and reveals clear differences in catastrophic medical expenditure risk across and within countries. In general, risk is higher among poorer, rural and chronically ill populations.

  2. Ototoxic Medications (Medication Effects)

    MedlinePlus

    ... Toggle navigation Careers Certification Publications Events Advocacy Continuing Education Practice Management Research Home / Information for the Public / Hearing and Balance Ototoxic Medications ( ...

  3. Medical Readers' Theater: Relevance to Geriatrics Medical Education

    ERIC Educational Resources Information Center

    Shapiro, Johanna; Cho, Beverly

    2011-01-01

    Medical Readers' Theater (MRT) is an innovative and simple way of helping medical students to reflect on difficult-to-discuss topics in geriatrics medical education, such as aging stereotypes, disability and loss of independence, sexuality, assisted living, relationships with adult children, and end-of-life issues. The authors describe a required…

  4. Hair loss

    MedlinePlus

    ... 70. PHYSICAL OR EMOTIONAL STRESS Physical or emotional stress may cause one-half to three-quarters of scalp hair ... for weeks to months after the episode of stress. Hair shedding ... long-term (chronic). Causes of this type of hair loss are: High ...

  5. Hair Loss

    MedlinePlus

    ... psychosocial impact of hair loss have found patients’ self-esteem, body image and self-confidence to be negatively ... 1-2 Known psychosocial complications include depression, low self-esteem, altered self-image, and less frequent and enjoyable ...

  6. Subsea adjustable choke valves

    SciTech Connect

    Cyvas, M.K. )

    1989-08-01

    With emphasis on deepwater wells and marginal offshore fields growing, the search for reliable subsea production systems has become a high priority. A reliable subsea adjustable choke is essential to the realization of such a system, and recent advances are producing the degree of reliability required. Technological developments have been primarily in (1) trim material (including polycrystalline diamond), (2) trim configuration, (3) computer programs for trim sizing, (4) component materials, and (5) diver/remote-operated-vehicle (ROV) interfaces. These five facets are overviewed and progress to date is reported. A 15- to 20-year service life for adjustable subsea chokes is now a reality. Another factor vital to efficient use of these technological developments is to involve the choke manufacturer and ROV/diver personnel in initial system conceptualization. In this manner, maximum benefit can be derived from the latest technology. Major areas of development still required and under way are listed, and the paper closes with a tabulation of successful subsea choke installations in recent years.

  7. Psychosocial adjustment to ALS: a longitudinal study

    PubMed Central

    Matuz, Tamara; Birbaumer, Niels; Hautzinger, Martin; Kübler, Andrea

    2015-01-01

    For the current study the Lazarian stress-coping theory and the appendant model of psychosocial adjustment to chronic illness and disabilities (Pakenham, 1999) has shaped the foundation for identifying determinants of adjustment to ALS. We aimed to investigate the evolution of psychosocial adjustment to ALS and to determine its long-term predictors. A longitudinal study design with four measurement time points was therefore, used to assess patients' quality of life, depression, and stress-coping model related aspects, such as illness characteristics, social support, cognitive appraisals, and coping strategies during a period of 2 years. Regression analyses revealed that 55% of the variance of severity of depressive symptoms and 47% of the variance in quality of life at T2 was accounted for by all the T1 predictor variables taken together. On the level of individual contributions, protective buffering, and appraisal of own coping potential accounted for a significant percentage in the variance in severity of depressive symptoms, whereas problem management coping strategies explained variance in quality of life scores. Illness characteristics at T2 did not explain any variance of both adjustment outcomes. Overall, the pattern of the longitudinal results indicated stable depressive symptoms and quality of life indices reflecting a successful adjustment to the disease across four measurement time points during a period of about two years. Empirical evidence is provided for the predictive value of social support, cognitive appraisals, and coping strategies, but not illness parameters such as severity and duration for adaptation to ALS. The current study contributes to a better conceptualization of adjustment, allowing us to provide evidence-based support beyond medical and physical intervention for people with ALS. PMID:26441696

  8. Unpleasant odors increase aversion to monetary losses.

    PubMed

    Stancak, Andrej; Xie, Yuxin; Fallon, Nicholas; Bulsing, Patricia; Giesbrecht, Timo; Thomas, Anna; Pantelous, Athanasios A

    2015-04-01

    Loss aversion is the tendency to prefer avoiding losses over acquiring gains of equal nominal values. Unpleasant odors not only influence affective state but have also been shown to activate brain regions similar to those mediating loss aversion. Therefore, we hypothesized a stronger loss aversion in a monetary gamble task if gambles were associated with an unpleasant as opposed to pleasant odor. In thirty human subjects, unpleasant (methylmercaptan), pleasant (jasmine), and neutral (clean air) odors were presented for 4 s. At the same time, uncertain gambles offering an equal chance of gain or loss of a variable amount of money, or a prospect of an assured win were displayed. One hundred different gambles were presented three times, each time paired with a different odor. Loss aversion, risk aversion, and logit sensitivity were evaluated using non-linear fitting of individual gamble decisions. Loss aversion was larger when prospects were displayed in the presence of methylmercaptan compared to jasmine or clean air. Moreover, individual differences in changes in loss aversion to the unpleasant as compared to pleasant odor correlated with odor pleasantness but not with odor intensity. Skin conductance responses to losses during the outcome period were larger when gambles were associated with methylmercaptan compared to jasmine. Increased loss aversion while perceiving an unpleasant odor suggests a dynamic adjustment of loss aversion toward greater sensitivity to losses. Given that odors are biological signals of hazards, such adjustment of loss aversion may have adaptive value in situations entailing threat or danger. PMID:25711689

  9. 26 CFR 1.165-1 - Losses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... adjusted basis for determining the loss from the sale or other disposition of the property involved. In the... recognized upon the sale or exchange of property shall be determined for purposes of section 165(a) in accordance with § 1.1002-1. (3) A loss from the sale or exchange of a capital asset shall be allowed as...

  10. Adolescent Mothers' Adjustment to Parenting.

    ERIC Educational Resources Information Center

    Samuels, Valerie Jarvis; And Others

    1994-01-01

    Examined adolescent mothers' adjustment to parenting, self-esteem, social support, and perceptions of baby. Subjects (n=52) responded to questionnaires at two time periods approximately six months apart. Mothers with higher self-esteem at Time 1 had better adjustment at Time 2. Adjustment was predicted by Time 2 variables; contact with baby's…

  11. Beam loss

    NASA Astrophysics Data System (ADS)

    VanGinneken, A.; Edwards, D.; Harrison, M.

    1989-04-01

    This paper presents results from simulations of beam losses during the operation of a superconducting accelerator. The calculations use a combination of hadron/electromagnetic cascade plus elastic scattering codes with accelerator tracking routines. These calculations have been used in conjunction with the design of the Fermilab Tevatron. First accelerator geometry is described. The rest of the paper discusses a detailed attempt to simulate a fast extraction cycle, essentially in chronological order. Beginning with an unperturbed beam, the simulation generates proton phase-space distributions incident on the electrostatic septum. These interact either elastically or inelastically with the septum wires, and the products of these interactions are traced through the machine. Where these leave the accelerator, energy deposition levels in the magnets are calculated together with the projected response of the beam-loss monitors in this region. Finally, results of the calculation are compared with experimental data. (AIP)

  12. Adjustable hybrid diffractive/refractive achromatic lens.

    PubMed

    Valley, Pouria; Savidis, Nickolaos; Schwiegerling, Jim; Dodge, Mohammad Reza; Peyman, Gholam; Peyghambarian, N

    2011-04-11

    We demonstrate a variable focal length achromatic lens that consists of a flat liquid crystal diffractive lens and a pressure-controlled fluidic refractive lens. The diffractive lens is composed of a flat binary Fresnel zone structure and a thin liquid crystal layer, producing high efficiency and millisecond switching times while applying a low ac voltage input. The focusing power of the diffractive lens is adjusted by electrically modifying the sub-zones and re-establishing phase wrapping points. The refractive lens includes a fluid chamber with a flat glass surface and an opposing elastic polydimethylsiloxane (PDMS) membrane surface. Inserting fluid volume through a pump system into the clear aperture region alters the membrane curvature and adjusts the refractive lens' focal position. Primary chromatic aberration is remarkably reduced through the coupling of the fluidic and diffractive lenses at selected focal lengths. Potential applications include miniature color imaging systems, medical and ophthalmic devices, or any design that utilizes variable focal length achromats.

  13. Female pattern hair loss.

    PubMed

    Singal, Archana; Sonthalia, Sidharth; Verma, Prashant

    2013-01-01

    Female pattern hair loss (FPHL) is a common cause of hair loss in women characterized by diffuse reduction in hair density over the crown and frontal scalp with retention of the frontal hairline. Its prevalence increases with advancing age and is associated with significant psychological morbidity. The pathophysiology of FPHL is still not completely understood and seems to be multifactorial. Although androgens have been implicated, the involvement of androgen-independent mechanisms is evident from frequent lack of clinical or biochemical markers of hyperandrogenism in affected women. The role of genetic polymorphisms involving the androgen and estrogen receptors is being increasingly recognized in its causation and predicting treatment response to anti-androgens. There are different clinical patterns and classifications of FPHL, knowledge of which facilitates patient management and research. Chronic telogen effluvium remains as the most important differential diagnosis. Thorough history, clinical examination, and evaluation are essential to confirm diagnosis. Patients with clinical signs of androgen excess require assessment of biochemical parameters and imaging studies. It is prudent to screen the patients for metabolic syndrome and cardiovascular risk factors. The treatment comprises medical and/or surgical modalities. Medical treatment should be initiated early as it effectively arrests hair loss progression rather than stimulating regrowth. Minoxidil continues to be the first line therapy whereas anti-androgens form the second line of treatment. The progressive nature of FPHL mandates long-term treatment for sustained effect. Medical therapy may be supplemented with cosmetic concealment in those desirous of greater hair density. Surgery may be worthwhile in some carefully selected patients. PMID:23974580

  14. Medical Transcriptionists

    MedlinePlus

    ... equipment or software that is connected to their computer. However, technological advances have changed the way medical ... this section Medical transcriptionists must be comfortable using computers. Medical transcriptionists typically need postsecondary education. Prospective medical ...

  15. A membrane-type acoustic metamaterial with adjustable acoustic properties

    NASA Astrophysics Data System (ADS)

    Langfeldt, F.; Riecken, J.; Gleine, W.; von Estorff, O.

    2016-07-01

    A new realization of a membrane-type acoustic metamaterial (MAM) with adjustable sound transmission properties is presented. The proposed design distinguishes itself from other realizations by a stacked arrangement of two MAMs which is inflated using pressurized air. The static pressurization leads to large nonlinear deformations and, consequently, geometrical stiffening of the MAMs which is exploited to adjust the eigenmodes and sound transmission loss of the structure. A theoretical analysis of the proposed inflatable MAM design using numerical and analytical models is performed in order to identify two important mechanisms, namely the shifting of the eigenfrequencies and modal residuals due to the pressurization, responsible for the transmission loss adjustment. Analytical formulas are provided for predicting the eigenmode shifting and normal incidence sound transmission loss of inflated single and double MAMs using the concept of effective mass. The investigations are concluded with results from a test sample measurement inside an impedance tube, which confirm the theoretical predictions.

  16. [Psychological adjustment following lower limb amputation].

    PubMed

    Panyi, Lilla Krisztina; Lábadi, Beatrix

    2015-09-27

    Rehabilitation of lower limb amputees and the fitting of their prosthesis depend highly on the psychological adjustment process and motivational state of the patient. The loss of a limb is extremely challenging and can cause various physical and psychological problems. Depression, anxiety, decreased well-being and quality of life, body image dissatisfaction and changes in self-concept and identity are frequent after lower limb amputation. In the interest of adjustment patients have to cope with the emerging changes and difficulties in their lifes as well as the problems in psychological functioning. It is important for them to accept the alterations in their body and identity, and integrate them in a new self-concept in which process motivation is a fundamental issue. The aim of this article is to review the literature on psychological consequences of lower limb amputation, and to propose an integrative way of rehabilitation for lower limb amputees. PMID:26550913

  17. Weight Loss Nutritional Supplements

    NASA Astrophysics Data System (ADS)

    Eckerson, Joan M.

    Obesity has reached what may be considered epidemic proportions in the United States, not only for adults but for children. Because of the medical implications and health care costs associated with obesity, as well as the negative social and psychological impacts, many individuals turn to nonprescription nutritional weight loss supplements hoping for a quick fix, and the weight loss industry has responded by offering a variety of products that generates billions of dollars each year in sales. Most nutritional weight loss supplements are purported to work by increasing energy expenditure, modulating carbohydrate or fat metabolism, increasing satiety, inducing diuresis, or blocking fat absorption. To review the literally hundreds of nutritional weight loss supplements available on the market today is well beyond the scope of this chapter. Therefore, several of the most commonly used supplements were selected for critical review, and practical recommendations are provided based on the findings of well controlled, randomized clinical trials that examined their efficacy. In most cases, the nutritional supplements reviewed either elicited no meaningful effect or resulted in changes in body weight and composition that are similar to what occurs through a restricted diet and exercise program. Although there is some evidence to suggest that herbal forms of ephedrine, such as ma huang, combined with caffeine or caffeine and aspirin (i.e., ECA stack) is effective for inducing moderate weight loss in overweight adults, because of the recent ban on ephedra manufacturers must now use ephedra-free ingredients, such as bitter orange, which do not appear to be as effective. The dietary fiber, glucomannan, also appears to hold some promise as a possible treatment for weight loss, but other related forms of dietary fiber, including guar gum and psyllium, are ineffective.

  18. Hearing loss in older adults.

    PubMed

    Walling, Anne D; Dickson, Gretchen M

    2012-06-15

    Hearing loss affects approximately one-third of adults 61 to 70 years of age and more than 80 percent of those older than 85 years. Men usually experience greater hearing loss and have earlier onset compared with women. The most common type is age-related hearing loss; however, many conditions can interfere with the conduction of sound vibrations to the inner ear and their conversion to electrical impulses for conduction to the brain. Screening for hearing loss is recommended in adults older than 50 to 60 years. Office screening tests include the whispered voice test and audioscopy. Older patients who admit to having difficulty hearing may be referred directly for audiometry. The history can identify risk factors for hearing loss, especially noise exposure and use of ototoxic medications. Examination of the auditory canal and tympanic membrane can identify causes of conductive hearing loss. Audiometric testing is required to confirm hearing loss. Adults presenting with idiopathic sudden sensorineural hearing loss should be referred for urgent assessment. Management of hearing loss is based on addressing underlying causes, especially obstructions (including cerumen) and ototoxic medications. Residual hearing should be optimized by use of hearing aids, assistive listening devices, and rehabilitation programs. Surgical implants are indicated for selected patients. Major barriers to improved hearing in older adults include lack of recognition of hearing loss; perception that hearing loss is a normal part of aging or is not amenable to treatment; and patient nonadherence with hearing aids because of stigma, cost, inconvenience, disappointing initial results, or other factors. PMID:22962895

  19. Diagnosis-Based Risk Adjustment for Medicare Capitation Payments

    PubMed Central

    Ellis, Randall P.; Pope, Gregory C.; Iezzoni, Lisa I.; Ayanian, John Z.; Bates, David W.; Burstin, Helen; Ash, Arlene S.

    1996-01-01

    Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula. PMID:10172666

  20. Losses in Ferroelectric Materials

    PubMed Central

    Liu, Gang; Zhang, Shujun; Jiang, Wenhua; Cao, Wenwu

    2015-01-01

    Ferroelectric materials are the best dielectric and piezoelectric materials known today. Since the discovery of barium titanate in the 1940s, lead zirconate titanate ceramics in the 1950s and relaxor-PT single crystals (such as lead magnesium niobate-lead titanate and lead zinc niobate-lead titanate) in the 1980s and 1990s, perovskite ferroelectric materials have been the dominating piezoelectric materials for electromechanical devices, and are widely used in sensors, actuators and ultrasonic transducers. Energy losses (or energy dissipation) in ferroelectrics are one of the most critical issues for high power devices, such as therapeutic ultrasonic transducers, large displacement actuators, SONAR projectors, and high frequency medical imaging transducers. The losses of ferroelectric materials have three distinct types, i.e., elastic, piezoelectric and dielectric losses. People have been investigating the mechanisms of these losses and are trying hard to control and minimize them so as to reduce performance degradation in electromechanical devices. There are impressive progresses made in the past several decades on this topic, but some confusions still exist. Therefore, a systematic review to define related concepts and clear up confusions is urgently in need. With this objective in mind, we provide here a comprehensive review on the energy losses in ferroelectrics, including related mechanisms, characterization techniques and collections of published data on many ferroelectric materials to provide a useful resource for interested scientists and engineers to design electromechanical devices and to gain a global perspective on the complex physical phenomena involved. More importantly, based on the analysis of available information, we proposed a general theoretical model to describe the inherent relationships among elastic, dielectric, piezoelectric and mechanical losses. For multi-domain ferroelectric single crystals and ceramics, intrinsic and extrinsic energy

  1. Delay Adjusted Incidence Infographic

    Cancer.gov

    This Infographic shows the National Cancer Institute SEER Incidence Trends. The graphs show the Average Annual Percent Change (AAPC) 2002-2011. For Men, Thyroid: 5.3*,Liver & IBD: 3.6*, Melanoma: 2.3*, Kidney: 2.0*, Myeloma: 1.9*, Pancreas: 1.2*, Leukemia: 0.9*, Oral Cavity: 0.5, Non-Hodgkin Lymphoma: 0.3*, Esophagus: -0.1, Brain & ONS: -0.2*, Bladder: -0.6*, All Sites: -1.1*, Stomach: -1.7*, Larynx: -1.9*, Prostate: -2.1*, Lung & Bronchus: -2.4*, and Colon & Rectum: -3/0*. For Women, Thyroid: 5.8*, Liver & IBD: 2.9*, Myeloma: 1.8*, Kidney: 1.6*, Melanoma: 1.5, Corpus & Uterus: 1.3*, Pancreas: 1.1*, Leukemia: 0.6*, Brain & ONS: 0, Non-Hodgkin Lymphoma: -0.1, All Sites: -0.1, Breast: -0.3, Stomach: -0.7*, Oral Cavity: -0.7*, Bladder: -0.9*, Ovary: -0.9*, Lung & Bronchus: -1.0*, Cervix: -2.4*, and Colon & Rectum: -2.7*. * AAPC is significantly different from zero (p<.05). Rates were adjusted for reporting delay in the registry. www.cancer.gov Source: Special section of the Annual Report to the Nation on the Status of Cancer, 1975-2011.

  2. Pediatric Sudden Sensorineural Hearing Loss.

    PubMed

    Kizilay, Ahmet; Koca, Çiğdem Firat

    2016-06-01

    Sudden sensorineural hearing loss is defined as sudden unilateral or bilateral sensorineural hearing loss with at least 30 dB decrease in threshold in 3 contiguous test frequencies occurring over 72 hours or less. It is rare among children. The mechanism of the process and prognosis of the disorder remains unclear. The current incidence of sudden sensorineural hearing loss among pediatric population is unknown. The authors carried out a retrospective chart analysis of patients under 15 years of age from 2004 to 2015, who consulted to the Otolaryngology Head and Neck Surgery Department of Inonu University Medical Faculty. Age, sex, number of affected ear and side, audiometric evaluations, medical follow-up, treatment method, duration of treatment recovery, associated complaints; tinnitus and/or vertigo, presence of mumps disease were recorded for each patient. A 4-frequency pure-tone average (500, 1000, 2000, and 4000 Hz) was calculated for each ear. Complete recovery, defined as some hearing level compared with the nonaffected ear, was observed in 3 patients (21.4 %) and there was no partial hearing recovery. The hearing loss of 11 patient remained unchanged after prednisolone treatment. Two of the 11 patients had bilaterally total sensorineural hearing loss and evaluated as appropriate for cochlear implantation. Sex of patient and laterality of hearing loss were not correlated with hearing recovery. Sensorineural hearing loss among pediatrics has been the issue of otolaryngologists. The incidence, etiology, and treatment methods should be more studied.

  3. Psychological adjustment to twins after infertility.

    PubMed

    Klock, Susan C

    2004-08-01

    The birth of twins and other multiples is physically and emotionally stressful. The increase in the use of the assisted reproductive technologies has lead to an exponential increase in the rates of twins and triplets in the US. Whereas the medical complications of twins and other multiples has been well studied, the psychological and social implications of these events has not. Very little empirical research has been conducted to assess the differential impact of twins, as compared to singletons, on maternal adjustment, postpartum depression and marital functioning. In addition, assessment of infant health, disposition and behavior and its relation to maternal adjustment is lacking. The birth of twins after a period of infertility complicates the clinical picture and the impact of infertility on subsequent parental adjustment is only beginning to be understood. Although research suggests that infertile couples often desire multiples, the experience of parenting multiples after infertility has not been studied. Research on fertile couples indicate that: (i) approximately 10% of women develop postpartum depression and; (ii) marital adjustment declines after the birth of the first child. Because of the unique demands of parenting multiples, it is hypothesized that mothers of twins who have a history of infertility would be at increased risk for depression and marital decline. Descriptive studies of these families support this view, although additional studies are needed to determine the degree and extent of the problem. Additionally, variables such as, prepregnancy adjustment, equitable division of child-care tasks and perceived social support should be studied to determine if they buffer against the expected effects.

  4. [Hereditary hearing loss: genetic counselling].

    PubMed

    Cabanillas Farpón, Rubén; Cadiñanos Bañales, Juan

    2012-01-01

    The aim of this review is to provide an updated overview of hereditary hearing loss, with special attention to the etiological diagnosis of sensorineural hearing loss, the genes most frequently mutated in our environment, the techniques available for their analysis and the clinical implications of genetic diagnosis. More than 60% of childhood sensorineural hearing loss is genetic. In adults, the percentage of hereditary hearing loss is unknown. Genetic testing is the highest yielding test for evaluating patients with sensorineural hearing loss. The process of genetic counselling is intended to inform patients and their families of the medical, psychological and familial implications of genetic diseases, as well as the risks, benefits and limitations of genetic testing. The implementation of any genetic analysis must be always preceded by an appropriate genetic counselling process.

  5. Efficient Adjustable Reflectivity Smart Window

    SciTech Connect

    D. Morgan Tench

    2005-12-01

    This project addressed the key technical issues for development of an efficient smart window based on reversible electrochemical transfer of silver between a mirror electrode and a localized counter electrode. Effort to provide uniform switching over large areas focused on use of a resistive transparent electrode innerlayer to increase the interelectrode resistance. An effective edge seal was developed in collaboration with adhesive suppliers and an electrochromic device manufacturer. Work to provide a manufacturable counter electrode focused on fabricating a dot matrix electrode without photolithography by electrodeposition of Pt nuclei on inherent active sites on a transparent oxide conductor. An alternative counter electrode based on a conducting polymer and an ionic liquid electrolyte was also investigated. Work in all of these areas was successful. Sputtered large-bandgap oxide innerlayers sandwiched between conductive indium tin oxide (ITO) layers were shown to provide sufficient cross-layer resistance (>300 ohm/cm{sup 2}) without significantly affecting the electrochemical properties of the ITO overlayer. Two edge seal epoxies, one procured from an epoxy manufacturer and one provided by an electrochromic device manufacturer in finished seals, were shown to be effective barriers against oxygen intrusion up to 80 C. The optimum density of nuclei for the dot matrix counter electrode was attained without use of photolithography by electrodeposition from a commercial alkaline platinum plating bath. Silver loss issues for cells with dot matrix electrodes were successfully addressed by purifying the electrolyte and adjusting the cell cycling parameters. More than 30K cycles were demonstrated for a REM cell (30-cm square) with a dot matrix counter electrode. Larger cells (30-cm square) were successfully fabricated but could not be cycled since the nucleation layers (provided by an outside supplier) were defective so that mirror deposits could not be produced.

  6. [Medical Devices Law for anesthesiologists].

    PubMed

    Regner, M

    2015-09-01

    The Medical Devices Law is a relatively new legal system, which has replaced the still well-known medical devices regulations in Germany. The Medical Devices Law in Germany is based on European directives, which have been translated into national law with the Medical Devices Act. The Medical Devices Act is a framework of regulations and incorporates a number of decrees that address specific topics within the medical devices directives and in turn individual regulations refer to guidelines and recommendations from other sources which provide detailed technical information on specific topics. Overall, the Medical Devices Act represents a very complex legal system, which needs to be permanently observed with respect to continuous updating and adjustment. In this article the design and the structure are described but most of all the article filters significant problem areas that need to be considered when using and operating medical devices, especially for anesthesiologists.

  7. 8 CFR 245.5 - Medical examination.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Medical examination. 245.5 Section 245.5... THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 245.5 Medical examination. Pursuant to section 232(b) of the Act, an applicant for adjustment of status shall be required to have a medical examination...

  8. 8 CFR 245.5 - Medical examination.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Medical examination. 245.5 Section 245.5... THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 245.5 Medical examination. Pursuant to section 232(b) of the Act, an applicant for adjustment of status shall be required to have a medical examination...

  9. 8 CFR 245.5 - Medical examination.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Medical examination. 245.5 Section 245.5... THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 245.5 Medical examination. Pursuant to section 232(b) of the Act, an applicant for adjustment of status shall be required to have a medical examination...

  10. 8 CFR 245.5 - Medical examination.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Medical examination. 245.5 Section 245.5... THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 245.5 Medical examination. Pursuant to section 232(b) of the Act, an applicant for adjustment of status shall be required to have a medical examination...

  11. 8 CFR 245.5 - Medical examination.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Medical examination. 245.5 Section 245.5... THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 245.5 Medical examination. Pursuant to section 232(b) of the Act, an applicant for adjustment of status shall be required to have a medical examination...

  12. Preventing and responding to medical identity theft.

    PubMed

    Amori, Geraldine

    2008-01-01

    Medical identity theft is a crime with two victims: patients and providers. It is easy to commit and lucrative because healthcare record keeping and business interactions are complex and mainly electronic. Patients whose identity has been stolen are vulnerable to both medical error and financial loss. Providers may suffer both reputation loss and financial loss. There are steps to help prevent and to respond appropriately to medical identity theft.

  13. Enlarged Vestibular Aqueducts and Childhood Hearing Loss

    MedlinePlus

    ... Health Info » Hearing, Ear Infections, and Deafness Enlarged Vestibular Aqueducts and Childhood Hearing Loss On this page: ... more information about enlarged vestibular aqueducts? What are vestibular aqueducts? The inner ear Credit: NIH Medical Arts ...

  14. Preventive effectiveness of pre-employment medical assessments.

    PubMed Central

    de Kort, W; van Dijk, F

    1997-01-01

    OBJECTIVE AND METHODS: Health gain, prevention of health loss, and avoidance of financial risk all seem to be driving forces for the use of pre-employment medical assessment. An attempt is made to measure the effect of implementing the pre-employment medical assessment on these end points. The anticipated maximum preventive effect (preventive effectiveness) of selection by means of pre-employment medical assessments for work related risks and the potential for disablement in individual workers can be calculated or estimated. Necessary parameters include test validity characteristics and epidemiological data for both the adverse outcome to be prevented, and risk factors of concern. RESULTS: The preventive effectiveness can be expressed as the effort (number of actions) needed to prevent one adverse event-for example, one case of occupational disease or one case of long term disablement. Actions include: a pre-employment health assessment, rejection of the candidate, individual precautions, adjustments of the job, and adjustments of the job environment. It seems that the preventive effectiveness of many actions can be low, implying that large numbers of actions are needed to prevent one adverse outcome. DISCUSSION: The medical assessment should consist of no more questions and tests than are required relevant to the stated aim. Particularly, when the pre-employment medical assessment is used to reject candidates at risk, the use of tests should be carefully weighed. If the preventive effectiveness is considered to be too low, then the question or test should not be incorporated for selection purposes. The application of a so called "expert judgment" should be based on professional guidelines wherever possible and should be made clear. The benefit of reducing the incidence of a serious adverse event by one may outweigh the costs of rejecting many candidates. CONCLUSIONS: The concept of preventive effectiveness may help to reach evidence based occupational medicine

  15. Mood Adjustment via Mass Communication.

    ERIC Educational Resources Information Center

    Knobloch, Silvia

    2003-01-01

    Proposes and experimentally tests mood adjustment approach, complementing mood management theory. Discusses how results regarding self-exposure across time show that patterns of popular music listening among a group of undergraduate students differ with initial mood and anticipation, lending support to mood adjustment hypotheses. Describes how…

  16. Spousal Adjustment to Myocardial Infarction.

    ERIC Educational Resources Information Center

    Ziglar, Elisa J.

    This paper reviews the literature on the stresses and coping strategies of spouses of patients with myocardial infarction (MI). It attempts to identify specific problem areas of adjustment for the spouse and to explore the effects of spousal adjustment on patient recovery. Chapter one provides an overview of the importance in examining the…

  17. 10 CFR 35.605 - Installation, maintenance, adjustment, and repair.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Installation, maintenance, adjustment, and repair. 35.605 Section 35.605 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Photon Emitting Remote Afterloader Units, Teletherapy Units, and Gamma Stereotactic Radiosurgery Units §...

  18. 10 CFR 35.605 - Installation, maintenance, adjustment, and repair.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Installation, maintenance, adjustment, and repair. 35.605 Section 35.605 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Photon Emitting Remote Afterloader Units, Teletherapy Units, and Gamma Stereotactic Radiosurgery Units §...

  19. 10 CFR 35.605 - Installation, maintenance, adjustment, and repair.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Installation, maintenance, adjustment, and repair. 35.605 Section 35.605 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Photon Emitting Remote Afterloader Units, Teletherapy Units, and Gamma Stereotactic Radiosurgery Units §...

  20. 10 CFR 35.605 - Installation, maintenance, adjustment, and repair.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Installation, maintenance, adjustment, and repair. 35.605 Section 35.605 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Photon Emitting Remote Afterloader Units, Teletherapy Units, and Gamma Stereotactic Radiosurgery Units §...

  1. 10 CFR 35.605 - Installation, maintenance, adjustment, and repair.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Installation, maintenance, adjustment, and repair. 35.605 Section 35.605 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Photon Emitting Remote Afterloader Units, Teletherapy Units, and Gamma Stereotactic Radiosurgery Units §...

  2. Predictors and Correlates of Follow-up Visit Adherence among Adolescents Receiving Laparoscopic Adjustable Gastric Banding

    PubMed Central

    Sysko, Robyn; Hildebrandt, Tom B.; Kaplan, Simona; Brewer, Stephanie K.; Zitsman, Jeffrey L.; Devlin, Michael J.

    2014-01-01

    Background Adherence behaviors have not been examined among adolescents undergoing laparoscopic adjustable gastric banding (LAGB). In addition, studies of youth receiving bariatric surgery have not considered the influence of psychopathology on postoperative adherence. Objective The purpose of this study was to evaluate predictors and correlates of adherence to post-surgery visits among a sample of adolescents undergoing LAGB. Setting Psychiatry Department, University Medical Center, United States. Methods Postoperative visits with surgical staff were analyzed over the two years following surgery (n= 101 adolescents). Growth mixture modeling examined trends in adherence. Results A three-class solution provided the best fit to the data. The classes from the final model were characterized by class 1 (61.6%) demonstrating high levels of adherence over the 24 months following LAGB, class 2 (28.5%) showing a more gradual decline in adherence, and class 3 (9.9%) with an accelerated decline in adherence. Higher levels of preoperative depressive symptoms and more preoperative episodes of loss of control over eating decreased the likelihood of adherence. Class 3 adolescents had significantly higher estimated 24-month body mass indices than Classes 1 or 2. Conclusions Variable patterns of follow-up visit adherence were identified among adolescents receiving LAGB, which were predicted by depressive symptoms and loss of control over eating. The trajectory characterized by a rapid decline in adherence to follow-up visits was also associated with less weight loss. PMID:25066443

  3. Parental Divorce and Children's Adjustment.

    PubMed

    Lansford, Jennifer E

    2009-03-01

    This article reviews the research literature on links between parental divorce and children's short-term and long-term adjustment. First, I consider evidence regarding how divorce relates to children's externalizing behaviors, internalizing problems, academic achievement, and social relationships. Second, I examine timing of the divorce, demographic characteristics, children's adjustment prior to the divorce, and stigmatization as moderators of the links between divorce and children's adjustment. Third, I examine income, interparental conflict, parenting, and parents well-being as mediators of relations between divorce and children's adjustment. Fourth, I note the caveats and limitations of the research literature. Finally, I consider notable policies related to grounds for divorce, child support, and child custody in light of how they might affect children s adjustment to their parents divorce.

  4. Discharges Against Medical Advice

    PubMed Central

    Franks, Peter; Meldrum, Sean; Fiscella, Kevin

    2006-01-01

    BACKGROUND Prior literature suggests that blacks are more likely to be discharged against medical advice (DAMA). OBJECTIVE We examined whether DAMA from general hospitals varies by race/ethnicity and whether this variation is explained by individual and hospital factors. DESIGN, SUBJECTS, AND MEASUREMENTS We conducted cross-sectional analyses of 1998 to 2000 hospital discharge data, linked to the American Hospital Association data, on adults admitted for acute general hospital care in California, Florida, and New York. A series of hierarchical logistic regression analyses explored factors associated with DAMA, initially adjusting for age and gender, then sequentially adding adjustment for comorbidities, individual socio-economic factors, and finally hospital characteristics. RESULTS Compared with whites, blacks had a 2-fold higher age-gender adjusted odds of DAMA, a risk that progressively diminished with increasing adjustment (final adjusted odds ratio [OR]=0.95, 95% confidence interval [CI]=0.91, 1.00). While Hispanics had an increased risk of DAMA in age-gender-adjusted analyses, the final model revealed a protective effect (adjusted OR=0.66, 95% CI=0.62, 0.70), similar to that observed for Asians. CONCLUSIONS Disparities in DAMA affecting minority patients in general hospitals are largely accounted for by individual and hospital socio-economic factors. The absence of any adjusted disparity affecting blacks, and the protective effect observed for Hispanics and other minorities suggest that individual discrimination and poor communication are not primary determinants of DAMA, but where patients are admitted does contribute to disparities in DAMA. PMID:16918741

  5. Medical marijuana

    MedlinePlus

    ... people who have not had relief from other treatments. Unlike medical marijuana, the active ingredient in these drugs can be ... American Academy of Neurology. Medical Marijuana in Certain Medical Disorders. ... . Accessed August 24, 2015. ...

  6. Laparoscopic Greater Curve Plication as an Outpatient Weight Loss Procedure

    PubMed Central

    Pacheco, Ilvia

    2015-01-01

    Background and Objectives: Laparoscopic greater curve plication is emerging as a weight loss procedure that avoids many of the complications of other surgeries that require gastrointestinal division, amputation, or use of a foreign body. Cost savings and affordability have also been promoted, as plication does not require the use of stapling devices, adjustable gastric bands, or prolonged hospitalization. The ability to predictably perform plication as an outpatient surgery may further define its role as a therapeutic option for treating morbid obesity. We present the 30-day outcomes and supplementary 12-month data in a series of 141 laparoscopic greater curve plication surgeries performed as outpatient procedures. Methods: Laparoscopic greater curve plication was performed as outpatient surgery in 141 consecutive patients. Outcomes including perioperative complications, incidental 12-month follow-up for weight loss, and change in diabetic and hypertensive medication are reported. Results: Of the 141 plications performed, 138 patients were discharged from the recovery room and 6 were readmitted. There was no conversion to open surgery and no mortality. Conclusions: The ability to reliably perform greater curve plication as an outpatient surgery may further define its role as an additional weight loss surgery technique. PMID:26508824

  7. Adjustment versus no adjustment when using adjustable sutures in strabismus surgery

    PubMed Central

    Liebermann, Laura; Hatt, Sarah R.; Leske, David A.; Holmes, Jonathan M.

    2013-01-01

    Purpose To compare long-term postoperative outcomes when performing an adjustment to achieve a desired immediate postoperative alignment versus simply tying off at the desired immediate postoperative alignment when using adjustable sutures for strabismus surgery. Methods We retrospectively identified 89 consecutive patients who underwent a reoperation for horizontal strabismus using adjustable sutures and also had a 6-week and 1-year outcome examination. In each case, the intent of the surgeon was to tie off and only to adjust if the patient was not within the intended immediate postoperative range. Postoperative success was predefined based on angle of misalignment and diplopia at distance and near. Results Of the 89 patients, 53 (60%) were adjusted and 36 (40%) were tied off. Success rates were similar between patients who were simply tied off immediately after surgery and those who were adjusted. At 6 weeks, the success rate was 64% for the nonadjusted group versus 81% for the adjusted group (P = 0.09; difference of 17%; 95% CI, −2% to 36%). At 1 year, the success rate was 67% for the nonadjusted group versus 77% for the adjusted group (P = 0.3; difference of 11%; 95% CI, −8% to 30%). Conclusions Performing an adjustment to obtain a desired immediate postoperative alignment did not yield inferior long-term outcomes to those obtained by tying off to obtain that initial alignment. If patients were who were outside the desired immediate postoperative range had not been not adjusted, it is possible that their long-term outcomes would have been worse, therefore, overall, an adjustable approach may be superior to a nonadjustable approach. PMID:23415035

  8. First-Day Newborn Weight Loss Predicts In-Hospital Weight Nadir for Breastfeeding Infants

    PubMed Central

    Bokser, Seth; Newman, Thomas B.

    2010-01-01

    Abstract Background Exclusive breastfeeding reduces infant infectious disease. Losing ≥10% birth weight may lead to formula use. The predictive value of first-day weight loss for subsequent weight loss has not been studied. The objective of the present study was to evaluate the relationship between weight loss at <24 hours and subsequent in-hospital weight loss ≥10%. Methods For 1,049 infants, we extracted gestational age, gender, delivery method, feeding type, and weights from medical records. Weight nadir was defined as the lowest weight recorded during birth hospitalization. We used multivariate logistic regression to assess the effect of first-day weight loss on subsequent in-hospital weight loss. Results Mean in-hospital weight nadir was 6.0 ± 2.6%, and mean age at in-hospital weight nadir was 38.7 ± 18.5 hours. While in the hospital 6.4% of infants lost ≥10% of birth weight. Infants losing ≥4.5% birth weight at <24 hours had greater risk of eventual in-hospital weight loss ≥10% (adjusted odds ratio 3.57 [1.75, 7.28]). In this cohort, 798 (76.1%) infants did not have documented weight gain while in the hospital. Conclusions Early weight loss predicts higher risk of ≥10% in-hospital weight loss. Infants with high first-day weight loss could be targeted for further research into improved interventions to promote breastfeeding. PMID:20113202

  9. Evidence-based practice: management of adult sensorineural hearing loss.

    PubMed

    Chau, Justin K; Cho, John J W; Fritz, Dieter K

    2012-10-01

    Sensorineural hearing loss is a complex disease state influenced by genetics, age, noise, and many other factors. This article reviews our current knowledge regarding the causes of sensorineural hearing loss and reviews the more challenging clinical presentations of sensorineural hearing loss. We have reviewed the latest medical literature in an attempt to provide an evidence-based strategy for the assessment and management of sudden sensorineural hearing loss, rapidly progressive sensorineural hearing loss, and asymmetric/unilateral sensorineural hearing loss.

  10. Early Parental Adjustment and Bereavement after Childhood Cancer Death

    ERIC Educational Resources Information Center

    Barrera, Maru; O'connor, Kathleen; D'Agostino, Norma Mammone; Spencer, Lynlee; Nicholas, David; Jovcevska, Vesna; Tallet, Susan; Schneiderman, Gerald

    2009-01-01

    This study comprehensively explored parental bereavement and adjustment at 6 months post-loss due to childhood cancer. Interviews were conducted with 18 mothers and 13 fathers. Interviews were transcribed verbatim and analyzed based on qualitative methodology. A model describing early parental bereavement and adaptation emerged with 3 domains:…

  11. Adjustable Induction-Heating Coil

    NASA Technical Reports Server (NTRS)

    Ellis, Rod; Bartolotta, Paul

    1990-01-01

    Improved design for induction-heating work coil facilitates optimization of heating in different metal specimens. Three segments adjusted independently to obtain desired distribution of temperature. Reduces time needed to achieve required temperature profiles.

  12. Time-adjusted variable resistor

    NASA Technical Reports Server (NTRS)

    Heyser, R. C.

    1972-01-01

    Timing mechanism was developed effecting extremely precisioned highly resistant fixed resistor. Switches shunt all or portion of resistor; effective resistance is varied over time interval by adjusting switch closure rate.

  13. 78 FR 62712 - Rate Adjustment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-22

    ... noticing a recent Postal Service filing seeking postal rate adjustments based on exigent circumstances...,'' is ``premised on the recent recession as an exigent event.'' Id. at 1, 2. In Order No. 1059,...

  14. 8 CFR 1209.2 - Adjustment of status of alien granted asylum.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., Medical Examination of Aliens Seeking Adjustment of Status, and a vaccination supplement to determine compliance with the vaccination requirements described under section 212(a)(1)(A)(ii) of the Act must...

  15. 8 CFR 1209.2 - Adjustment of status of alien granted asylum.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., Medical Examination of Aliens Seeking Adjustment of Status, and a vaccination supplement to determine compliance with the vaccination requirements described under section 212(a)(1)(A)(ii) of the Act must...

  16. 8 CFR 1209.2 - Adjustment of status of alien granted asylum.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., Medical Examination of Aliens Seeking Adjustment of Status, and a vaccination supplement to determine compliance with the vaccination requirements described under section 212(a)(1)(A)(ii) of the Act must...

  17. 8 CFR 1209.2 - Adjustment of status of alien granted asylum.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., Medical Examination of Aliens Seeking Adjustment of Status, and a vaccination supplement to determine compliance with the vaccination requirements described under section 212(a)(1)(A)(ii) of the Act must...

  18. 8 CFR 1209.2 - Adjustment of status of alien granted asylum.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., Medical Examination of Aliens Seeking Adjustment of Status, and a vaccination supplement to determine compliance with the vaccination requirements described under section 212(a)(1)(A)(ii) of the Act must...

  19. Vision Loss, Sudden

    MedlinePlus

    ... of age-related macular degeneration. Spotlight on Aging: Vision Loss in Older People Most commonly, vision loss ... Some Causes and Features of Sudden Loss of Vision Cause Common Features* Tests Sudden loss of vision ...

  20. Weighing the value of memory loss in the surgical evaluation of left temporal lobe epilepsy: A decision analysis

    PubMed Central

    Akama-Garren, Elliot H.; Bianchi, Matt T.; Leveroni, Catherine; Cole, Andrew J.; Cash, Sydney S.; Westover, M. Brandon

    2016-01-01

    SUMMARY Objectives Anterior temporal lobectomy is curative for many patients with disabling medically refractory temporal lobe epilepsy, but carries an inherent risk of disabling verbal memory loss. Although accurate prediction of iatrogenic memory loss is becoming increasingly possible, it remains unclear how much weight such predictions should have in surgical decision making. Here we aim to create a framework that facilitates a systematic and integrated assessment of the relative risks and benefits of surgery versus medical management for patients with left temporal lobe epilepsy. Methods We constructed a Markov decision model to evaluate the probabilistic outcomes and associated health utilities associated with choosing to undergo a left anterior temporal lobectomy versus continuing with medical management for patients with medically refractory left temporal lobe epilepsy. Three base-cases were considered, representing a spectrum of surgical candidates encountered in practice, with varying degrees of epilepsy-related disability and potential for decreased quality of life in response to post-surgical verbal memory deficits. Results For patients with moderately severe seizures and moderate risk of verbal memory loss, medical management was the preferred decision, with increased quality-adjusted life expectancy. However, the preferred choice was sensitive to clinically meaningful changes in several parameters, including quality of life impact of verbal memory decline, quality of life with seizures, mortality rate with medical management, probability of remission following surgery, and probability of remission with medical management. Significance Our decision model suggests that for patients with left temporal lobe epilepsy, quantitative assessment of risk and benefit should guide recommendation of therapy. In particular, risk for and potential impact of verbal memory decline should be carefully weighed against the degree of disability conferred by continued

  1. Weight loss and progressive left ventricular remodelling: The Multi-Ethnic Study of Atherosclerosis (MESA)

    PubMed Central

    Shah, Ravi V; Murthy, Venkatesh L; Abbasi, Siddique A; Eng, John; Wu, Colin; Ouyang, Pamela; Kwong, Raymond Y; Goldfine, Allison; Bluemke, David A; Lima, Joao; Jerosch-Herold, Michael

    2016-01-01

    Aims Impact of weight loss on cardiac structure has not been extensively investigated in large, multi-ethnic, community-based populations. We investigated the longitudinal impact of weight loss on cardiac structure by cardiac magnetic resonance (CMR). Methods and results 2351 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent CMR at Exam 1 (2002) and Exam 5 (2011) were included. Primary outcomes were percentage change in LV mass (indexed to height) and LV mass-to-volume ratio (concentric LV remodelling). Multivariable linear regression was used to measure the association between outcomes and weight change. At median 9.4 years' follow-up, 639 individuals (27%) experienced >5% weight loss (median 6.9 kg) and 511 (22%) had >5% weight gain (median 6.4 kg). A >5% weight gain was associated with the greatest increase in LV mass (+5.4% median) and LV mass-to-volume ratio (+12.2% median). Adjusting for medications, hypertension/diabetes (and change in these risk factors), age, race and other risk factors, every 5% weight loss was associated with a 1.3% decrease in height-indexed LV mass and 1.3% decrease in LV mass-to-volume ratio (p <0.0001). There was no effect modification/confounding by age, race, gender or baseline BMI. Change in LV mass-to-volume ratio was roughly linear, specifically for modest degrees of weight loss (−10% to +10%). Change in LV mass was linear with weight loss, suggesting no threshold of weight loss is needed for LV mass regression. Conclusions In a large multi-ethnic population, weight loss is associated with beneficial effects on cardiac structure, independent of age, race, gender, BMI and obesity-related cardiometabolic risk. There is no threshold of weight loss required to produce these effects. PMID:25009171

  2. A comparison of White and Hispanic women's stories of adjustment to the birth of a child.

    PubMed

    Pollard, Sara E; Nievar, M Angela; Nathans, Laura L; Riggs, Shelley A

    2014-01-01

    As part of a larger project designed to inform prevention and treatment of postpartum depression and promote positive mother-child relationships in diverse families, this study describes personal stories of postnatal adjustment from 14 White and 9 Hispanic women recruited from prenatal care clinics. Qualitative interviews conducted in the mothers' primary language (English or Spanish) were analyzed using a modified grounded theory content-analysis approach. The coding scheme developed to capture the women's discourse about their experiences included child temperament and health; intergenerational patterns; work demands and job loss; schedule changes; increased responsibilities; difficulties with parenting tasks; emotional distress; social stressors and resources; coping strategies; and changes in work, personal, social, and marital domains. More White mothers than Hispanic mothers reported changes in time structure, work stressors, use of psychotropic medication, informational support, and social support from other mothers and professionals; however, within-group differences were more evident than were cross-group ethnic differences. Analyses of qualitative interviews led to the integration of Belsky's Determinants of Parenting Model (1984) and the Double ABCX Model of Family Adjustment and Adaptation (McCubbin & Patterson, 1983) into a hybrid third theoretical framework. PMID:25798475

  3. 7 CFR 251.7 - Formula adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 4 2010-01-01 2010-01-01 false Formula adjustments. 251.7 Section 251.7 Agriculture... GENERAL REGULATIONS AND POLICIES-FOOD DISTRIBUTION THE EMERGENCY FOOD ASSISTANCE PROGRAM § 251.7 Formula adjustments. Formula adjustments. (a) Commodity adjustments. The Department will make annual adjustments...

  4. 12 CFR 1209.80 - Inflation adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 10 2014-01-01 2014-01-01 false Inflation adjustments. 1209.80 Section 1209.80... PROCEDURE Civil Money Penalty Inflation Adjustments § 1209.80 Inflation adjustments. The maximum amount of... thereafter adjusted in accordance with the Inflation Adjustment Act, on a recurring four-year cycle, is...

  5. 12 CFR 1209.80 - Inflation adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 9 2012-01-01 2012-01-01 false Inflation adjustments. 1209.80 Section 1209.80... PROCEDURE Civil Money Penalty Inflation Adjustments § 1209.80 Inflation adjustments. The maximum amount of... thereafter adjusted in accordance with the Inflation Adjustment Act, on a recurring four-year cycle, is...

  6. 12 CFR 1209.80 - Inflation adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 9 2013-01-01 2013-01-01 false Inflation adjustments. 1209.80 Section 1209.80... PROCEDURE Civil Money Penalty Inflation Adjustments § 1209.80 Inflation adjustments. The maximum amount of... thereafter adjusted in accordance with the Inflation Adjustment Act, on a recurring four-year cycle, is...

  7. 21 CFR 880.5100 - AC-powered adjustable hospital bed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false AC-powered adjustable hospital bed. 880.5100... (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Therapeutic Devices § 880.5100 AC-powered adjustable hospital bed. (a) Identification. An...

  8. Psychological Adjustment to Spinal Cord Injury as Related to Manner of Onset of Disability.

    ERIC Educational Resources Information Center

    Athelstan, Gary T.; Crewe, Nancy M.

    1979-01-01

    People with spinal cord injury have behavioral tendencies that place them at-risk of such injuries. This study investigated the relationship between personality characteristics as suggested by manner of onset of injury and long-term medical, vocational, and psychological adjustment. Imprudent subjects tended to be better adjusted at follow-up than…

  9. Adjustment Issues Affecting Employment for Immigrants from the Former Soviet Union.

    ERIC Educational Resources Information Center

    Yost, Anastasia Dimun; Lucas, Margaretha S.

    2002-01-01

    Describes major issues, including culture shock and loss of status, that affect general adjustment of immigrants and refugees from the former Soviet Union who are resettling in the United States. Issues that affect career and employment adjustment are described and the interrelatedness of general and career issues is explored. (Contains 39…

  10. Low medication adherence and the incidence of stroke symptoms among individuals with hypertension: the REGARDS study.

    PubMed

    Muntner, Paul; Halanych, Jewell H; Reynolds, Kristi; Durant, Raegan; Vupputuri, Suma; Sung, Victor W; Meschia, James F; Howard, Virginia J; Safford, Monika M; Krousel-Wood, Marie

    2011-07-01

    The authors analyzed data on 9950 participants taking antihypertensive medications in the nationwide Reasons for Geographic and Racial Differences in Stroke (REGARDS) study to determine the association between medication adherence and incident stroke symptoms. Medication adherence was assessed using a validated 4-item self-report scale and participants were categorized into 4 groups (scores of 0, 1, 2, and 3 or 4, with higher scores indicating worse adherence). The incidence of 6 stroke symptoms (sudden weakness on one side of the body, numbness, painless loss of vision in one or both eyes, loss of half vision, losing the ability to understand people, and losing the ability to express oneself verbally or in writing) was assessed via telephone interviews every 6 months. During a median of 4 years, the incidence of any stroke symptom was 14.6%, 17.9%, 20.2%, and 24.9% among participants with adherence scores of 0, 1, 2, and 3 or 4, respectively (P<.001). The multivariable adjusted hazard ratio (95% confidence interval) for any stroke symptom associated with adherence scores of 1, 2, and 3 or 4, vs 0, was 1.20 (1.04-1.39), 1.23 (0.94-1.60), and 1.59 (1.08-2.33), respectively (P<.001). Worse adherence was also associated with higher multivariable adjusted hazard ratios for each of the 6 stroke symptoms. PMID:21762360

  11. Contrast Enhancement Algorithm Based on Gap Adjustment for Histogram Equalization

    PubMed Central

    Chiu, Chung-Cheng; Ting, Chih-Chung

    2016-01-01

    Image enhancement methods have been widely used to improve the visual effects of images. Owing to its simplicity and effectiveness histogram equalization (HE) is one of the methods used for enhancing image contrast. However, HE may result in over-enhancement and feature loss problems that lead to unnatural look and loss of details in the processed images. Researchers have proposed various HE-based methods to solve the over-enhancement problem; however, they have largely ignored the feature loss problem. Therefore, a contrast enhancement algorithm based on gap adjustment for histogram equalization (CegaHE) is proposed. It refers to a visual contrast enhancement algorithm based on histogram equalization (VCEA), which generates visually pleasing enhanced images, and improves the enhancement effects of VCEA. CegaHE adjusts the gaps between two gray values based on the adjustment equation, which takes the properties of human visual perception into consideration, to solve the over-enhancement problem. Besides, it also alleviates the feature loss problem and further enhances the textures in the dark regions of the images to improve the quality of the processed images for human visual perception. Experimental results demonstrate that CegaHE is a reliable method for contrast enhancement and that it significantly outperforms VCEA and other methods. PMID:27338412

  12. MCCB warm adjustment testing concept

    NASA Astrophysics Data System (ADS)

    Erdei, Z.; Horgos, M.; Grib, A.; Preradović, D. M.; Rodic, V.

    2016-08-01

    This paper presents an experimental investigation in to operating of thermal protection device behavior from an MCCB (Molded Case Circuit Breaker). One of the main functions of the circuit breaker is to assure protection for the circuits where mounted in for possible overloads of the circuit. The tripping mechanism for the overload protection is based on a bimetal movement during a specific time frame. This movement needs to be controlled and as a solution to control this movement we choose the warm adjustment concept. This concept is meant to improve process capability control and final output. The warm adjustment device design will create a unique adjustment of the bimetal position for each individual breaker, determined when the testing current will flow thru a phase which needs to trip in a certain amount of time. This time is predetermined due to scientific calculation for all standard types of amperages and complies with the IEC 60497 standard requirements.

  13. Medical neglect.

    PubMed

    Boos, Stephen C; Fortin, Kristine

    2014-11-01

    Medical neglect occurs when children are harmed or placed at significant risk of harm by gaps in their medical care. This is most likely to occur and to be recognized when families lack resources, commonly due to poverty, and when medical demands are high, such as with complex, severe, and chronic illness. A systematic evaluation of the probabilities for harm from gaps in care versus benefits from improved care will define medical neglect. A broad consideration of child, family, community, and medical system contributions to identified gaps will guide management. Special circumstances, such as lapsed immunizations, unremitting obesity, and medically motivated alterations in care, are often challenging for medical providers. Guidance for these specific situations is available from the American Academy of Pediatrics, and from the medical literature.

  14. Medication Errors

    MedlinePlus

    ... to reduce the risk of medication errors to industry and others at FDA. Additionally, DMEPA prospectively reviews ... List of Abbreviations Regulations and Guidances Guidance for Industry: Safety Considerations for Product Design to Minimize Medication ...

  15. Judging hospitals by severity-adjusted mortality rates: the influence of the severity-adjustment method.

    PubMed Central

    Iezzoni, L I; Ash, A S; Shwartz, M; Daley, J; Hughes, J S; Mackiernan, Y D

    1996-01-01

    OBJECTIVES: This research examined whether judgments about a hospital's risk-adjusted mortality performance are affected by the severity-adjustment method. METHODS: Data came from 100 acute care hospitals nationwide and 11880 adults admitted in 1991 for acute myocardial infarction. Ten severity measures were used in separate multivariable logistic models predicting in-hospital death. Observed-to-expected death rates and z scores were calculated with each severity measure for each hospital. RESULTS: Unadjusted mortality rates for the 100 hospitals ranged from 4.8% to 26.4%. For 32 hospitals, observed mortality rates differed significantly from expected rates for 1 or more, but not for all 10, severity measures. Agreement between pairs of severity measures on whether hospitals were flagged as statistical mortality outliers ranged from fair to good. Severity measures based on medical records frequently disagreed with measures based on discharge abstracts. CONCLUSIONS: Although the 10 severity measures agreed about relative hospital performance more often than would be expected by chance, assessments of individual hospital mortality rates varied by different severity-adjustment methods. PMID:8876505

  16. Convective adjustment in baroclinic atmospheres

    NASA Technical Reports Server (NTRS)

    Emanuel, Kerry A.

    1986-01-01

    Local convection in planetary atmospheres is generally considered to result from the action of gravity on small regions of anomalous density. That in rotating baroclinic fluids the total potential energy for small scale convection contains a centrifugal as well as a gravitational contribution is shown. Convective adjustment in such an atmosphere results in the establishment of near adiabatic lapse rates of temperature along suitably defined surfaces of constant angular momentum, rather than in the vertical. This leads in general to sub-adiabatic vertical lapse rates. That such an adjustment actually occurs in the earth's atmosphere is shown by example and the magnitude of the effect for several other planetary atmospheres is estimated.

  17. Naproxen-associated sudden sensorineural hearing loss.

    PubMed

    McKinnon, B J; Lassen, L F

    1998-11-01

    Naproxen is a commonly used nonsteroidal anti-inflammatory drug (NSAID) whose side effects include tinnitus and transient hearing loss. Sudden sensorineural hearing loss has rarely been reported as a result of NSAID use. This usually occurs in patients taking other ototoxic medications, with poor renal function, or with autoimmune disease. This article reports the case of an otherwise healthy patient who experienced permanent sensorineural hearing loss after a brief course of naproxen and reviews the literature on NSAID-related permanent sensorineural hearing loss.

  18. Corps of Engineers considers adjustable-speed generation

    SciTech Connect

    Not Available

    1993-04-01

    The US Army Corps of Engineers and the Bonneville Power Administration recently commissioned a study to assess the various aspects of adjustable-speed generation (also called variable-speed generation). Electronic Power Conditioning Inc., of Corvallis, Oregon, studied the cost, efficiency, and other operating implications of installing the necessary hardware to enable adjustable-speed generation at four Corps hydroelectric plants on the lower Snake River (Ice Harbor, Lower Monumental, Little Goose, and Lower Granite). Results of the study indicate that, while costly, five adjustable-speed options could be installed and operated on a practical basis. The Corps initiated the study to determine the cost for adding adjustable-speed generation at the four projects to improve fish survival. The Northwest Power Planning Council currently is considering proposals to modify operating procedures for hydroelectric projects on the Columbia River and its tributaries, including seasonal adjustments of pool levels behind dams to flush fish through the river system more rapidly. However, dropping pool levels significantly below normal levels may cause a loss in generating efficiency and a corresponding increase in fish mortality. Adjustable-speed generation is seen as a method for solving both problems

  19. Medical Appointments

    MedlinePlus

    ... trouble concentrating, stomach problems or emotional issues like anxiety. New or increasing side effects or reactions to your medications. Again, for how long? How serious are they? Medication compliance: How well you’ve been taking your medications. Have you missed doses? If so, ...

  20. MEDICAL "DEPRIVATION."

    ERIC Educational Resources Information Center

    SUCHMAN, EDWARD A.

    THE SOCIAL AND MEDICAL PROBLEM TODAY HAS SHIFTED FROM PROVIDING FOR THE EMERGENCY MEDICAL NEEDS OF THE INDIGENT SICK TO RAISING THE LEVEL OF LOWER CLASS PARTICIPATION IN THE BENEFITS OF MODERN MEDICINE. GREATER ATTENTION IS BEING FOCUSED ON MEDICAL DEPRIVATION SUFFERED BY LARGE SEGMENTS OF THE POPULATION WHO DO NOT SHARE EQUALLY IN MEDICAL…

  1. Weight loss and rapid cognitive decline in community-dwelling patients with Alzheimer's disease.

    PubMed

    Soto, Maria E; Secher, Marion; Gillette-Guyonnet, Sophie; Abellan van Kan, Gabor; Andrieu, Sandrine; Nourhashemi, Fati; Rolland, Yves; Vellas, Bruno

    2012-01-01

    Weight loss is a frequent complication of Alzheimer's disease (AD) and a strong predictor of adverse outcomes in patients suffering from this disease. The aim of this study was to determine whether weight loss was a predictor of rapid cognitive decline (RCD) in AD. Four hundred fourteen community-dwelling ambulatory patients with a diagnosis of probable AD and a Mini-Mental State Examination (MMSE) score between 10 and 26 from the REAL.FR (REseau sur la maladie d'ALzheimer FRançais) cohort were studied and followed up during 4 years. Patients were classified in 2 groups according to weight loss defined by a loss of 4% or more during the first year of follow-up. RCD was defined as the loss of 3 points or more in MMSE over 6 months. The incidence of RCD was determined among both groups over the last 3 years of follow-up. MMSE, Katz's Activity of Daily Living scale, Mini-Nutritional Assessment scale, co-morbidities, behavioral and psychological symptoms of dementia, medication, level of education, living arrangement, and caregiver's burden were assessed every 6 months. Eighty-seven patients (21.0%) lost 4% or more of their initial weight during the first year. The incidence of RCD for all patients was 57.6 (95% confidence interval (CI) = 51.6-64.8) per 100 person-year (median follow-up of 15.1 months). In Cox proportional hazards models, after controlling for potential confounders, weight loss was a significant predictor factor of RCD (adjusted hazard ratio (HR) = 1.50, 95% CI = 1.04-2.17). In conclusion, weight loss predicted RCD in this cohort. Whether the prevention of weight loss (by improving nutritional status) impacts cognitive decline remains an open question.

  2. Medical Management

    MedlinePlus

    ... them powered by the flip of a switch. Sensory loss Combined with the regular abrasions caused by ... check your feet regularly for injuries. Paradoxically, despite sensory loss, some people with CMT experience pain — a ...

  3. Hearing Loss in Adults.

    ERIC Educational Resources Information Center

    House, John W.

    1997-01-01

    This article discusses hearing loss in adults. It begins with an explanation of the anatomy of the ear and then explains the three types of hearing loss: conductive hearing loss, sensorineural hearing loss, and mixed conductive-sensorineural hearing loss. Tinnitus, hearing aids, and cochlear implants are also addressed. (CR)

  4. 8 CFR 1245.5 - Medical examination.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... the Act and § 214.2(k) of 8 CFR chapter I if the applicant was medically examined prior to, and as a... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Medical examination. 1245.5 Section 1245.5... REGULATIONS ADJUSTMENT OF STATUS TO THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 1245.5...

  5. 8 CFR 1245.5 - Medical examination.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... the Act and § 214.2(k) of 8 CFR chapter I if the applicant was medically examined prior to, and as a... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Medical examination. 1245.5 Section 1245.5... REGULATIONS ADJUSTMENT OF STATUS TO THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 1245.5...

  6. 20 CFR 220.46 - Medical evidence.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... custodian or by any authorized employee of the Railroad Retirement Board, Social Security Administration... impairment(s), the medical source's opinion about the claimant's ability to reason or make occupational, personal, or social adjustments. (See § 220.112). (c) Completeness. The medical evidence, including...

  7. 8 CFR 1245.5 - Medical examination.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... the Act and § 214.2(k) of 8 CFR chapter I if the applicant was medically examined prior to, and as a... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Medical examination. 1245.5 Section 1245.5... REGULATIONS ADJUSTMENT OF STATUS TO THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 1245.5...

  8. Medication safety.

    PubMed

    Keohane, Carol A; Bates, David W

    2008-03-01

    Patient safety is a state of mind, not a technology. The technologies used in the medical setting represent tools that must be properly designed, used well, and assessed on an on-going basis. Moreover, in all settings, building a culture of safety is pivotal for improving safety, and many nontechnologic approaches, such as medication reconciliation and teaching patients about their medications, are also essential. This article addresses the topic of medication safety and examines specific strategies being used to decrease the incidence of medication errors across various clinical settings.

  9. Adjustable-Angle Drill Block

    NASA Technical Reports Server (NTRS)

    Gallimore, F. H.

    1986-01-01

    Adjustable angular drill block accurately transfers hole patterns from mating surfaces not normal to each other. Block applicable to transfer of nonperpendicular holes in mating contoured assemblies in aircraft industry. Also useful in general manufacturing to transfer mating installation holes to irregular and angular surfaces.

  10. Economic Pressures and Family Adjustment.

    ERIC Educational Resources Information Center

    Haccoun, Dorothy Markiewicz; Ledingham, Jane E.

    The relationships between economic stress on the family and child and parental adjustment were examined for a sample of 199 girls and boys in grades one, four, and seven. These associations were examined separately for families in which both parents were present and in which mothers only were at home. Economic stress was associated with boys'…

  11. Integrating Risk Adjustment and Enrollee Premiums in Health Plan Payment

    PubMed Central

    McGuire, Thomas G.; Glazer, Jacob; Newhouse, Joseph P.; Normand, Sharon-Lise; Shi, Julie; Sinaiko, Anna D.; Zuvekas, Samuel

    2013-01-01

    In two important health policy contexts – private plans in Medicare and the new state-run “Exchanges” created as part of the Affordable Care Act (ACA) – plan payments come from two sources: risk-adjusted payments from a Regulator and premiums charged to individual enrollees. This paper derives principles for integrating risk-adjusted payments and premium policy in individual health insurance markets based on fitting total plan payments to health plan costs per person as closely as possible. A least squares regression including both health status and variables used in premiums reveals the weights a Regulator should put on risk adjusters when markets determine premiums. We apply the methods to an Exchange-eligible population drawn from the Medical Expenditure Panel Survey (MEPS). PMID:24308878

  12. Impact of Visual Field Loss on Health-Related Quality of Life in Glaucoma

    PubMed Central

    McKean-Cowdin, Roberta; Wang, Ying; Wu, Joanne; Azen, Stanley P.; Varma, Rohit

    2016-01-01

    Purpose To examine the association between health-related quality of life (HRQOL) and visual field (VF) loss in participants with open-angle glaucoma (OAG) in the Los Angeles Latino Eye Study (LALES). Design Population-based cross-sectional study. Participants Two hundred thirteen participants with OAG and 2821 participants without glaucoma or VF loss. Methods Participants in the LALES—a population-based prevalence study of eye disease in Latinos 40 years and older, residing in Los Angeles, California—underwent a detailed eye examination including an assessment of their VF using the Humphrey Automated Field Analyzer (Swedish interactive thresholding algorithm Standard 24-2). Open-angle glaucoma was determined by clinical examination. Mean deviation scores were used to assess severity of VF loss. Health-related QOL was assessed by the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) and 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Linear regression and analysis of covariance were used to assess the relationship between HRQOL scores and VF loss after adjusting for sociodemographic variables and visual acuity. Main Outcome Measures The 25-item NEI-VFQ and SF-12 scores. Results A trend of worse NEI-VFQ-25 scores for most subscales was observed with worse VF loss (using both monocular and calculated binocular data). Open-angle glaucoma participants with VF loss had lower scores than participants with no VF loss. This association was also present in participants who were previously undiagnosed and untreated for OAG (N = 160). Participants with any central VF loss had lower NEI-VFQ-25 scores than those with unilateral or bilateral peripheral VF loss. There was no significant impact of severity or location of VF loss on SF-12 scores. Conclusion Greater severity of VF loss in persons with OAG impacts vision-related QOL. This impact was present in persons who were previously unaware that they had glaucoma. Prevention of VF

  13. Vision Loss and Psychological Distress among Ethiopians Adults: A Comparative Cross-Sectional Study

    PubMed Central

    Abateneh, Aemero; Tesfaye, Markos; Bekele, Sisay; Gelaw, Yeshigeta

    2013-01-01

    Background Vision loss causes major changes in lifestyle and habits that may result in psychological distress and further reduction in the quality of life. Little is known about the magnitude of psychological distress in patients with vision loss and its variation with the normal. The aim of this study is, therefore, to investigate the psychological effects of vision loss and its determinants among Ethiopians. Methods A comparative cross-sectional study was conducted on adults attending the Eye clinic of Jimma University Hospital. One hundred fifteen consecutive adults with visual loss at least in one eye and 115 age-and sex-matched controls with normal vision were studied. The psychological distress was measured using standardized Self-Reporting Questionnaire (SRQ-20). Chi-square test and logistic regression were carried out and associations were considered significant at P<0.05. Results The overall prevalence of psychological distress was 33.4%. While psychological distress was found in 49.8% of patients who had loss of vision at least in one eye, only 18.3% of the controls had it. In the adjusted analysis, patients with vision loss had 4.6 times higher risk of suffering from psychological distress compared to patients with normal vision (AOR 4.56; 95% CI 2.16-9.62). Moreover, patients with vision loss in both eyes (AOR 4.00; 95% CI 1.453-11.015) and with worse visual acuity in the better eye (AOR 3.66; 95% CI 1.27-10.54) were significantly more likely to have psychological distress than those patients with vision loss in one eye only and good visual acuity in the better eye respectively. The cause of visual loss, pattern of visual loss, duration of visual loss and sociodemographic variables did not influence the likelihood of having psychological distress. Conclusion Prevalence of psychological distress was significantly higher in patients with visual loss compared to patients with normal vision. There is a need for integration of psychosocial care into the

  14. Living with vision loss

    MedlinePlus

    Diabetes - vision loss; Retinopathy - vision loss; Low vision; Blindness - vision loss ... Low vision is a visual disability. Wearing regular glasses or contacts does not help. People with low vision have ...

  15. (Re)Discovering Meaning: A Tale of Two Losses

    ERIC Educational Resources Information Center

    Smith, Claire

    2012-01-01

    Can the two narrative autoethnographic stories I perform here help me to therapeutically deal with the losses they describe? The first story speaks of my PhD defense and its aftermath. I consider the event a loss that is clothed in accomplishment; I work through my feelings by writing about them. The second story describes a medical loss. After…

  16. 20 CFR 345.118 - Adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... calendar year because of an error that does not constitute a compensation adjustment as defined in... compensation adjustment as defined in paragraph (b) of this section, the employer shall adjust the error by... compensation, proper adjustments with respect to the contributions shall be made, without interest,...

  17. 20 CFR 345.118 - Adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... calendar year because of an error that does not constitute a compensation adjustment as defined in... compensation adjustment as defined in paragraph (b) of this section, the employer shall adjust the error by... compensation, proper adjustments with respect to the contributions shall be made, without interest,...

  18. Adjusting to University: The Hong Kong Experience

    ERIC Educational Resources Information Center

    Yau, Hon Keung; Sun, Hongyi; Cheng, Alison Lai Fong

    2012-01-01

    Students' adjustment to the university environment is an important factor in predicting university outcomes and is crucial to their future achievements. University support to students' transition to university life can be divided into three dimensions: academic adjustment, social adjustment and psychological adjustment. However, these…

  19. 12 CFR 19.240 - Inflation adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Inflation adjustments. 19.240 Section 19.240... PROCEDURE Civil Money Penalty Inflation Adjustments § 19.240 Inflation adjustments. (a) The maximum amount... Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note) as follows: ER10NO08.001 (b)...

  20. 12 CFR 19.240 - Inflation adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Inflation adjustments. 19.240 Section 19.240... PROCEDURE Civil Money Penalty Inflation Adjustments § 19.240 Inflation adjustments. (a) The maximum amount... Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note) as follows: ER10NO08.001 (b)...

  1. 12 CFR 19.240 - Inflation adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Inflation adjustments. 19.240 Section 19.240... PROCEDURE Civil Money Penalty Inflation Adjustments § 19.240 Inflation adjustments. (a) The maximum amount... Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note) as follows: ER10NO08.001 (b)...

  2. Race and diagnostic related group prospective hospital payment for medical patients.

    PubMed

    Muñoz, E; Barrios, E; Johnson, H; Goldstein, J; Mulloy, K; Chalfin, D; Wise, L

    1989-08-01

    The diagnostic related group (DRG) prospective hospital payment system has been on line for five years with no major changes implemented by the federal government. Data suggest that the DRG system may be inequitable to patients of lower socioeconomic status. We studied the consumption of hospital resources by race (ie, white vs black) for hospitalized medical patients using the DRG prospective payment system. All adult medical admissions (N = 30,097) were analyzed for a three-year period at a large academic medical center using the DRG "all payor" classification scheme in effect for New York State. We found that black patients (N = 3,373) had a significantly greater (P less than .0001) mean length of hospital stay and cost per patient (adjusted for DRG weight index) compared with white patients (N = 26,724). Black patients also exposed the medical center to greater (P less than .0001) financial risk compared with white patients, as measured by outliers and losses under DRGs. Black patients (P less than .0001) had a significantly higher proportion of emergency admissions to the hospital, a greater severity of illness (as measured by total International Classification of Diseases-9-Clinical Modification codes) (P less than .0001), and higher diagnostic costs (P less than .0001) for each episode of illness. These data suggest that at our medical center black medical patients may consume more hospital resources (adjusted for DRG case mix) compared with whites. It is important that methods to modify DRG prospective hospital payment for medical diseases be considered to provide more equitable DRG reimbursement for black Americans in the future.

  3. Somali Women's Reflections on the Adjustment of Their Children in the United States

    ERIC Educational Resources Information Center

    Nilsson, Johanna E.; Barazanji, Danah M.; Heintzelman, Ashley; Siddiqi, Mubeena; Shilla, Yasmine

    2012-01-01

    Somali women were interviewed regarding their children's adjustment. Qualitative analysis revealed 5 themes: cultural comparisons, concerns about children, parents' loss of disciplinary authority, available support, and the future. The women discussed changes in their children, such as loss of respect and threats to use law enforcement against…

  4. Academic and Social Adjustment among Deaf and Hard of Hearing College Students in Taiwan

    ERIC Educational Resources Information Center

    Liu, Chia-fen

    2013-01-01

    This study was conducted to identify the factors that may influence the academic and social adjustment of college students with hearing loss in Taiwan. These factors included age, gender, degree of hearing loss, primary communication mode, amplification, high school educational experience, and family relationship. The instruments used to address…

  5. Medical criminalistics.

    PubMed

    Pollak, S

    2007-01-17

    Medical criminalistics is an essential part of legal/forensic medicine. It includes the clinical examination of surviving victims and suspects, the inspection of the scene in suspicious deaths with subsequent performance of medico-legal autopsies, the assessment of (biological) traces and the reconstruction of criminal events under medical aspects. Just as the circumstances of life and the manifestations of crime are changing with time, there is a permanent alteration regarding the issues of medical criminalistics. Legal/forensic medicine is a university subject in most countries and therefore, research work is one of the main tasks also in medical criminalistics. In contrast to clinical medicine and basic research, some common study designs are not suitable for the special needs of medical criminalistics, whereas other types are more appropriate like epidemiological evaluations, cross-sectional studies and (retrospective) observation studies. Moreover, experimental model tests and case reports also rate high in medical criminalistics. PMID:16822631

  6. Medical criminalistics.

    PubMed

    Pollak, S

    2007-01-17

    Medical criminalistics is an essential part of legal/forensic medicine. It includes the clinical examination of surviving victims and suspects, the inspection of the scene in suspicious deaths with subsequent performance of medico-legal autopsies, the assessment of (biological) traces and the reconstruction of criminal events under medical aspects. Just as the circumstances of life and the manifestations of crime are changing with time, there is a permanent alteration regarding the issues of medical criminalistics. Legal/forensic medicine is a university subject in most countries and therefore, research work is one of the main tasks also in medical criminalistics. In contrast to clinical medicine and basic research, some common study designs are not suitable for the special needs of medical criminalistics, whereas other types are more appropriate like epidemiological evaluations, cross-sectional studies and (retrospective) observation studies. Moreover, experimental model tests and case reports also rate high in medical criminalistics.

  7. Medical management of osteoarthritis.

    PubMed

    Manek, N J

    2001-05-01

    Osteoarthritis (OA) is the most common articular disease, and it continues to be a major public health problem related to pain, disability, loss of time from work, and economics. Most patients with OA seek medical attention because of pain. In the past few years, changes in the treatment of OA have been substantial. More effective nonnarcotic analgesics, cyclooxygenase-2-specific inhibitors, nutraceuticals, and intra-articular hyaluronates are some of the new medications and agents that are now available. The understanding and use of nonpharmacological interventions, including patient education, exercise programs, and weight reduction when appropriate, have also improved. Relief of pain and restoration of function can be accomplished in many patients, particularly with an integrated approach. This article focuses on medical treatment approaches for OA, both pharmacological and nonpharmacological.

  8. Hearing loss in students at a conservatory.

    PubMed

    Schmidt, J M; Verschuure, J; Brocaar, M P

    1994-01-01

    We tend not to think of music as noise but as a pleasant sound. Yet, played loud enough, music can become a threat to the human ear. The question arises whether professional musicians suffer from hearing losses caused by their playing of music. The hearing of students at the Rotterdam conservatory was studied; medical students served as a reference group. High percentages of audiometric noise dips (16%) and high-frequency losses (20%) were found in students of the conservatory, as well as a high percentage (72%) of extended high-frequency losses relative to the reference curves of Dreschler et al. Surprisingly, an equally large (and in the high-frequency region an even higher) percentage of hearing losses was found in the control group of medical students with the same median age. In sum, the exposure of conservatory students to the practice of music has as yet had no effect on their hearing.

  9. [Occupational hearing loss: new principles of certification].

    PubMed

    Guzek, Wojciech J; Sułkowski, Wiesław J

    2002-01-01

    Noise-induced hearing loss, together with presbyacusis, are the most prevalent causes of the functional impairment of the inner ear in an adult population. The authors discuss briefly the epidemiological, diagnostic and medical certification issues. The paper is focused on the new legislation that brings about considerable changes in the procedure of medical certification of noise-induced hearing loss. Both the definition of the pathology and new principles for its certification as an occupational disease were intended to harmonize Polish regulations with respective legislation of the EU countries.

  10. Medical confidence.

    PubMed

    Havard, J

    1985-03-01

    If medical confidentiality is not observed patients may well be reluctant to disclose information to their doctors or even to seek medical advice. Therefore, argues the author, it is of the utmost importance that doctors strive to protect medical confidentiality, particularly now when it is under threat not only in this country but also overseas. The profession must cease to regard ethical issues to do with confidentiality, and indeed to do with all areas of medical practice, as abstract phenomena requiring no justification. If it does not then it will come under increasing and justified criticism from the community it serves.

  11. [METHODOLOGICAL APPROACHES TO THE CALCULATION OF ACTUAL AND PREVENTED AS A RESULT OF CONTROL AND SUPERVISORY ACTIVITIES, MEDICAL-DEMOGRAPHIC AND ECONOMIC LOSSES, ASSOCIATED WITH THE NEGATIVE IMPACT OF ENVIRONMENTAL FACTORS].

    PubMed

    Popova, A Yu; Zaytseva, N V; May, I V; Kir'yanov, D A

    2015-01-01

    In the article there are reported the methodological approaches to the calculation of actual and avoided as a result of control and supervisory activities of economic losses caused by mortality, morbidity and disability in the population, associated with the negative impact of environmental factors. There is suggested a consistent solution of the chain of problems: the establishment of cause-and-effect relationships between indices of the health status and indices of the quality of the environment; indices of the quality of the environment and indices of the control and supervision activity of organs and institutions of Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing calculation of the cases of violations of health prevented as a result of the activity ofthe service; evaluation of their economic equivalents. Approbation of approaches on the example of the Russian Federation allowed to establish that as a result of the activity of organs and institutions of Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing in 2013, a positive trend was observed on 51 indices of quality of the habitat environment, there were prevented about 160 thousands of deaths and more than 2 million cases of disease that would be held in conditions of the lack of adequate control and surveillance measures in the field of sanitary and epidemiological welfare of the population. Loss prevention of gross domestic product (GDP) amounted to more than 120 billion rubles, Tax shortfalls in the federal budget--about 25.7 billion rubles. With taking into account the costs of the federal budgetfor the activities of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing in 2013 in part to ensure sanitary epidemiological surveillance in the amount of 11.386 billion rubles there was prevented loss of GDP of 10.56 rubles per 1 rub. of the cost of the federal budget and there was warned the shortfall of taxes to

  12. Sudden hearing loss associated with methylphenidate therapy.

    PubMed

    Karapinar, Ugur; Saglam, Omer; Dursun, Engin; Cetin, Bilal; Salman, Nergis; Sahan, Murat

    2014-01-01

    An 8-year-old child diagnosed with attention deficit/hyperactivity disorder presented to our Department of Otolaryngology 4 days after suffering hearing loss, loss of balance, tinnitus, and fullness sensation of the left ear. Her symptoms occured with the first dose of methylphenidate. The medical history and physical examination revealed no other diseases associated with sudden hearing loss. The audiogram revealed a total hearing loss on the left ear. Stapedial reflexes, distortion product and transient-evoked otoacoustic emissions were absent in left ear. The absence of clinical, laboratory and radiological evidence of a possible cause for complaints, an association between methylphenidate and sudden hearing loss was suggested. The patient received a standard course of oral corticosteroid and hyperbaric oxygen therapy. Weekly otological and audiological examinations were performed. Conservative and medical treatments offered no relief from hearing loss. Sudden hearing loss is a serious and irreversible adverse effect of methylphenidate. Therefore, the risk of hearing loss should be taken into consideration when initiating methylphenidate therapy.

  13. 26 CFR 1.904(b)-1 - Special rules for capital gains and losses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... capital gain by netting all of BB's capital gains and losses, from sources within and outside the United...) foreign tax credit limitation fractions, CC must adjust capital gain net income by netting all of CC's... adjust capital gain net income by netting all of DD's capital gains and losses from sources within...

  14. 26 CFR 301.6402-7 - Claims for refund and applications for tentative carryback adjustments involving consolidated...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... operating loss of a member of the loss year group is a reference to the portion of the loss year group's... tentative carryback adjustments involving consolidated groups that include insolvent financial institutions... involving consolidated groups that include insolvent financial institutions. (a) In general—(1)...

  15. Hair loss in women.

    PubMed

    Harfmann, Katya L; Bechtel, Mark A

    2015-03-01

    Hair loss is a common cause of morbidity for many women. As a key member of the woman's health care team, the obstetrician/gynecologist may be the first person to evaluate the complaint of hair loss. Common types of nonscarring hair loss, including female pattern hair loss and telogen effluvium, may be diagnosed and managed by the obstetrician/gynecologist. A systematic approach to diagnosis and management of these common forms of hair loss is presented. PMID:25517757

  16. Hair loss in women.

    PubMed

    Harfmann, Katya L; Bechtel, Mark A

    2015-03-01

    Hair loss is a common cause of morbidity for many women. As a key member of the woman's health care team, the obstetrician/gynecologist may be the first person to evaluate the complaint of hair loss. Common types of nonscarring hair loss, including female pattern hair loss and telogen effluvium, may be diagnosed and managed by the obstetrician/gynecologist. A systematic approach to diagnosis and management of these common forms of hair loss is presented.

  17. Cardiac Medications

    MedlinePlus

    ... Diovan) What the Medication Does Rather than lowering levels of angiotensin II (as ACE inhibitors do) angiotensin II receptor blockers prevent this chemical from having any effects on the heart and blood vessels. This keeps blood pressure from rising. Reason for Medication Used to treat or improve ...

  18. Medical photography.

    PubMed

    Brown, S E

    Medical photography and illustration still provides an essential service for the clinician and researcher, despite an ever-increasing remit. This article describes the role of the medical illustration department and may help the hospital practitioner to use this service to the full.

  19. Medication reviews

    PubMed Central

    Blenkinsopp, Alison; Bond, Christine; Raynor, David K

    2012-01-01

    Recent years have seen a formalization of medication review by pharmacists in all settings of care. This article describes the different types of medication review provided in primary care in the UK National Health Service (NHS), summarizes the evidence of effectiveness and considers how such reviews might develop in the future. Medication review is, at heart, a diagnostic intervention which aims to identify problems for action by the prescriber, the clinican conducting the review, the patient or all three but can also be regarded as an educational intervention to support patient knowledge and adherence. There is good evidence that medication review improves process outcomes of prescribing including reduced polypharmacy, use of more appropriate medicines formulation and more appropriate choice of medicine. When ‘harder’ outcome measures have been included, such as hospitalizations or mortality in elderly patients, available evidence indicates that whilst interventions could improve knowledge and adherence they did not reduce mortality or hospital admissions with one study showing an increase in hospital admissions. Robust health economic studies of medication reviews remain rare. However a review of cost-effectiveness analyses of medication reviews found no studies in which the cost of the intervention was greater than the benefit. The value of medication reviews is now generally accepted despite lack of robust research evidence consistently demonstrating cost or clinical effectiveness compared with traditional care. Medication reviews can be more effectively deployed in the future by targeting, multi-professional involvement and paying greater attention to medicines which could be safely stopped. PMID:22607195

  20. Adjustable link for kinematic mounting systems

    DOEpatents

    Hale, Layton C.

    1997-01-01

    An adjustable link for kinematic mounting systems. The adjustable link is a low-cost, passive device that provides backlash-free adjustment along its single constraint direction and flexural freedom in all other directions. The adjustable link comprises two spheres, two sockets in which the spheres are adjustable retain, and a connection link threadly connected at each end to the spheres, to provide a single direction of restraint and to adjust the length or distance between the sockets. Six such adjustable links provide for six degrees of freedom for mounting an instrument on a support. The adjustable link has applications in any machine or instrument requiring precision adjustment in six degrees of freedom, isolation from deformations of the supporting platform, and/or additional structural damping. The damping is accomplished by using a hollow connection link that contains an inner rod and a viscoelastic separation layer between the two.

  1. Adjustable link for kinematic mounting systems

    DOEpatents

    Hale, L.C.

    1997-07-01

    An adjustable link for kinematic mounting systems is disclosed. The adjustable link is a low-cost, passive device that provides backlash-free adjustment along its single constraint direction and flexural freedom in all other directions. The adjustable link comprises two spheres, two sockets in which the spheres are adjustable retain, and a connection link threadly connected at each end to the spheres, to provide a single direction of restraint and to adjust the length or distance between the sockets. Six such adjustable links provide for six degrees of freedom for mounting an instrument on a support. The adjustable link has applications in any machine or instrument requiring precision adjustment in six degrees of freedom, isolation from deformations of the supporting platform, and/or additional structural damping. The damping is accomplished by using a hollow connection link that contains an inner rod and a viscoelastic separation layer between the two. 3 figs.

  2. Achromatic and uncoupled medical gantry

    DOEpatents

    Tsoupas, Nicholaos; Kayran, Dmitry; Litvinenko, Vladimir; MacKay, William W.

    2011-11-22

    A medical gantry that focus the beam from the beginning of the gantry to the exit of the gantry independent of the rotation angle of the gantry by keeping the beam achromatic and uncoupled, thus, avoiding the use of collimators or rotators, or additional equipment to control the beam divergence, which may cause beam intensity loss or additional time in irradiation of the patient, or disadvantageously increase the overall gantry size inapplicable for the use in the medical treatment facility.

  3. Methadone Induced Sensorineural Hearing Loss

    PubMed Central

    Saifan, Chadi; Barakat, Iskandar; El-Sayegh, Suzanne

    2013-01-01

    Background. Sudden sensorineural hearing loss (SSHL) caused by opiate abuse or overuse has been well documented in the medical literature. Most documented case reports have involved either heroin or hydrocodone/acetaminophen. Recently, case reposts of methadone induced SSHL have been published. Case Report. We present the case of a 31-year-old man who developed SSHL after a methadone overdose induced stupor. He was subsequently restarted on methadone at his regular dose. On follow-up audiometry exams, he displayed persistent moderately severe sensorineural hearing loss bilaterally. Discussion. This case is notable because unlike all but one previously reported case, the patient—who was restated on methadone—did not make a complete recovery. Conclusion. Methadone overuse in rare cases causes SSHL. PMID:23983704

  4. Practical management of hair loss.

    PubMed Central

    Shapiro, J.; Wiseman, M.; Lui, H.

    2000-01-01

    OBJECTIVE: To describe an organized diagnostic approach for both nonscarring and scarring alopecias to help family physicians establish an accurate in-office diagnosis. To explain when ancillary laboratory workup is necessary to confirm the diagnosis. QUALITY OF EVIDENCE: Current diagnostic and therapeutic interventions for hair loss are based on randomized controlled studies, uncontrolled studies, and case series. MEDLINE was searched from January 1966 to December 1998 with the MeSH words alopecia, hair, and alopecia areata. Articles were selected on the basis of experimental design, with priority given to the most current large multicentre controlled studies. Overall global evidence for therapeutic intervention for hair loss is quite strong. MAIN MESSAGE: The most common forms of nonscarring alopecias are androgenic alopecia, telogen effluvium, and alopecia areata. Other disorders include trichotillomania, traction alopecia, tinea capitis, and hair shaft abnormalities. Scarring alopecia is caused by trauma, infections, discoid lupus erythematosus, or lichen planus. Key to establishing an accurate diagnosis is a detailed history, including medication use, systemic illnesses, endocrine dysfunction, hair-care practices, and family history. All hair-bearing sites should be examined. A 4-mm punch biopsy of the scalp is useful, particularly to diagnose scarring alopecias. Once a diagnosis has been established, specific therapy can be initiated. CONCLUSIONS: Diagnosis and management of hair loss is an interesting challenge for family physicians. An organized approach to recognizing characteristic differential features of hair loss disorders is key to diagnosis and management. Images Figure 1 Figure 2 Figure 5 Figure 6 PMID:10925761

  5. Adjustable extender for instrument module

    DOEpatents

    Sevec, J.B.; Stein, A.D.

    1975-11-01

    A blank extender module used to mount an instrument module in front of its console for repair or test purposes has been equipped with a rotatable mount and means for locking the mount at various angles of rotation for easy accessibility. The rotatable mount includes a horizontal conduit supported by bearings within the blank module. The conduit is spring-biased in a retracted position within the blank module and in this position a small gear mounted on the conduit periphery is locked by a fixed pawl. The conduit and instrument mount can be pulled into an extended position with the gear clearing the pawl to permit rotation and adjustment of the instrument.

  6. Structuring payment for medical homes.

    PubMed

    Merrell, Katie; Berenson, Robert A

    2010-05-01

    Despite widespread interest in the medical home model, there has been a lack of careful assessment of alternative methods to pay practices that serve as medical homes. This paper examines four specific payment approaches: enhanced fee-for-service payments for evaluation and management; additional codes for medical home activities within fee-for-service payments; per patient per month medical home payments to augment fee-for-service visit payments; and risk-adjusted, comprehensive per patient per month payments. Payment policies selected will affect both the adoption of the model and its longer-term evaluation. Evaluations of ongoing demonstrations should focus on payment design as well as on care--and cost.

  7. Parenting Perfectionism and Parental Adjustment.

    PubMed

    Lee, Meghan A; Schoppe-Sullivan, Sarah J; Kamp Dush, Claire M

    2012-02-01

    The parental role is expected to be one of the most gratifying and rewarding roles in life. As expectations of parenting become ever higher, the implications of parenting perfectionism for parental adjustment warrant investigation. Using longitudinal data from 182 couples, this study examined the associations between societal- and self-oriented parenting perfectionism and new mothers' and fathers' parenting self-efficacy, stress, and satisfaction. For mothers, societal-oriented parenting perfectionism was associated with lower parenting self-efficacy, but self-oriented parenting perfectionism was associated with higher parenting satisfaction. For fathers, societal-oriented parenting perfectionism was associated with higher parenting stress, whereas higher levels of self-oriented parenting perfectionism were associated with higher parenting self-efficacy, lower parenting stress, and greater parenting satisfaction. These findings support the distinction between societal- and self-oriented perfectionism, extend research on perfectionism to interpersonal adjustment in the parenting domain, and provide the first evidence for the potential consequences of holding excessively high standards for parenting. PMID:22328797

  8. Adjustable fetal phantom for pulse oximetry

    NASA Astrophysics Data System (ADS)

    Stubán, Norbert; Niwayama, Masatsugu

    2009-05-01

    As the measuring head of a fetal pulse oximeter must be attached to the head of the fetus inside the mother's uterus during labor, testing, and developing of fetal pulse oximeters in real environment have several difficulties. A fetal phantom could enable evaluation of pulse oximeters in a simulated environment without the restrictions and difficultness of medical experiments in the labor room. Based on anatomic data we developed an adjustable fetal head phantom with three different tissue layers and artificial arteries. The phantom consisted of two arteries with an inner diameter of 0.2 and 0.4 mm. An electronically controlled pump produced pulse waves in the arteries. With the phantom we investigated the sensitivity of a custom-designed wireless pulse oximeter at different pulsation intensity and artery diameters. The results showed that the oximeter was capable of identifying 4% and 2% changes in diameter between the diastolic and systolic point in arteries of over 0.2 and 0.4 mm inner diameter, respectively. As the structure of the phantom is based on reported anatomic values, the results predict that the investigated custom-designed wireless pulse oximeter has sufficient sensitivity to detect the pulse waves and to calculate the R rate on the fetal head.

  9. Adjusting the Contour of Reflector Panels

    NASA Technical Reports Server (NTRS)

    Palmer, W. B.; Giebler, M. M.

    1984-01-01

    Postfabrication adjustment of contour of panels for reflector, such as parabolic reflector for radio antennas, possible with simple mechanism consisting of threaded stud, two nuts, and flexure. Contours adjusted manually.

  10. Research Design in Marital Adjustment Studies.

    ERIC Educational Resources Information Center

    Croake, James W.; Lyon, Rebecca S.

    1978-01-01

    The numerous marital adjustment studies which exist in the literature are confounded by basic design problems. Marital stability should be the baseline for data. It is then possible to discuss "happiness,""success,""adjustment," and "satisfaction." (Author)

  11. Renal Drug Dosage Adjustment According to Estimated Creatinine Clearance in Hospitalized Patients With Heart Failure.

    PubMed

    Altunbas, Gokhan; Yazc, Mehmet; Solak, Yalcin; Gul, Enes E; Kayrak, Mehmet; Kaya, Zeynettin; Akilli, Hakan; Aribas, Alpay; Gaipov, Abduzhappar; Yazc, Raziye; Ozdemir, Kurtulus

    2016-01-01

    It is of clinical importance to determine creatinine clearance and adjust doses of prescribed drugs accordingly in patients with heart failure to prevent untoward effects. There is a scarcity of studies in the literature investigating this issue particularly in patients with heart failure, in whom many have impaired kidney function. The purpose of this study was to determine the degree of awareness of medication prescription as to creatinine clearance in patients hospitalized with heart failure. Patients hospitalized with a diagnosis of heart failure were retrospectively evaluated. Among screened charts, patients with left ventricular ejection fraction <40% and an estimated glomerular filtration rate (eGFR) of ≤50 mL/min were included in the analysis. The medications and respective doses prescribed at discharge were recorded. Medications requiring renal dose adjustment were determined and evaluated for appropriate dosing according to eGFR. A total of 388 patients with concomitant heart failure and renal dysfunction were included in the study. The total number of prescribed medications was 2808 and 48.3% (1357 medications) required renal dose adjustment. Of the 1357 medications, 12.6% (171 medications) were found to be inappropriately prescribed according to eGFR. The most common inappropriately prescribed medications were famotidine, metformin, perindopril, and ramipril. A significant portion of medications used in heart failure requires dose adjustment. Our results showed that in a typical cohort of patients with heart failure, many drugs are prescribed at inappropriately high doses according to creatinine clearance. Awareness should be increased among physicians caring for patients with heart failure to prevent adverse events related to medications.

  12. Sudden sensorineural hearing loss after non-otologic surgery.

    PubMed

    Page, Joshua Cody; Peters, Bob

    2015-01-01

    Sudden sensorineural hearing loss following non-otologic surgery is a rare event described in the medical literature. Cardiopulmonary bypass surgery is most commonly associated with this type of hearing loss. Our case report and review of the literature describe two cases with postoperative hearing loss - neither of which are cardiac surgeries - making them exceedingly rare in the medical literature. Regardless of the rarity of this unfortunate event, the possibility for permanent hearing loss is a potentially devastating unanticipated complication and one that all surgeons should be aware.

  13. Generalized adjustment by least squares ( GALS).

    USGS Publications Warehouse

    Elassal, A.A.

    1983-01-01

    The least-squares principle is universally accepted as the basis for adjustment procedures in the allied fields of geodesy, photogrammetry and surveying. A prototype software package for Generalized Adjustment by Least Squares (GALS) is described. The package is designed to perform all least-squares-related functions in a typical adjustment program. GALS is capable of supporting development of adjustment programs of any size or degree of complexity. -Author

  14. Self-reported adjustment of teenagers at soccer training centers: the Soccer Trainee Adjustment Scale.

    PubMed

    Laurin, Raphaël; Nicolas, Michel; Labruère-Chazal, Catherine; Lacassagne, Marie-Françoise

    2008-08-01

    The aim of this study was to develop a questionnaire to measure adjustment of teenagers at soccer training centers, particularly newcomers. The Soccer Trainee Adjustment Scale was adapted from the Institutional Integration Scale and assesses the trainee's adjustment to operating and social activities. The scale was tested on a sample of 136 trainees from four soccer centers. Exploratory analysis indicated that the 13 items formed five factors: peer adjustment, boarding supervisor adjustment, soccer adjustment, scholastic adjustment, and boarding adjustment. These factors had internal consistency reliability ranging from .76 to .94.

  15. Medical Imaging.

    ERIC Educational Resources Information Center

    Barker, M. C. J.

    1996-01-01

    Discusses four main types of medical imaging (x-ray, radionuclide, ultrasound, and magnetic resonance) and considers their relative merits. Describes important recent and possible future developments in image processing. (Author/MKR)

  16. Medical Scientists

    MedlinePlus

    ... scientists typically have a Ph.D., usually in biology or a related life science. Some medical scientists ... specialize in this field seek to understand the biology of aging and investigate ways to improve the ...

  17. Adjusting to living with multiple sclerosis: The role of social groups.

    PubMed

    Tabuteau-Harrison, Sophie L; Haslam, Catherine; Mewse, Avril J

    2016-01-01

    Multiple sclerosis (MS) is typically associated with life-long adjustment to wide-ranging, changeable symptoms and psychosocial disruption as all relationships are changed or lost. Despite accumulating evidence, the therapeutic impact of harnessing social group factors in MS management and rehabilitation remains largely unexplored. We investigated their role specific to adjusting to MS. A qualitative approach was used with thematic analysis to induce a rich and developing account of the impact of social groups on adjustment for 15 individuals with MS. An adjustment questionnaire was used to provide a framework for its organisation and discussion. The analysis revealed three themes associated with loss, change and social processes that influenced adjustment. These features distinguished between those who were more or less able to adjust, and resonated well with processes previously identified as central to identity loss and change. Social factors enhanced adjustment through easing transition between pre- and post-MS diagnosis lives. Notably, maintenance of pre-existing social roles and relationships was critical in providing a meaningful basis for integrating the old with new senses of self. The capacity to join new social groups was as key in adjustment as was awareness of having access to multiple social groups to avoid being solely defined by MS. These concepts provided a more stable grounding upon which to nurture value systems and employ collective support to counter the negative consequences of living with MS.

  18. Adjusting to living with multiple sclerosis: The role of social groups.

    PubMed

    Tabuteau-Harrison, Sophie L; Haslam, Catherine; Mewse, Avril J

    2016-01-01

    Multiple sclerosis (MS) is typically associated with life-long adjustment to wide-ranging, changeable symptoms and psychosocial disruption as all relationships are changed or lost. Despite accumulating evidence, the therapeutic impact of harnessing social group factors in MS management and rehabilitation remains largely unexplored. We investigated their role specific to adjusting to MS. A qualitative approach was used with thematic analysis to induce a rich and developing account of the impact of social groups on adjustment for 15 individuals with MS. An adjustment questionnaire was used to provide a framework for its organisation and discussion. The analysis revealed three themes associated with loss, change and social processes that influenced adjustment. These features distinguished between those who were more or less able to adjust, and resonated well with processes previously identified as central to identity loss and change. Social factors enhanced adjustment through easing transition between pre- and post-MS diagnosis lives. Notably, maintenance of pre-existing social roles and relationships was critical in providing a meaningful basis for integrating the old with new senses of self. The capacity to join new social groups was as key in adjustment as was awareness of having access to multiple social groups to avoid being solely defined by MS. These concepts provided a more stable grounding upon which to nurture value systems and employ collective support to counter the negative consequences of living with MS. PMID:25494942

  19. Medical Marijuana.

    PubMed

    Capriotti, Teri

    2016-01-01

    The use of medicinal marijuana is increasing. Marijuana has been shown to have therapeutic effects in certain patients, but further research is needed regarding the safety and efficacy of marijuana as a medical treatment for various conditions. A growing body of research validates the use of marijuana for a variety of healthcare problems, but there are many issues surrounding the use of this substance. This article discusses the use of medical marijuana and provides implications for home care clinicians.

  20. Medical education.

    PubMed

    Krishnan, P

    1992-01-01

    In theory, the Medical Council of India (MCI) determines the standards and qualifications of medical schools. It also sanctions curricula and ensures standards. Yet no standards exist on the mode of selection in medical schools, duration of study, course content, student stipends or period of internship. It takes 4.5 years to finish medical school. Students undergo preclinical, paraclinical, and clinical training. Most courses are in English which tends to favor the urban elite. Students cannot always communicate with patients in local languages. Textbooks often provide medical examples unrelated to India. Pedagogy consists mainly of lectures and rote learning predominates. Curricula tend not to provide courses in community health. Students pick up on the elitist attitudes of the faculty. For example, faculty do not put much emphasis on community health, individual health, equity in health care delivery, and teamwork. Further the education system is not patient oriented, but hospital or disease oriented. Faculty should train students in creating sanitation programs, knowing local nutritious foods, and in making community diagnoses. Yet they tend to be practitioners 1st then educators. Further faculty are not paid well and are not always invited to take part in improving curriculum, so morale is often low. Moreover experience in health planning and management issues is not required for administrators. In addition, medical schools are not well equipped with learning aids, libraries, or teaching staff. Tax revenues finance medical education. 75% of graduating physicians set up a private practice. Further many physicians go to urban areas. 34-57% emigrate to other countries. The problems of medical education will not be solved until the political and economic system becomes more responsive to the health needs of the people.

  1. Medical Acoustics

    NASA Astrophysics Data System (ADS)

    Beach, Kirk W.; Dunmire, Barbrina

    Medical acoustics can be subdivided into diagnostics and therapy. Diagnostics are further separated into auditory and ultrasonic methods, and both employ low amplitudes. Therapy (excluding medical advice) uses ultrasound for heating, cooking, permeablizing, activating and fracturing tissues and structures within the body, usually at much higher amplitudes than in diagnostics. Because ultrasound is a wave, linear wave physics are generally applicable, but recently nonlinear effects have become more important, even in low-intensity diagnostic applications.

  2. Medical marijuana.

    PubMed

    1999-04-30

    The Florida Supreme Court heard oral arguments in April regarding a glaucoma patient's request for a medical exception to the State prohibition on use of marijuana. [Name removed] was convicted on possession and cultivation charges, and a trial judge refused to allow a medical necessity defense. A State appeals court subsequently overturned [name removed]'s conviction. The case focuses on whether the legislature intended to prohibit such a defense when it declared in 1993 that the substance had no medicinal benefits.

  3. Genetics of Hearing Loss

    MedlinePlus

    ... in Latin America Information For... Media Policy Makers Genetics of Hearing Loss Language: English Español (Spanish) Recommend ... of hearing loss in babies is due to genetic causes. There are also a number of things ...

  4. Photovoltaic array loss mechanisms

    NASA Technical Reports Server (NTRS)

    Gonzalez, Charles

    1986-01-01

    Loss mechanisms which come into play when solar cell modules are mounted in arrays are identified. Losses can occur either from a reduction in the array electrical performance or with nonoptimal extraction of power from the array. Electrical performance degradation is caused by electrical mismatch, transmission losses from cell surface soiling and steep angle of reflectance, and electrical losses from field wiring resistance and the voltage drop across blocking diodes. The second type of loss, concerned with the operating points of the array, can involve nonoptimal load impedance and limiting the operating envelope of the array to specific ranges of voltage and current. Each of the loss mechanisms are discussed and average energy losses expected from soiling, steep reflectance angles and circuit losses are calculated.

  5. Weight Loss Surgery

    MedlinePlus

    Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you cannot lose weight ... obesity. There are different types of weight loss surgery. They often limit the amount of food you ...

  6. Loss and Recovery

    NASA Technical Reports Server (NTRS)

    Schwer, Ken

    2002-01-01

    The author recounts his experiences of the loss of the QuickTOMS (Total Ozone Mapping Spectrometer) spacecraft, for which he was project manager. He draws from the launch failure lessons on leadership, coping with loss and maintaining morale.

  7. Genes and Hearing Loss

    MedlinePlus

    ... Meeting Calendar Find an ENT Doctor Near You Genes and Hearing Loss Genes and Hearing Loss Patient ... mutation may only have dystopia canthorum. How Do Genes Work? Genes are a road map for the ...

  8. Weight Loss & Acute Porphyria

    MedlinePlus

    ... Sale You are here Home Diet and Nutrition Weight loss & acute Porphyria Being overweight is a particular problem ... one of these diseases before they enter a weight-loss program. Also, they should not participate in a ...

  9. Capacity for Physical Activity Predicts Weight Loss After Roux-en-Y Gastric Bypass

    PubMed Central

    Hatoum, Ida J.; Stein, Heather K.; Merrifield, Benjamin F.; Kaplan, Lee M.

    2014-01-01

    Despite its overall excellent outcomes, weight loss after Roux-en-Y gastric bypass (RYGB) is highly variable. We conducted this study to identify clinical predictors of weight loss after RYGB. We reviewed charts from 300 consecutive patients who underwent RYGB from August 1999 to November 2002. Data collected included patient demographics, medical comorbidities, and diet history. Of the 20 variables selected for univariate analysis, 9 with univariate P values ≤ 0.15 were entered into a multivariable regression analysis. Using backward selection, covariates with P < 0.05 were retained. Potential confounders were added back into the model and assessed for effect on all model variables. Complete records were available for 246 of the 300 patients (82%). The patient characteristics were 75% female, 93% white, mean age of 45 years, and mean initial BMI of 52.3 kg/m2. One year after surgery, patients lost an average of 64.8% of their excess weight (s.d. = 20.5%). The multivariable regression analysis revealed that limited physical activity, higher initial BMI, lower educational level, diabetes, and decreased attendance at postoperative appointments had an adverse effect on weight loss after RYGB. A model including these five factors accounts for 41% of the observed variability in weight loss (adjusted r2 = 0.41). In this cohort, higher initial BMI and limited physical activity were the strongest predictors of decreased excess weight loss following RYGB. Limited physical activity may be particularly important because it represents an opportunity for potentially meaningful pre- and postsurgical intervention to maximize weight loss following RYGB. PMID:18997674

  10. 19 CFR 201.205 - Salary adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 3 2011-04-01 2011-04-01 false Salary adjustments. 201.205 Section 201.205 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt Collection § 201.205 Salary adjustments. Any negative adjustment to pay arising out of an employee's...

  11. 19 CFR 201.205 - Salary adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 3 2010-04-01 2010-04-01 false Salary adjustments. 201.205 Section 201.205 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt Collection § 201.205 Salary adjustments. Any negative adjustment to pay arising out of an employee's...

  12. 24 CFR 5.611 - Adjusted income.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Adjusted income. 5.611 Section 5... Serving Persons with Disabilities: Family Income and Family Payment; Occupancy Requirements for Section 8 Project-Based Assistance Family Income § 5.611 Adjusted income. Adjusted income means annual income...

  13. 34 CFR 36.2 - Penalty adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 1 2014-07-01 2014-07-01 false Penalty adjustment. 36.2 Section 36.2 Education Office of the Secretary, Department of Education ADJUSTMENT OF CIVIL MONETARY PENALTIES FOR INFLATION § 36.2..., Section 36.2—Civil Monetary Penalty Inflation Adjustments Statute Description New maximum (and minimum,...

  14. 34 CFR 36.2 - Penalty adjustment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 1 2011-07-01 2011-07-01 false Penalty adjustment. 36.2 Section 36.2 Education Office of the Secretary, Department of Education ADJUSTMENT OF CIVIL MONETARY PENALTIES FOR INFLATION § 36.2..., Section 36.2—Civil Monetary Penalty Inflation Adjustments Statute Description New maximum (and minimum,...

  15. 34 CFR 36.2 - Penalty adjustment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Penalty adjustment. 36.2 Section 36.2 Education Office of the Secretary, Department of Education ADJUSTMENT OF CIVIL MONETARY PENALTIES FOR INFLATION § 36.2..., Section 36.2—Civil Monetary Penalty Inflation Adjustments Statute Description New maximum (and minimum,...

  16. 34 CFR 36.2 - Penalty adjustment.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 1 2013-07-01 2013-07-01 false Penalty adjustment. 36.2 Section 36.2 Education Office of the Secretary, Department of Education ADJUSTMENT OF CIVIL MONETARY PENALTIES FOR INFLATION § 36.2..., Section 36.2—Civil Monetary Penalty Inflation Adjustments Statute Description New maximum (and minimum,...

  17. 12 CFR 1780.80 - Inflation adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Inflation adjustments. 1780.80 Section 1780.80... DEVELOPMENT RULES OF PRACTICE AND PROCEDURE RULES OF PRACTICE AND PROCEDURE Civil Money Penalty Inflation Adjustments § 1780.80 Inflation adjustments. The maximum amount of each civil money penalty within...

  18. 12 CFR 1780.80 - Inflation adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Inflation adjustments. 1780.80 Section 1780.80... DEVELOPMENT RULES OF PRACTICE AND PROCEDURE RULES OF PRACTICE AND PROCEDURE Civil Money Penalty Inflation Adjustments § 1780.80 Inflation adjustments. The maximum amount of each civil money penalty within...

  19. Acute Vision Loss.

    PubMed

    Bagheri, Nika; Mehta, Sonia

    2015-09-01

    Acute vision loss can be transient (lasting <24 hours) or persistent (lasting >24 hours). When patients present with acute vision loss, it is important to ascertain the duration of vision loss and whether it is a unilateral process affecting one eye or a bilateral process affecting both eyes. This article focuses on causes of acute vision loss in the nontraumatic setting and provides management pearls to help health care providers better triage these patients.

  20. Canine hearing loss management.

    PubMed

    Scheifele, Lesa; Clark, John Greer; Scheifele, Peter M

    2012-11-01

    Dog owners and handlers are naturally concerned when suspicion of hearing loss arises for their dogs. Questions frequently asked of the veterinarian center on warning signs of canine hearing loss and what can be done for the dog if hearing loss is confirmed. This article addresses warning signs of canine hearing loss, communication training and safety awareness issues, and the feasibility of hearing aid amplification for dogs.

  1. Acute Vision Loss.

    PubMed

    Bagheri, Nika; Mehta, Sonia

    2015-09-01

    Acute vision loss can be transient (lasting <24 hours) or persistent (lasting >24 hours). When patients present with acute vision loss, it is important to ascertain the duration of vision loss and whether it is a unilateral process affecting one eye or a bilateral process affecting both eyes. This article focuses on causes of acute vision loss in the nontraumatic setting and provides management pearls to help health care providers better triage these patients. PMID:26319342

  2. Risk-adjusted capitation funding models for chronic disease in Australia: alternatives to casemix funding.

    PubMed

    Antioch, K M; Walsh, M K

    2002-01-01

    Under Australian casemix funding arrangements that use Diagnosis-Related Groups (DRGs) the average price is policy based, not benchmarked. Cost weights are too low for State-wide chronic disease services. Risk-adjusted Capitation Funding Models (RACFM) are feasible alternatives. A RACFM was developed for public patients with cystic fibrosis treated by an Australian Health Maintenance Organization (AHMO). Adverse selection is of limited concern since patients pay solidarity contributions via Medicare levy with no premium contributions to the AHMO. Sponsors paying premium subsidies are the State of Victoria and the Federal Government. Cost per patient is the dependent variable in the multiple regression. Data on DRG 173 (cystic fibrosis) patients were assessed for heteroskedasticity, multicollinearity, structural stability and functional form. Stepwise linear regression excluded non-significant variables. Significant variables were 'emergency' (1276.9), 'outlier' (6377.1), 'complexity' (3043.5), 'procedures' (317.4) and the constant (4492.7) (R(2)=0.21, SE=3598.3, F=14.39, Prob<0.0001. Regression coefficients represent the additional per patient costs summed to the base payment (constant). The model explained 21% of the variance in cost per patient. The payment rate is adjusted by a best practice annual admission rate per patient. The model is a blended RACFM for in-patient, out-patient, Hospital In The Home, Fee-For-Service Federal payments for drugs and medical services; lump sum lung transplant payments and risk sharing through cost (loss) outlier payments. State and Federally funded home and palliative services are 'carved out'. The model, which has national application via Coordinated Care Trials and by Australian States for RACFMs may be instructive for Germany, which plans to use Australian DRGs for casemix funding. The capitation alternative for chronic disease can improve equity, allocative efficiency and distributional justice. The use of Diagnostic Cost

  3. Loss of employment and mortality.

    PubMed Central

    Morris, J. K.; Cook, D. G.; Shaper, A. G.

    1994-01-01

    OBJECTIVE--To assess effect of unemployment and early retirement on mortality in a group of middle aged British men. DESIGN--Prospective cohort study (British Regional Heart Study). Five years after initial screening, information on employment experience was obtained with a postal questionnaire. SETTING--One general practice in each of 24 towns in Britain. SUBJECTS--6191 men aged 40-59 who had been continuously employed for at least five years before initial screening in 1978-80: 1779 experienced some unemployment or retired during the five years after screening, and 4412 remained continuously employed. MAIN OUTCOME MEASURE--Mortality during 5.5 years after postal questionnaire. RESULTS--Men who experienced unemployment in the five years after initial screening were twice as likely to die during the following 5.5 years as men who remained continuously employed (relative risk 2.13 (95% confidence interval 1.71 to 2.65). After adjustment for socioeconomic variables (town and social class), health related behaviour (smoking, alcohol consumption, and body weight), and health indicators (recall of doctor diagnoses) that had been assessed at initial screening the relative risk was slightly reduced, to 1.95 (1.57 to 2.43). Even men who retired early for reasons other than illness and who appeared to be relatively advantaged and healthy had a significantly increased risk of mortality compared with men who remained continuously employed (relative risk 1.87 (1.35 to 2.60)). The increased risk of mortality from cancer was similar to that of mortality from cardiovascular disease (adjusted relative risk 2.07 and 2.13 respectively). CONCLUSIONS--In this group of stably employed middle aged men loss of employment was associated with an increased risk of mortality even after adjustment for background variables, suggesting a causal effect. The effect was non-specific, however, with the increased mortality involving both cancer and cardiovascular disease. PMID:8173455

  4. Transition after Traumatic Loss

    ERIC Educational Resources Information Center

    Kuban, Caelan

    2011-01-01

    Children experience grief when they suffer the loss of a close relationship. When that loss also traumatizes children, they experience additional emotional reactions. It is important that adults educate themselves and others who deal with children about typical, healthy grief reactions. Following a non-violent loss, the initial reactions of…

  5. Proven Weight Loss Methods

    MedlinePlus

    Fact Sheet Proven Weight Loss Methods What can weight loss do for you? Losing weight can improve your health in a number of ways. It can lower ... at www.hormone.org/Spanish . Proven Weight Loss Methods Fact Sheet www.hormone.org

  6. Hearing loss in space

    NASA Technical Reports Server (NTRS)

    Buckey, J. C. Jr; Musiek, F. E.; Kline-Schoder, R.; Clark, J. C.; Hart, S.; Havelka, J.

    2001-01-01

    BACKGROUND: Temporary and, in some cases, permanent hearing loss has been documented after long-duration spaceflights. METHODS: We examined all existing published data on hearing loss after space missions to characterize the losses. RESULTS: Data from Russian missions suggest that the hearing loss, when it occurs, affects mainly mid to high frequencies and that using hearing protection often might prevent the loss. Several significant questions remain about hearing loss in space. While the hearing loss has been presumed to be noise-induced, no clear link has been established between noise exposure and hearing loss during spaceflight. In one documented case of temporary hearing loss from the Shuttle-Mir program, the pattern of loss was atypical for a noise-induced loss. Continuous noise levels that have been measured on the Mir and previous space stations, while above engineering standards, are not at levels usually associated with hearing loss in ground-based studies (which have usually been limited to 8-10 h exposure periods). Attempts to measure hearing in space using threshold-based audiograms have been unsuccessful in both the American and Russian programs due to noise interference with the measurements. CONCLUSIONS: The existing data highlight the need for reliable monitoring of both hearing and noise in long-duration spaceflight.

  7. Vision Loss in Older Adults.

    PubMed

    Pelletier, Allen L; Rojas-Roldan, Ledy; Coffin, Janis

    2016-08-01

    Vision loss affects 37 million Americans older than 50 years and one in four who are older than 80 years. The U.S. Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in adults older than 65 years. However, family physicians play a critical role in identifying persons who are at risk of vision loss, counseling patients, and referring patients for disease-specific treatment. The conditions that cause most cases of vision loss in older patients are age-related macular degeneration, glaucoma, ocular complications of diabetes mellitus, and age-related cataracts. Vitamin supplements can delay the progression of age-related macular degeneration. Intravitreal injection of a vascular endothelial growth factor inhibitor can preserve vision in the neovascular form of macular degeneration. Medicated eye drops reduce intraocular pressure and can delay the progression of vision loss in patients with glaucoma, but adherence to treatment is poor. Laser trabeculoplasty also lowers intraocular pressure and preserves vision in patients with primary open-angle glaucoma, but long-term studies are needed to identify who is most likely to benefit from surgery. Tight glycemic control in adults with diabetes slows the progression of diabetic retinopathy, but must be balanced against the risks of hypoglycemia and death in older adults. Fenofibrate also slows progression of diabetic retinopathy. Panretinal photocoagulation is the mainstay of treatment for diabetic retinopathy, whereas vascular endothelial growth factor inhibitors slow vision loss resulting from diabetic macular edema. Preoperative testing before cataract surgery does not improve outcomes and is not recommended. PMID:27479624

  8. Vision Loss in Older Adults.

    PubMed

    Pelletier, Allen L; Rojas-Roldan, Ledy; Coffin, Janis

    2016-08-01

    Vision loss affects 37 million Americans older than 50 years and one in four who are older than 80 years. The U.S. Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in adults older than 65 years. However, family physicians play a critical role in identifying persons who are at risk of vision loss, counseling patients, and referring patients for disease-specific treatment. The conditions that cause most cases of vision loss in older patients are age-related macular degeneration, glaucoma, ocular complications of diabetes mellitus, and age-related cataracts. Vitamin supplements can delay the progression of age-related macular degeneration. Intravitreal injection of a vascular endothelial growth factor inhibitor can preserve vision in the neovascular form of macular degeneration. Medicated eye drops reduce intraocular pressure and can delay the progression of vision loss in patients with glaucoma, but adherence to treatment is poor. Laser trabeculoplasty also lowers intraocular pressure and preserves vision in patients with primary open-angle glaucoma, but long-term studies are needed to identify who is most likely to benefit from surgery. Tight glycemic control in adults with diabetes slows the progression of diabetic retinopathy, but must be balanced against the risks of hypoglycemia and death in older adults. Fenofibrate also slows progression of diabetic retinopathy. Panretinal photocoagulation is the mainstay of treatment for diabetic retinopathy, whereas vascular endothelial growth factor inhibitors slow vision loss resulting from diabetic macular edema. Preoperative testing before cataract surgery does not improve outcomes and is not recommended.

  9. Associations Among Disaster Exposure, Intimate Relationship Adjustment, and PTSD Symptoms: Can Disaster Exposure Enhance a Relationship?

    PubMed Central

    Fredman, Steffany J.; Monson, Candice M.; Schumm, Jeremiah A.; Adair, Kathryn C.; Taft, Casey T.; Resick, Patricia A.

    2010-01-01

    This study examined associations among disaster characteristics, relationship adjustment, and posttraumatic stress disorder (PTSD) symptomatology 9 months postdisaster in 205 women exposed to extensive flooding. Bivariately, threat/harm and loss exposure dimensions were related to each other but differentially related to relationship adjustment and PTSD symptoms. Results from structural equation modeling revealed a positive and significant direct association between threat/harm and PTSD symptoms. Conversely, loss was not significantly associated with PTSD symptoms, but was positively and significantly associated with relationship adjustment. Relationship adjustment was negatively and significantly related to PTSD symptoms. These data suggest that some aspects of disaster exposure can have a mobilizing and positive effect on intimate relationships. In turn, positive intimate relationships may buffer individuals against PTSD symptoms. PMID:20623594

  10. Medical Device Safety

    MedlinePlus

    ... Vaccines, Blood & Biologics Animal & Veterinary Cosmetics Tobacco Products Medical Devices Home Medical Devices Medical Device Safety Medical Device Safety Share Tweet Linkedin Pin it More sharing ...

  11. Medical Renaissance.

    PubMed

    Toledo-Pereyra, Luis H

    2015-06-01

    The Medical Renaissance started as the regular Renaissance did in the early 1400s and ended in the late 1600s. During this time great medical personalities and scholar humanists made unique advances to medicine and surgery. Linacre, Erasmus, Leonicello and Sylvius will be considered first, because they fit the early classic Renaissance period. Andreas Vesalius and Ambroise Paré followed thereafter, making outstanding anatomical contributions with the publication of the "Human Factory" (1543) by Vesalius, and describing unique surgical developments with the publication of the "The Apologie and Treatise of Ambroise Paré." At the end of the Renaissance and beginning of the New Science, William Harvey, noted British medical doctor and cardiovascular researcher, discovered the general circulation. He published his findings in "The Motu Cordis" in 1628 (Figure 1). The Medical Renaissance, in summary, included a great number of accomplished physicians and surgeons who made especial contributions to human anatomy; Vesalius assembled detailed anatomical information; Paré advanced surgical techniques; and Harvey, a medical genius, detailed the circulatory anatomy and physiology. PMID:26065591

  12. Medical Renaissance.

    PubMed

    Toledo-Pereyra, Luis H

    2015-06-01

    The Medical Renaissance started as the regular Renaissance did in the early 1400s and ended in the late 1600s. During this time great medical personalities and scholar humanists made unique advances to medicine and surgery. Linacre, Erasmus, Leonicello and Sylvius will be considered first, because they fit the early classic Renaissance period. Andreas Vesalius and Ambroise Paré followed thereafter, making outstanding anatomical contributions with the publication of the "Human Factory" (1543) by Vesalius, and describing unique surgical developments with the publication of the "The Apologie and Treatise of Ambroise Paré." At the end of the Renaissance and beginning of the New Science, William Harvey, noted British medical doctor and cardiovascular researcher, discovered the general circulation. He published his findings in "The Motu Cordis" in 1628 (Figure 1). The Medical Renaissance, in summary, included a great number of accomplished physicians and surgeons who made especial contributions to human anatomy; Vesalius assembled detailed anatomical information; Paré advanced surgical techniques; and Harvey, a medical genius, detailed the circulatory anatomy and physiology.

  13. Interface Circuit for Vibration Energy Harvesting with Adjustable Bias Voltage

    NASA Astrophysics Data System (ADS)

    Wei, J.; Lefeuvre, E.; Mathias, H.; Costa, F.

    2015-12-01

    This paper presents a new interface circuit for electrostatic vibration energy harvesting with adjustable bias voltage. An electronic switch is used to modify the circuit configuration so that the harvested energy increases the voltage across a biasing capacitor. Decrease of this biasing capacitor voltage occurs naturally due to the circuit imperfections. Such a control of the bias voltage enables to adjust the amount of energy converted by the variable capacitor on each cycle. This feature can be used to optimize the mechanical damping induced by the energy conversion process in order to maximize the harvested power. Another feature of this interface circuit is that it is capable to get high bias voltage whatever the battery voltage with low energy loss.

  14. Magnetic field adjustment structure and method for a tapered wiggler

    SciTech Connect

    Halbach, Klaus

    1988-03-01

    An improved method and structure is disclosed for adjusting the magnetic field generated by a group of electromagnet poles spaced along the path of a charged particle beam to compensate for energy losses in the charged particles which comprises providing more than one winding on at least some of the electromagnet poles; connecting one respective winding on each of several consecutive adjacent electromagnet poles to a first power supply, and the other respective winding on the electromagnet pole to a different power supply in staggered order; and independently adjusting one power supply to independently vary the current in one winding on each electromagnet pole in a group whereby the magnetic field strength of each of a group of electromagnet poles may be changed in smaller increments.

  15. Magnetic field adjustment structure and method for a tapered wiggler

    SciTech Connect

    Halbach, Klaus

    1988-01-01

    An improved method and structure is disclosed for adjusting the magnetic field generated by a group of electromagnet poles spaced along the path of a charged particle beam to compensate for energy losses in the charged particles which comprises providing more than one winding on at least some of the electromagnet poles; connecting one respective winding on each of several consecutive adjacent electromagnet poles to a first power supply, and the other respective winding on the electromagnet pole to a different power supply in staggered order; and independently adjusting one power supply to independently vary the current in one winding on each electromagnet pole in a group whereby the magnetic field strength of each of a group of electromagnet poles may be changed in smaller increments.

  16. Magnetic field adjustment structure and method for a tapered wiggler

    SciTech Connect

    Halbach, K.

    1988-03-01

    An improved wiggler having means for adjusting the magnetic field generated by electromagnet poles spaced along the path of a charged particle beam to compensate for energy losses in the charge particles is described which comprises; (a) windings on at least some of the electromagnet poles in the wiggler; (b) one of the windings on each of a group of adjacent electromagnet poles connected to a first power supply, and another winding on the electromagnet poles having more than one winding connected to a second power supply; and (c) means for independently adjusting one power supply to independently vary the current in one of the windings on a group of adjacent electromagnet poles; whereby the magnetic field strength of a group of adjacent electromagnet poles in the wiggler may be changed in smaller increments.

  17. Hearing loss in shipyard employees

    PubMed Central

    Alexopoulos, Evangelos C.; Tsouvaltzidou, Thomaella

    2015-01-01

    Background: Noise-induced hearing loss (NIHL) is one of the most prevalent occupational illnesses, with a higher incidence in the heavy industry. Objectives of the Study: The aim of this study is to investigate the prevalence of NIHL in Greece and explore its correlations with other job and individual-related factors. Materials and Methods: Questionnaires were administered, and audiograms were conducted to 757 employees of a shipyard company in Greece, both white- and blue-collar, during the period 2006–2009. A modification of the 1979' equation of the American Academy of Otolaryngology was used to calculate hearing loss. Statistical analysis was conducted by means of the SPSS v. 17. Results: A 27.1% of the employees were hearing handicap. Hearing loss was correlated with age, past medical history of ear disease (Meniere's disease, acoustic neuroma, otosclerosis) or injury, hyperlipidemia, job title and level of education. A few questions on subjective hearing ability and symptoms showed strong discriminatory power of hearing pathology. Conclusions: The results of this study emphasize the burden of disease in the shipyard industry, and the need for continuous monitoring, implementation of preventive measures and hearing conservation programs. PMID:26023266

  18. [Crisis in medical ethics].

    PubMed

    Stellamor, K

    1996-01-01

    There is a disproportion between diagnostic and therapeutic medical achievements and the doctor/patient relationship. Are we allowed to do everything we are able to do in medicine? People are concerned and worried (genetic technology, invasive medicine, embryos in test tubes etc.). The crisis of ethics in medicine is evident. The analysis of the situation shows one of the causes in the shift of the paradigma-modern times to postmodern following scientific positivism-but also a loss of ethics in medicine due to an extreme secularism and to modern philosophical trends (Hans Jonas and the responsibility for the future and on the other hand modern utilitarism). PMID:9036685

  19. [Crisis in medical ethics].

    PubMed

    Stellamor, K

    1996-01-01

    There is a disproportion between diagnostic and therapeutic medical achievements and the doctor/patient relationship. Are we allowed to do everything we are able to do in medicine? People are concerned and worried (genetic technology, invasive medicine, embryos in test tubes etc.). The crisis of ethics in medicine is evident. The analysis of the situation shows one of the causes in the shift of the paradigma-modern times to postmodern following scientific positivism-but also a loss of ethics in medicine due to an extreme secularism and to modern philosophical trends (Hans Jonas and the responsibility for the future and on the other hand modern utilitarism).

  20. Curriculum in Canadian Medical Education

    PubMed Central

    Macleod, J. Wendell

    1963-01-01

    In general, its teaching curriculum reflects the history of a medical school's interaction with a series of pressures, such as the staggering advance of scientific knowledge and the social demand for greater security against hazards to the welfare of entire populations. Secondary consequences include the isolation of the scientist and loss of the overall view; decline in interest in teaching; depersonalization of medical care; hospital-centred instruction and loss of contact with the viewpoint of the community at the very time that it is demanding more attention. Compensating trends include: increasing confidence in scientific methods, team-work in teaching, the project method of teaching, comprehensive care clinics, and research in educational methods. The conclusion favours medical education that is devoted to the educational needs of the student, to the health needs of the individual patient and of the community, and to the advancement of knowledge and understanding. PMID:20327473

  1. Normalised flood losses in Europe: 1970-2006

    NASA Astrophysics Data System (ADS)

    Barredo, J. I.

    2009-02-01

    This paper presents an assessment of normalised flood losses in Europe for the period 1970-2006. Normalisation provides an estimate of the losses that would occur if the floods from the past take place under current societal conditions. Economic losses from floods are the result of both societal and climatological factors. Failing to adjust for time-variant socio-economic factors produces loss amounts that are not directly comparable over time, but rather show an ever-growing trend for purely socio-economic reasons. This study has used available information on flood losses from the Emergency Events Database (EM-DAT) and the Natural Hazards Assessment Network (NATHAN). Following the conceptual approach of previous studies, we normalised flood losses by considering the effects of changes in population, wealth, and inflation at the country level. Furthermore, we removed inter-country price differences by adjusting the losses for purchasing power parities (PPP). We assessed normalised flood losses in 31 European countries. These include the member states of the European Union, Norway, Switzerland, Croatia, and the Former Yugoslav Republic of Macedonia. Results show no detectable sign of human-induced climate change in normalised flood losses in Europe. The observed increase in the original flood losses is mostly driven by societal factors.

  2. Laparoscopic adjustable gastric banding. A prospective randomized study comparing the Swedish Adjustable Gastric Band and the MiniMizer Extra: one-year results

    PubMed Central

    Brimas, Gintautas; Strupas, Kęstutis

    2011-01-01

    Introduction A number of different adjustable gastric bands are available for laparoscopic adjustable gastric banding (LAGB). Few attempts have been made to compare the influence of band design differences for efficiency and complication rate and conflicting results have emerged from comparative studies. Aim To compare SAGB (Swedish Adjustable Gastric Band) and MiniMizer Extra adjustable gastric bands. Material and methods One hundred and three patients were included in the prospective randomized study. All patients underwent LAGB. The SAGB was used in 49 and MiniMizer Extra in 54 patients. The primary endpoint was weight loss, and secondary endpoints were complication rate, correction of co-morbidities and improvement of quality of life. Results There were no early complications. A significant difference in the proportion of patients who have reached good or excellent weight loss results (≥ 50% of initial excess body mass index loss) was found in favour of the MiniMizer Extra group (29.6% vs. 8.2%, p = 0.006). No difference was found in other weight loss parameters, resolution of co-morbidities and improvement of quality of life. One oesophageal dilatation and one leakage were diagnosed in the MiniMizer Extra group. Five band penetrations (9.3%) were diagnosed in the MiniMizer Extra group and no penetrations in the SAGB group (p = 0.069). Conclusions No major significant differences were found between the compared bands. Further results need to be confirmed by longer follow-up. PMID:23255982

  3. Medical Biofilms

    PubMed Central

    2009-01-01

    For more than two decades, Biotechnology and Bioengineering has documented research focused on natural and engineered microbial biofilms within aquatic and subterranean ecosystems, wastewater and waste-gas treatment systems, marine vessels and structures, and industrial bioprocesses. Compared to suspended culture systems, intentionally engineered biofilms are heterogeneous reaction systems that can increase reactor productivity, system stability, and provide inherent cell: product separation. Unwanted biofilms can create enormous increases in fluid frictional resistances, unacceptable reductions in heat transfer efficiency, product contamination, enhanced material deterioration, and accelerated corrosion. Missing from B&B has been an equivalent research dialogue regarding the basic molecular microbiology, immunology, and biotechnological aspects of medical biofilms. Presented here are the current problems related to medical biofilms; current concepts of biofilm formation, persistence, and interactions with the host immune system; and emerging technologies for controlling medical biofilms. PMID:18366134

  4. Strategies of enduring and the suffering of loss: modes of comfort used by a resilient survivor.

    PubMed

    Morse, J M; Carter, B J

    1995-04-01

    In this case study, the narrative of a young mother who survived multiple losses and excruciating and prolonged pain in the treatment of burns is explored to develop and contrast the concepts of enduring and suffering. Joan survived an explosion that resulted in the death of her three children, disfiguring thermal injuries, the loss of her husband through divorce, and, as a consequence, the loss of her home, church, and community. Strategies of enduring--surviving the immediate impact of trauma, the long-term medical treatment and rehabilitation, and social adjustment--are described and contrasted with the experience of suffering. The article describes how Joan ultimately reformulated an acceptable sense of self and of the future. Her capacity to endure pervaded both physical and emotional dimensions of healing. Nursing care that did not assist her to endure, and therefore increased her suffering, and care that was perceived to be comforting, and therefore enhanced her ability to endure and reduced her suffering, are described. PMID:7721967

  5. Medical leasing.

    PubMed

    Holden, Elizabeth A

    2012-01-01

    Leases for medical space can have far-reaching (and sometimes unintentional) consequences for the future of the practice and the costs of the business. In order to prevent hardship and expense down the line, it is especially important to review the lease to make sure that it reflects the practice's goals, needs, and structure. This article provides a number of provisions that are especially crucial to review and negotiate when leasing medical space, including use restrictions, assignment and subleasing clauses, build-out terms, and legal compliance requirements.

  6. Medical genetics

    SciTech Connect

    Jorde, L.B.; Carey, J.C.; White, R.L.

    1995-10-01

    This book on the subject of medical genetics is a textbook aimed at a very broad audience: principally, medical students, nursing students, graduate, and undergraduate students. The book is actually a primer of general genetics as applied to humans and provides a well-balanced introduction to the scientific and clinical basis of human genetics. The twelve chapters include: Introduction, Basic Cell Biology, Genetic Variation, Autosomal Dominant and Recessive Inheritance, Sex-linked and Mitochondrial Inheritance, Clinical Cytogenetics, Gene Mapping, Immunogenetics, Cancer Genetics, Multifactorial Inheritance and Common Disease, Genetic Screening, Genetic Diagnosis and Gene Therapy, and Clinical Genetics and Genetic Counseling.

  7. 75 FR 79348 - TRICARE; Formerly Known as the Civilian Health and Medical Program of the Uniformed Services...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-20

    ... of the applicable DRG-based payment rate plus any amounts payable for Indirect Medical Education... CMS uses hospital- specific cost-to-charge ratios. G. Indirect Medical Education (IDME) Adjustment... calculation of the indirect medical education (IDME) adjustment factor. Since the IDME formula used by...

  8. Physical, emotional and social adjustments to home dialysis.

    PubMed

    Brown, D J; Craick, C C; Davies, S E; Johnson, M L; Dawborn, J K; Heale, W F

    1978-03-11

    Forty home dialysis patients and their families were interviewed by means of a standard questionnaire to determine their physical, emotional, and social adjustment to treatment. The results indicated a reasonable level of health, particularly in patients under the age of 50 years. However, home dialysis produced considerable strain in the family, particularly in the dialysis partners. Home training programmes should provide appropriate learning and technical experience for the dialysis partners and continued support, including integrated medical and paramedical services, domiciliary visiting, and regular holidays. Limited-care dialysis facilities should be provided where home dialysis is impractical or becomes intolerable.

  9. Determination of spallation neutron flux through spectral adjustment techniques

    NASA Astrophysics Data System (ADS)

    Mosby, M. A.; Engle, J. W.; Jackman, K. R.; Nortier, F. M.; Birnbaum, E. R.

    2016-08-01

    The Los Alamos Isotope Production Facility (IPF) creates medical isotopes using a proton beam impinged on a target stack. Spallation neutrons are created in the interaction of the beam with target. The use of these spallation neutrons to produce additional radionuclides has been proposed. However, the energy distribution and magnitude of the flux is not well understood. A modified SAND-II spectral adjustment routine has been used with radioactivation foils to determine the differential neutron fluence for these spallation neutrons during a standard IPF production run.

  10. Use of the Satisfaction With Amplification in Daily Life Questionnaire to Assess Patient Satisfaction Following Remote Hearing Aid Adjustments (Telefitting)

    PubMed Central

    Bento, Ricardo Ferreira; Battistella, Linamara Rizzo

    2014-01-01

    Background Hearing loss can affect approximately 15% of the pediatric population and up to 40% of the adult population. The gold standard of treatment for hearing loss is amplification of hearing thresholds by means of a hearing aid instrument. A hearing aid is an electronic device equipped with a topology of only three major components of aggregate cost. The gold standard of hearing aid fittings is face-to-face appointments in hearing aid centers, clinics, or hospitals. Telefitting encompasses the programming and adjustments of hearing aid settings remotely. Fitting hearing aids remotely is a relatively simple procedure, using minimal computer hardware and Internet access. Objective This project aimed to examine the feasibility and outcomes of remote hearing aid adjustments (telefitting) by assessing patient satisfaction via the Portuguese version of the Satisfaction With Amplification in Daily Life (SADL) questionnaire. Methods The Brazilian Portuguese version of the SADL was used in this experimental research design. Participants were randomly selected through the Rehabilitation Clinical (Espaco Reouvir) of the Otorhinolaryngology Department Medical School University of Sao Paulo. Of the 8 participants in the study, 5 were female and 3 were male, with a mean age of 71.5 years. The design consisted of two face-to-face sessions performed within 15 working days of each other. The remote assistance took place 15 days later. Results The average scores from this study are above the mean scores from the original SADL normative data. These indicate a high level of satisfaction in participants who were fitted remotely. Conclusions The use of an evaluation questionnaire is a simple yet effective method to objectively assess the success of a remote fitting. Questionnaire outcomes can help hearing stakeholders improve the National Policy on Hearing Health Care in Brazil. The results of this project indicated that patient satisfaction levels of those fitted remotely were

  11. Exploration adjustment by ant colonies

    PubMed Central

    2016-01-01

    How do animals in groups organize their work? Division of labour, i.e. the process by which individuals within a group choose which tasks to perform, has been extensively studied in social insects. Variability among individuals within a colony seems to underpin both the decision over which tasks to perform and the amount of effort to invest in a task. Studies have focused mainly on discrete tasks, i.e. tasks with a recognizable end. Here, we study the distribution of effort in nest seeking, in the absence of new nest sites. Hence, this task is open-ended and individuals have to decide when to stop searching, even though the task has not been completed. We show that collective search effort declines when colonies inhabit better homes, as a consequence of a reduction in the number of bouts (exploratory events). Furthermore, we show an increase in bout exploration time and a decrease in bout instantaneous speed for colonies inhabiting better homes. The effect of treatment on bout effort is very small; however, we suggest that the organization of work performed within nest searching is achieved both by a process of self-selection of the most hard-working ants and individual effort adjustment. PMID:26909180

  12. Psychosocial adjustment to recurrent cancer.

    PubMed

    Mahon, S M; Cella, D F; Donovan, M I

    1990-01-01

    This descriptive study of the perceptions and needs of people with recurrent malignancies asks three questions: How do patients describe the meaning of a recurrence of cancer? Do individuals perceive the diagnosis of recurrence and the initial diagnosis of cancer differently? What are the key psychosocial problems associated with recurrent cancer? The theoretical framework was based on Lazarus and Folkman's theory of stress, appraisal, and coping. Subjects completed the Impact of Event Scale (IES), the Psychosocial Adjustment to Illness Scale--Self-Report (PAIS), and a semistructured qualitative interview. The interview elicited perceptions of the event of recurrence and differences between the diagnosis of recurrence and the initial diagnosis. The convenience sample included 40 patients diagnosed with recurrent cancer within the last 30 days. Many subjects (78%) reported that the recurrence was more upsetting than the initial diagnosis. Scores on both the IES and the PAIS were high when compared to normative samples of patients with cancer suggesting that this sample of patients experienced a lot of psychological distress as well as problems at home, work, and in their social lives. These concerns often were unknown to caregivers. Although more research is needed, the authors propose that, with more accurate assessment, more effective intervention could be implemented and the quality of life improved for patients with recurrent cancer.

  13. Functional Visual Loss

    PubMed Central

    Bruce, Beau B; Newman, Nancy J

    2010-01-01

    Synopsis Neurologists frequently evaluate patients complaining of vision loss, especially when the patient has been examined by an ophthalmologist who has found no ocular disease. A significant proportion of patients presenting to the neurologist with visual complaints will have non-organic or functional visual loss. While there are examination techniques which can aid in the detection and diagnosis of functional visual loss, the frequency with which functional visual loss occurs concomitantly with organic disease warrants substantial caution on the part of the clinician. Furthermore, purely functional visual loss is never a diagnosis of exclusion, and must be supported by positive findings on examination that demonstrate normal visual function. The relationship of true psychological disease and functional visual loss is unclear and most patients respond well to simple reassurance. PMID:20638000

  14. Medical marijuana.

    PubMed

    Marmor, J B

    1998-06-01

    Although many clinical studies suggest the medical utility of marijuana for some conditions, the scientific evidence is weak. Many patients in California are self-medicating with marijuana, and physicians need data to assess the risks and benefits. The only reasonable solution to this problem is to encourage research on the medical effects of marijuana. The current regulatory system should be modified to remove barriers to clinical research with marijuana. The NIH panel has identified several conditions for which there may be therapeutic benefit from marijuana use and that merit further research. Marijuana should be held to the same evaluation standards of safety and efficacy as other drugs (a major flaw in Proposition 215) but should not have to be proved better than current medications for its use to be adopted. The therapeutic window for marijuana and THC between desired effect and unpleasant side effects is narrow and is a major reason for discontinuing use. Although the inhaled route of administration has the benefit of allowing patients to self-titrate the dose, the smoking of crude plant material is problematic. The NIH panel recommended that a high priority be given to the development of a controlled inhaled form of THC. The presence of a naturally occurring cannabinoid-receptor system in the brain suggests that research on selective analogues of THC may be useful to enhance its therapeutic effects and minimize adverse effects.

  15. Medical genetics

    SciTech Connect

    Nora, J.J.; Fraser, F.C.

    1989-01-01

    This book presents a discussion of medical genetics for the practitioner treating or counseling patients with genetic disease. It includes a discussion of the relationship of heredity and diseases, the chromosomal basis for heredity, gene frequencies, and genetics of development and maldevelopment. The authors also focus on teratology, somatic cell genetics, genetics and cancer, genetics of behavior.

  16. Debt and foregone medical care.

    PubMed

    Kalousova, Lucie; Burgard, Sarah A

    2013-06-01

    Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession. Overall debt and ratios of debt to income and debt to assets were positively associated with foregoing medical or dental care in the past 12 months, even after adjusting for the poorer socioeconomic and health characteristics of those foregoing care and for respondents' household incomes and net worth. These overall associations were driven largely by credit card and medical debt, while housing debt and automobile and student loans were not associated with foregoing care. These results suggest that debt is an understudied aspect of health stratification.

  17. Plasmonics: Loss and gain

    NASA Astrophysics Data System (ADS)

    Oulton, Rupert F.

    2012-04-01

    Providing sufficient gain to overcome loss remains a fundamental challenge for light amplification in miniaturized plasmonic devices. Ongoing research gives hope for a cautious but optimistic outlook.

  18. Ergonomic evaluation of the Apple Adjustable Keyboard

    SciTech Connect

    Tittiranonda, P.; Burastero, S.; Shih, M.; Rempel, D.

    1994-05-01

    This study presents an evaluation of the Apple Adjustable Keyboard based on subjective preference and observed joint angles during typing. Thirty five keyboard users were asked to use the Apple adjustable keyboard for 7--14 days and rate the various characteristics of the keyboard. Our findings suggest that the most preferred opening angles range from 11--20{degree}. The mean ulnar deviation on the Apple Adjustable keyboard is 11{degree}, compared to 16{degree} on the standard keyboard. The mean extension was decreased from 24{degree} to 16{degree} when using the adjustable keyboard. When asked to subjectively rate the adjustable keyboard in comparison to the standard, the average subject felt that the Apple Adjustable Keyboard was more comfortable and easier to use than the standard flat keyboard.

  19. Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine.

    PubMed

    Solak, Yalcin; Biyik, Zeynep; Gaipov, Abduzhappar; Kayrak, Mehmet; Ciray, Hilal; Cizmecioglu, Ahmet; Tonbul, Halil Zeki; Turk, Suleyman

    2016-01-01

    Many drugs that are administered during hospitalization are metabolized or excreted through kidneys, consequently require dosage adjustment. We aimed to investigate inappropriate prescription of drugs requiring renal dose adjustment (RDA) in various surgical and medical inpatient clinics. We retrospectively determined dialysis patients hospitalized between January 2007 and December 2010. Inpatient clinics, including cardiology, pulmonary medicine, neurology, infectious diseases (medical clinics) and cardiovascular surgery, orthopedics, general surgery, obstetrics and gynecology, and neurosurgery (surgical clinics), were screened via electronic database. Total and RDA medications were determined. RDA drugs correctly adjusted to creatinine clearance were labeled as RDA-A (appropriate), otherwise as RDA-I (inappropriate). Renal doses of RDA medications were based on the "American College of Physicians Drug Prescribing in Renal Failure, fifth Edition." Two hundred seventeen hospitalization records of 172 dialysis patients (92 men and 80 women) were included in the analysis. Mean age of patients was 59.4 ± 14.6 years, and the mean hospitalization duration was 8.5 ± 7.8 days. In total, 247 (84.3%, percentage in drugs requiring dose adjustment) and 175 (46.2%) drugs have been inadequately dosed in surgical and medical clinics, respectively. The percentage of patients to whom at least 1 RDA-I drug was ordered was 92% and 91.4% for surgical and medical clinics, respectively (P > 0.05). Nephrology consultation numbers were 8 (7.1%) in surgical and 32 (30.4%) in medical clinics. The most common RDA-I drugs were aspirin and famotidine. A significant portion of RDA drugs was ordered inappropriately both in surgical and medical clinics. Nephrology consultation rate was very low. Measures to increase physician awareness are required to improve results.

  20. Three-dimensional adjustment of trilateration data

    NASA Technical Reports Server (NTRS)

    Sung, L.-Y.; Jackson, D. D.

    1985-01-01

    The three-dimensional locations of the monuments in the USGS Hollister trilateration network were adjusted to fit line length observations observed in 1977, using a Bayesian approach, and incorporating prior elevation estimates as data in the adjustment procedure. No significant discrepancies in the measured line lengths were found, but significant elevation adjustments (up to 1.85 m) were needed to fit the length data.

  1. Techniques and applications of adjustable sutures.

    PubMed

    Fells, P

    1987-02-01

    The 'rediscovery' of adjustable sutures some 10 years ago has given the ophthalmic surgeon much more confidence in his ability to correct strabismus. Three methods of use are described: during surgery under general anaesthesia with adjustment during the operation using the 'springback' test to centralise the eye; during surgery under general anaesthesia and subsequent adjustment under local anaesthesia using the patient's subjective responses to obtain optimal positioning; and performance of the operation and adjustment under topical local anaesthesia in one procedure. Full details are given of each technique and the indications for their application to particular problems are discussed. PMID:3297111

  2. Marital conflict, divorce, and children's adjustment.

    PubMed

    Kelly, J B

    1998-04-01

    This article summarizes current research on children's adjustment after separation and divorce, and then focuses on the contributions of marital conflict, marital violence, and hostile family environments to children's adjustment during marriage and after divorce. Children living in marriages with frequent and intense conflict are significantly more likely to have substantial adjustment problems before parental divorce and compromised parent-child relationships. These findings suggest that the deleterious effects of divorce per se have been overstated, with insufficient attention paid in the clinical and research literature to the damaging effects of highly troubled marriages on children's adjustment.

  3. Energy losses in switches

    SciTech Connect

    Martin, T.H.; Seamen, J.F.; Jobe, D.O.

    1993-07-01

    The authors experiments show energy losses between 2 and 10 times that of the resistive time predictions. The experiments used hydrogen, helium, air, nitrogen, SF{sub 6} polyethylene, and water for the switching dielectric. Previously underestimated switch losses have caused over predicting the accelerator outputs. Accurate estimation of these losses is now necessary for new high-efficiency pulsed power devices where the switching losses constitute the major portion of the total energy loss. They found that the switch energy losses scale as (V{sub peak}I{sub peak}){sup 1.1846}. When using this scaling, the energy losses in any of the tested dielectrics are almost the same. This relationship is valid for several orders of magnitude and suggested a theoretical basis for these results. Currents up to .65 MA, with voltages to 3 MV were applied to various gaps during these experiments. The authors data and the developed theory indicates that the switch power loss continues for a much longer time than the resistive time, with peak power loss generally occurring at peak current in a ranging discharge instead of the early current time. All of the experiments were circuit code modeled after developing a new switch loss version based on the theory. The circuit code predicts switch energy loss and peak currents as a function of time. During analysis of the data they noticed slight constant offsets between the theory and data that depended on the dielectric. They modified the plasma conductivity for each tested dielectric to lessen this offset.

  4. Income inequality and tooth loss in the United States.

    PubMed

    Bernabé, E; Marcenes, W

    2011-06-01

    This study explored the relationship between state income inequality and individual tooth loss among 386,629 adults in the United States who participated in the 2008 Behavioral and Risk Factor Surveillance System. Multilevel models were used to test the association of the state Gini coefficient with tooth loss after sequential adjustment for state- (median household income) and individual-level confounders (sex, age, race, education, and household income), as well as state- (percent receiving fluoridated water and dentist-to-population ratio) and individual-level mediators (marital status and last dental visit). The state Gini coefficient was significantly associated with tooth loss even after adjustment for state- and individual-level confounders and potential mediators (Odds Ratio, 1.17; 95% Confidence Interval, 1.05 to 1.30). This study provides support for the relationship between state income inequality and individual tooth loss in the United States.

  5. Understanding Grief & Loss.

    ERIC Educational Resources Information Center

    Parker, Judith

    1995-01-01

    Although death is the one certainty in life, death or the grieving process is rarely discussed. Grief includes physical, emotional, spiritual, and psychological reactions to loss, and is not limited to feelings about death. Grief can be the response to loss of home or country, separation or displacement, and changes resulting from new life stages.…

  6. Hearing loss and music

    MedlinePlus

    Noise induced hearing loss - music; Sensory hearing loss - music ... talking is 40 dB to 60 dB. A rock concert is between 110 dB and 120 ... when listening to music depends on: How loud the music is How ...

  7. Hereditary Hearing Loss.

    ERIC Educational Resources Information Center

    Tran, LenhAnh P.; Grundfast, Kenneth M.

    1997-01-01

    This article discusses inheritance patterns in hearing loss, epidemiology, clues to genetic causes, locating genes that cause hereditary disorders, genes related to hearing loss disorders in individuals with Usher syndrome, Waardenburg syndrome, Treacher-Collins syndrome, Branchio-oto-renal and Pendred syndromes, and the significance of finding…

  8. Hearing Loss and Cytomegalovirus.

    ERIC Educational Resources Information Center

    Strauss, Melvin

    1997-01-01

    Cytomegalovirus is the most common cause of congenital virally induced hearing loss. Maternal infection is most often asymptomatic as is the infection in the newborn. Hearing loss occurs in both clinically apparent infection and in the asymptomatic infection. Current methods of detection, treatment, and prevention and research efforts are…

  9. Help! It's Hair Loss!

    MedlinePlus

    ... Homework? Here's Help White House Lunch Recipes Help! It's Hair Loss! KidsHealth > For Kids > Help! It's Hair Loss! Print A A A Text Size ... part above the skin, is dead. (That's why it doesn't hurt to get a haircut!) This ...

  10. CEBAF beam loss accounting

    SciTech Connect

    Ursic, R.; Mahoney, K.; Hovater, C.; Hutton, A.; Sinclair, C.

    1995-12-31

    This paper describes the design and implementation of a beam loss accounting system for the CEBAF electron accelerator. This system samples the beam curent throughout the beam path and measures the beam current accurately. Personnel Safety and Machine Protection systems use this system to turn off the beam when hazardous beam losses occur.

  11. Understanding Rural Population Loss.

    ERIC Educational Resources Information Center

    McGranahan, David A.; Beale, Calvin L.

    2002-01-01

    A quarter of nonmetro counties lost population in the 1990s, but population loss was not related to poverty rate or low educational levels, perhaps because low-skill workers can no longer expect better wages in urban areas. Population loss was related to low population density and remoteness (which decrease access to services), lack of natural…

  12. Female pattern hair loss: Current treatment concepts

    PubMed Central

    Dinh, Quan Q; Sinclair, Rodney

    2007-01-01

    Fewer than 45% of women go through life with a full head of hair. Female pattern hair loss is the commonest cause of hair loss in women and prevalence increases with advancing age. Affected women may experience psychological distress and impaired social functioning. In most cases the diagnosis can be made clinically and the condition treated medically. While many women using oral antiandrogens and topical minoxidil will regrow some hair, early diagnosis and initiation of treatment is desirable as these treatments are more effective at arresting progression of hair loss than stimulating regrowth. Adjunctive nonpharmacological treatment modalities such as counseling, cosmetic camouflage and hair transplantation are important measures for some patients. The histology of female pattern hair loss is identical to that of male androgenetic alopecia. While the clinical pattern of the hair loss differs between men, the response to oral antiandrogens suggests that female pattern hair loss is an androgen dependant condition, at least in the majority of cases. Female pattern hair loss is a chronic progressive condition. All treatments need to be continued to maintain the effect. An initial therapeutic response often takes 12 or even 24 months. Given this delay, monitoring for treatment effect through clinical photography or standardized clinical severity scales is helpful. PMID:18044135

  13. Implications of Sensorineural Hearing Loss With Hydrocodone/Acetaminophen Abuse

    PubMed Central

    Novac, Andrei; Iosif, Anamaria M.; Groysman, Regina; Bota, Robert G.

    2015-01-01

    Sensorineural hearing loss is an infrequently recognized side effect of pain medication abuse. Chronic pain patients treated with opiates develop different degrees of tolerance to pain medications. In many cases, the tolerance becomes the gateway to a variety of cycles of overuse and unmasking of significant psychiatric morbidity and mortality. An individualized approach utilizing combined treatment modalities (including nonopiate pharmaceuticals) is expected to become the norm. Patients can now be provided with multidisciplinary care that addresses an individual’s psychiatric, social, and medical needs, which requires close cooperation between physicians of varying specialties. This report describes a patient who experienced hearing loss from hydrocodone/acetaminophen abuse. PMID:26835162

  14. Implications of Sensorineural Hearing Loss With Hydrocodone/Acetaminophen Abuse.

    PubMed

    Novac, Andrei; Iosif, Anamaria M; Groysman, Regina; Bota, Robert G

    2015-01-01

    Sensorineural hearing loss is an infrequently recognized side effect of pain medication abuse. Chronic pain patients treated with opiates develop different degrees of tolerance to pain medications. In many cases, the tolerance becomes the gateway to a variety of cycles of overuse and unmasking of significant psychiatric morbidity and mortality. An individualized approach utilizing combined treatment modalities (including nonopiate pharmaceuticals) is expected to become the norm. Patients can now be provided with multidisciplinary care that addresses an individual's psychiatric, social, and medical needs, which requires close cooperation between physicians of varying specialties. This report describes a patient who experienced hearing loss from hydrocodone/acetaminophen abuse. PMID:26835162

  15. Medical imaging

    NASA Astrophysics Data System (ADS)

    Elliott, Alex

    2005-07-01

    Diagnostic medical imaging is a fundamental part of the practice of modern medicine and is responsible for the expenditure of considerable amounts of capital and revenue monies in healthcare systems around the world. Much research and development work is carried out, both by commercial companies and the academic community. This paper reviews briefly each of the major diagnostic medical imaging techniques—X-ray (planar and CT), ultrasound, nuclear medicine (planar, SPECT and PET) and magnetic resonance. The technical challenges facing each are highlighted, with some of the most recent developments. In terms of the future, interventional/peri-operative imaging, the advancement of molecular medicine and gene therapy are identified as potential areas of expansion.

  16. Asymmetric and Unilateral Hearing Loss in Children

    PubMed Central

    Vila, Peter; Lieu, Judith E. C.

    2015-01-01

    Asymmetric and unilateral hearing losses in children have traditionally been underappreciated, but health care practitioners are now beginning to understand their effect on development and the underlying pathophysiologic mechanisms. The common wisdom among medical and educational professionals has been that at least one normal hearing or near-normal hearing ear was sufficient for typical speech and language development in children. The objective of this review is to illustrate to the non-otolaryngologist the consequences of asymmetric and unilateral hearing loss in children on developmental and educational outcomes. In the process, etiology, detection, and management are discussed. Lastly, implications for further research are considered. PMID:26004144

  17. Precision Adjustable Liquid Regulator (ALR)

    NASA Astrophysics Data System (ADS)

    Meinhold, R.; Parker, M.

    2004-10-01

    A passive mechanical regulator has been developed for the control of fuel or oxidizer flow to a 450N class bipropellant engine for use on commercial and interplanetary spacecraft. There are several potential benefits to the propulsion system, depending on mission requirements and spacecraft design. This system design enables more precise control of main engine mixture ratio and inlet pressure, and simplifies the pressurization system by transferring the function of main engine flow rate control from the pressurization/propellant tank assemblies, to a single component, the ALR. This design can also reduce the thermal control requirements on the propellant tanks, avoid costly Qualification testing of biprop engines for missions with more stringent requirements, and reduce the overall propulsion system mass and power usage. In order to realize these benefits, the ALR must meet stringent design requirements. The main advantage of this regulator over other units available in the market is that it can regulate about its nominal set point to within +/-0.85%, and change its regulation set point in flight +/-4% about that nominal point. The set point change is handled actively via a stepper motor driven actuator, which converts rotary into linear motion to affect the spring preload acting on the regulator. Once adjusted to a particular set point, the actuator remains in its final position unpowered, and the regulator passively maintains outlet pressure. The very precise outlet regulation pressure is possible due to new technology developed by Moog, Inc. which reduces typical regulator mechanical hysteresis to near zero. The ALR requirements specified an outlet pressure set point range from 225 to 255 psi, and equivalent water flow rates required were in the 0.17 lb/sec range. The regulation output pressure is maintained at +/-2 psi about the set point from a P (delta or differential pressure) of 20 to over 100 psid. Maximum upstream system pressure was specified at 320 psi

  18. [Inner Ear Hearing Loss].

    PubMed

    Hesse, G

    2016-06-01

    Hearing loss is one of the most dominant handicaps in modern societies, which additionally very often is not realized or not admitted. About one quarter of the general population suffers from inner ear hearing loss and is therefore restricted in communicational skills. Demographic factors like increasing age play an important role as well as environmental influences and an increasing sound and noise exposure especially in leisure activities. Thus borders between a "classical" presbyacusis - if it ever existed - and envirionmentally induced hearing loss disappear. Today restrictions in hearing ability develop earlier in age but at the same time they are detected and diagnosed earlier. This paper can eventually enlighten the wide field of inner ear hearing loss only fragmentarily; therefore mainly new research, findings and developments are reviewed. The first part discusses new aspects of diagnostics of inner ear hearing loss and different etiologies. PMID:27259171

  19. Medicare Part B income-related monthly adjustment amount. Final rules.

    PubMed

    2006-10-27

    We are adding to our regulations a new subpart, Medicare Part B Income-Related Monthly Adjustment Amount, to contain the rules we will follow for Medicare Part B income-related monthly adjustment amount determinations. The monthly adjustment amount represents the amount of decrease in the Medicare Part B premium subsidy, i.e. the amount of the Federal Government's contribution to the Federal Supplementary Medical Insurance (SMI) Trust Fund. This new subpart implements section 811 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the Medicare Modernization Act or MMA) and contains the rules for determining when, based on income, a monthly adjustment amount will be added to a Medicare Part B beneficiary's standard monthly premium. These final rules describe: What the new subpart is about; what information we will use to determine whether you will pay an income-related monthly adjustment amount and the amount of the adjustment when applicable; when we will consider a major life-changing event that results in a significant reduction in your modified adjusted gross income; and how you can appeal our determination about your income-related monthly adjustment amount.

  20. Sensitivity Analysis of the Integrated Medical Model for ISS Programs

    NASA Technical Reports Server (NTRS)

    Goodenow, D. A.; Myers, J. G.; Arellano, J.; Boley, L.; Garcia, Y.; Saile, L.; Walton, M.; Kerstman, E.; Reyes, D.; Young, M.

    2016-01-01

    Sensitivity analysis estimates the relative contribution of the uncertainty in input values to the uncertainty of model outputs. Partial Rank Correlation Coefficient (PRCC) and Standardized Rank Regression Coefficient (SRRC) are methods of conducting sensitivity analysis on nonlinear simulation models like the Integrated Medical Model (IMM). The PRCC method estimates the sensitivity using partial correlation of the ranks of the generated input values to each generated output value. The partial part is so named because adjustments are made for the linear effects of all the other input values in the calculation of correlation between a particular input and each output. In SRRC, standardized regression-based coefficients measure the sensitivity of each input, adjusted for all the other inputs, on each output. Because the relative ranking of each of the inputs and outputs is used, as opposed to the values themselves, both methods accommodate the nonlinear relationship of the underlying model. As part of the IMM v4.0 validation study, simulations are available that predict 33 person-missions on ISS and 111 person-missions on STS. These simulated data predictions feed the sensitivity analysis procedures. The inputs to the sensitivity procedures include the number occurrences of each of the one hundred IMM medical conditions generated over the simulations and the associated IMM outputs: total quality time lost (QTL), number of evacuations (EVAC), and number of loss of crew lives (LOCL). The IMM team will report the results of using PRCC and SRRC on IMM v4.0 predictions of the ISS and STS missions created as part of the external validation study. Tornado plots will assist in the visualization of the condition-related input sensitivities to each of the main outcomes. The outcomes of this sensitivity analysis will drive review focus by identifying conditions where changes in uncertainty could drive changes in overall model output uncertainty. These efforts are an integral

  1. Medical Applications

    NASA Astrophysics Data System (ADS)

    Boccara, A. Claude; Mordon, Serge

    2015-10-01

    In re-listening to the lectures of Charles Townes shortly after the invention of the laser (e.g., in the Boston Science Museum), one can already have a realistic vision of the potentialities of this new tool in the field of medical therapy, as evidenced by the use of the laser in ophthalmology to cure retinal detachment in the 1960's. Since then, applications have flourished in the domain of therapy. We will thus illustrate here only some of the main fields of application of medical lasers. On the opposite, the use of lasers in medical imaging is, with one exception in ophthalmology, still at the development level. It is becoming a diagnostic tool in addition to high performance imaging facilities that are often very expensive (such as CT scan, Magnetic Resonance Imaging (MRI) and nuclear imaging). Even if progress is sometimes slow, one can now image with light inside the human body, in spite of the strong scattering of light by tissues, in the same way as a pathologist sees surgical specimens.

  2. Medical Telemetry

    NASA Technical Reports Server (NTRS)

    1978-01-01

    Telemetry is the process whereby physiological or other data is acquired by instruments, translated into radio signals and j sent to a receiving station where the signals are decoded and recorded. Extensively used in I space operations, it is finding new Earth applications, among them transmission of medical data between emergency vehicles and hospitals. For example, transmission of an electrocardiogram from an ambulance to a hospital enables a physician to read the telemetered EKG and advise ambulance attendants on emergency procedures. Central Medical Emergency Dispatch (CMED) operates as a regional emergency medical communications center for Cleveland, Ohio and Cuyahoga County. The CMED system includes radio and telephone communications from hospital-to-hospital and from ambulance-to-hospital, but for improved emergency life support CMED sought to add a county-wide telemetry capability. The problem was that there were only eight radio frequencies available for telemetry and there were more than 30 potential users in Cleveland alone. NASA's Lewis Research Center volunteered its expert assistance. The Center's engineers studied the systems of other telemetry using cities, surveyed area hospitals to assure compatibility of telemetry equipment, and advised what types of equipment would be needed in emergency vehicles and at the various hospitals. The Lewis plan suggested that CMED be designated the central coordinating agency for the Cuyahoga County system, monitoring all telemetry frequencies and, when requested, assigning one not in use or one to be used at a sufficient distance that it would create no interference problem.

  3. 42 CFR 423.2420 - Calculation of medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... current conditions such as changes in exposure, claim frequency or severity. (v) Changes in other claims... ceding Part D sponsor. (6) Reinsured incurred claims for a block of business that was subject to... administration of the block, must be reported by the assuming issuer and must not be reported by the...

  4. 75 FR 30693 - Revised Medical Criteria for Evaluating Hearing Loss

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-02

    ... available on the date of publication in the Federal Register at http://www.gpoaccess.gov/fr/index.html... published in the Federal Register on August 13, 2008 (73 FR 47103). The preamble to the NPRM discussed the... rules revising the listings for visual disorders in the Federal Register on November 20, 2006 (71...

  5. Loss of work productivity due to illness and medical treatment.

    PubMed

    Cockburn, I M; Bailit, H L; Berndt, E R; Finkelstein, S N

    1999-11-01

    We examined the effects on work productivity of treatment with antihistamines in a retrospective study using linked health claims data and daily work output records for a sample of nearly 6000 claims processors at a large insurance company, between 1993 and 1995. We explained the variation in work output depending on the subjects' demographic characteristics, their jobs, and whether they were treated with "sedating" versus "nonsedating" antihistamines for nasal allergies. Differences of up to 13% in productivity were found after the subjects took sedating or nonsedating antihistamines. The observed effect suggests substantial indirect economic costs, which up to now have been largely overlooked because work productivity has proved difficult to measure objectively. PMID:10570499

  6. Psychosocial adjustment and adherence to dialysis treatment regimes.

    PubMed

    Brownbridge, G; Fielding, D M

    1994-12-01

    Sixty children and adolescents in end-stage renal failure who were undergoing either haemodialysis or continuous ambulatory peritoneal dialysis at one of five United Kingdom dialysis centres were assessed on psychosocial adjustment and adherence to their fluid intake, diet and medication regimes. Parental adjustment was also measured and data on sociodemographic and treatment history variables collected. A structured family interview and standardised questionnaire measures of anxiety, depression and behavioural disturbance were used. Multiple measures of treatment adherence were obtained, utilising children's and parents' self-reports, weight gain between dialysis, blood pressure, serum potassium level, blood urea level, dietitians' surveys and consultants' ratings. Correlational analyses showed that low treatment adherence was associated with poor adjustment to diagnosis and dialysis by children and parents (P < 0.01), self-ratings of anxiety and depression in children and parents (P < 0.001), age (adolescents tended to show poorer adherence than younger children, P < 0.001), duration of dialysis (P < 0.05), low family socioeconomic status (P < 0.05) and family structure (P < 0.01). These findings demonstrate the importance of psychosocial care in the treatment of this group of children. Future research should develop and evaluate psychosocial interventions aimed at improving treatment adherence.

  7. Adaptation and adjustment in children of transsexual parents.

    PubMed

    White, Tonya; Ettner, Randi

    2007-06-01

    It is a relatively uncommon event that children find themselves in a situation with a parent who undergoes a transition from one sex to another. Unlike situations of divorce or a parent with a medical or major psychiatric disorder, it is unlikely that the children will know of other children who encounter similar situations. There is very little literature that describes the adjustment of these children and the nature of their relationships with their parents and peers. Such information would be beneficial for clinicians assisting children and families in this situation. To better delineate the adjustment of these children, we interviewed 27 parents of 55 children. The interview took place on average 6 years after the gender transition. The measures obtained included the parent and child relationships at present and also at the time of the transition. We also inquired about academic function, peer relationships and social stigma. The results found that children who were younger at the time of the parent's transition tended to have better relationships and less adjustment difficulties. In addition, parental conflict that continues after the transition period tends to reflect greater family conflict between the transitioned parent and their child.

  8. Misconceiving medical leadership.

    PubMed

    Parker, Malcolm

    2013-01-01

    Medical leadership and leadership education have recently emerged as subjects of an expanding though as yet uncritical literature. Considerable attention is being given to the development of courses and electives, together with some proposals for generalizing these offerings to all medical students and doctors. This article briefly sketches this development and its derivation from business and corporate leadership models and accompanying literature, and subjects its adoption by medicine to critical scrutiny. Putative motivations for these developments are discussed, and an alternative explanation is offered, tied to the loss of physician status. The nature of leadership as complex, emergent, and unpredictable has been ignored in the promotion of medical leadership and leadership training, and this is reflected in the false assumption that leadership in medicine is something that can be taught. Although the leadership literature is beginning to recognize these complex aspects of leadership, so far their implications have not been acknowledged. This article aims to stimulate further analytic discussion of this under-theorized aspect of medicine.

  9. Misconceiving medical leadership.

    PubMed

    Parker, Malcolm

    2013-01-01

    Medical leadership and leadership education have recently emerged as subjects of an expanding though as yet uncritical literature. Considerable attention is being given to the development of courses and electives, together with some proposals for generalizing these offerings to all medical students and doctors. This article briefly sketches this development and its derivation from business and corporate leadership models and accompanying literature, and subjects its adoption by medicine to critical scrutiny. Putative motivations for these developments are discussed, and an alternative explanation is offered, tied to the loss of physician status. The nature of leadership as complex, emergent, and unpredictable has been ignored in the promotion of medical leadership and leadership training, and this is reflected in the false assumption that leadership in medicine is something that can be taught. Although the leadership literature is beginning to recognize these complex aspects of leadership, so far their implications have not been acknowledged. This article aims to stimulate further analytic discussion of this under-theorized aspect of medicine. PMID:24375120

  10. Hearing Loss and Older Adults

    MedlinePlus

    ... Home » Health Info » Hearing, Ear Infections, and Deafness Hearing Loss and Older Adults On this page: What is ... about hearing loss and older adults? What is hearing loss? Hearing loss is a sudden or gradual decrease ...

  11. The Use of the Integrated Medical Model for Forecasting and Mitigating Medical Risks for a Near-Earth Asteroid Mission

    NASA Technical Reports Server (NTRS)

    Kerstman, Eric; Saile, Lynn; Freire de Carvalho, Mary; Myers, Jerry; Walton, Marlei; Butler, Douglas; Lopez, Vilma

    2011-01-01

    Introduction The Integrated Medical Model (IMM) is a decision support tool that is useful to space flight mission managers and medical system designers in assessing risks and optimizing medical systems. The IMM employs an evidence-based, probabilistic risk assessment (PRA) approach within the operational constraints of space flight. Methods Stochastic computational methods are used to forecast probability distributions of medical events, crew health metrics, medical resource utilization, and probability estimates of medical evacuation and loss of crew life. The IMM can also optimize medical kits within the constraints of mass and volume for specified missions. The IMM was used to forecast medical evacuation and loss of crew life probabilities, as well as crew health metrics for a near-earth asteroid (NEA) mission. An optimized medical kit for this mission was proposed based on the IMM simulation. Discussion The IMM can provide information to the space program regarding medical risks, including crew medical impairment, medical evacuation and loss of crew life. This information is valuable to mission managers and the space medicine community in assessing risk and developing mitigation strategies. Exploration missions such as NEA missions will have significant mass and volume constraints applied to the medical system. Appropriate allocation of medical resources will be critical to mission success. The IMM capability of optimizing medical systems based on specific crew and mission profiles will be advantageous to medical system designers. Conclusion The IMM is a decision support tool that can provide estimates of the impact of medical events on human space flight missions, such as crew impairment, evacuation, and loss of crew life. It can be used to support the development of mitigation strategies and to propose optimized medical systems for specified space flight missions. Learning Objectives The audience will learn how an evidence-based decision support tool can be

  12. 15 CFR 6.5 - Effective date of adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... INFLATION ADJUSTMENTS § 6.5 Effective date of adjustments. The adjustments made by § 6.4 of this part, of... December 7, 2012, and before the effective date of any future inflation adjustment thereto made...

  13. 15 CFR 6.5 - Effective date of adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... INFLATION ADJUSTMENTS § 6.5 Effective date of adjustments. The adjustments made by § 6.4 of this part, of... December 7, 2012, and before the effective date of any future inflation adjustment thereto made...

  14. 15 CFR 6.5 - Effective date of adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... INFLATION ADJUSTMENTS § 6.5 Effective date of adjustments. The adjustments made by § 6.4 of this part, of... December 11, 2008, and before the effective date of any future inflation adjustment thereto made...

  15. 15 CFR 6.5 - Effective date of adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... INFLATION ADJUSTMENTS § 6.5 Effective date of adjustments. The adjustments made by § 6.4 of this part, of... December 11, 2008, and before the effective date of any future inflation adjustment thereto made...

  16. 15 CFR 6.5 - Effective date of adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... INFLATION ADJUSTMENTS § 6.5 Effective date of adjustments. The adjustments made by § 6.4 of this part, of... December 11, 2008, and before the effective date of any future inflation adjustment thereto made...

  17. 42 CFR 416.200 - Payment adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) MEDICARE PROGRAM (CONTINUED) AMBULATORY SURGICAL SERVICES Adjustment in Payment Amounts for New Technology... the amount of the payment adjustment for classes of new technology IOLs through proposed and final... approved as belonging to a class of new technology IOLs for the 5-year period of time established for...

  18. 42 CFR 416.200 - Payment adjustment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) MEDICARE PROGRAM AMBULATORY SURGICAL SERVICES Adjustment in Payment Amounts for New Technology Intraocular... amount of the payment adjustment for classes of new technology IOLs through proposed and final rulemaking... approved as belonging to a class of new technology IOLs for the 5-year period of time established for...

  19. 42 CFR 416.200 - Payment adjustment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) MEDICARE PROGRAM (CONTINUED) AMBULATORY SURGICAL SERVICES Adjustment in Payment Amounts for New Technology... the amount of the payment adjustment for classes of new technology IOLs through proposed and final... approved as belonging to a class of new technology IOLs for the 5-year period of time established for...

  20. 42 CFR 416.200 - Payment adjustment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) MEDICARE PROGRAM AMBULATORY SURGICAL SERVICES Adjustment in Payment Amounts for New Technology Intraocular... amount of the payment adjustment for classes of new technology IOLs through proposed and final rulemaking... approved as belonging to a class of new technology IOLs for the 5-year period of time established for...

  1. 42 CFR 416.200 - Payment adjustment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) MEDICARE PROGRAM (CONTINUED) AMBULATORY SURGICAL SERVICES Adjustment in Payment Amounts for New Technology... the amount of the payment adjustment for classes of new technology IOLs through proposed and final... approved as belonging to a class of new technology IOLs for the 5-year period of time established for...

  2. Adjusting to Retirement: Considerations for Counselors.

    ERIC Educational Resources Information Center

    LaBauve, Bill J.; Robinson, Chester R.

    1999-01-01

    Examines retirement, while focusing on issues older adults face in adjusting to retirement, and suggests implications for counseling people who are making this transition. Discusses adjustment to retirement in terms of role, disengagement, activity, continuity, crisis, and compromise/negotiation theories. (Author/MKA)

  3. Family Adjustment Measure: Scale Construction and Validation

    ERIC Educational Resources Information Center

    Daire, Andrew P.; Dominguez, Vanessa N.; Carlson, Ryan G.; Case-Pease, Jenene

    2014-01-01

    We administered the Family Adjustment Measure to 368 parents of children with special needs to identify positive adjustment. We randomly split the sample to conduct exploratory factor analysis ("n" = 194) and confirmatory factor analysis ("n" = 174). Results indicated four possible subscales and that explain 51% of the variance.

  4. 24 CFR 902.24 - Database adjustment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Database adjustment. 902.24 Section 902.24 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED... PUBLIC HOUSING ASSESSMENT SYSTEM Physical Condition Indicator § 902.24 Database adjustment....

  5. 24 CFR 902.24 - Database adjustment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Database adjustment. 902.24 Section 902.24 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED... PUBLIC HOUSING ASSESSMENT SYSTEM Physical Condition Indicator § 902.24 Database adjustment....

  6. 24 CFR 902.24 - Database adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Database adjustment. 902.24 Section 902.24 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED... PUBLIC HOUSING ASSESSMENT SYSTEM Physical Condition Indicator § 902.24 Database adjustment....

  7. 24 CFR 902.24 - Database adjustment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Database adjustment. 902.24 Section 902.24 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED... PUBLIC HOUSING ASSESSMENT SYSTEM Physical Condition Indicator § 902.24 Database adjustment....

  8. 24 CFR 886.112 - Rent adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Adjustment Factor most recently published by HUD in the Federal Register in accordance with 24 CFR part 888... unassisted housing in the area to ensure that adjustments in the Contract Rents shall not result in material differences between the rents charged for assisted and comparable unassisted units. Contract Rents may...

  9. 24 CFR 886.112 - Rent adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Adjustment Factor most recently published by HUD in the Federal Register in accordance with 24 CFR part 888... unassisted housing in the area to ensure that adjustments in the Contract Rents shall not result in material differences between the rents charged for assisted and comparable unassisted units. Contract Rents may...

  10. 24 CFR 886.112 - Rent adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Adjustment Factor most recently published by HUD in the Federal Register in accordance with 24 CFR part 888... unassisted housing in the area to ensure that adjustments in the Contract Rents shall not result in material differences between the rents charged for assisted and comparable unassisted units. Contract Rents may...

  11. 24 CFR 886.112 - Rent adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Adjustment Factor most recently published by HUD in the Federal Register in accordance with 24 CFR part 888... unassisted housing in the area to ensure that adjustments in the Contract Rents shall not result in material differences between the rents charged for assisted and comparable unassisted units. Contract Rents may...

  12. 24 CFR 886.112 - Rent adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Adjustment Factor most recently published by HUD in the Federal Register in accordance with 24 CFR part 888... unassisted housing in the area to ensure that adjustments in the Contract Rents shall not result in material differences between the rents charged for assisted and comparable unassisted units. Contract Rents may...

  13. 34 CFR 36.2 - Penalty adjustment.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... of the Secretary, Department of Education ADJUSTMENT OF CIVIL MONETARY PENALTIES FOR INFLATION § 36.2..., Section 36.2—Civil Monetary Penalty Inflation Adjustments Statute Description New maximum (and minimum, if... institution of higher education (IHE) to provide information on the cost of higher education to...

  14. Building Skills in Divorce Adjustment Groups.

    ERIC Educational Resources Information Center

    Kessler, Sheila

    1978-01-01

    The purpose of this study was to compare three different treatment modalities for divorce adjustment groups, that is, structured, unstructured, and control groups. Implications suggest that skill-building exercises might add an important therapeutic dimension for those experiencing adjustment to divorce. (Author)

  15. 12 CFR 611.1124 - Territorial adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., Consolidations, and Charter Amendments of Associations § 611.1124 Territorial adjustments. This section shall apply to any request submitted to the Farm Credit Administration to modify association charters for the purpose of transferring territory from one association to another. (a) Territorial adjustments, except...

  16. 12 CFR 611.1124 - Territorial adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., Consolidations, and Charter Amendments of Associations § 611.1124 Territorial adjustments. This section shall apply to any request submitted to the Farm Credit Administration to modify association charters for the purpose of transferring territory from one association to another. (a) Territorial adjustments, except...

  17. College Student Adjustment and Health Behaviors

    ERIC Educational Resources Information Center

    Hall, Lisa Anne

    2010-01-01

    This study explored the relationship between student adjustment theory and college student health behaviors. Specifically, this research examined first-year freshmen college student physical activity and nutrition behaviors and impact on adjustment to college (N = 37,564). The design for this study was a non-experimental "ex post facto"…

  18. 20 CFR 345.118 - Adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Adjustments. 345.118 Section 345.118... additional contribution on the next report filed after discovery of the error; and (ii) Paying the amount... filed after discovery of the error. However, if the overpayment cannot be adjusted because the...

  19. 20 CFR 345.118 - Adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Adjustments. 345.118 Section 345.118... additional contribution on the next report filed after discovery of the error; and (ii) Paying the amount... filed after discovery of the error. However, if the overpayment cannot be adjusted because the...

  20. Individualized Client Planning for Work Adjustment Services.

    ERIC Educational Resources Information Center

    Esser, Thomas J.

    To assist work adjustors, evaluators, and counselors in learning how to write individualized work adjustment plans, this publication describes one method of developing individual client plans--the Materials Development Center Individualized Work Adjustment Plan. The detailed description of this plan explains the two basic parts of its format: (1)…

  1. Ergonomically Adjustable School Furniture for Male Students

    ERIC Educational Resources Information Center

    Al-Saleh, Khalid S.; Ramadan, Mohamed Z.; Al-Ashaikh, Riyad A.

    2013-01-01

    The need for adjustability in school furniture, in order to accommodate the variation in anthropometric measures of different genders, cultures and ages is becoming increasingly important. Four chair-table combinations, different in dimensions, with adjustable chair seating heights and table heights were designed, manufactured and distributed to…

  2. 45 CFR 84.44 - Academic adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Academic adjustments. 84.44 Section 84.44 Public... Academic adjustments. (a) Academic requirements. A recipient to which this subpart applies shall make such modifications to its academic requirements as are necessary to ensure that such requirements do not...

  3. 22 CFR 142.44 - Academic adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Academic adjustments. 142.44 Section 142.44... OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Postsecondary Education § 142.44 Academic adjustments. (a) Academic requirements. A recipient to which this subpart applies shall make...

  4. 15 CFR 8b.22 - Academic adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Academic adjustments. 8b.22 Section 8b... Secondary Education § 8b.22 Academic adjustments. (a) Academic requirements. A recipient to which this subpart applies shall make such modifications to its academic requirements as are necessary to ensure...

  5. 45 CFR 605.44 - Academic adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Academic adjustments. 605.44 Section 605.44 Public... Postsecondary Education § 605.44 Academic adjustments. (a) Academic requirements. A recipient to which this subpart applies shall make such modifications to its academic requirements as are necessary to ensure...

  6. 34 CFR 104.44 - Academic adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Academic adjustments. 104.44 Section 104.44 Education... Postsecondary Education § 104.44 Academic adjustments. (a) Academic requirements. A recipient to which this subpart applies shall make such modifications to its academic requirements as are necessary to ensure...

  7. 22 CFR 217.44 - Academic adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Academic adjustments. 217.44 Section 217.44... PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Postsecondary Education § 217.44 Academic adjustments. (a) Academic requirements. A recipient to which this subpart applies shall make...

  8. 7 CFR 15b.32 - Academic adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Academic adjustments. 15b.32 Section 15b.32... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Postsecondary Education § 15b.32 Academic adjustments. (a) Academic requirements. A recipient to which this subpart applies shall make such modifications to...

  9. 45 CFR 1170.44 - Academic adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Academic adjustments. 1170.44 Section 1170.44... ASSISTED PROGRAMS OR ACTIVITIES Postsecondary Education § 1170.44 Academic adjustments. (a) Academic requirements. A recipient to which this subpart applies shall make such modifications to its...

  10. 38 CFR 18.444 - Academic adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Academic adjustments. 18....444 Academic adjustments. (a) Academic requirements. A recipient shall make necessary modifications to its academic requirements to ensure that these requirements do not discriminate or have the effect...

  11. Religiousity, Spirituality and Adolescents' Self-Adjustment

    ERIC Educational Resources Information Center

    Japar, Muhammad; Purwati

    2014-01-01

    Religiuosity, spirituality, and adolescents' self-adjustment. The objective of this study is to test the correlation among religiosity, spirituality and adolescents' self-adjustment. A quantitative approach was employed in this study. Data were collected from 476 junior high schools students of 13 State Junior High Schools and one Junior High…

  12. 10 CFR 905.34 - Adjustment provisions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Adjustment provisions. 905.34 Section 905.34 Energy DEPARTMENT OF ENERGY ENERGY PLANNING AND MANAGEMENT PROGRAM Power Marketing Initiative § 905.34 Adjustment... continue to take place based on existing contract/marketing criteria principles....

  13. 10 CFR 905.34 - Adjustment provisions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Adjustment provisions. 905.34 Section 905.34 Energy DEPARTMENT OF ENERGY ENERGY PLANNING AND MANAGEMENT PROGRAM Power Marketing Initiative § 905.34 Adjustment... continue to take place based on existing contract/marketing criteria principles....

  14. 10 CFR 905.34 - Adjustment provisions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Adjustment provisions. 905.34 Section 905.34 Energy DEPARTMENT OF ENERGY ENERGY PLANNING AND MANAGEMENT PROGRAM Power Marketing Initiative § 905.34 Adjustment... continue to take place based on existing contract/marketing criteria principles....

  15. 10 CFR 905.34 - Adjustment provisions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Adjustment provisions. 905.34 Section 905.34 Energy DEPARTMENT OF ENERGY ENERGY PLANNING AND MANAGEMENT PROGRAM Power Marketing Initiative § 905.34 Adjustment... continue to take place based on existing contract/marketing criteria principles....

  16. 7 CFR 2201.30 - Adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Adjustments. 2201.30 Section 2201.30 Agriculture Regulations of the Department of Agriculture (Continued) LOCAL TELEVISION LOAN GUARANTEE BOARD LOCAL TELEVISION LOAN GUARANTEE PROGRAM-PROGRAM REGULATIONS Loan Guarantees § 2201.30 Adjustments. (a) The...

  17. 7 CFR 2201.30 - Adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Adjustments. 2201.30 Section 2201.30 Agriculture Regulations of the Department of Agriculture (Continued) LOCAL TELEVISION LOAN GUARANTEE BOARD LOCAL TELEVISION LOAN GUARANTEE PROGRAM-PROGRAM REGULATIONS Loan Guarantees § 2201.30 Adjustments. (a) The...

  18. 7 CFR 1744.64 - Budget adjustment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... another source, requests a deficiency loan, or scales back the project. (b) RUS may make a budget... AGRICULTURE POST-LOAN POLICIES AND PROCEDURES COMMON TO GUARANTEED AND INSURED TELEPHONE LOANS Advance and... description of how the adjustment will affect loan purposes. RUS will not approve a budget adjustment...

  19. Consanguineous Marriage and Marital Adjustment in Turkey.

    ERIC Educational Resources Information Center

    Fisiloglu, Hurol

    2001-01-01

    Investigates the relationship between consanguineous marriage and marital adjustment in Turkey. The results of the study show that the consanguineous marriage group had significantly lower marital adjustment and had more conflict with extended family than the nonconsanguineous marriage group. The finding is discussed in the context of research and…

  20. Fuel injection pump with adjustable timing

    SciTech Connect

    Nakamura, H.; Abe, N.

    1987-04-28

    A fuel injection pump is described comprising: a pump body; a plunger disposed in the pump body for reciprocating within the pump body; and a pre-stroke adjusting mechanism disposed in the pump body and operatively connected with the plunger for adjusting an effective pre-stroke of the plunger.

  1. Does Fall History Influence Residential Adjustments?

    ERIC Educational Resources Information Center

    Leland, Natalie; Porell, Frank; Murphy, Susan L.

    2011-01-01

    Purpose of the study: To determine whether reported falls at baseline are associated with an older adult's decision to make a residential adjustment (RA) and the type of adjustment made in the subsequent 2 years. Design and Methods: Observations (n = 25,036) were from the Health and Retirement Study, a nationally representative sample of…

  2. 49 CFR 630.11 - Data adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Data adjustments. 630.11 Section 630.11 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.11 Data adjustments. Errors in the data used...

  3. 49 CFR 630.11 - Data adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Data adjustments. 630.11 Section 630.11 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.11 Data adjustments. Errors in the data used...

  4. 49 CFR 630.11 - Data adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Data adjustments. 630.11 Section 630.11 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.11 Data adjustments. Errors in the data used...

  5. 49 CFR 630.11 - Data adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Data adjustments. 630.11 Section 630.11 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.11 Data adjustments. Errors in the data used...

  6. 49 CFR 630.11 - Data adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Data adjustments. 630.11 Section 630.11 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.11 Data adjustments. Errors in the data used...

  7. 76 FR 42140 - Rate Adjustment Remand

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-18

    ... the amount of the revenue lost as a result of the exigent circumstances.'' Id. \\6\\ Id. The court... amount of the proposed adjustments precisely to the amount of revenue lost as a result of the exigent... amount of an exigent rate adjustment must match the amount of revenue lost as a result of an...

  8. Divorcing Parents: Guidelines for Promoting Children's Adjustment.

    ERIC Educational Resources Information Center

    Freeman, Kurt A.; Adams, Christina D; Drabman, Ronald S.

    1998-01-01

    There are measures that parents can take to help their children through the often distressing process of parental divorce. Describes the empirical literature regarding issues and factors relevant to children's adjustment to divorce. Provides practical guidelines and suggestions likely to help parents enhance their children's adjustment.…

  9. 7 CFR 15b.32 - Academic adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 1 2011-01-01 2011-01-01 false Academic adjustments. 15b.32 Section 15b.32... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Postsecondary Education § 15b.32 Academic adjustments. (a) Academic requirements. A recipient to which this subpart applies shall make such modifications to...

  10. 15 CFR 8b.22 - Academic adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 15 Commerce and Foreign Trade 1 2011-01-01 2011-01-01 false Academic adjustments. 8b.22 Section 8b... Secondary Education § 8b.22 Academic adjustments. (a) Academic requirements. A recipient to which this subpart applies shall make such modifications to its academic requirements as are necessary to ensure...

  11. 15 CFR 6.6 - Subsequent adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 15 Commerce and Foreign Trade 1 2014-01-01 2014-01-01 false Subsequent adjustments. 6.6 Section 6.6 Commerce and Foreign Trade Office of the Secretary of Commerce CIVIL MONETARY PENALTY INFLATION... once every four years after October 23, 1996, make the inflation adjustment, described in Section...

  12. 15 CFR 6.6 - Subsequent adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Subsequent adjustments. 6.6 Section 6.6 Commerce and Foreign Trade Office of the Secretary of Commerce CIVIL MONETARY PENALTY INFLATION... once every four years after October 23, 1996, make the inflation adjustment, described in Section...

  13. 15 CFR 6.6 - Subsequent adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 15 Commerce and Foreign Trade 1 2011-01-01 2011-01-01 false Subsequent adjustments. 6.6 Section 6.6 Commerce and Foreign Trade Office of the Secretary of Commerce CIVIL MONETARY PENALTY INFLATION... once every four years after October 23, 1996, make the inflation adjustment, described in Section...

  14. 15 CFR 6.6 - Subsequent adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 15 Commerce and Foreign Trade 1 2012-01-01 2012-01-01 false Subsequent adjustments. 6.6 Section 6.6 Commerce and Foreign Trade Office of the Secretary of Commerce CIVIL MONETARY PENALTY INFLATION... once every four years after October 23, 1996, make the inflation adjustment, described in Section...

  15. 15 CFR 6.6 - Subsequent adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 15 Commerce and Foreign Trade 1 2013-01-01 2013-01-01 false Subsequent adjustments. 6.6 Section 6.6 Commerce and Foreign Trade Office of the Secretary of Commerce CIVIL MONETARY PENALTY INFLATION... once every four years after October 23, 1996, make the inflation adjustment, described in Section...

  16. The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Space Flight Medical Systems

    NASA Technical Reports Server (NTRS)

    Kerstman, Eric; Minard, Charles; Saile, Lynn; deCarvalho, Mary Freire; Myers, Jerry; Walton, Marlei; Butler, Douglas; Iyengar, Sriram; Johnson-Throop, Kathy; Baumann, David

    2009-01-01

    The Integrated Medical Model (IMM) is a decision support tool that is useful to mission planners and medical system designers in assessing risks and designing medical systems for space flight missions. The IMM provides an evidence based approach for optimizing medical resources and minimizing risks within space flight operational constraints. The mathematical relationships among mission and crew profiles, medical condition incidence data, in-flight medical resources, potential crew functional impairments, and clinical end-states are established to determine probable mission outcomes. Stochastic computational methods are used to forecast probability distributions of crew health and medical resource utilization, as well as estimates of medical evacuation and loss of crew life. The IMM has been used in support of the International Space Station (ISS) medical kit redesign, the medical component of the ISS Probabilistic Risk Assessment, and the development of the Constellation Medical Conditions List. The IMM also will be used to refine medical requirements for the Constellation program. The IMM outputs for ISS and Constellation design reference missions will be presented to demonstrate the potential of the IMM in assessing risks, planning missions, and designing medical systems. The implementation of the IMM verification and validation plan will be reviewed. Additional planned capabilities of the IMM, including optimization techniques and the inclusion of a mission timeline, will be discussed. Given the space flight constraints of mass, volume, and crew medical training, the IMM is a valuable risk assessment and decision support tool for medical system design and mission planning.

  17. Sexual adjustment to androgen deprivation therapy: struggles and strategies.

    PubMed

    Walker, Lauren M; Robinson, John W

    2012-04-01

    More than half of all men with prostate cancer will be treated with androgen deprivation therapy (ADT) at some point during their lives. Though an effective treatment for prostate cancer, ADT results in profound changes in the man's sense of masculinity and sexuality (e.g., erectile dysfunction, loss of libido, genital atrophy and severe genital shrinkage, hot flashes, loss of muscle mass, fatigue, bodily feminization). These changes usually result in the cessation of all sexual activity. Surprisingly, some couples do find ways of continuing to have satisfying sex despite the man's castrate level of testosterone. Herein, we describe the sexual struggles that couples encounter when attempting to adapt sexually to ADT. A grounded theory methodology was used to analyze interview data. The successful strategies that couples used to overcome struggles, as well as those which seemed to exacerbate struggles, are documented. Couples adjusting to ADT might benefit from knowing which strategies are most likely to result in positive adjustment and which are not.

  18. 76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-17

    ... Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care-Acquired... amounts expended for providing medical assistance for health care-acquired conditions. It would also... Federal financial participation FY Fiscal year HAC Hospital-acquired condition HCAC Health...

  19. How Older Rural Adults Utilize Self-Directed Learning in Late Life Adjustments

    ERIC Educational Resources Information Center

    Roberson, Donald N., Jr.

    2003-01-01

    The increasing numbers and influence of older adults is causing many segments of western society to re-evaluate the concept of old age. Medical advances and personal lifestyles have resulted in older adults living longer and healthier lives. As one ages, adjustments in work, family, and health must be made. Self-directed learning (SDL) is one way…

  20. Attachment for sucker rod depth adjustment

    SciTech Connect

    Collins, N.D.

    1992-04-07

    This patent describes a surface unit of an oil well pumping system, having a walking beam, a suspended carrier bar and an interconnected sucker rod assembly for stroking a reciprocating down-hole pump. It comprises a cross bar having a centrally located passage therein for the sucker rod assembly and adapted to be transversely supported by the carrier bar; a depth adjusting bar, having a centrally located passage therein for the sucker rod assembly, positioned at a selected fixed dimension above and parallel to the cross bar and adapted to operatively support the sucker rod assembly; clamping means for fixing the sucker rod relative to the depth adjusting bar; and hydraulically extendable means supportively connecting the depth adjusting bar to the cross bar on at least each side of the carrier bar for adjusting the selected fixed dimension and maintaining the adjustment during operation.