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Sample records for adjusted medical loss

  1. 45 CFR 158.320 - Information supporting a request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Information supporting a request for adjustment to the medical loss ratio. 158.320 Section 158.320 Public Welfare Department of Health and Human Services... for adjustment to the medical loss ratio. A State must submit in electronic format the...

  2. 45 CFR 158.322 - Proposal for adjusted medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Proposal for adjusted medical loss ratio. 158.322 Section 158.322 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH... the MLR for a State's Individual Market § 158.322 Proposal for adjusted medical loss ratio. A...

  3. 45 CFR 158.350 - Subsequent requests for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Subsequent requests for adjustment to the medical loss ratio. 158.350 Section 158.350 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... medical loss ratio. A State that has made a previous request for an adjustment to the MLR standard...

  4. 45 CFR 158.322 - Proposal for adjusted medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Proposal for adjusted medical loss ratio. 158.322 Section 158.322 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH... the MLR for a State's Individual Market § 158.322 Proposal for adjusted medical loss ratio. A...

  5. 45 CFR 158.320 - Information supporting a request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Information supporting a request for adjustment to the medical loss ratio. 158.320 Section 158.320 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... for adjustment to the medical loss ratio. A State must submit in electronic format the...

  6. 45 CFR 158.350 - Subsequent requests for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Subsequent requests for adjustment to the medical loss ratio. 158.350 Section 158.350 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... medical loss ratio. A State that has made a previous request for an adjustment to the MLR standard...

  7. 45 CFR 158.350 - Subsequent requests for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Subsequent requests for adjustment to the medical loss ratio. 158.350 Section 158.350 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... medical loss ratio. A State that has made a previous request for an adjustment to the MLR standard...

  8. 45 CFR 158.340 - Process for submitting request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Process for submitting request for adjustment to the medical loss ratio. 158.340 Section 158.340 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... adjustment to the medical loss ratio. (a) Electronic submission. A State must submit electronically, to...

  9. 45 CFR 158.350 - Subsequent requests for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Subsequent requests for adjustment to the medical loss ratio. 158.350 Section 158.350 Public Welfare Department of Health and Human Services REQUIREMENTS... medical loss ratio. A State that has made a previous request for an adjustment to the MLR standard...

  10. 45 CFR 158.340 - Process for submitting request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Process for submitting request for adjustment to the medical loss ratio. 158.340 Section 158.340 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... adjustment to the medical loss ratio. (a) Electronic submission. A State must submit electronically, to...

  11. 45 CFR 158.320 - Information supporting a request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Information supporting a request for adjustment to the medical loss ratio. 158.320 Section 158.320 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... for adjustment to the medical loss ratio. A State must submit in electronic format the...

  12. 45 CFR 158.322 - Proposal for adjusted medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Proposal for adjusted medical loss ratio. 158.322 Section 158.322 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH... the MLR for a State's Individual Market § 158.322 Proposal for adjusted medical loss ratio. A...

  13. 45 CFR 158.340 - Process for submitting request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Process for submitting request for adjustment to the medical loss ratio. 158.340 Section 158.340 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... adjustment to the medical loss ratio. (a) Electronic submission. A State must submit electronically, to...

  14. 45 CFR 158.322 - Proposal for adjusted medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Proposal for adjusted medical loss ratio. 158.322 Section 158.322 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH... the MLR for a State's Individual Market § 158.322 Proposal for adjusted medical loss ratio. A...

  15. 45 CFR 158.320 - Information supporting a request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Information supporting a request for adjustment to the medical loss ratio. 158.320 Section 158.320 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... for adjustment to the medical loss ratio. A State must submit in electronic format the...

  16. 45 CFR 158.340 - Process for submitting request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Process for submitting request for adjustment to the medical loss ratio. 158.340 Section 158.340 Public Welfare Department of Health and Human Services... adjustment to the medical loss ratio. (a) Electronic submission. A State must submit electronically, to...

  17. 45 CFR 158.330 - Criteria for assessing request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Criteria for assessing request for adjustment to... Potential Adjustment to the MLR for a State's Individual Market § 158.330 Criteria for assessing request for adjustment to the medical loss ratio. The Secretary may consider the following criteria in assessing...

  18. 45 CFR 158.310 - Who may request adjustment to the medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Who may request adjustment to the medical loss ratio. 158.310 Section 158.310 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... loss ratio. A request for an adjustment to the MLR standard for a State must be submitted by the...

  19. 45 CFR 158.310 - Who may request adjustment to the medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Who may request adjustment to the medical loss ratio. 158.310 Section 158.310 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... loss ratio. A request for an adjustment to the MLR standard for a State must be submitted by the...

  20. 45 CFR 158.310 - Who may request adjustment to the medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Who may request adjustment to the medical loss ratio. 158.310 Section 158.310 Public Welfare Department of Health and Human Services REQUIREMENTS... loss ratio. A request for an adjustment to the MLR standard for a State must be submitted by the...

  1. 45 CFR 158.310 - Who may request adjustment to the medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Who may request adjustment to the medical loss ratio. 158.310 Section 158.310 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... loss ratio. A request for an adjustment to the MLR standard for a State must be submitted by the...

  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 medical loss ratio. 158.330 Section 158.330 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... adjustment to the medical loss ratio. The Secretary may consider the following criteria in assessing whether... factors such as surplus level, risked-based capital ratio, net income, and operating or underwriting...

  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... adjustment to the medical loss ratio. The Secretary may consider the following criteria in assessing whether... factors such as surplus level, risked-based capital ratio, net income, and operating or underwriting...

  4. 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 medical loss ratio. 158.330 Section 158.330 Public Welfare Department of Health and Human Services... adjustment to the medical loss ratio. The Secretary may consider the following criteria in assessing whether... factors such as surplus level, risked-based capital ratio, net income, and operating or underwriting...

  5. 45 CFR 158.311 - Duration of adjustment to the medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Duration of adjustment to the medical loss ratio. 158.311 Section 158.311 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING... ratio. A State may request that an adjustment to the MLR standard be for up to three MLR reporting years....

  6. 45 CFR 158.301 - Standard for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Standard for adjustment to the medical loss ratio. 158.301 Section 158.301 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING... ratio. The Secretary may adjust the MLR standard that must be met by issuers offering coverage in...

  7. 45 CFR 158.301 - Standard for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Standard for adjustment to the medical loss ratio. 158.301 Section 158.301 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING... ratio. The Secretary may adjust the MLR standard that must be met by issuers offering coverage in...

  8. 45 CFR 158.301 - Standard for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Standard for adjustment to the medical loss ratio. 158.301 Section 158.301 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING... ratio. The Secretary may adjust the MLR standard that must be met by issuers offering coverage in...

  9. 45 CFR 158.311 - Duration of adjustment to the medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Duration of adjustment to the medical loss ratio. 158.311 Section 158.311 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING... ratio. A State may request that an adjustment to the MLR standard be for up to three MLR reporting years....

  10. 45 CFR 158.301 - Standard for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Standard for adjustment to the medical loss ratio. 158.301 Section 158.301 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING... ratio. The Secretary may adjust the MLR standard that must be met by issuers offering coverage in...

  11. 45 CFR 158.311 - Duration of adjustment to the medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Duration of adjustment to the medical loss ratio. 158.311 Section 158.311 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING... ratio. A State may request that an adjustment to the MLR standard be for up to three MLR reporting years....

  12. 45 CFR 158.311 - Duration of adjustment to the medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Duration of adjustment to the medical loss ratio. 158.311 Section 158.311 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING... ratio. A State may request that an adjustment to the MLR standard be for up to three MLR reporting years....

  13. 45 CFR 158.345 - Determination on a State's request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Determination on a State's request for adjustment to the medical loss ratio. 158.345 Section 158.345 Public Welfare DEPARTMENT OF HEALTH AND HUMAN...'s request for adjustment to the medical loss ratio. (a) General time frame. The Secretary will...

  14. 45 CFR 158.345 - Determination on a State's request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Determination on a State's request for adjustment to the medical loss ratio. 158.345 Section 158.345 Public Welfare DEPARTMENT OF HEALTH AND HUMAN...'s request for adjustment to the medical loss ratio. (a) General time frame. The Secretary will...

  15. 45 CFR 158.345 - Determination on a State's request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Determination on a State's request for adjustment to the medical loss ratio. 158.345 Section 158.345 Public Welfare Department of Health and Human...'s request for adjustment to the medical loss ratio. (a) General time frame. The Secretary will...

  16. 45 CFR 158.345 - Determination on a State's request for adjustment to the medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Determination on a State's request for adjustment to the medical loss ratio. 158.345 Section 158.345 Public Welfare DEPARTMENT OF HEALTH AND HUMAN...'s request for adjustment to the medical loss ratio. (a) General time frame. The Secretary will...

  17. Medications for Memory Loss

    MedlinePlus

    ... memory loss, confusion, and problems with thinking and reasoning) of Alzheimer's disease. There is also a medication ... the latest Alzheimer's medications available today, and the clinical trials that may bring us closer to new ...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 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...

  4. 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 HUMANITIES FEDERAL COUNCIL ON THE ARTS AND THE HUMANITIES INDEMNITIES UNDER THE ARTS AND ARTIFACTS...

  5. Weight-loss medications

    MedlinePlus

    ... term use. All other drugs are approved for short-term use of no more than a few weeks. Be sure you understand the side effects of weight-loss medicines. Side effects can include: Increase in blood pressure Problems sleeping, headache, nervousness, and palpitations Nausea, constipation, and dry ...

  6. 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…

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

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 6 2013-01-01 2013-01-01 false Agent and loss adjuster responsibilities. 400.405 Section 400.405 Agriculture Regulations of the Department of Agriculture (Continued) FEDERAL CROP INSURANCE CORPORATION, DEPARTMENT OF AGRICULTURE GENERAL ADMINISTRATIVE REGULATIONS General...

  8. 7 CFR 400.405 - Agent and loss adjuster responsibilities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 6 2012-01-01 2012-01-01 false Agent and loss adjuster responsibilities. 400.405 Section 400.405 Agriculture Regulations of the Department of Agriculture (Continued) FEDERAL CROP INSURANCE CORPORATION, DEPARTMENT OF AGRICULTURE GENERAL ADMINISTRATIVE REGULATIONS General...

  9. 7 CFR 400.405 - Agent and loss adjuster responsibilities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 6 2014-01-01 2014-01-01 false Agent and loss adjuster responsibilities. 400.405 Section 400.405 Agriculture Regulations of the Department of Agriculture (Continued) FEDERAL CROP INSURANCE CORPORATION, DEPARTMENT OF AGRICULTURE GENERAL ADMINISTRATIVE REGULATIONS General...

  10. 7 CFR 400.405 - Agent and loss adjuster responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 6 2011-01-01 2011-01-01 false Agent and loss adjuster responsibilities. 400.405 Section 400.405 Agriculture Regulations of the Department of Agriculture (Continued) FEDERAL CROP INSURANCE CORPORATION, DEPARTMENT OF AGRICULTURE GENERAL ADMINISTRATIVE REGULATIONS General...

  11. 7 CFR 400.405 - Agent and loss adjuster responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Agent and loss adjuster responsibilities. 400.405 Section 400.405 Agriculture Regulations of the Department of Agriculture (Continued) FEDERAL CROP INSURANCE CORPORATION, DEPARTMENT OF AGRICULTURE GENERAL ADMINISTRATIVE REGULATIONS General...

  12. Executive functions predict weight loss in a medically supervised weight loss programme

    PubMed Central

    Bond, D.; Gunstad, J.; Pera, V.; Rathier, L.; Tremont, G.

    2016-01-01

    Summary Background Deficits in executive functions are related to poorer weight loss after bariatric surgery; however, less is known about the role that these deficits may play during participation in nonsurgical weight loss programmes. This study examined associations between objectively measured executive functions and weight loss during participation in a medically supervised weight loss programme. Methods Twenty‐three adult patients (age 50.4 ± 15.1, BMI 44.2 ± 8.8, 68% female, 92% White) enrolled in a medically supervised weight loss programme, involving prescription of a very low calorie diet and strategies to change eating and activity behaviours, underwent comprehensive computerized testing of executive functions at baseline. Weight was obtained at baseline and 8 weeks. Demographic and clinical information were obtained through medical chart review. Results Participants lost an average of 9.8 ± 3.4% of their initial body weight at 8 weeks. Fewer correct responses on a set‐shifting task and faster reaction time on a response inhibition task were associated with lower weight loss percentage at 8 weeks after adjusting for age, education and depressive symptoms. There were no associations between performance on tests of working memory or planning and weight loss. Conclusions This study shows that worse performance on a set‐shifting task (indicative of poorer cognitive flexibility) and faster reaction times on a response inhibition test (indicative of higher impulsivity) are associated with lower weight loss among participants in a medically supervised weight loss programme. Pre‐treatment assessment of executive functions may be useful in identifying individuals who may be at risk for suboptimal treatment outcomes. Future research is needed to replicate these findings in larger samples and identify underlying mechanisms. PMID:28090338

  13. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 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. CMS... number of inpatient days in the acute inpatient area of the hospital by the number of days in the...

  14. An improved accrual: reducing medical malpractice year-end adjustments.

    PubMed

    Frese, Richard C

    2012-08-01

    Healthcare organizations can improve their year-end malpractice insurance accruals by taking the following steps: Maintain productive communication. Match accrual and accounting policies. Adjust amount of credit to own historical loss experience. Request more frequent analysis. Obtain a second opinion.

  15. 7 CFR 760.641 - Adjustments made to NAMP to reflect loss of quality.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... the FSA State committee. The adjustment factor will be based on the average actual market price... 7 Agriculture 7 2010-01-01 2010-01-01 false Adjustments made to NAMP to reflect loss of quality... Assistance Payments Program § 760.641 Adjustments made to NAMP to reflect loss of quality. (a) The...

  16. 42 CFR 423.2420 - Calculation of medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Calculation of medical loss ratio. 423.2420 Section... for a Minimum Medical Loss Ratio § 423.2420 Calculation of medical loss ratio. (a) Determination of the MLR. (1) The MLR for each contract under this part is the ratio of the numerator (as defined...

  17. Can Weight Loss Reduce the Need for Blood Pressure Medication?

    MedlinePlus

    ... weight loss reduce the need for blood pressure medication? Answers from Sheldon G. Sheps, M.D. If ... possible to reduce your dose of blood pressure medication — or stop taking your blood pressure medication completely. ...

  18. [From crisis to adjustment disorder: a medicalization of a concept?].

    PubMed

    Gil, Tsvi

    2013-01-01

    This review aimed to compare two concepts in the psychiatric literature: crisis and adjustment disorder. The two concepts stem from different theoretical perspectives, rely upon different (though relatively loose) bodies of data, and may serve different purposes. The concept of crisis originated from an approach that could be considered psychodynamic, humanistic, and community oriented. Treatment, according to this approach, is known as crisis intervention and is characterized as being principally psychological, social, humanistic, and systemic. The generic approach to crisis calls for immediate aid rather than for a diagnosis and regular appointments, as is customary in psychiatric practice. The concept of adjustment disorder, on the other hand, is a rather medical nosological approach, which strives to achieve a phenomenological and objective description of the patient, and which may lead to ordinary psychiatric treatment, such as pharmacotherapy. Herein we present a review of literature on both approaches, with an emphasis on theoretical and empirical data. The findings appear to provide rather weak empirical support for both concepts. Some theoretical resolutions are proposed in an attempt to link the two concepts, such as a continuum of severity. We conclude that practitioners should decide for themselves, according to one's own theoretical framework and purpose of usage. Nonetheless, as formal psychiatric diagnosis demands more extensive scientific support and bears further implications (such as stigma), the current use of the diagnosis of adjustment disorder may seems less justified.

  19. African refugees in Egypt: trauma, loss, and cultural adjustment.

    PubMed

    Henry, Hani M

    2012-08-01

    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 home countries, as well as their life experiences in Egypt. All participants kept continuing bonds with their native cultures, but these bonds manifested differently depending on their ability to assimilate pre-immigration trauma and cultural losses. Participants who successfully assimilated both pre-immigration trauma and cultural losses developed continuing bonds with their native cultures that helped them (a) integrate the Egyptian culture into their life experiences and (b) tolerate difficult political conditions in Egypt. Participants who could not assimilate their pre-immigration trauma and cultural losses also developed continuing bonds with their native culture, but these bonds only provided them with solace.

  20. 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)...

  1. 45 CFR 158.210 - Minimum medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 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)...

  2. 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)...

  3. 45 CFR 158.210 - Minimum medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 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)...

  4. Locus of Control and School Adjustment Following the Loss of a Parent.

    ERIC Educational Resources Information Center

    Enos, Thomas A.; Hartman, Bruce W.

    This study investigates whether students experiencing difficulty adapting to parental loss also feel they have little or no control over life events; whether an inability to adapt to the stress of parental loss surfaces as a school adjustment problem; and whether these relationships are stronger for students losing a parent through death than…

  5. Traumatic amputation: psychosocial adjustment of six Army women to loss of one or more limbs.

    PubMed

    Cater, Janet K

    2012-01-01

    More than 220,000 U.S. servicewomen fought in Iraq and Afghanistan. In addition, more than 135 gave their lives, more than 600 were injured, and at least 24 lost one or more limbs. With no research on the adjustment of women to amputation or on military women's adjustment to traumatic limb loss, the phenomenological approach was used to gain an in-depth understanding of this life experience. Six Army women shared their personal adjustment experience to limb loss. This experience included personal safety fears, body image issues, grief, and loss. Recovering from traumatic amputation in a military environment promoted a "kick-butt" attitude, with these servicewomen reporting that a positive attitude, social support, personal courage, resiliency, military training, humor, and the belief their loss had meaning most influenced their recovery.

  6. Gender, Pre-loss Marital Dependence, and Older Adults Adjustment to Widowhood

    ERIC Educational Resources Information Center

    Carr, Deborah

    2004-01-01

    I examine how pre-loss emotional and instrumental dependence on one's spouse affects older adults psychological adjustment to widowhood. Analyses are based on 297 persons from the Changing Lives of Older Couples CLOC study, a prospective study of widowhood among adults aged 65 and older. Women who were most emotionally dependent on their spouses…

  7. Adjusting the Measurement of the Output of the Medical Sector for Quality: A Review of the Literature.

    PubMed

    Hall, Anne E

    2016-08-11

    The Bureau of Economic Analysis recently created new price indexes for health care in its health care satellite account and now faces the problem of how to adjust them for quality. I review the literature on this topic and divide the articles that created quality-adjusted price indexes for individual medical conditions into those that use primarily outcomes-based adjustments and those that use only process-based adjustments. Outcomes-based adjustments adjust the indexes based on observed aggregate health outcomes, usually mortality. Process-based adjustments adjust the indexes based on the treatments provided and medical knowledge of their effectiveness. Outcomes-based adjustments are easier to implement, while process-based adjustments are more demanding in terms of data and medical knowledge. In general, the research literature shows adjusting for quality in the measurement of output in the medical sector to be quantitatively important.

  8. Stronger seasonal adjustment in leaf turgor loss point in lianas than trees in an Amazonian forest.

    PubMed

    Maréchaux, Isabelle; Bartlett, Megan K; Iribar, Amaia; Sack, Lawren; Chave, Jérôme

    2017-01-01

    Pan-tropically, liana density increases with decreasing rainfall and increasing seasonality. This pattern has led to the hypothesis that lianas display a growth advantage over trees under dry conditions. However, the physiological mechanisms underpinning this hypothesis remain elusive. A key trait influencing leaf and plant drought tolerance is the leaf water potential at turgor loss point (πtlp). πtlp adjusts under drier conditions and this contributes to improved leaf drought tolerance. For co-occurring Amazonian tree (n = 247) and liana (n = 57) individuals measured during the dry and the wet seasons, lianas showed a stronger osmotic adjustment than trees. Liana leaves were less drought-tolerant than trees in the wet season, but reached similar drought tolerances during the dry season. Stronger osmotic adjustment in lianas would contribute to turgor maintenance, a critical prerequisite for carbon uptake and growth, and to the success of lianas relative to trees in growth under drier conditions.

  9. 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…

  10. Annual cost of illness and quality-adjusted life year losses in the United States due to 14 foodborne pathogens.

    PubMed

    Hoffmann, Sandra; Batz, Michael B; Morris, J Glenn

    2012-07-01

    In this article we estimate the annual cost of illness and quality-adjusted life year (QALY) loss in the United States caused by 14 of the 31 major foodborne pathogens reported on by Scallan et al. (Emerg. Infect. Dis. 17:7-15, 2011), based on their incidence estimates of foodborne illness in the United States. These 14 pathogens account for 95 % of illnesses and hospitalizations and 98 % of deaths due to identifiable pathogens estimated by Scallan et al. We estimate that these 14 pathogens cause $14.0 billion (ranging from $4.4 billion to $33.0 billion) in cost of illness and a loss of 61,000 QALYs (ranging from 19,000 to 145,000 QALYs) per year. Roughly 90 % of this loss is caused by five pathogens: nontyphoidal Salmonella enterica ($3.3 billion; 17,000 QALYs), Campylobacter spp. ($1.7 billion; 13,300 QALYs), Listeria monocytogenes ($2.6 billion; 9,400 QALYs), Toxoplasma gondii ($3 billion; 11,000 QALYs), and norovirus ($2 billion; 5,000 QALYs). A companion article attributes losses estimated in this study to the consumption of specific categories of foods. To arrive at these estimates, for each pathogen we create disease outcome trees that characterize the symptoms, severities, durations, outcomes, and likelihoods of health states associated with that pathogen. We then estimate the cost of illness (medical costs, productivity loss, and valuation of premature mortality) for each pathogen. We also estimate QALY loss for each health state associated with a given pathogen, using the EuroQol 5D scale. Construction of disease outcome trees, outcome-specific cost of illness, and EuroQol 5D scoring are described in greater detail in a second companion article.

  11. 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.

  12. 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…

  13. Prior use of durable medical equipment as a risk adjuster for health-based capitation.

    PubMed

    van Kleef, Richard C; van Vliet, René C J A

    This paper examines a new risk adjuster for capitation payments to Dutch health plans, based on the prior use of durable medical equipment (DME). The essence is to classify users of DME in a previous year into clinically homogeneous classes and to apply the resulting classification as a risk adjuster for capitation payments in the subsequent year. We evaluate 143 DME types in terms of incentives, validity, predictive value, and measurability, resulting in 14 functional disability classes (FDCs). We conclude that FDCs can significantly improve the Dutch risk adjustment model, although possible incentives for oversupply have to be monitored.

  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. A Cost-effectiveness Analysis of Laparoscopic Gastric Bypass, Adjustable Gastric Banding and Non-Surgical Weight Loss Interventions

    PubMed Central

    Salem, Leon; Devlin, Allison; Sullivan, Sean D.; Flum, David R.

    2009-01-01

    Setting Laparoscopic adjustable gastric banding (LAGB) and Laparoscopic Roux-en-Y gastric bypass (LRYGB) are the two most commonly performed bariatric procedures. While both procedures likely reduce healthcare expenditures related to the resolution of comorbid conditions, they have different rates of perioperative risks and differential rates of associated weight loss. Objective We designed a model to evaluate the incremental cost-effectiveness (ICER) of these procedures compared to non-operative weight loss interventions and to each other. Methods Deterministic, payer-perspective model comparing the lifetime expected costs and outcomes of LAGB, LRYGB and non-surgical treatment. The major endpoints were survival, health related quality of life and weight loss. Life expectancy and lifetime medical costs were calculated across age, sex and body mass index (BMI) strata using previously published data. Results For both men and women LRYGB and LAGB were cost-effective at less than $25,000/QALY even when evaluating the full range of baseline BMI and estimates of adverse outcomes, weight loss and costs. For base-case scenarios in men (age 35, BMI 40) the ICER was $11,604 per QALY for LAGB, compared to $18,543 per QALY for LRYGB. For base-case scenarios in women (age 35, BMI 40) the ICER was $8,878 per QALY for LAGB, compared to $14,680 per QALY for LRYGB. Conclusions Modeled cost-effectiveness analysis showed that both operative interventions for morbid obesity, LAGB and RYGB, were cost-effective at less than $25,000, and LAGB was more cost-effective than RYGB for all the base-case scenarios. PMID:18069075

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

    PubMed

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

    2015-01-01

    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 to 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 led 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 = .08). No single dietary change stood out as the most effective, but calorie changes were largely unhelpful (10% with additional benefit).

  17. 78 FR 43820 - Medicare Program; Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-22

    ... Program; Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare Prescription Drug...; Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare Prescription Drug Benefit...-referencing errors in the Medicare Program; Medical Loss Ratio Requirements for the Medicare Advantage and...

  18. 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...

  19. 42 CFR 422.2420 - Calculation of the medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Calculation of the medical loss ratio. 422.2420... Medical Loss Ratio § 422.2420 Calculation of the medical loss ratio. (a) Determination of MLR. (1) The MLR for each contract under this part is the ratio of the numerator (as defined in paragraph (b) of...

  20. 38 CFR 10.2 - Evidence required of loss, destruction or mutilation of adjusted service certificate.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... an adjusted service certificate issued pursuant to the provisions of section 501 of the World War..., destruction or mutilation of adjusted service certificate. 10.2 Section 10.2 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUSTED COMPENSATION Adjusted Compensation; General §...

  1. 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.

  2. 78 FR 12427 - Medicare Program; Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-22

    ... 42 CFR Parts 422 and 423 Medicare Program; Medical Loss Ratio Requirements for the Medicare Advantage... Loss Ratio Requirements for the Medicare Advantage and the Medicare Prescription Drug Benefit Programs... proposed rule would implement medical loss ratio (MLR) requirements for the Medicare Advantage Program...

  3. A comparison of confounding adjustment methods for assessment of asthma controller medication effectiveness.

    PubMed

    Li, Lingling; Vollmer, William M; Butler, Melissa G; Wu, Pingsheng; Kharbanda, Elyse O; Wu, Ann Chen

    2014-03-01

    We compared the impact of 3 confounding adjustment procedures-covariate-adjusted regression, propensity score regression, and high-dimensional propensity score regression-to assess the effects of selected asthma controller medication use (leukotriene antagonists and inhaled corticosteroids) on the following 4 asthma-related adverse outcomes: emergency department visits, hospitalizations, oral corticosteroid use, and the composite outcome of these. We examined a cohort of 24,680 new users who were 4-17 years of age at the incident dispensing from the Population-Based Effectiveness in Asthma and Lung Diseases (PEAL) Network of 5 commercial health plans and TennCare, the Tennessee Medicaid program, during the period January 1, 2004, to December 31, 2010. The 3 methods yielded similar results, indicating that pediatric patients treated with leukotriene antagonists were no more likely than those treated with inhaled corticosteroids to experience adverse outcomes. Children in the TennCare population who had a diagnosis of allergic rhinitis and who then initiated the use of leukotriene antagonists were less likely to experience an asthma-related emergency department visit. A plausible explanation is that our data set is large enough that the 2 advanced propensity score-based analyses do not have advantages over the traditional covariate-adjusted regression approach. We provide important observations on how to correctly apply the methods in observational data analysis and suggest statistical research areas that need more work to guide implementation.

  4. 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...

  5. 48 CFR 1602.170-14 - FEHB-specific medical loss ratio threshold calculation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ratio threshold calculation. 1602.170-14 Section 1602.170-14 Federal Acquisition Regulations System... DEFINITIONS OF WORDS AND TERMS Definitions of FEHBP Terms 1602.170-14 FEHB-specific medical loss ratio threshold calculation. (a) Medical Loss Ratio (MLR) means the ratio of plan incurred claims, including...

  6. 45 CFR 158.221 - Formula for calculating an issuer's medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... ratio. 158.221 Section 158.221 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... and Providing the Rebate § 158.221 Formula for calculating an issuer's medical loss ratio. (a) Medical loss ratio. (1) An issuer's MLR is the ratio of the numerator, as defined in paragraph (b) of...

  7. 45 CFR 158.221 - Formula for calculating an issuer's medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ratio. 158.221 Section 158.221 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... and Providing the Rebate § 158.221 Formula for calculating an issuer's medical loss ratio. (a) Medical loss ratio. (1) An issuer's MLR is the ratio of the numerator, as defined in paragraph (b) of...

  8. 48 CFR 1602.170-14 - FEHB-specific medical loss ratio threshold calculation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... ratio threshold calculation. 1602.170-14 Section 1602.170-14 Federal Acquisition Regulations System... DEFINITIONS OF WORDS AND TERMS Definitions of FEHBP Terms 1602.170-14 FEHB-specific medical loss ratio threshold calculation. (a) Medical loss ratio (MLR) means the ratio of plan incurred claims, including...

  9. 48 CFR 1602.170-14 - FEHB-specific medical loss ratio threshold calculation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... ratio threshold calculation. 1602.170-14 Section 1602.170-14 Federal Acquisition Regulations System... DEFINITIONS OF WORDS AND TERMS Definitions of FEHBP Terms § 1602.170-14 FEHB-specific medical loss ratio threshold calculation. (a) Medical Loss Ratio (MLR) means the ratio of plan incurred claims, including...

  10. 45 CFR 158.221 - Formula for calculating an issuer's medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ratio. 158.221 Section 158.221 Public Welfare Department of Health and Human Services REQUIREMENTS... and Providing the Rebate § 158.221 Formula for calculating an issuer's medical loss ratio. (a) Medical loss ratio. (1) An issuer's MLR is the ratio of the numerator, as defined in paragraph (b) of...

  11. 45 CFR 158.221 - Formula for calculating an issuer's medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... ratio. 158.221 Section 158.221 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... and Providing the Rebate § 158.221 Formula for calculating an issuer's medical loss ratio. (a) Medical loss ratio. (1) An issuer's MLR is the ratio of the numerator, as defined in paragraph (b) of...

  12. 48 CFR 1602.170-14 - FEHB-specific medical loss ratio threshold calculation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ratio threshold calculation. 1602.170-14 Section 1602.170-14 Federal Acquisition Regulations System... DEFINITIONS OF WORDS AND TERMS Definitions of FEHBP Terms 1602.170-14 FEHB-specific medical loss ratio threshold calculation. (a) Medical Loss Ratio (MLR) means the ratio of plan incurred claims, including...

  13. Urinary Concentrations of Phthalate Metabolites in Relation to Pregnancy Loss among Women Conceiving with Medically Assisted Reproduction

    PubMed Central

    Messerlian, Carmen; Wylie, Blair J.; Minguez-Alarcon, Lidia; Williams, Paige L.; Ford, Jennifer B.; Souter, Irene C.; Calafat, Antonia M.; Hauser, Russ

    2017-01-01

    Background Animal studies demonstrate that several phthalates are embryofetotoxic and are associated with increased pregnancy loss and malformations. Results from human studies on phthalates and pregnancy loss are inconsistent. Methods We examined pregnancy loss prospectively in relation to urinary phthalate metabolite concentrations among women undergoing medically assisted reproduction. We used data from 256 women conceiving 303 pregnancies recruited between 2004 and 2012 from the Massachusetts General Hospital Fertility Center. We quantified eleven phthalate metabolite concentrations and calculated the molar sum of four di(2-ethylhexyl) phthalate (DEHP) metabolites (ΣDEHP). We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for biochemical loss and total pregnancy loss (<20 weeks’ gestation) across quartiles using repeated measures log-binomial models, adjusted for age, body mass index, smoking and infertility diagnosis. Results Of the 303 pregnancies, 83 (27%) ended in loss less than 20 weeks’ gestation and among these, 31 (10%) ended in biochemical loss. Although imprecise, the RRs for biochemical loss increased across quartiles of ∑DEHP and three individual DEHP metabolites. For ∑DEHP, the RRs (CIs) were: 2.3 (0.63, 8.5), 2.0 (0.58, 7.2), and 3.4 (0.97, 11.7) for quartiles two, three and four, compared to one, respectively (p-trend=0.04). RRs for total pregnancy loss were elevated in the highest quartiles of ΣDEHP and three DEHP metabolites. The remaining seven phthalate metabolite concentrations evaluated were not associated with either outcome. Conclusions We found a suggestive pattern of association between conception cycle-specific urinary concentrations of DEHP metabolites and biochemical and total pregnancy loss among women undergoing medically assisted reproduction. PMID:27299194

  14. 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)

  15. 42 CFR 423.2420 - Calculation of medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... vendors for secondary network savings. (B) Amounts paid to third party vendors for any of the following... paragraph (b) of this section) to the denominator (as defined in paragraph (c) of this section). An MLR may be increased by a credibility adjustment according to the rules at § 423.2440, or subject to...

  16. 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

  17. 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…

  18. 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…

  19. 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.

  20. 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.

  1. 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.

  2. 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...

  3. 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...

  4. 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...

  5. 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...

  6. What are the risks and the benefits of current and emerging weight-loss medications?

    PubMed

    Robinson, Jamie R; Niswender, Kevin D

    2009-10-01

    Obesity is epidemic; new medications and therapeutic options are urgently needed to reduce the associated health care burden. The initial clinical strategy for weight loss is lifestyle modification involving a combination of diet, exercise, and behavior change. However, it is difficult for many to achieve and maintain weight loss solely through this approach. Only two drugs, orlistat and sibutramine, have been approved by the US Food and Drug Administration (FDA) to treat obesity long term, and both medications have undesirable side effects, leaving an enormous unmet need for efficacious and safe therapy for obesity. Other medications with weight-loss effects have been approved by the FDA for short-term treatment of obesity or for disorders other than obesity, but these also have potential adverse effects. This article discusses the perceived benefits and risks of these approved medications along with emerging drugs that have shown weight-loss effects.

  7. Medical respiratory monitoring sensors based on microbend fiber loss

    NASA Astrophysics Data System (ADS)

    Zhao, Yong; Zhouxiao, Liuting; Yang, Jian; Li, Xianjing

    2016-11-01

    In this work, a medical respiratory monitoring sensor based on the microbend effect of optical fiber on light transmission is proposed. The microbend effect of multimode optical fiber is analyzed theoretically using optical theory. A respiratory signal modulator with a "sandwich" microbender structure is designed enabling the noninvasive real-time monitoring. In vitro testing showed that the proposed sensor has excellent following characteristics and can automatically discern respiratory condition, the signal-to-noise ratio can be better than 28dB.

  8. Patient Factors Associated with Undergoing Laparoscopic Adjustable Gastric Banding vs Roux-en-Y Gastric Bypass for Weight Loss

    PubMed Central

    Apovian, Caroline M; Huskey, Karen W; Chiodi, Sarah; Hess, Donald T; Schneider, Benjamin E; Blackburn, George L; Jones, Daniel B; Wee, Christina C

    2013-01-01

    Background Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding are two commonly performed bariatric procedures in the US with different profiles for risk and effectiveness. Little is known about factors that might lead patients to proceed with one procedure over the other. Study Design We recruited and interviewed patients seeking bariatric surgery from 2 academic centers in Boston (response rate 70%). We conducted multivariable analyses to identify patient perceptions and clinical and behavioral characteristics that correlated with undergoing gastric banding (n=237) versus gastric bypass (n=298). Results After adjustment for sociodemographic and clinical factors, we found that older patients [OR 1.03 (95 % CI1.00-1.05)] and those with higher quality of life (QOL) scores and higher levels of uncontrolled eating were more likely to undergo gastric banding as opposed to gastric bypass. In contrast, patients with type 2 diabetes [0.46 (0.28,0.77)those who desired greater weight loss, and those who were willing to assume higher mortality risk to achieve their ideal weight were less likely to proceed with gastric banding. After initial adjustment, male sex and lower BMI were associated with likelihood to undergo gastric banding; however, these factors were no longer significant after adjustment for other significant correlates such as patients' perceived ideal weight, predilection to assume risk to lose weight, and eating behavior. Conclusions Patients' diabetes status, quality of life, eating behavior, ideal weight loss, and willingness to assume mortality risk to lose weight were associated with whether patients proceeded with gastric banding as opposed to gastric bypass. Other clinical factors were less important. PMID:24083911

  9. 45 CFR 158.211 - Requirement in States with a higher medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ratio. 158.211 Section 158.211 Public Welfare Department of Health and Human Services REQUIREMENTS... and Providing the Rebate § 158.211 Requirement in States with a higher medical loss ratio. (a) State option to set higher minimum loss ratio. For coverage offered in a State whose law provides that...

  10. 45 CFR 158.211 - Requirement in States with a higher medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ratio. 158.211 Section 158.211 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... and Providing the Rebate § 158.211 Requirement in States with a higher medical loss ratio. (a) State option to set higher minimum loss ratio. For coverage offered in a State whose law provides that...

  11. 45 CFR 158.211 - Requirement in States with a higher medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... ratio. 158.211 Section 158.211 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... and Providing the Rebate § 158.211 Requirement in States with a higher medical loss ratio. (a) State option to set higher minimum loss ratio. For coverage offered in a State whose law provides that...

  12. 45 CFR 158.211 - Requirement in States with a higher medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... ratio. 158.211 Section 158.211 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS... and Providing the Rebate § 158.211 Requirement in States with a higher medical loss ratio. (a) State option to set higher minimum loss ratio. For coverage offered in a State whose law provides that...

  13. A Multidisciplinary Approach to Medical Weight Loss Prior to Complex Abdominal Wall Reconstruction: Is it Feasible?

    PubMed

    Rosen, Michael J; Aydogdu, Kasim; Grafmiller, Kevin; Petro, Clayton C; Faiman, Gregg H; Prabhu, Ajita

    2015-08-01

    Obesity is a major risk factor for perioperative morbidity, especially for patients undergoing complex incisional hernia repair. The feasibility and effectiveness of medical weight loss programs prior to complex abdominal wall reconstruction have not been well characterized. Here, we report our experience collaborating with a medical weight loss specialist utilizing a protein sparing modified fast in order to optimize weight loss prior to complex abdominal wall reconstruction. Morbidly obese patients (body mass index (BMI) > 35 kg/m(2)) evaluated by our medical weight loss specialist prior to complex ventral hernia repair were identified within our prospective database. Our primary outcome measure was the amount of weight lost prior to surgical intervention. Our secondary outcome measure was to determine the maintenance of weight loss during long-term follow-up after the surgical intervention. A total of 25 patients with a BMI > 35 kg/m(2) were evaluated by our medical weight loss specialist prior to undergoing a planned incisional hernia repair. The mean weight of the patients preoperatively was 128 kg ± 25 (range 96-205 kg) (mean ± standard deviation), and the mean BMI was 49 kg/m(2) ± 10 (range 36-85). After completion of the preoperative modified protein sparing fast, the mean preoperative weight loss of the group was 24 kg ± 21 (range 2-80 kg). The overall change in BMI for the group prior to surgery was 9 kg/m(2) ± 8 (0.6 to 33). The percentage of excess BMI loss and total BMI loss preoperatively was 37 % ± 23 (2 to 83) and 18 % ± 12 (1 to 43), respectively. Of the 24 patients that initially lost weight in the program preoperatively, 22 (88 %) successfully maintained their weight loss for the entire study period for an average of 18 months. Collaboration with a medical weight loss specialist and a surgeon with a structured approach using a modified protein sparing fast can successfully result in meaningful weight

  14. 20 CFR 416.962 - 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. 416.962 Section 416.962 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Vocational Considerations...

  15. 20 CFR 416.962 - 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. 416.962 Section 416.962 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Vocational Considerations...

  16. 20 CFR 416.962 - 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. 416.962 Section 416.962 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Vocational Considerations...

  17. 20 CFR 416.962 - 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. 416.962 Section 416.962 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Vocational Considerations...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. Quantifying and Adjusting for Disease Misclassification Due to Loss to Follow-Up in Historical Cohort Mortality Studies

    PubMed Central

    Scott, Laura L. F.; Maldonado, George

    2015-01-01

    The purpose of this analysis was to quantify and adjust for disease misclassification from loss to follow-up in a historical cohort mortality study of workers where exposure was categorized as a multi-level variable. Disease classification parameters were defined using 2008 mortality data for the New Zealand population and the proportions of known deaths observed for the cohort. The probability distributions for each classification parameter were constructed to account for potential differences in mortality due to exposure status, gender, and ethnicity. Probabilistic uncertainty analysis (bias analysis), which uses Monte Carlo techniques, was then used to sample each parameter distribution 50,000 times, calculating adjusted odds ratios (ORDM-LTF) that compared the mortality of workers with the highest cumulative exposure to those that were considered never-exposed. The geometric mean ORDM-LTF ranged between 1.65 (certainty interval (CI): 0.50–3.88) and 3.33 (CI: 1.21–10.48), and the geometric mean of the disease-misclassification error factor (εDM-LTF), which is the ratio of the observed odds ratio to the adjusted odds ratio, had a range of 0.91 (CI: 0.29–2.52) to 1.85 (CI: 0.78–6.07). Only when workers in the highest exposure category were more likely than those never-exposed to be misclassified as non-cases did the ORDM-LTF frequency distributions shift further away from the null. The application of uncertainty analysis to historical cohort mortality studies with multi-level exposures can provide valuable insight into the magnitude and direction of study error resulting from losses to follow-up. PMID:26501295

  4. 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.

  5. 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.

  6. '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.

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

    PubMed

    2014-01-07

    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.

  8. 76 FR 76595 - Medical Loss Ratio Rebate Requirements for Non-Federal Governmental Plans

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-07

    ... programs or the rights and obligations of recipients thereof; or (4) raising novel legal or policy issues... December 7, 2011 Part V Department of Health and Human Services 45 CFR Part 158 Medical Loss Ratio Rebate... / Wednesday, December 7, 2011 / Rules and Regulations#0;#0; ] DEPARTMENT OF HEALTH AND HUMAN SERVICES 45...

  9. 78 FR 53702 - Computation of, and Rules Relating to, Medical Loss Ratio; Hearing Cancellation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-30

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BL05 Computation of, and Rules Relating to, Medical Loss Ratio; Hearing Cancellation AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Cancellation of a notice of public hearing on proposed rulemaking. SUMMARY: This document cancels a public hearing...

  10. 45 CFR 158.220 - Aggregation of data in calculating an issuer's medical loss ratio.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Aggregation of data in calculating an issuer's medical loss ratio. 158.220 Section 158.220 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... ratio. (a) Aggregation by State and by market. In general, an issuer's MLR must be calculated...

  11. 45 CFR 158.220 - Aggregation of data in calculating an issuer's medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Aggregation of data in calculating an issuer's medical loss ratio. 158.220 Section 158.220 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... ratio. (a) Aggregation by State and by market. In general, an issuer's MLR must be calculated...

  12. 45 CFR 158.220 - Aggregation of data in calculating an issuer's medical loss ratio.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Aggregation of data in calculating an issuer's medical loss ratio. 158.220 Section 158.220 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... ratio. (a) Aggregation by State and by market. In general, an issuer's MLR must be calculated...

  13. 45 CFR 158.220 - Aggregation of data in calculating an issuer's medical loss ratio.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Aggregation of data in calculating an issuer's medical loss ratio. 158.220 Section 158.220 Public Welfare Department of Health and Human Services... ratio. (a) Aggregation by State and by market. In general, an issuer's MLR must be calculated...

  14. Adjusted Analyses in Studies Addressing Therapy and Harm: Users' Guides to the Medical Literature.

    PubMed

    Agoritsas, Thomas; Merglen, Arnaud; Shah, Nilay D; O'Donnell, Martin; Guyatt, Gordon H

    2017-02-21

    Observational studies almost always have bias because prognostic factors are unequally distributed between patients exposed or not exposed to an intervention. The standard approach to dealing with this problem is adjusted or stratified analysis. Its principle is to use measurement of risk factors to create prognostically homogeneous groups and to combine effect estimates across groups.The purpose of this Users' Guide is to introduce readers to fundamental concepts underlying adjustment as a way of dealing with prognostic imbalance and to the basic principles and relative trustworthiness of various adjustment strategies.One alternative to the standard approach is propensity analysis, in which groups are matched according to the likelihood of membership in exposed or unexposed groups. Propensity methods can deal with multiple prognostic factors, even if there are relatively few patients having outcome events. However, propensity methods do not address other limitations of traditional adjustment: investigators may not have measured all relevant prognostic factors (or not accurately), and unknown factors may bias the results.A second approach, instrumental variable analysis, relies on identifying a variable associated with the likelihood of receiving the intervention but not associated with any prognostic factor or with the outcome (other than through the intervention); this could mimic randomization. However, as with assumptions of other adjustment approaches, it is never certain if an instrumental variable analysis eliminates bias.Although all these approaches can reduce the risk of bias in observational studies, none replace the balance of both known and unknown prognostic factors offered by randomization.

  15. 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.

  16. 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

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

    PubMed

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

    2015-10-02

    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.

  18. 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…

  19. The Validity of US Nutritional Surveillance: USDA's Loss-Adjusted Food Availability Data Series 1971-2010.

    PubMed

    Archer, Edward; Thomas, Diana M; McDonald, Samantha M; Pavela, Gregory; Lavie, Carl J; Hill, James O; Blair, Steven N

    The purpose of this study was to examine the validity of the 1971-2010 United States Department of Agriculture's (USDA's) loss-adjusted food availability (LAFA) per capita caloric consumption estimates. Estimated total daily energy expenditure (TEE) was calculated for nationally representative samples of US adults, 20-74 years, using the Institute of Medicine's predictive equations with "low-active" (TEE L-ACT) and "sedentary" (TEE SED) physical activity values. TEE estimates were subtracted from LAFA estimates to create disparity values (kcal/d). A validated mathematical model was applied to calculate expected weight change in reference individuals resulting from the disparity. From 1971-2010, the disparity between LAFA and TEE L-ACT varied by 394kcal/d-(P < 0.001), from -205kcal/d (95% CI: -214, -196) to +189kcal/d (95% CI: 168, 209). The disparity between LAFA and TEE SED varied by 412kcal/d (P < 0.001), from -84kcal/d (95% CI: -93, -76) to +328kcal/d (95% CI: 309, 348). Our model suggests that if LAFA estimates were actually consumed, reference individuals would have lost ~1-4kg/y from 1971-1980 (an accumulated loss of ~12 to ~36kg), and gained ~3-7kg/y from 1988-2010 (an accumulated gain of ~42 to ~98kg). These estimates differed from the actual measured increments of 10kg and 9kg in reference men and women, respectively, over the 39-year period. The USDA LAFA data provided inconsistent, divergent estimates of per capita caloric consumption over its 39-year history. The large, variable misestimation suggests that the USDA LAFA per capita caloric intake estimates lack validity and should not be used to inform public policy.

  20. The fundamental and medical impacts of recent progress in research on hereditary hearing loss.

    PubMed

    Kalatzis, V; Petit, C

    1998-01-01

    What would define real progress in the field of deafness research in fundamental and medical terms? In fundamental terms, progress would be measured by an improvement in our knowledge of the development and physiology of the ear. In medical terms, progress would lead to the division of the broad category of hearing defects into distinct clinical entities or subclasses, the collection of epidemiological data, the creation of molecular diagnostic tests, the improvement of genetic counselling services and the development of new therapeutics. In this review, we will introduce some general considerations on hereditary hearing loss and on the structure and function of the ear, present the rapidly emerging data on the molecular basis of syndromic and non-syndromic forms of hearing loss and comment on relevant recent progress in this field of research. Generally speaking, the isolation of genes underlying hereditary hearing loss has, as yet, had little impact on our understanding of the biology of the ear, whereas it has made major contributions to the medical field, in particular due to the recognition of two genes, Cx26 and mitochondrial 12S rRNA , as frequently underlying cases of non-syndromic hearing impairment.

  1. 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

  2. Medical and genetic differences in the adverse impact of sleep loss on performance: ethical considerations for the medical profession.

    PubMed

    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

  3. 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

  4. 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.

  5. A compact dual-wavelength Nd:LuVO4 laser with adjustable power-ratio between 1064 nm and 1342 nm lines by controlling polarization dependent loss

    NASA Astrophysics Data System (ADS)

    Qi, Yaoyao; Yu, Haijuan; Zhang, Jingyuan; Zhang, Ling; He, Chaojian; Lin, Xuechun

    2017-01-01

    We demonstrate a compact dual-wavelength operation of Nd:LuVO4 laser with a power-ratio adjustable between 1064 nm and 1342 nm lines in a compound cavity configuration. The output power at two wavelengths of the laser indicates that it depends not only on pumping-power and but also on the controllable polarization loss in the cavity. Also, the power-ratio, defined as ratio between the output power at 1064 nm and that at 1342 nm, can be adjusted from 0 to 8 or higher accurately by rotating a quarter-wave plate (QWP) in the cavity.

  6. [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

  7. Longitudinal regional brain volume loss in schizophrenia: Relationship to antipsychotic medication and change in social function

    PubMed Central

    Guo, Joyce Y.; Huhtaniska, Sanna; Miettunen, Jouko; Jääskeläinen, Erika; Kiviniemi, Vesa; Nikkinen, Juha; Moilanen, Jani; Haapea, Marianne; Mäki, Pirjo; Jones, Peter B.; Veijola, Juha; Isohanni, Matti; Murray, Graham K.

    2015-01-01

    Background Progressive brain volume loss in schizophrenia has been reported in previous studies but its cause and regional distribution remains unclear. We investigated progressive regional brain reductions in schizophrenia and correlations with potential mediators. Method Participants were drawn from the Northern Finland Birth Cohort 1966. A total of 33 schizophrenia individuals and 71 controls were MRI scanned at baseline (mean age = 34.7, SD = 0.77) and at follow-up (mean age = 43.4, SD = 0.44). Regional brain change differences and associations with clinical mediators were examined using FSL voxelwise SIENA. Results Schizophrenia cases exhibited greater progressive brain reductions than controls, mainly in the frontal and temporal lobes. The degree of periventricular brain volume reductions were predicted by antipsychotic medication exposure at the fourth ventricular edge and by the number of days in hospital between the scans (a proxy measure of relapse duration) at the thalamic ventricular border. Decline in social and occupational functioning was associated with right supramarginal gyrus reduction. Conclusion Our findings are consistent with the possibility that antipsychotic medication exposure and time spent in relapse partially explain progressive brain reductions in schizophrenia. However, residual confounding could also account for the findings and caution must be applied before drawing causal inferences from associations demonstrated in observational studies of modest size. Less progressive brain volume loss in schizophrenia may indicate better preserved social and occupational functions. PMID:26189075

  8. State-Level Lifetime Medical and Work-Loss Costs of Fatal Injuries - United States, 2014.

    PubMed

    Luo, Feijun; Florence, Curtis

    2017-01-13

    Injury-associated deaths have substantial economic consequences in the United States. The total estimated lifetime medical and work-loss costs associated with fatal injuries in 2013 were $214 billion (1). In 2014, unintentional injury, suicide, and homicide (the fourth, tenth, and seventeenth leading causes of death, respectively) accounted for 194,635 deaths in the United States (2). In 2014, a total of 199,756 fatal injuries occurred in the United States, and the associated lifetime medical and work-loss costs were $227 billion (3). This report examines the state-level economic burdens of fatal injuries by extending a previous national-level study (1). Numbers and rates of fatal injuries, lifetime costs, and lifetime costs per capita were calculated for each of the 50 states and the District of Columbia (DC) and for four injury intent categories (all intents, unintentional, suicide, and homicide). During 2014, injury mortality rates and economic burdens varied widely among the states and DC. Among fatal injuries of all intents, the mortality rate and lifetime costs per capita ranged from 101.9 per 100,000 and $1,233, respectively (New Mexico) to 40.2 per 100,000 and $491 (New York). States can engage more effectively and efficiently in injury prevention if they are aware of the economic burden of injuries, identify areas for immediate improvement, and devote necessary resources to those areas.

  9. Baseline observations from the POSSIBLE EU® study: characteristics of postmenopausal women receiving bone loss medications

    PubMed Central

    Cooper, Cyrus; Roux, Christian; Díez-Pérez, Adolfo; Guillemin, Francis; Jonsson, Bengt; Ortolani, Sergio; Pfeilschifter, Johannes; Horne, Rob; Kakad, Shilpa; Shepherd, Susan; Möller, Gerd; Marciniak, Anne; Martinez, Luc

    2010-01-01

    Summary Prospective Observational Scientific Study Investigating Bone Loss Experience in Europe (POSSIBLE EU®) is an ongoing longitudinal cohort study that utilises physician- and patient-reported measures to describe the characteristics and management of postmenopausal women on bone loss therapies. We report the study design and baseline characteristics of 3,402 women recruited from general practice across five European countries. Purpose The POSSIBLE EU® is a study describing the characteristics and management of postmenopausal women receiving bone loss medications. Methods Between 2005 and 2008, general practitioners enrolled postmenopausal women initiating, switching or continuing treatment with bone loss treatment in France, Germany, Italy, Spain and the UK. Patients and physicians completed questionnaires at study entry and at 3-month intervals, for 1 year. Results Of 3,402 women enrolled (mean age 68.2 years [SD] 9.83), 96% were diagnosed with low bone mass; 55% of these using dual energy X-ray absorptiometry. Most women (92%) had comorbidities. Mean minimum T score (hip or spine) at diagnosis was −2.7 (SD 0.89; median −2.7 [interquartile range, −3.2, −2.2]) indicating low bone mineral density. Almost 40% of the women had prior fractures in adulthood, mostly non-vertebral, non-hip in nature, 30% of whom had at least two fractures and more than half experienced moderate/severe pain or fatigue. Bisphosphonates were the most common type of bone loss treatment prescribed in the 12 months preceding the study. Conclusions POSSIBLE EU® characterises postmenopausal women with low bone mass, exhibiting a high rate of prevalent fracture, substantial bone fragility and overall comorbidity burden. Clinical strategies for managing osteoporosis in this population varied across the five participating European countries, reflecting their different guidelines, regulations and standards of care. PMID:21258637

  10. 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.

  11. 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.

  12. 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.

  13. [Characteristics of morbidity, loss in man-hours, medical disqualification from flight duties and improvement of the medical flight certification process at the modern phase].

    PubMed

    Kniga, V V; Pitsyk, S P

    2003-01-01

    Examined and analyzed was dynamics of morbidity, losses in man-hours, medical discharge and attrition of the flying personnel in various types and branches of aviation of the Russian Federation Military Forces over the recent 10 years (1991-2000). Results of the review of the RF MF medical flight certification process (MCP) laid the ground for developing guidelines and scientifically substantiated proposals for MCP improvement in line with the present-day reform of the RF MF aviation.

  14. Does medically induced weight loss improve obstructive sleep apnoea in the obese: review of randomized trials.

    PubMed

    Hemmingsson, E

    2011-02-01

    Obstructive sleep apnoea is characterized by repeated periods of breathing cessation during sleep. Obstructive sleep apnoea is both common and underdiagnosed in the obese. A recent study found that as many as 86% of older obese type 2 diabetics had obstructive sleep apnoea. Obesity is independently associated with developing obstructive sleep apnoea, and the reverse may also occur. The prevalence of obstructive sleep apnoea is therefore expected to rise in the wake of the obesity epidemic. The number of partial (hypopnoea) or complete (apnoea) airway obstructions per hour (apnoea-hypopnoea index) is used to classify obstructive sleep apnoea as mild (5-14 events per hour), moderate (15-30) or severe (>30). Severe obstructive sleep apnoea is associated with a two to sixfold increase in all-cause mortality; the impact of mild and moderate obstructive sleep apnoea is less clear. Until recently, the evidence supporting a beneficial effect of weight loss on obstructive sleep apnoea has been limited by a lack of randomized trials. In 2009, at least three randomized controlled trials evaluated whether medically induced weight loss improves obstructive sleep apnoea. The treatment effect ranged from 42% to 62% improvement, although the highest estimate was seen in a very short duration study (9 weeks). Patients who either lost 10-15 kg or more, or had severe obstructive sleep apnoea at baseline, benefited most from treatment.

  15. 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.

  16. 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

  17. Distribution and Medical Impact of Loss-of-Function Variants in the Finnish Founder Population

    PubMed Central

    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

    2014-01-01

    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

  18. 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.

  19. ‘Miscarriage or abortion?’ Understanding the medical language of pregnancy loss in Britain; a historical perspective

    PubMed Central

    Moscrop, Andrew

    2013-01-01

    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. PMID:23429567

  20. 75 FR 19297 - Medical Loss Ratios; Request for Comments Regarding Section 2718 of the Public Health Service Act

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-14

    ... reserves) to earned premiums (also known as the medical loss ratio (MLR)). Section 2718(a) requires that... (or change in contract reserves) to earned premiums--including the percentage of premiums spent on... annual reports to the Secretary on the percentages of premiums that the coverage spends on...

  1. 45 CFR 158.240 - Rebating premium if the applicable medical loss ratio standard is not met.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Rebating premium if the applicable medical loss ratio standard is not met. 158.240 Section 158.240 Public Welfare DEPARTMENT OF HEALTH AND HUMAN... ratio standard is not met. (a) General requirement. For each MLR reporting year, an issuer must...

  2. 45 CFR 158.240 - Rebating premium if the applicable medical loss ratio standard is not met.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Rebating premium if the applicable medical loss ratio standard is not met. 158.240 Section 158.240 Public Welfare Department of Health and Human... ratio standard is not met. (a) General requirement. For each MLR reporting year, an issuer must...

  3. 45 CFR 158.240 - Rebating premium if the applicable medical loss ratio standard is not met.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Rebating premium if the applicable medical loss ratio standard is not met. 158.240 Section 158.240 Public Welfare DEPARTMENT OF HEALTH AND HUMAN... ratio standard is not met. (a) General requirement. For each MLR reporting year, an issuer must...

  4. 45 CFR 158.240 - Rebating premium if the applicable medical loss ratio standard is not met.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Rebating premium if the applicable medical loss ratio standard is not met. 158.240 Section 158.240 Public Welfare DEPARTMENT OF HEALTH AND HUMAN... ratio standard is not met. (a) General requirement. For each MLR reporting year, an issuer must...

  5. 42 CFR 422.2420 - Calculation of the medical loss ratio.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...: (A) Amounts paid to third party vendors for secondary network savings. (B) Amounts paid to third... section) to the denominator (as defined in paragraph (c) of this section). An MLR may be increased by a credibility adjustment according to the rules at § 422.2440, or subject to an adjustment determined by CMS...

  6. [Changes in medical standards and the need for adjusting legal standards of care from the point of view of criminal law].

    PubMed

    Erlinger, Rainer

    2007-01-01

    In addition to the possibility of adjusting medical standards to the limited resources in health care, which is also included in civil law, German criminal law provides various other instruments. These include (1) the subjective person-related standard of diligence, (2) a restriction of the associated legal concept of "Ubernahmeverschulden" (fault by assumption), (3) admissible risk, (4) social adequacy, and (5) reasonableness and possibility within the scope of criminal omission. Although especially social adequacy and reasonableness and possibility from the point of view of criminal law may lead to satisfactory solutions, the adjustment of medical standards should--for the sake of the unity of law--be preferred so that synchronization with civil law liability may thus be achieved.

  7. Short-term medical benefits and adverse effects of weight loss.

    PubMed

    Pi-Sunyer, F X

    1993-10-01

    Weight loss reduces many of the health hazards associated with obesity including insulin resistance, diabetes mellitus, hypertension, dyslipidemia, sleep apnea, hypoxemia and hypercarbia, and osteoarthritis. Potential adverse effects of weight loss include a greater risk for gallstone formation and cholecystitis, excessive loss of lean body mass, water and electrolyte problems, mild liver dysfunction, and elevated uric acid levels. Less consequential problems such as diarrhea, constipation, hair loss, and cold intolerance may also occur. The short-term adverse effects are not severe enough to contraindicate weight loss, nor do they outweigh its short-term benefits.

  8. 20 CFR 416.962 - 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... ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Vocational Considerations § 416.962 Medical-vocational profiles showing an inability to make...

  9. 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

  10. 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.

  11. 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

  12. Disease-outcome trees, EQ-5D scores, and estimated annual losses of quality-adjusted life years (QALYs) for 14 foodborne pathogens in the United States.

    PubMed

    Batz, Michael; Hoffmann, Sandra; Morris, J Glenn

    2014-05-01

    Measures of disease burden such as quality-adjusted life years (QALYs) are increasingly important to risk-based food safety policy. They provide a means of comparing relative risk from diverse health outcomes. We present detailed disease-outcome trees and EQ-5D scoring for 14 major foodborne pathogens representing over 95% of foodborne illnesses, hospitalizations, and deaths due to specified agents in the United States (Campylobacter spp., Clostridium perfringens, Cryptosporidium parvum, Cyclospora cayetanensis, Escherichia coli O157:H7, Shiga toxin-producing E. coli non-O157, Listeria monocytogenes, nontyphoidal Salmonella enterica, Shigella, Toxoplasma gondii, Vibrio vulnificus, Vibrio parahaemolyticus and other noncholera Vibrio, and Yersinia enterocolitica). We estimate over 5800 QALYs lost per 1000 cases of L. monocytogenes and V. vulnificus, compared to 125 QALYs lost per 1000 cases of T. gondii, 26 for E. coli O157:H7, 16 for Salmonella and Campylobacter, and 14 for Y. enterocolitica. The remaining 7 pathogens are estimated to cause less than 5 QALYs lost per 1000 cases. In total, these 14 pathogens cause over 61,000 in QALY loss annually, with more than 90% due solely to acute infection being responsible for 65% of total QALY loss, with premature mortality and morbidity due to chronic and congenital illness responsible for another 28%. These estimates of the burden of chronic sequelae are likely conservative; additional epidemiological research is needed to support more accurate burden estimates. This study shows the value of using integrated metrics for comparing disease burden, and the need to consider chronic and congenital illness when prioritizing foodborne pathogens.

  13. 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…

  14. Ototoxic Medications (Medication Effects)

    MedlinePlus

    ... Information for the Public / Hearing and Balance Ototoxic Medications (Medication Effects) By Barbara Cone, Patricia Dorn, Dawn Konrad- ... Audiology Information Series [PDF]. What Is Ototoxicity? Certain medications can damage the ear, resulting in hearing loss, ...

  15. 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

    2015-10-02

    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.

  16. Understanding medical group financial and operational performance: the synergistic effect of linking statistical process control and profit and loss.

    PubMed

    Smolko, J R; Greisler, D S

    2001-01-01

    There is ongoing pressure for medical groups owned by not-for-profit health care systems or for-profit entrepreneurs to generate profit. The fading promise of superior strategy through health care integration has boards of directors clamoring for bottom-line performance. While prudent, sole focus on the bottom line through the lens of the profit-and-loss (P&L) statement provides incomplete information upon which to base executive decisions. The purpose of this paper is to suggest that placing statistical process control (SPC) charts in tandem with the P&L statement provides a more complete picture of medical group performance thereby optimizing decision making as executives deal with the whitewater issues surrounding physician practice ownership.

  17. Adjusting to Random Demands of Patient Care: A Predictive Model for Nursing Staff Scheduling at Naval Medical Center San Diego

    DTIC Science & Technology

    2008-09-01

    rich mix of medical services that range from simple ambulatory visits to plastic surgery , neuro- surgery , general surgery , bariatric , ophthalmology...CENTER SAN DIEGO NMCSD is a 266-bed tertiary care facility providing patient services ranging from same day surgery to brain surgery . The hospital...orthopedics, cardiology, thoracic surgery , vascular surgery , transient ischemic attack/cerebro vascular accident (TIA/CVA), OB/GYN, urology, non

  18. Emergency department crowding and loss of medical licensure: a new risk of patient care in hallways.

    PubMed

    Derlet, Robert W; McNamara, Robert M; Kazzi, Amin Antoine; Richards, John R

    2014-03-01

    We report the case of a 32-year-old male recently diagnosed with type 2 diabetes treated at an urban university emergency department (ED) crowded to 250% over capacity. His initial symptoms of shortness of breath and feeling ill for several days were evaluated with chest radiograph, electrocardiogram (EKG), and laboratory studies, which suggested mild diabetic ketoacidosis. His medical care in the ED was conducted in a crowded hallway. After correction of his metabolic abnormalities he felt improved and was discharged with arrangements made for outpatient follow-up. Two days later he returned in cardiac arrest, and resuscitation efforts failed. The autopsy was significant for multiple acute and chronic pulmonary emboli but no coronary artery disease. The hospital settled the case for $1 million and allocated major responsibility to the treating emergency physician (EP). As a result the state medical board named the EP in a disciplinary action, claiming negligence because the EKG had not been personally interpreted by that physician. A formal hearing was conducted with the EP's medical license placed in jeopardy. This case illustrates the risk to EPs who treat patients in crowded hallways, where it is difficult to provide the highest level of care. This case also demonstrates the failure of hospital administration to accept responsibility and provide resources to the ED to ensure patient safety.

  19. Antarctic ice sheet mass loss, glacio-isostatic adjustment and surface processes from a Bayesian combination of gravimetry, altimetry and GPS data

    NASA Astrophysics Data System (ADS)

    Bamber, J. L.; Martin, A.; Zammit-Mangion, A.; Clarke, P. J.; Flament, T.; Helm, V.; King, M. A.; Luthcke, S. B.; Petrie, L.; Remy, F.; Wouters, B.

    2015-12-01

    Constraining past ice mass changes, identifying their cause(s) and determining rigorous error estimates, is important for closing the sea level budget and as an input for and test of numerical models. Despite the progress that has been made over the last decade, significant differences remain for estimates of the mass evolution of the Antarctic ice sheet. These estimates often yield conflicting results with non-overlapping error bars, while the commonly adopted use of different forward models to isolate and remove the effects of glacio-isostatic adjustment (GIA) and surface mass balance (SMB) processes introduces another source of uncertainty which is hard to quantify. To address both these issues, we present a statistical modeling approach that utilises a spatio-temporal Bayesian hierarchical model, alongside novel dimensional reduction methods to allow the solution to remain tractable in the presence of the large number (> 10^7) of observations. We solve simultaneously for GIA, surface processes, elastic rebound, firn compaction and ice dynamics. Over 2003-2013, Antarctica has been losing mass at a rate of -82+-23 Gt/yr. West Antarctica is the largest contributor with -114+-10 Gt/yr, mainly triggered by high thinning rates of glaciers draining into the Amundsen Sea Embayment. The Antarctic Peninsula has experienced a dramatic increase in mass loss in the last decade, with a mean rate of -25+-6 Gt/yr, and significantly higher values for the most recent years following the destabilization of the Southern Antarctic Peninsula around 2010. The total mass loss is partly compensated by a significant mass gain of 57+-20 Gt/yr in East Antarctica due to positive SMB anomalies and an interesting small dynamic component. We compare our time series of SMB anomalies with those from RACMO-2.3, obtaining good agreement for the large-scale patterns, although differences arise at a basin scale. Also, a data-driven GIA solution is obtained which could be used to constrain and

  20. Antarctic ice sheet mass loss, glacio-isostatic adjustment and surface processes from ENVISAT, ICESat, CryoSat-2, GRACE and GPS

    NASA Astrophysics Data System (ADS)

    Bamber, Jonathan L.; Martin-Espanol, Alba; Schoen, Nana; Zammit-Mangion, Andrew; Luthcke, Scott; Petrie, Liz; Remy, Frederique; Wouters, Bert; King, Matt; Rougier, Jonty

    2015-04-01

    Constraining past ice mass changes, identifying their cause(s) and determining rigorous error estimates, is important for closing the sea level budget and as an input for and test of numerical models. For the Antarctic ice sheet, considerable uncertainty remains between different methods and groups. Estimates obtained from altimetry, gravimetry, and mass-budget methods can yield conflicting results with error estimates that do not always overlap, while the, commonly adopted, use of different forward models to isolate and remove the effects of glacio-isostatic adjustment (GIA) and surface mass balance (SMB) processes introduces another source of uncertainty which is hard to quantify. To address both these issues, we present a statistical modelling approach to the problem. We combine the observational data, including satellite altimetry, GRACE, GPS and InSAR, and use the different degrees of spatial and temporal smoothness to constrain the underlying geophysical processes. This is achieved via a spatio-temporal Bayesian hierarchical model, employing dimensionality reduction methods to allow the solution to remain tractable in the presence of the large number (> 10^7) of observations involved. The resulting trend estimates are only dependent on length and smoothness properties obtained from numerical models, but are otherwise entirely data-driven. As a consequence, the solutions provide a valuable independent test of the forward models. Here, we present the annually-resolved spatial fields for i) dynamic ice loss, ii) SMB anomaly, iii) firn compaction and iv) (the time invariant) GIA, using a combination of GRACE, ICESat, ENVISat, CryoSat 2 and GPS vertical uplift rates, for 2003-2013. The elastic flexure of the crust is also determined simultaneously. We focus here primarily on the mass trends rather than solid earth effects. We obtain a mean rate of -97+-16 Gt/yr for the 11 year period with a statstically significant positive trend for East Antarctica and negative

  1. Development and validation of a continuously age-adjusted measure of patient condition for hospitalized children using the electronic medical record.

    PubMed

    Rothman, Michael J; Tepas, Joseph J; Nowalk, Andrew J; Levin, James E; Rimar, Joan M; Marchetti, Albert; Hsiao, Allen L

    2017-02-01

    Awareness of a patient's clinical status during hospitalization is a primary responsibility for hospital providers. One tool to assess status is the Rothman Index (RI), a validated measure of patient condition for adults, based on empirically derived relationships between 1-year post-discharge mortality and each of 26 clinical measurements available in the electronic medical record. However, such an approach cannot be used for pediatrics, where the relationships between risk and clinical variables are distinct functions of patient age, and sufficient 1-year mortality data for each age group simply do not exist. We report the development and validation of a new methodology to use adult mortality data to generate continuously age-adjusted acuity scores for pediatrics. Clinical data were extracted from EMRs at three pediatric hospitals covering 105,470 inpatient visits over a 3-year period. The RI input variable set was used as a starting point for the development of the pediatric Rothman Index (pRI). Age-dependence of continuous variables was determined by plotting mean values versus age. For variables determined to be age-dependent, polynomial functions of mean value and mean standard deviation versus age were constructed. Mean values and standard deviations for adult RI excess risk curves were separately estimated. Based on the "find the center of the channel" hypothesis, univariate pediatric risk was then computed by applying a z-score transform to adult mean and standard deviation values based on polynomial pediatric mean and standard deviation functions. Multivariate pediatric risk is estimated as the sum of univariate risk. Other age adjustments for categorical variables were also employed. Age-specific pediatric excess risk functions were compared to age-specific expert-derived functions and to in-hospital mortality. AUC for 24-h mortality and pRI scores prior to unplanned ICU transfers were computed. Age-adjusted risk functions correlated well with similar

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

    PubMed Central

    Nassel, Ariann F.; Thomas, Deborah

    2016-01-01

    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

  3. 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.

  4. 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...

  5. Validity of the SPEx sports injury surveillance system for time-loss and medical attention injuries in sports.

    PubMed

    Møller, M; Wedderkopp, N; Myklebust, G; Lind, M; Sørensen, H; Hebert, J J; Emery, C A; Attermann, J

    2017-03-07

    The accurate measurement of sport exposure time and injury occurrence is key to effective injury prevention and management. Current measures are limited by their inability to identify all types of sport-related injury, narrow scope of injury information, or lack the perspective of the injured athlete. The aims of the study were to evaluate the proportion of injuries and the agreement between sport exposures reported by the SMS messaging and follow-up telephone part of the SMS, Phone, and medical staff Examination (SPEx) sports injury surveillance system when compared to measures obtained by trained on-field observers and medical staff (comparison method). We followed 24 elite adolescent handball players over 12 consecutive weeks. Eighty-six injury registrations were obtained by the SPEx and comparison methods. Of them 35 injury registrations (41%) were captured by SPEx only, 10 injury registrations (12%) by the comparison method only, and 41 injury registrations (48%) by both methods. Weekly exposure time differences (95% limits of agreement) between SPEx and the comparison method ranged from -4.2 to 6.3 hours (training) and -1.5 to 1.0 hours (match) with systematic differences being 1.1 hours (95% CI 0.7 to 1.4) and -0.2 (95% CI -0.3 to -0.2), respectively. These results support the ability of the SPEx system to measure training and match play exposures and injury occurrence among young athletes. High weekly response rates (mean 83%) indicate that SMS messaging can be used for player measures of injury consequences beyond time-loss from sport. However, this needs to be further evaluated in large-scale studies. This article is protected by copyright. All rights reserved.

  6. [Extent to which a claimant's loss-mitigation and cooperation obligations towards the insurer are enforceable--requirements for an expert medical opinion].

    PubMed

    Stadtland, C; Seidelmann, S; Wandl, U

    2007-03-01

    A policyholder claiming an annuity benefit on the grounds that, he is no longer able to pursue his occupation must meet certain obligations vis-à-vis the insurer, e.g. duty to mitigate the loss, duty to cooperate with the insurer. These obligations are often curtailed by the claimants' rights. Physicians and providers of expert medical opinions frequently do not share this opinion. Where medical and legal considerations intermingle and, potentially, conflict, there is great uncertainty as to whether, and to what extent, an insurer may require a claimant to undergo medical treatment. Before deciding on whether or not to grant an annuity, the insurer generally calls in medical experts to assess the policyholder's actual degree of disability and offer an opinion on whether and, if so, by what medical means that disability might be mitigated or remedied. Expert medical opinions are often decisive in such cases. The present article discusses the extent to which a claimant's loss-mitigation and cooperation obligations towards the insurer are enforceable; in this context, a number of court decisions are quoted. In addition, the authors define the requirements that an expert medical opinion must meet.

  7. 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.

  8. Novel Multiplexer to Enable Multiple-Module Imaging with Adjustable High Spatial Resolution and Predetermined Display Bandwidth for Array Medical Imaging Systems.

    PubMed

    Sharma, P; Titus, A H; Qu, B; Huang, Y; Wang, W; Kuhls-Gilcrist, A; Cartwright, A N; Bednarek, D R; Rudin, S

    2010-01-01

    We describe a custom multiple-module multiplexer integrated circuit (MMMIC) that enables the combination of discrete Electron multiplying charge coupled devices (EMCCD) based imaging modules to improve medical imaging systems. It is highly desirable to have flexible imaging systems that provide high spatial resolution over a specific region of interest (ROI) and a field of view (FOV) large enough to encompass areas of clinical interest. Also, such systems should be dynamic, i.e. should be able to maintain a specified acquisition bandwidth irrespective of the size of the imaged FOV. The MMMIC achieves these goals by 1) multiplexing the outputs of an array of imaging modules to enable a larger FOV, 2) enabling a number of binning modes for adjustable high spatial resolution, and 3) enabling selection of a subset of modules in the array to achieve ROI imaging at a predetermined display bandwidth. The MMMIC design also allows multiple MMMICs to be connected to control larger arrays. The prototype MMMIC was designed and fabricated in the ON-SEMI 0.5μm CMOS process through MOSIS (www.mosis.org). It has three 12-bit inputs, a single 12-bit output, three input enable bits, and one output enable, so that one MMMIC can control the output from three discrete imager arrays. The modular design of the MMMIC enables four identical chips, connected in a two-stage sequential arrangement, to readout a 3×3 collection of individual imaging modules. The first stage comprises three MMMICs (each connected to three of the individual imaging module), and the second stage is a single MMMIC whose 12-bit output is then sent via a CameraLink interface to the system computer. The prototype MMMIC was successfully tested using digital outputs from two EMCCD-based detectors to be used in an x-ray imaging array detector system.Finally, we show how the MMMIC can be used to extend an imaging system to include any arbitrary (M×N) array of imaging modules enabling a large FOV along with ROI imaging

  9. [Post-accident injuries to the locomotor system and divergent medical opinions on the percentage of health loss in insured persons].

    PubMed

    Kordel, Krzysztof; Stryjska, Małgorzata; Tuszyński, Krzysztof; Tomaszkiewicz, Jan; Wiśniewski, Sławomir

    2006-01-01

    The authors present the results of an analysis of certification rules applied by insurance companies for the purpose of medical expertise. It was found that the percentage of health loss was very frequently understated by insurance companies as compared with that decided by Polish courts. This mostly applied to diseases of musculoskeletal system and consequences of head injuries, which proved to be profitable for insurance companies. It was also common for medical experts working for insurance companies to use the lowest possible rates in estimating the loss of health. The authors emphasized the need to unify the rules and criteria for determining the percentage of health loss, or to inform insurance applicants about the fact that insurance companies have their own rules, which differ from those applied by courts.

  10. 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.

  11. Protocol Adherence in Prehospital Medical Care Provided for Patients with Chest Pain and Loss of Consciousness; a Brief Report

    PubMed Central

    Mehrara, Mostafa; Tavakoli, Nader; Fathi, Marzieh; Mahshidfar, Babak; Zare, Mohammad Amin; Asadi, Azita; Hosseinzadeh, Saeedeh; Safdarian, Mehdi

    2017-01-01

    Introduction: Although many protocols are available in the field of the prehospital medical care (PMC), there is still a notable gap between protocol based directions and applied clinical practice. This study measures the rate of protocol adherence in PMC provided for patients with chest pain and loss of consciousness (LOC). Method: In this cross-sectional study, 10 educated research assistants audited the situation of provided PMC for non-traumatic chest pain and LOC patients, presenting to the emergency department of a tertiary level teaching hospital, compare to national recommendations in these regards. Results: 101 cases with the mean age of 56.7 ± 12.3 years (30-78) were audited (55.4% male). 61 (60.3%) patients had chest pain and 40 (39.7%) cases had LOC. Protocol adherence rates for cardiac monitoring (62.3%), O2 therapy (32.8%), nitroglycerin administration (60.7%), and aspirin administration (52.5%) in prehospital care of patients with chest pain were fair to poor. Protocol adherence rates for correct patient positioning (25%), O2 therapy (75%), cardiac monitoring (25%), pupils examination (25%), bedside glucometery (50%), and assessing for naloxone administration (55%) in prehospital care of patients with LOC were fair to poor. Conclusion: There were more than 20% protocol violation regarding prehospital care of chest pain patients regarding cardiac monitoring, O2 therapy, and nitroglycerin and aspirin administration. There were same situation regarding O2 therapy, positioning, cardiac monitoring, pupils examination, bedside glucometery, and assessing for naloxone administration of LOC patients in prehospital setting. PMID:28286847

  12. Hair Loss

    MedlinePlus

    ... loss in teens: Illnesses or medical conditions. Endocrine (hormonal) conditions, such as uncontrolled diabetes or thyroid disease , can interfere with hair production and cause hair loss. People with lupus can also lose hair. The hormone imbalance that happens in polycystic ovary syndrome can cause ...

  13. Chiropractic Adjustment

    MedlinePlus

    ... structural alignment and improve your body's physical function. Low back pain, neck pain and headache are the most common ... treated. Chiropractic adjustment can be effective in treating low back pain, although much of the research done shows only ...

  14. Adjustment disorder

    MedlinePlus

    ... from other people Skipped heartbeats and other physical complaints Trembling or twitching To have adjustment disorder, you ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  15. 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: ...

  16. 45 CFR 800.204 - Reinsurance, risk corridors, and risk adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 3 2014-10-01 2014-10-01 false Reinsurance, risk corridors, and risk adjustment. 800.204 Section 800.204 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF PERSONNEL MANAGEMENT MULTI-STATE PLAN PROGRAM Premiums, Rating Factors, Medical Loss Ratios, and...

  17. 45 CFR 800.204 - Reinsurance, risk corridors, and risk adjustment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 3 2013-10-01 2013-10-01 false Reinsurance, risk corridors, and risk adjustment. 800.204 Section 800.204 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF PERSONNEL MANAGEMENT MULTI-STATE PLAN PROGRAM Premiums, Rating Factors, Medical Loss Ratios, and...

  18. 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.

  19. 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.

  20. 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.

  1. Adjustable Optical-Fiber Attenuator

    NASA Technical Reports Server (NTRS)

    Buzzetti, Mike F.

    1994-01-01

    Adjustable fiber-optic attenuator utilizes bending loss to reduce strength of light transmitted along it. Attenuator functions without introducing measurable back-reflection or insertion loss. Relatively insensitive to vibration and changes in temperature. Potential applications include cable television, telephone networks, other signal-distribution networks, and laboratory instrumentation.

  2. Ways Children Adjust to Limb Loss

    MedlinePlus

    ... March/April 2006 Original article by Douglas G. Smith, MD Translated into plain language by Helen Osborne ... Limb Deficiencies: Issues and Expectations,” by Douglas G. Smith, MD and Kellye Campbell, RN, ARNP published in ...

  3. Wartime Stress: Family Adjustment to Loss

    DTIC Science & Technology

    1981-07-31

    grief stages postulated by Kubler - Ross (1969); i.e., denial, anger, bargaining, depression, and acceptance. Other theorists have delineated similar...all of Kubler - Ross ’ steps of the grief cycle, on a "temporary" basis. They are bouncing back and forth within that cycle .... *The Task Force on...experience, and marital status. Journal of Consulting Psychology, 1951, 15, 320-4. KUBLER - ROSS , E. On death and dying. NY: Macmillan Publishing Co

  4. 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.

  5. Getting past the accident: explosive devices, limb loss, and refashioning a life in a military medical center.

    PubMed

    Messinger, Seth D

    2010-09-01

    I describe the refashioning of a sense of self and identity of a junior officer in the U.S. Army who was injured in Iraq. Ethnographic data for this article were collected between July 2006 and January 2008. The setting for this article is the U.S. Armed Forces Amputee Patient Care Program at Walter Reed Army Medical Center. Two models of rehabilitation are contrasted in the rehabilitation program. The first focuses on the refashioning of identity through a sports model of rehabilitation emphasizing physical functioning. The second approaches rehabilitation by emphasizing individual interests and the concern of a person who has a future life to develop. I conclude by arguing that understanding the process of rehabilitation from traumatic injury would benefit from a perspective that melds multiple dimensions, taking into account both the physical body and the social world that patients have inhabited and will inhabit.

  6. Managing Hearing Loss

    MedlinePlus

    ... a total loss of hearing. It can be hereditary or it can result from disease, trauma, certain ... build-up, fluid, or a punctured eardrum. Medical treatment or surgery can usually restore conductive hearing loss. ...

  7. Weight Loss Surgery

    MedlinePlus

    ... serious medical problems. Weight loss surgery (also called bariatric surgery) can help very obese people lose weight. But ... Gastric banding is the simplest of the three weight loss surgeries. People who get it might not lose as ...

  8. 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.

  9. Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress

    PubMed Central

    Mayer, Stephanie B.; Levy, James R.; Farrell-Carnahan, Leah; Nichols, Michelle G.; Raman, Shekar

    2016-01-01

    , Levy JR, Farrell-Carnahan L, Nichols MG, Raman S. Obese veterans enrolled in a veterans affairs medical center outpatient weight loss clinic are likely to experience disordered sleep and posttraumatic stress. J Clin Sleep Med 2016;12(7):997–1002. PMID:27070244

  10. Hypertension, Diuretic Use, and Risk of Hearing Loss

    PubMed Central

    Lin, Brian M.; Curhan, Sharon G.; Wang, Molin; Eavey, Roland; Stankovic, Konstantina M.; Curhan, Gary C.

    2016-01-01

    Background Hearing loss is highly prevalent among adults in the United States. Hypertension is also common and is often treated with diuretics. Hypertension may increase the risk of hearing loss by decreasing vascular supply to the stria vascularis. Use of thiazides has been anecdotally associated with hearing loss. In small studies, furosemide use has been associated with hearing loss that is usually reversible, but can be permanent. We investigated the relation between hypertension, diuretic use, and hearing loss in a prospective cohort of 54,721 women in Nurses’ Health Study I (NHSI), 1994–2012. Methods Eligible participants included 54,721 female nurses aged 48–73 years in 1994 who provided information on thiazide diuretic and furosemide use in 1994, answered the question on hearing loss over their lifetime in 2012, and did not report hearing loss with date of onset before date of onset of hypertension diagnosis or medication use. The outcome was self-reported hearing loss. Cox proportional hazards regression was used to adjust for potential confounders. Results During 774,096 person-years of follow-up, 19,296 cases of hearing loss were reported (incidence rate: 25 cases per 1000 person-years). At baseline in 1994, the mean age was 57.9 years and mean body mass index was 26.3 kg/m2. 30.8% of participants had a history of hypertension. History of hypertension was independently associated with a modestly higher risk of hearing loss (multivariable adjusted relative risk = 1.04 [1.01, 1.07]). Among women with a history of hypertension, neither thiazide diuretic (multivariable adjusted relative risk = 1.07 [0.99, 1.16]) nor furosemide use (multivariable adjusted relative risk = 0.91 [0.75, 1.09]) was significantly associated with risk of hearing loss, when compared with women not taking anti-hypertensive medications. There was no significant effect modification by age. Conclusions History of hypertension was associated with a small increased risk of hearing

  11. 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.

  12. 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

  13. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hydraulic adjustable hospital bed. 880.5110... Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic adjustable hospital bed is a device intended for medical purposes that consists of a bed with a hydraulic...

  14. 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... Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic adjustable hospital bed is a device intended for medical purposes that consists of a bed with a hydraulic...

  15. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hydraulic adjustable hospital bed. 880.5110... Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic adjustable hospital bed is a device intended for medical purposes that consists of a bed with a hydraulic...

  16. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hydraulic adjustable hospital bed. 880.5110... Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic adjustable hospital bed is a device intended for medical purposes that consists of a bed with a hydraulic...

  17. 21 CFR 880.5110 - Hydraulic adjustable hospital bed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hydraulic adjustable hospital bed. 880.5110... Therapeutic Devices § 880.5110 Hydraulic adjustable hospital bed. (a) Identification. A hydraulic adjustable hospital bed is a device intended for medical purposes that consists of a bed with a hydraulic...

  18. 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... 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...

  19. 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.

  20. Impact of Disordered Eating and Psychological Functioning on Overweight Adolescents Participating in a Placebo-Controlled Medication and Behavioral Weight Loss Trial

    DTIC Science & Technology

    2009-11-23

    2007). Bariatric Surgery Bariatric surgery for weight reduction is recommended only in extreme cases wherein obesity is severe, is associated...with related health co-morbidities, and when the individual has failed at structured weight loss programs. Bariatric surgery has demonstrated greater... bariatric surgery be well informed, motivated, and undergo extensive psychological assessment prior to surgery (Dziurowicz-Kozlowska, Wierzbicki

  1. Medical Misuse of Controlled Medications Among Adolescents

    PubMed Central

    McCabe, Sean Esteban; West, Brady T.; Cranford, James A.; Ross-Durow, Paula; Young, Amy; Teter, Christian J.; Boyd, Carol J.

    2011-01-01

    Objectives To determine the past-year medical misuse prevalence for 4 controlled medication classes (pain, stimulant, sleeping, and antianxiety) among adolescents, and to assess substance use outcomes among adolescents who report medical misuse. Design A Web-based survey was self-administered by 2744 secondary school students in 2009-2010. Setting Two southeastern Michigan school districts. Participants The sample had a mean age of 14.8 years and was 51.1% female. The racial/ethnic distribution was 65.0% white, 29.5% African American, 3.7% Asian, 1.3% Hispanic, and 0.5% other. Main Outcome Measures Past-year medical use and misuse of 4 controlled medication classes. Results Eighteen percent of the sample reported past-year medical use of at least 1 prescribed controlled medication. Among past-year medical users, 22.0% reported misuse of their controlled medications, including taking too much, intentionally getting high, or using to increase alcohol or other drug effects. Medical misusers were more likely than nonmisusers to divert their controlled medications and to abuse other substances. The odds of a positive screening result for drug abuse were substantially higher among medical misusers (adjusted odds ratio, 7.8; 95% confidence interval, 4.3-14.2) compared with medical users who used their controlled medications appropriately. The odds of drug abuse did not differ between medical users who used their controlled medications appropriately and nonusers. Conclusions Most adolescents who used controlled medications took their medications appropriately. Substance use and diversion of controlled medications were more prevalent among adolescents who misused their controlled medications. Careful therapeutic monitoring could reduce medical misuse and diversion of controlled medications among adolescents. PMID:21810634

  2. 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.

  3. 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

  4. 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).

  5. Weight and metabolic effects of dietary weight loss and exercise interventions in postmenopausal antidepressant medication users and non-users: a randomized controlled trial

    PubMed Central

    Imayama, Ikuyo; Alfano, Catherine M.; Mason, Caitlin; Wang, Chiachi; Duggan, Catherine; Campbell, Kristin L.; Kong, Angela; Foster-Schubert, Karen E.; Blackburn, George L.; Wang, Ching-Yun; McTiernan, Anne

    2013-01-01

    Objective Antidepressants may attenuate the effects of diet and exercise programs. We compared adherence and changes in body measures and biomarkers of glucose metabolism and inflammation between antidepressant users and non-users in a 12-month randomized controlled trial. Methods Overweight or obese, postmenopausal women were assigned to: diet (10% weight loss goal, N=118); moderate-to-vigorous aerobic exercise (225 minutes/week, N=117); diet+exercise (N=117); and control (N=87) in Seattle, WA 2005–2009. Women using antidepressants at baseline were classified as users (N=109). ANCOVA and generalized estimating equation approaches, respectively, were used to compare adherence (exercise amount, diet session attendance, and changes in percent calorie intake from fat, cardiopulmonary fitness, and pedometer steps) and changes in body measures (weight, waist and percent body fat) and serum biomarkers (glucose, insulin, homeostasis assessment-insulin resistance, and high-sensitivity C-reactive protein) between users and non-users. An interaction term (intervention × antidepressant use) tested effect modification. Results There were no differences in adherence except diet session attendance was lower among users in the diet+exercise group (P<0.05 vs. non-users). Changes in body measures and serum biomarkers did not differ by antidepressant use (Pinteraction>0.05). Conclusion Dietary weight loss and exercise improved body measures and biomarkers of glucose metabolism and inflammation independent of antidepressant use. PMID:23859929

  6. 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.

  7. 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.

  8. 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.

  9. Adjustable Pitot Probe

    NASA Technical Reports Server (NTRS)

    Ashby, George C., Jr.; Robbins, W. Eugene; Horsley, Lewis A.

    1991-01-01

    Probe readily positionable in core of uniform flow in hypersonic wind tunnel. Formed of pair of mating cylindrical housings: transducer housing and pitot-tube housing. Pitot tube supported by adjustable wedge fairing attached to top of pitot-tube housing with semicircular foot. Probe adjusted both radially and circumferentially. In addition, pressure-sensing transducer cooled internally by water or other cooling fluid passing through annulus of cooling system.

  10. 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.

  11. Hair Loss

    MedlinePlus

    ... thyroid disease , can interfere with hair production and cause hair loss. People with lupus can also lose hair. The hormone imbalance that happens in polycystic ovary syndrome can cause hair loss in teen girls as well as ...

  12. Topoisomerase II alpha gene copy loss has adverse prognostic significance in ERBB2-amplified breast cancer: a retrospective study of paraffin-embedded tumor specimens and medical charts

    PubMed Central

    Usha, Lydia; Tabesh, Bita; Morrison, Larry E; Rao, Ruta D; Jacobson, Kris; Zhu, April; Basu, Sanjib; Coon, John S

    2008-01-01

    Background Amplification of the ERBB2 (Her-2/neu) oncogene, which occurs in approximately 25% of breast carcinomas, is a known negative prognostic factor. Available data indicate that a variable number of nearby genes on chromosome 17q may be co-amplified or deleted, forming a continuous amplicon of variable size. In approximately 25% of these patients, the amplicon extends to the gene for topoisomerase II alpha (TOP2A), a target for anthracyclines. We sought to understand the significance of these associated genomic changes for breast cancer prognosis and predicting response to therapy. Methods and patients Archival tissue samples from 63 breast cancer patients with ERBB2 amplification, stages 0–IV, were previously analyzed with FISH probes for genes located near ERBB2. In the present study, the clinical outcome data were determined for all patients presenting at stages I–III for whom adequate clinical follow up was available. Results Four amplicon patterns (Classes) were identified. These were significantly associated with the clinical outcome, specifically, recurrence of breast cancer. The Amplicon class IV with deleted TOP2A had 67% (6/9) cases with recurrence, whereas the other three classes combined had only 12% (3/25) cases (p-value = 0.004) at the time of last follow-up. TOP2A deletion was also significantly associated with time to recurrence (p-value = 0.0002). After adjusting for age in Cox regression analysis, the association between TOP2A deletion and time to recurrence remains strongly significant (p-value = 0.002) whereas the association with survival is marginally significant (p-value = 0.06). Conclusion TOP2A deletion is associated with poor prognosis in ERBB2-amplified breast carcinomas. Clarification of the mechanism of this association will require additional study. PMID:18702822

  13. Enteric coating of mycophenolate reduces dosage adjustments.

    PubMed

    Brister, K; Yau, C L; Slakey, D

    2009-06-01

    Mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS) are bioequivalent. However, the effectiveness of MMF may be limited by gastrointestinal (GI) side effects. This study assessed the relationship between the number of medication dosage adjustments and posttransplantation side effects. In a review of 109 kidney transplant patients, 65 initially received MMF and 44 initially received EC-MPS. The incidences of patient-reported GI complications were significantly different: MMF 45.5% vs EC-MPS 35.3% (P = .0194). The proportions of patients requiring dosage adjustment due to GI complications were MMF 5.9% and EC-MPS 2.3% (P < .0001). Patients receiving MMF were more likely to experience GI complications resulting in dosage adjustment (odds ratio = 9.9; P = .0306). The incidences of acute rejection, cytomegalovirus (CMV), and leukopenia resulting in dosage adjustment were not significantly different. Patients receiving MMF required more immunosuppressive medication adjustments, which may complicate care and decrease overall compliance.

  14. Recirculating valve lash adjuster

    SciTech Connect

    Stoody, R.R.

    1987-02-24

    This patent describes an internal combustion engine with a valve assembly of the type including overhead valves supported by a cylinder head for opening and closing movements in a substantially vertical direction and a rotatable overhead camshaft thereabove lubricated by engine oil pumped by an engine oil pump. A hydraulic lash adjuster with an internal reservoir therein is solely supplied with run-off lubricating oil from the camshaft which oil is pumped into the internal reservoir of the lash adjuster by self-pumping operation of the lash adjuster produced by lateral forces thereon by the rotative operation of the camshaft comprising: a housing of the lash adjuster including an axially extending bore therethrough with a lower wall means of the housing closing the lower end thereof; a first plunger member being closely slidably received in the bore of the housing and having wall means defining a fluid filled power chamber with the lower wall means of the housing; and a second plunger member of the lash adjuster having a portion being loosely slidably received and extending into the bore of the housing for reciprocation therein. Another portion extends upwardly from the housing to operatively receive alternating side-to-side force inputs from operation of the camshaft.

  15. 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.

  16. 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

  17. Capping risk adjustment?

    PubMed

    Eugster, Patrick; Sennhauser, Michèle; Zweifel, Peter

    2010-07-01

    When premiums are community-rated, risk adjustment (RA) serves to mitigate competitive insurers' incentive to select favorable risks. However, unless fully prospective, it also undermines their incentives for efficiency. By capping its volume, one may try to counteract this tendency, exposing insurers to some financial risk. This in term runs counter the quest to refine the RA formula, which would increase RA volume. Specifically, the adjuster, "Hospitalization or living in a nursing home during the previous year" will be added in Switzerland starting 2012. This paper investigates how to minimize the opportunity cost of capping RA in terms of increased incentives for risk selection.

  18. 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…

  19. Psychological Adjustment and Homosexuality.

    ERIC Educational Resources Information Center

    Gonsiorek, John C.

    In this paper, the diverse literature bearing on the topic of homosexuality and psychological adjustment is critically reviewed and synthesized. The first chapter discusses the most crucial methodological issue in this area, the problem of sampling. The kinds of samples used to date are critically examined, and some suggestions for improved…

  20. 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.

  1. 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.

  2. Measurements of Glacial Isostatic Adjustment in Greenland

    NASA Astrophysics Data System (ADS)

    Khan, Shfaqat Abbas; Bamber, Jonathan; Bevis, Michael; Wahr, John; van dam, Tonie; Wouters, Bert; Willis, Michael

    2015-04-01

    The Greenland GPS network (GNET) was constructed to provide a new means to assess viscoelastic and elastic adjustments driven by past and present-day changes in ice mass. Here we assess existing glacial isostatic adjustments (GIA) models by analysing 1995-present data from 61 continuous GPS receivers located along the edge of the Greenland ice sheet. Since GPS receivers measure both the GIA and elastic signal, we isolate the GIA signal, by removing the elastic adjustments of the crust due to present-day mass loss using high-resolution ice surface elevation change grids derived from satellite and airborne altimetry measurements (ERS1/2, ICESat, ATM, ENVISAT, and CryoSat-2). In general, our observed GIA rates contradict models, suggesting GIA models and hence their ice load history for Greenland are not well constrained.

  3. 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.

  4. Pregnancy Loss

    MedlinePlus

    ... and painful this loss can be. You might wonder if you'll ever have a baby to hold and call your own. But surviving the emotional impact of pregnancy loss is possible. And many women go on to have successful pregnancies. Expand all | ...

  5. 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.

  6. 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.

  7. Hearing Loss

    MedlinePlus

    ... turn the volume higher when you listen to music, the radio or television Some causes of hearing ... levels include snowmobiling, motorcycling or listening to loud music. Some medications. Drugs, such as the antibiotic gentamicin ...

  8. Memory loss

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/003257.htm Memory loss To use the sharing features on this ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  9. Hearing Loss

    MedlinePlus

    ... topic was provided by the National Institute on Deafness and Other Communication Disorders Topic last reviewed: December ... a total loss of hearing. It can be hereditary or it can result from disease, trauma, certain ...

  10. Hair Loss

    MedlinePlus

    ... Situations Pets and Animals myhealthfinder Food and Nutrition Healthy Food Choices Weight Loss and Diet Plans Nutrients and Nutritional Info Sugar and Sugar Substitutes Exercise and Fitness Exercise Basics Sports Safety Injury Rehabilitation Emotional Well- ...

  11. Tooth loss patterns in older adults with special needs: a Minnesota cohort

    PubMed Central

    Chen, Xi; Clark, Jennifer J

    2011-01-01

    This study was conducted to detail tooth loss patterns in older adults with special needs. A total of 491 elderly subjects with special needs were retrospectively selected and followed during 10/1999-12/2006. Medical, dental, cognitive, and functional assessments were abstracted from dental records and used to predict risk of tooth loss. Tooth loss events were recorded for subjects during follow-up. Chi-squared tests were used to study the association between tooth loss and the selected risk factors. Logistic, poisson, and negative binomial regressions were developed to study tooth loss patterns. Overall, 27% of the subjects lost at least one tooth during follow-up. Fourteen subjects had tooth loss events per 100 person-years. Tooth loss pattern did not differ significantly among different special-needs subgroups (i.e. community-dwelling vs. long-term care, physically disabled vs. functionally independent). Special-needs subjects with three or more active dental conditions at arrival had more than twice the risk of losing teeth than those without any existing conditions. After adjusting other factors, the number of carious teeth or retained roots at arrival was a significant predictor of tooth loss for older adults with special needs (P=0.001). These findings indicate that appropriately managing active caries and associated conditions is important to prevent tooth loss for older adults with special needs. PMID:21449213

  12. 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

  13. Adjustable Reeds For Weaving

    NASA Technical Reports Server (NTRS)

    Farley, Gary L.

    1994-01-01

    Local characteristics of fabrics varied to suit special applications. Adjustable reed machinery proposed for use in weaving fabrics in various net shapes, widths, yarn spacings, and yarn angles. Locations of edges of fabric and configuration of warp and filling yarns varied along fabric to obtain specified properties. In machinery, reed wires mounted in groups on sliders, mounted on lengthwise rails in reed frame. Mechanisms incorporated to move sliders lengthwise, parallel to warp yarns, by sliding them along rails; move sliders crosswise by translating reed frame rails perpendicular to warp yarns; and crosswise by spreading reed rails within group. Profile of reed wires in group on each slider changed.

  14. Continuously adjustable Pulfrich spectacles

    NASA Astrophysics Data System (ADS)

    Jacobs, Ken; Karpf, Ron

    2011-03-01

    A number of Pulfrich 3-D movies and TV shows have been produced, but the standard implementation has inherent drawbacks. The movie and TV industries have correctly concluded that the standard Pulfrich 3-D implementation is not a useful 3-D technique. Continuously Adjustable Pulfrich Spectacles (CAPS) is a new implementation of the Pulfrich effect that allows any scene containing movement in a standard 2-D movie, which are most scenes, to be optionally viewed in 3-D using inexpensive viewing specs. Recent scientific results in the fields of human perception, optoelectronics, video compression and video format conversion are translated into a new implementation of Pulfrich 3- D. CAPS uses these results to continuously adjust to the movie so that the viewing spectacles always conform to the optical density that optimizes the Pulfrich stereoscopic illusion. CAPS instantly provides 3-D immersion to any moving scene in any 2-D movie. Without the glasses, the movie will appear as a normal 2-D image. CAPS work on any viewing device, and with any distribution medium. CAPS is appropriate for viewing Internet streamed movies in 3-D.

  15. Psychosocial adjustment to ALS: a longitudinal study.

    PubMed

    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.

  16. 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

  17. Hair Loss

    MedlinePlus

    ... certain diseases, such as thyroid problems, diabetes, or 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 ...

  18. Limb Loss

    MedlinePlus

    ... limb. Learning how to use it takes time. Physical therapy can help you adapt. Recovery from the loss of a limb can be hard. Sadness, anger, and frustration are common. If you are having a tough time, talk to your doctor. Treatment with medicine or counseling can help.

  19. 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…

  20. 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.

  1. Case-mix adjustments require tighter documentation.

    PubMed

    Grimaldi, P L; Shlala, T J

    1986-04-01

    Six states currently incorporate case-mix adjustments into their payment formulas for long-term care, and Medicare is likely to follow suit in the near future. Case-mix systems require facilities to keep detailed records on patients' functional abilities, medical conditions, daily progress, and treatment plans. Much of the information required is similar to the data that the Patient Care and Services (PaCS) survey program will collect and evaluate for the new Medicare and Medicaid certification process. Long-term care facilities must establish policies and procedures to accommodate the new requirements. Recommended steps include: Redesign medical record forms so that each patient's functional limitations and medical conditions can be documented. Design care plans so that they identify the patients' disabilities and medical problems, set realistic short- and long-term treatment goals, establish appropriate interventions, and designate the care giver responsible for each intervention. Focus progress notes on problem resolution. Replace medical care evaluation processes with a quality assurance program that determines whether care plans are followed and goals reached.

  2. [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.

  3. 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.

  4. Medical vest broadens treatment capability

    NASA Technical Reports Server (NTRS)

    Johnson, G. S.

    1970-01-01

    Universal sized vest, with specially tailored pockets designed to hold medical supplies, provides first aid/first care medical teams with broadened on-site capability. Vest is made of nylon, tough fibrous materials, and polyvinyl chloride. Design facilitates rapid donning, doffing, and adjustment.

  5. Delay Adjusted Incidence

    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.

  6. Nonlinear Hydrostatic Adjustment.

    NASA Astrophysics Data System (ADS)

    Bannon, Peter R.

    1996-12-01

    The final equilibrium state of Lamb's hydrostatic adjustment problem is found for finite amplitude heating. Lamb's problem consists of the response of a compressible atmosphere to an instantaneous, horizontally homogeneous heating. Results are presented for both isothermal and nonisothermal atmospheres.As in the linear problem, the fluid displacements are confined to the heated layer and to the region aloft with no displacement of the fluid below the heating. The region above the heating is displaced uniformly upward for heating and downward for cooling. The amplitudes of the displacements are larger for cooling than for warming.Examination of the energetics reveals that the fraction of the heat deposited into the acoustic modes increases linearly with the amplitude of the heating. This fraction is typically small (e.g., 0.06% for a uniform warming of 1 K) and is essentially independent of the lapse rate of the base-state atmosphere. In contrast a fixed fraction of the available energy generated by the heating goes into the acoustic modes. This fraction (e.g., 12% for a standard tropospheric lapse rate) agrees with the linear result and increases with increasing stability of the base-state atmosphere.The compressible results are compared to solutions using various forms of the soundproof equations. None of the soundproof equations predict the finite amplitude solutions accurately. However, in the small amplitude limit, only the equations for deep convection advanced by Dutton and Fichtl predict the thermodynamic state variables accurately for a nonisothermal base-state atmosphere.

  7. Psychological distress, personality, and adjustment among nursing students.

    PubMed

    Warbah, L; Sathiyaseelan, M; Vijayakumar, C; Vasantharaj, B; Russell, S; Jacob, K S

    2007-08-01

    Psychological distress and poor adjustment among a significant number of nursing students is an important issue facing nursing education. The concerns need to be studied in detail and solutions need to be built into the nursing course in order to help students with such difficulty. This study used a cross-sectional survey design to study psychological distress, personality and adjustment among nursing students attending the College of Nursing, Christian Medical College, Vellore, India. One hundred and forty five nursing students were assessed using the General Health Questionnaire 12, the Eysenck Personality Questionnaire, and the Bell's Adjustment Inventory to investigate psychological distress, personality profile and adjustment, respectively. Thirty participants (20.7%) of the 145 students assessed reported high scores on the General Health Questionnaire. Psychological distress was significantly associated with having neurotic personality and adjustment difficulties in different areas of functioning.

  8. 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.

  9. 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.

  10. 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.

  11. Losses in Ferroelectric Materials.

    PubMed

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

    2015-03-01

    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

  12. 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

  13. 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.

  14. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Bid Pricing Data Release; Medicare Advantage and Part D Medical Loss Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model; Medicare Shared Savings Program Requirements. Final rule.

    PubMed

    2016-11-15

    This major final rule addresses changes to the physician fee schedule and other Medicare Part B payment policies, such as changes to the Value Modifier, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. This final rule also includes changes related to the Medicare Shared Savings Program, requirements for Medicare Advantage Provider Networks, and provides for the release of certain pricing data from Medicare Advantage bids and of data from medical loss ratio reports submitted by Medicare health and drug plans. In addition, this final rule expands the Medicare Diabetes Prevention Program model.

  15. Secondhand Smoke Exposure and the Risk of Hearing Loss

    PubMed Central

    Fabry, David A.; Davila, Evelyn P.; Arheart, Kristopher L.; Serdar, Berrin; Dietz, Noella A.; Bandiera, Frank C.; Lee, David J.

    2011-01-01

    Background Hearing loss has been associated with tobacco smoking, but its relationship with secondhand smoke is not known. We sought to investigate the association between secondhand smoke exposure and hearing loss in a nationally representative sample of adults. Methods The National Health and Nutrition Examination Survey, a nationally representative cross-sectional dataset, was utilized to investigate the association between secondhand smoke exposure and hearing loss. Data collected from non-smoking participants aged 20-69 years were included in the analysis if they had completed audiometric testing, had a valid serum cotinine value, and provided complete smoking, medical co-morbidity and noise exposure histories (n=3,307). Hearing loss was assessed from averaged pure-tone thresholds over low- or mid-frequencies (500, 1,000, and 2,000 Hz) and high-frequencies (3,000, 4,000, 6,000, and 8,000 Hz), and was defined as mild or greater severity (pure-tone average in excess of 25 dB HL). Results SHS exposure was significantly associated with increased risk of hearing loss for low-/mid-frequencies (Adjusted Odds Ratio = 1.14; 95% CI = 1.02-1.28 for never smokers and 1.30; 1.10-1.54 for former smokers) and high-frequencies (1.40; 1.22-1.81 for former smokers), after controlling for potential confounders. Conclusions Findings from the present analysis indicate that SHS exposure is associated with hearing loss in non-smoking adults. PMID:21081307

  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. Dealing with our losses.

    PubMed

    Mount, B M

    1986-07-01

    The repeated losses experienced by a clinical oncologist may constitute a significant source of personal stress. Studies documenting high stress levels on oncology services and the prevalence among physicians of alcoholism, cirrhosis, suicide, and marital discord lend urgency to the need to examine etiologic factors, clinical manifestations, and strategies for the management of job-related stress. Significant etiologic factors include death as an existential fact emphasizing our finite nature, the cumulative grief associated with repeated unresolved losses, the pressure of a health care system fueled by the medical information explosion, the inability to achieve the idealistic goals embraced by holistic medical care, stresses inherent in working as a "team," and an undermined context of meaning as an outcome of treatment failures. Clinical manifestations of stress are reviewed as an aid to early diagnosis. Strategies useful in the prevention and management of stress include the encouragement of increased awareness of stress in self and colleagues, the clarification of appropriate goals and priorities, encouragement of appropriate limit setting, the mobilization of collaborative input, the clarification of team roles and organizational patterns, the establishment of team support meetings and favorable working conditions, exercise, and the clarification and working through of previously unresolved personal psychodynamic issues. Differences between the work-related stress involved in clinical oncology as compared with hospice care are examined.

  18. 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...

  19. 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...

  20. 8 CFR 1245.5 - 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. 1245.5 Section 1245.5... REGULATIONS ADJUSTMENT OF STATUS TO THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 1245.5 Medical... have a medical examination by a designated civil surgeon, whose report setting forth the findings...

  1. 8 CFR 1245.5 - 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. 1245.5 Section 1245.5... REGULATIONS ADJUSTMENT OF STATUS TO THAT OF PERSON ADMITTED FOR PERMANENT RESIDENCE § 1245.5 Medical... have a medical examination by a designated civil surgeon, whose report setting forth the findings...

  2. 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 §...

  3. 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 §...

  4. 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 880.5120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal...

  5. Beware of Products Promising Miracle Weight Loss

    MedlinePlus

    ... Devices Radiation-Emitting Products Vaccines, Blood & Biologics Animal & Veterinary Cosmetics Tobacco Products For Consumers Home For Consumers ... Weight Loss Products More in Consumer Updates Animal & Veterinary Children's Health Cosmetics Dietary Supplements Drugs Food Medical ...

  6. 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.

  7. 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:…

  8. 26 CFR 1.1368-2 - Accumulated adjustments account (AAA).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... earnings and profits or previously taxed income pursuant to an election made under section 1368(e)(3) and... AAA for redemptions and distributions in the year of a redemption. (c) Distribution of money and loss... the adjusted basis of which exceeds its fair market value on the date of the distribution and...

  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. Oral Medication

    MedlinePlus

    ... Size: A A A Listen En Español Oral Medication The first treatment for type 2 diabetes blood ... new — even over-the-counter items. Explore: Oral Medication How Much Do Oral Medications Cost? Save money ...

  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. Medicare Program; End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program Bid Surety Bonds, State Licensure and Appeals Process for Breach of Contract Actions, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program and Fee Schedule Adjustments, Access to Care Issues for Durable Medical Equipment; and the Comprehensive End-Stage Renal Disease Care Model. Final rule.

    PubMed

    2016-11-04

    This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2017. It also finalizes policies for coverage and payment for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. This rule also sets forth requirements for the ESRD Quality Incentive Program, including the inclusion of new quality measures beginning with payment year (PY) 2020 and provides updates to programmatic policies for the PY 2018 and PY 2019 ESRD QIP. This rule also implements statutory requirements for bid surety bonds and state licensure for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). This rule also expands suppliers' appeal rights in the event of a breach of contract action taken by CMS, by revising the appeals regulation to extend the appeals process to all types of actions taken by CMS for a supplier's breach of contract, rather than limit an appeal for the termination of a competitive bidding contract. The rule also finalizes changes to the methodologies for adjusting fee schedule amounts for DMEPOS using information from CBPs and for submitting bids and establishing single payment amounts under the CBPs for certain groupings of similar items with different features to address price inversions. Final changes also are made to the method for establishing bid limits for items under the DMEPOS CBPs. In addition, this rule summarizes comments on the impacts of coordinating Medicare and Medicaid Durable Medical Equipment for dually eligible beneficiaries. Finally, this rule also summarizes comments received in response to a request for information related to the Comprehensive ESRD Care Model and future payment models affecting renal care.

  13. Denying Medical Students' Emotions.

    ERIC Educational Resources Information Center

    USA Today, 1984

    1984-01-01

    Medical educators nationwide are questioning the process that leads to the denial of the emotional side of medicine by its practitioners. Emotional dilemmas are often verbally suppressed by most students, but they surface in many ways, such as depression, insomnia, loss of appetite, and anxiety. (RM)

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 76 FR 77019 - Final Adjusted Assessment of Annual Needs for the List I Chemicals: Ephedrine, Pseudoephedrine...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-09

    ... Enforcement Administration Final Adjusted Assessment of Annual Needs for the List I Chemicals: Ephedrine... needs for the List I chemicals ephedrine, pseudoephedrine, and phenylpropanolamine. DATES: Effective... States in 2011 to provide adequate supplies of each chemical for the estimated medical,...

  20. 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.

  1. Medication supply for people evacuated during disasters.

    PubMed

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

    2015-02-01

    Medication loss is a major problem in disaster settings, and it is crucial for patients to bring their medication and healthcare items with them when they leave their homes during an evacuation. This article is based on a systematic literature review on medication loss, the objectives of which were to identify the extent and implications of medication loss, to identify the burden of prescription refill, and to make recommendations on effective preparedness. The review revealed that medication loss, prescription loss and refills, and the loss of medical aids are a significant burden on the medical relief teams. The medical aids are not limited to drugs, but include routine medications, medical/allergy records, devices for specific care and daily life, and emergency medications. One possible solution is to make a personal emergency pack and for people to carry this with them at all times. To ensure that patients are adequately prepared, stakeholders, especially health professionals, need to be actively involved in the preparation plans. Since our findings have little impact on disaster risk reduction unless shared broadly, we are now taking actions to spread our findings, such as presenting in conferences and via posters, in order to raise awareness among patients and healthcare professionals. As part of these activities, our findings were presented at the Evidence Aid Symposium on 20 September 2014, at Hyderabad, India.

  2. Adjusting to Chronic Health Conditions.

    PubMed

    Helgeson, Vicki S; Zajdel, Melissa

    2017-01-03

    Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.

  3. 42 CFR 414.42 - Adjustment for first 4 years of practice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Adjustment for first 4 years of practice. 414.42 Section 414.42 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Physicians and Other Practitioners § 414.42 Adjustment...

  4. 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

  5. Adjustable hybrid diffractive/refractive achromatic lens

    PubMed Central

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

    2011-01-01

    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. PMID:21503055

  6. 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.

  7. Comparable-Worth Adjustments: Yes--Comparable-Worth Adjustments: No.

    ERIC Educational Resources Information Center

    Galloway, Sue; O'Neill, June

    1985-01-01

    Two essays address the issue of pay equity and present opinions favoring and opposing comparable-worth adjustments. Movement of women out of traditionally female jobs, the limits of "equal pay," fairness of comparable worth and market-based wages, implementation and efficiency of comparable worth system, and alternatives to comparable…

  8. 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…

  9. 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

  10. Structural adjustment: the wrong prescription for Africa?

    PubMed

    Logie, D E; Woodroffe, J

    1993-07-03

    The medical and social consequences and the wide effects of the African structural adjustment program (SAP), specifically for women and children, and examples of the impact in Zimbabwe, Zambia, and Senegal, are discussed. Structural adjustment is defined and the history of its inception is provided. Significant economic and social welfare improvement occurred during the 1960s and 1970s, and considerable decline occurred during the 1980s. The present reality is that Africa,m contrary to popular myths about being a "bottomless pit of Western charity," transfers $10 billion/year to the rich North. Debtor countries are 61% more indebted in 1990 than they were in 1982. During the 1980s, oil prices and interest rates rose dramatically, African export prices dropped, and industrialized countries set up protectionist policies. In addition, there was civil war, drought, poor leadership which put military spending before poverty reduction, and the AIDS epidemic. The Western response was to restructure debt payments in return for implementation of SAPs. Structural adjustment involved a package of trade liberalization, devaluation, removal of government subsidies and price controls, privatization, credit shortages, higher interest rates, and "cost recovery" in health and education. The theory is that economic growth will "ultimately" lead to poverty reduction. A critical view is that SAP insures debt repayment, export of cheap raw materials to the North, and may not sustain longterm economic growth. The results for the poor have been high prices for food, transportation, school and medical fees, and a decline in wages and unemployment. Land is used for exports. A solution is to reduce the debt burden, to place the needs of the poor as a top priority in SAPs, and to put pressure on the World Bank, the International Monetary Fund, and governments to consider health outcomes. Other alternatives noted in the African Framework to SAPs are to place well being and self-reliance as

  11. 75 FR 33379 - Railroad Cost Recovery Procedures-Productivity Adjustment; Quarterly Rail Cost Adjustment Factor

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-11

    ... Surface Transportation Board Railroad Cost Recovery Procedures--Productivity Adjustment; Quarterly Rail... Railroads that the Board restate the previously published productivity adjustment for the 2003-2007 averaging period (2007 productivity adjustment) so that it tracks the 2007 productivity adjustment...

  12. 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

  13. The Economic Burden of Vision Loss and Eye Disorders among the United States Population Younger than 40 Years

    PubMed Central

    Wittenborn, John S.; Zhang, Xinzhi; Feagan, Charles W.; Crouse, Wesley L.; Shrestha, Sundar; Kemper, Alex R.; Hoerger, Thomas J.; Saaddine, Jinan B.

    2017-01-01

    Objective To estimate the economic burden of vision loss and eye disorders in the United States population younger than 40 years in 2012. Design Econometric and statistical analysis of survey, commercial claims, and census data. Participants The United States population younger than 40 years in 2012. Methods We categorized costs based on consensus guidelines. We estimated medical costs attributable to diagnosed eye-related disorders, undiagnosed vision loss, and medical vision aids using Medical Expenditure Panel Survey and MarketScan data. The prevalence of vision impairment and blindness were estimated using National Health and Nutrition Examination Survey data. We estimated costs from lost productivity using Survey of Income and Program Participation. We estimated costs of informal care, low vision aids, special education, school screening, government spending, and transfer payments based on published estimates and federal budgets. We estimated quality-adjusted life years (QALYs) lost based on published utility values. Main Outcome Measures Costs and QALYs lost in 2012. Results The economic burden of vision loss and eye disorders among the United States population younger than 40 years was $27.5 billion in 2012 (95% confidence interval, $21.5–$37.2 billion), including $5.9 billion for children and $21.6 billion for adults 18 to 39 years of age. Direct costs were $14.5 billion, including $7.3 billion in medical costs for diagnosed disorders, $4.9 billion in refraction correction, $0.5 billion in medical costs for undiagnosed vision loss, and $1.8 billion in other direct costs. Indirect costs were $13 billion, primarily because of $12.2 billion in productivity losses. In addition, vision loss cost society 215 000 QALYs. Conclusions We found a substantial burden resulting from vision loss and eye disorders in the United States population younger than 40 years, a population excluded from previous studies. Monetizing quality-of-life losses at $50 000 per QALY would

  14. Dyadic Adjustment: An Ecosystemic Examination.

    ERIC Educational Resources Information Center

    Wilson, Stephan M.; Larson, Jeffry H.; McCulloch, B. Jan; Stone, Katherine L.

    1997-01-01

    Examines the relationship of background, individual, and family influences on dyadic adjustment, using an ecological perspective. Data from 102 married couples were used. Age at marriage for husbands, emotional health for wives, and number of marriage and family problems as well as family life satisfaction for both were related to dyadic…

  15. Problems of Adjustment to School.

    ERIC Educational Resources Information Center

    Bartolini, Leandro A.

    This paper, one of several written for a comprehensive policy study of early childhood education in Illinois, examines and summarizes the literature on the problems of young children in adjusting to starting school full-time and describes the nature and extent of their difficulties in relation to statewide educational policy. The review of studies…

  16. 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'…

  17. 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

  18. Medical Transcriptionists

    MedlinePlus

    ... have an understanding of medical terminology, anatomy and physiology, grammar, and word-processing software. Pay The median ... must become familiar with medical terminology, anatomy and physiology, diagnostic procedures, pharmacology, and treatment assessments. Their ability ...

  19. Medical ethics

    PubMed Central

    Markose, Aji; Krishnan, Ramesh; Ramesh, Maya

    2016-01-01

    Mutual trust and relationship between doctors and patients is an important factor of treatment plan. Changing trends in medical field does affect this relationship. This article reviews the basic code of conduct for every medical practitioner. PMID:27829735

  20. ADHD Medications

    MedlinePlus

    ... ADHD medications work by increasing the levels of brain chemicals called neurotransmitters . Neurotransmitters help send messages between nerve cells in the brain. There are two main kinds of ADHD medications: ...

  1. Abortion - medical

    MedlinePlus

    ... an undesired pregnancy. The medicine helps remove the fetus and placenta from the mother's womb (uterus). There are different types of medical abortions: Therapeutic medical abortion is done because the woman ...

  2. 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)

  3. 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…

  4. Medical Assistants

    MedlinePlus

    ... medical assistants often fill out insurance forms or code patients’ medical information. They often answer telephones and ... charts and diagnoses. They may be required to code a patient’s medical records for billing purposes. Detail ...

  5. Oral medications.

    PubMed

    Albretsen, Jay C

    2002-03-01

    Many medications are available today by prescription or in over-the-counter preparations. This article reviews the pharmacokinetics, mechanism of action, toxicity, clinical signs, and management procedures necessary for some oral medications. The medications reviewed include selective serotonin reuptake inhibitors, benzodiazepines, amphetamines or amphetamine like drugs, carprofen, cyclooxygenase-2 inhibitors, pseudoephedrine, calcium channel blockers, and baclofen.

  6. 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 of each civil money penalty within the OCC's jurisdiction is adjusted in accordance with the...

  7. 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)...

  8. 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)...

  9. 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…

  10. Coverage-adjusted entropy estimation.

    PubMed

    Vu, Vincent Q; Yu, Bin; Kass, Robert E

    2007-09-20

    Data on 'neural coding' have frequently been analyzed using information-theoretic measures. These formulations involve the fundamental and generally difficult statistical problem of estimating entropy. We review briefly several methods that have been advanced to estimate entropy and highlight a method, the coverage-adjusted entropy estimator (CAE), due to Chao and Shen that appeared recently in the environmental statistics literature. This method begins with the elementary Horvitz-Thompson estimator, developed for sampling from a finite population, and adjusts for the potential new species that have not yet been observed in the sample-these become the new patterns or 'words' in a spike train that have not yet been observed. The adjustment is due to I. J. Good, and is called the Good-Turing coverage estimate. We provide a new empirical regularization derivation of the coverage-adjusted probability estimator, which shrinks the maximum likelihood estimate. We prove that the CAE is consistent and first-order optimal, with rate O(P)(1/log n), in the class of distributions with finite entropy variance and that, within the class of distributions with finite qth moment of the log-likelihood, the Good-Turing coverage estimate and the total probability of unobserved words converge at rate O(P)(1/(log n)(q)). We then provide a simulation study of the estimator with standard distributions and examples from neuronal data, where observations are dependent. The results show that, with a minor modification, the CAE performs much better than the MLE and is better than the best upper bound estimator, due to Paninski, when the number of possible words m is unknown or infinite.

  11. 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.

  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. 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…

  14. 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…

  15. Weight Loss Surgery

    MedlinePlus

    ... A Week of Healthy Breakfasts Shyness Weight Loss Surgery KidsHealth > For Teens > Weight Loss Surgery A A ... Risks and Side Effects? What Is Weight Loss Surgery? For some people, being overweight is about more ...

  16. Psychiatry of the medically ill in the burn unit.

    PubMed

    Ilechukwu, Sunny T

    2002-03-01

    Clinical experience and burn survivor testimony show that the experience of being burned can be associated with catastrophic stress and lead to drastic permanent body image changes from scarring and limb-function loss. Close relatives, if not killed in the fire, often also experience clinically significant bystander stress. Closeness of relationships may be lost, and self-image may suffer. Property damage and loss of crucial resources may be associated with fires. Although many burns result from accidents, most result from preventable causes associated with psychiatric disorders, which include mood disorders, psychoses, cognitive disorders, and substance-use disorders. Burns then result from: Deliberate self-harm Impaired judgment and poor coordination associated with substance intoxication Risk-taking behavior Poor supervision of children and impaired elderly persons Careless handling of flammable materials. Many clinical syndromes, such as delirium, ASD, acute psychosis, suicidality, and pain need to be addressed by the consulting psychiatrist to facilitate surgical treatment of the burn injury. Other psychiatric disorders, such as PTSD, major depression, and adjustment disorder, need to be treated to expedite long-term adjustment. Hospital length of stay and RTW/RTS are major outcome variables. The psychiatry consultant can positively affect both variables substantially using both pharmacologic and psychosocial measures. The important role of psychiatric issues both before and after burn injury support the need for more consistent and comprehensive medical insurance coverage for psychiatric consultation to burn units and clinics. Burn Support Groups are an invaluable asset.

  17. Medical marijuana: Irresponsible medical care?

    PubMed

    Gordon, Nayvin

    2017-03-01

    Illness should continue to be treated by health professionals employing scientific evidence. This is responsible policy. It is not appropriate or medically justified for family physicians to refer patients to medical marijuana clinics; instead, they should inform their patients that medical treatment must be based on scientific evidence.

  18. (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…

  19. Perioperative outcomes of laparoscopic adjustable gastric banding in mildly obese (BMI < 35 kg/m2) compared to severely obese.

    PubMed

    Varela, J Esteban; Frey, Wanda

    2011-04-01

    Laparoscopic adjustable gastric banding (LAGB) has become a standard restrictive procedure in the USA for the treatment of severe obesity (body mass index, BMI > 35 kg/m(2)). Mildly obese individuals (BMI < 35 kg/m(2)) are also at increased risk from obesity-related conditions. Recently, an FDA panel supported its use in this subgroup. We compared the perioperative outcomes of LAGB in mildly and severely obese. Thirty consecutive patients (mildly obese n=10; severely obese n=20) that underwent preoperative medical weight loss followed by LAGB procedures were prospectively evaluated. Outcome variables included: operative room (OR) time, intraoperative estimated blood loss (EBL), length of hospital (LOS), and intensive care unit (ICU) stay, reoperations, readmissions, 30-day morbidity and mortality. Demographic data was comparable between groups. BMI was significantly higher in the severely obese compared to mildly obese (44.0 ± 5 vs. 33.6 ± 1 kg/m(2)). OR time, EBL, LOS, and ICU admissions were similar between BMI groups. There were no reoperations or 30-day mortality in either group. Minor morbidity was only observed in the severely obese group. BMI correlated with OR time and EBL. In mildly obese, LAGB is as safe as in the severely obese with no perioperative morbidity. The perioperative outcomes and hospital resource utilization are comparable between BMI groups. Lower BMI is associated with lower operative times and blood loss.

  20. Association of skin color, race/ethnicity, and hearing loss among adults in the USA.

    PubMed

    Lin, Frank R; Maas, Paige; Chien, Wade; Carey, John P; Ferrucci, Luigi; Thorpe, Roland

    2012-02-01

    Epidemiologic studies of hearing loss in adults have demonstrated that the odds of hearing loss are substantially lower in black than in white individuals. The basis of this association is unknown. We hypothesized that skin pigmentation as a marker of melanocytic functioning mediates this observed association and that skin pigmentation is associated with hearing loss independent of race/ethnicity. We analyzed cross-sectional data from 1,258 adults (20-59 years) in the 2003-2004 cycle of the National Health and Nutritional Examination Survey who had assessment of Fitzpatrick skin type and pure-tone audiometric testing. Audiometric thresholds in the worse hearing ear were used to calculate speech- (0.5-4 kHz) and high-frequency (3-8 kHz) pure-tone averages (PTA). Regression models were stratified by Fitzpatrick skin type or race/ethnicity to examine the association of each factor with hearing loss independent of the other. Models were adjusted for potential confounders (demographic, medical, and noise exposure covariates). Among all participants, race/ethnicity was associated with hearing thresholds (black participants with the best hearing followed by Hispanics and then white individuals), but these associations were not significant in analyses stratified by skin color. In contrast, in race-stratified analyses, darker-skinned Hispanics had better hearing than lighter-skinned Hispanics by an average of -2.5 dB hearing level (HL; 95% CI, -4.8 to -0.2) and -3.1 dB HL (95% CI, -5.3 to -0.8) for speech and high-frequency PTA, respectively. Associations between skin color and hearing loss were not significant in white and black participants. Our results demonstrate that skin pigmentation is independently associated with hearing loss in Hispanics and suggest that skin pigmentation as a marker of melanocytic functioning may mediate the strong association observed between race/ethnicity and hearing loss.

  1. 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.

  2. Inflation Adjustments for Defense Acquisition

    DTIC Science & Technology

    2014-10-01

    Harmon Daniel B. Levine Stanley A. Horowitz, Project Leader INSTITUTE FOR DEFENSE ANALYSES 4850 Mark Center Drive Alexandria, Virginia 22311-1882 Approved...T U T E F O R D E F E N S E A N A L Y S E S IDA Document D-5112 Inflation Adjustments for Defense Acquisition Bruce R. Harmon Daniel B. Levine...might do a better job? The focus of the study is on aircraft procurement. By way of terminology , “cost index,” “price index,” and “deflator” are used

  3. 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.

  4. Medication Guide

    MedlinePlus

    ... Who Quit Community Helping Someone Quit Stress & Mood Stress & Mood Smoking & Mood Stress Depression Anger Weight Management Weight Management Smoking and Weight Healthy Weight Loss Being Comfortable in ...

  5. 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.

  6. 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.

  7. 48 CFR 1450.103 - Contract adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Contract adjustments. 1450.103 Section 1450.103 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR CONTRACT... Contract adjustments....

  8. First Year Adjustment in the Secondary School.

    ERIC Educational Resources Information Center

    Loosemore, Jean Ann

    1978-01-01

    This study investigated the relationship between adjustment to secondary school and 17 cognitive and noncognitive variables, including intelligence (verbal and nonverbal reasoning), academic achievement, extraversion-introversion, stable/unstable, social adjustment, endeavor, age, sex, and school form. (CP)

  9. [Euthanasia: medications and medical procedures].

    PubMed

    Lossignol, D

    2008-09-01

    The Belgian law relative to euthanasia has been published in 2002. A physician is allowed to help a patient with intractable suffering (physical or psychological). Legal conditions are clear. However, nothing is said about medical procedures or medications to be used. The present paper will present specific clinical situations at the end of life, practical procedures and medications. A special focus is made on psychological impact of euthanasia.

  10. Structural adjustment and health policy in Africa.

    PubMed

    Loewenson, R

    1993-01-01

    World Bank/International Monetary Fund Structural Adjustment Programs (SAPs) have been introduced in over 40 countries of Africa. This article outlines their economic policy measures and the experience of the countries that have introduced them, in terms of nutrition, health status, and health services. The evidence indicates that SAPs have been associated with increasing food insecurity and undernutrition, rising ill-health, and decreasing access to health care in the two-thirds or more of the population of African countries that already lives below poverty levels. SAPs have also affected health policy, with loss of a proactive health policy framework, a widening gap between the affected communities and policy makers, and the replacement of the underlying principle of equity in and social responsibility for health care by a policy in which health is marketed commodity and access to health care becomes an individual responsibility. The author argues that there is a deep contradiction between SAPs and policies aimed at building the health of the population. Those in the health sector need to contribute to the development and advocacy of economic policies in which growth is based on human resource development, and to the development of a civic environment in Africa that can ensure the implementation of such policies.

  11. Monitoring medication.

    PubMed

    Griffiths, Matt

    2016-08-17

    A recent study from researchers at Ghent University in Belgium, involving 503 community-based adults aged 80 and over, found that 58% were taking five or more long-term medications daily, but few were taking them appropriately. The underuse of prescribed medication occurred in 67% of those studied and misuse occurred in 56%, with some overlap.

  12. 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.

  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. 49 CFR 393.53 - Automatic brake adjusters and brake adjustment indicators.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... brake adjustment indicators. (a) Automatic brake adjusters (hydraulic brake systems). Each commercial motor vehicle manufactured on or after October 20, 1993, and equipped with a hydraulic brake...

  15. School-related adjustment in children and adolescents with CHD.

    PubMed

    Im, Yu-Mi; Lee, Sunhee; Yun, Tae-Jin; Choi, Jae Young

    2017-03-20

    Advancements in medical and surgical treatment have increased the life expectancy of patients with CHD. Many patients with CHD, however, struggle with the medical, psychosocial, and behavioural challenges as they transition from childhood to adulthood. Specifically, the environmental and lifestyle challenges in school are very important factors that affect children and adolescents with CHD. This study aimed to evaluate school-related adjustments depending on school level and disclosure of disease in children and adolescents with CHD. This was a descriptive and exploratory study with 205 children and adolescents, aged 7-18 years, who were recruited from two congenital heart clinics from 5 January to 27 February, 2015. Data were analysed using the Student's t-test, analysis of variance, and a univariate general linear model. School-related adjustment scores were significantly different according to school level and disclosure of disease (p<0.001) when age, religion, experience being bullied, and parents' educational levels were assigned as covariates. The school-related adjustment score of patients who did not disclose their disease dropped significantly in high school. This indicated that it is important for healthcare providers to plan developmentally appropriate educational transition programmes for middle-school students with CHD in order for students to prepare themselves before entering high school.

  16. 7 CFR 1744.64 - Budget adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 11 2014-01-01 2014-01-01 false Budget adjustment. 1744.64 Section 1744.64... Disbursement of Funds § 1744.64 Budget adjustment. (a) If more funds are required than are available in a budget account, the borrower may request RUS's approval of a budget adjustment to use funds from...

  17. 7 CFR 1744.64 - Budget adjustment.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 11 2012-01-01 2012-01-01 false Budget adjustment. 1744.64 Section 1744.64... Disbursement of Funds § 1744.64 Budget adjustment. (a) If more funds are required than are available in a budget account, the borrower may request RUS's approval of a budget adjustment to use funds from...

  18. 7 CFR 1744.64 - Budget adjustment.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 11 2013-01-01 2013-01-01 false Budget adjustment. 1744.64 Section 1744.64... Disbursement of Funds § 1744.64 Budget adjustment. (a) If more funds are required than are available in a budget account, the borrower may request RUS's approval of a budget adjustment to use funds from...

  19. 7 CFR 1744.64 - Budget adjustment.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 11 2011-01-01 2011-01-01 false Budget adjustment. 1744.64 Section 1744.64... Disbursement of Funds § 1744.64 Budget adjustment. (a) If more funds are required than are available in a budget account, the borrower may request RUS's approval of a budget adjustment to use funds from...

  20. 7 CFR 1744.64 - Budget adjustment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false Budget adjustment. 1744.64 Section 1744.64... Disbursement of Funds § 1744.64 Budget adjustment. (a) If more funds are required than are available in a budget account, the borrower may request RUS's approval of a budget adjustment to use funds from...

  1. 24 CFR 5.611 - Adjusted income.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 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...

  2. 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...

  3. 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...

  4. 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...

  5. 12 CFR 313.55 - Salary adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 4 2011-01-01 2011-01-01 false Salary adjustments. 313.55 Section 313.55 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PROCEDURES FOR CORPORATE DEBT COLLECTION Salary Offset § 313.55 Salary adjustments. Any negative adjustment to pay...

  6. 12 CFR 313.55 - Salary adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 5 2012-01-01 2012-01-01 false Salary adjustments. 313.55 Section 313.55 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PROCEDURES FOR CORPORATE DEBT COLLECTION Salary Offset § 313.55 Salary adjustments. Any negative adjustment to pay...

  7. 12 CFR 313.55 - Salary adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 5 2013-01-01 2013-01-01 false Salary adjustments. 313.55 Section 313.55 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PROCEDURES FOR CORPORATE DEBT COLLECTION Salary Offset § 313.55 Salary adjustments. Any negative adjustment to pay...

  8. 12 CFR 313.55 - Salary adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 5 2014-01-01 2014-01-01 false Salary adjustments. 313.55 Section 313.55 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PROCEDURES FOR CORPORATE DEBT COLLECTION Salary Offset § 313.55 Salary adjustments. Any negative adjustment to pay...

  9. 19 CFR 201.205 - Salary adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 3 2014-04-01 2014-04-01 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...

  10. 19 CFR 201.205 - Salary adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 3 2012-04-01 2012-04-01 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, 2013 CFR

    2013-04-01

    ... 19 Customs Duties 3 2013-04-01 2013-04-01 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. 12 CFR 313.55 - Salary adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Salary adjustments. 313.55 Section 313.55 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PROCEDURES FOR CORPORATE DEBT COLLECTION Salary Offset § 313.55 Salary adjustments. Any negative adjustment to pay...

  13. 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...

  14. 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...

  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, 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,...

  17. 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.

  18. [Adjustment processes of foreign exchange high school students in Japan].

    PubMed

    Nagai, S

    1988-04-01

    The main purpose of the present study was to excavate the adjustment problems of 93 high school exchange students in Japan. Questionnaires including Cornell Medical Index (CMI) were administered longitudinally. In addition, individual interviews were held with those who had failed to adjust to the Japanese society. As for the subjective psychosomatic symptoms manifested in CMI, there was no significant sex difference while Asians were successively found to be significantly more liable to diseases and less adjusted than non-Asians. The questionnaires other than CMI disclosed difficulties which exchange students found in adjusting at Japanese home, including delicate personal relationships with host siblings, apparent lack of affective gestures (hugs and kisses), and early curfew. In the meanwhile, language barrier and trifling rules constituted the primary difficulties they faced at host school. On account of prejudice against women, girls had more unpleasant experiences than boys. Through individual interviews, all of the early returners were found to have already had a basic problem in their home countries.

  19. Limitations of quantitative research in the study of structural adjustment.

    PubMed

    Lundy, P

    1996-02-01

    Sociologists and, more recently, critical medical anthropologists have been arguing for a refocusing of the analysis of health and health care towards a perspective which considers the broader global political economy. In the context of the debt crisis and IMF/World Bank-inspired structural adjustment policies, the political economy theoretical perspective is becoming even more relevant in the analysis of health underdevelopment in many 'Third World' countries. This study focuses on the direct and indirect effects of the Jamaican debt crisis and structural adjustment programmes on health care services and health standards. In this paper it is argued that there are methodological problems using quantitative data when studying the effects of structural adjustment. In addition to providing a limited account of the effects, it is argued that the basic problem is a matter of the availability and reliability of the quantitative data in many 'Third World' countries. It is argued that some of these problems could be overcome by the application of qualitative micro-level analysis. This type of methodology is important to ascertain the effects of global processes at the grass roots level and to gain insights into what those working in the health sector are experiencing and what they perceive as the effects, if any, of structural adjustment policies. This has often been missing from the impersonal accounts offered by quantitative research on the subject to date.

  20. 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.

  1. Living with hearing loss

    MedlinePlus

    ... medlineplus.gov/ency/patientinstructions/000360.htm Living with hearing loss To use the sharing features on this page, please enable JavaScript. If you are living with hearing loss, you know that it takes extra effort to ...

  2. Photovoltaic array loss mechanisms

    NASA Astrophysics Data System (ADS)

    Gonzalez, Charles

    1986-10-01

    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.

  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. 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.

  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. Hair loss in women.

    PubMed

    Tosti, A; Piraccini, B M; Sisti, A; Duque-Estrada, B

    2009-10-01

    Hair loss in women is a very common clinical complaint, and is usually associated with severe emotional distress. In this article, the authors review the most common clinical causes of hair loss in women, and emphasize the role of hormonal changes in the regulation of hair loss and hair growth.

  8. Hearing loss - infants

    MedlinePlus

    ... loss. Two common tests are used to screen newborn infants for hearing loss: Auditory brain stem response (ABR) ... Over 30 states in the United States require newborn hearing screenings. Treating hearing loss early can allow many infants to develop normal language skills without delay. In ...

  9. 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 ...

  10. ADHD Medications

    MedlinePlus

    ... under a psychiatrist's or other doctor's care. ADHD medications have helped teens with ADHD in all sorts of areas, even helping reduce things like substance abuse, injuries, and automobile accidents. ADHD medicines also can ...

  11. Medication Guide

    MedlinePlus

    ... more than one type of medication. Alpha Agonist Company Brand Name Generic Name Alcon, Inc. Iopidine® Apraclonidine ... drowsiness, dry mouth and dry nose. Beta Blockers Company Brand Name Generic Name Akorn Ophthalmics Timolol Maleate ...

  12. 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.

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

    DOEpatents

    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.

  14. 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.

  15. 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.

  16. Some Physiological Adjustments Relating to Nutrition in Pregnancy

    PubMed Central

    Beaton, George H.

    1966-01-01

    Information from human and animal studies clearly indicates that a number of adjustments in protein, fat, iron and calcium metabolism occur during pregnancy. Recognition of these adjustments has led to a reappraisal of nutrient requirements during pregnancy. The existence of significant protein storage during pregnancy is called into question; in contrast, the evidence suggests that the major storage component is fat, perhaps in anticipation of the energy costs of lactation. In women who will not lactate, this storage is of no benefit and is an etiologic factor in obesity. From a consideration of iron metabolism in pregnancy, it is concluded that it is better to prevent iron depletion in non-pregnant women, especially that associated with excessive menstrual loss, than to administer iron therapy to pregnant women. PMID:5330280

  17. 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.

  18. 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.

  19. Medical marijuana

    MedlinePlus

    ... reaction times Drowsiness Possible mental or emotional side effects include: A strong feeling of happiness or well-being Short-term memory loss Trouble concentrating Confusion Decreased or increased anxiety

  20. 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

  1. 78 FR 74163 - Harrison Medical Center, a Subsidiary of Franciscan Health System Bremerton, Washington; Notice...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-10

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF LABOR Employment and Training Administration Harrison Medical Center, a Subsidiary of Franciscan Health System... Adjustment Assistance (TAA), applicable to workers and former workers of Harrison Medical Center,...

  2. Determination of spallation neutron flux through spectral adjustment techniques

    SciTech Connect

    Mosby, Michelle A.; Engle, Jonathan Ward; Jackman, Kevin Richard; Nortier, Francois Meiring; Birnbaum, Eva R.

    2016-05-30

    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 in this paper. However, the energy distribution and magnitude of the flux is not well understood. Finally, 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.

  3. 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.

  4. [Hyponatremia - carbamazepine medication complications].

    PubMed

    Dedinská, I; Maňka, V; Ságová, I; Klimentová, A; Makovický, P; Polko, J; Sadloňová, J; Mokáň, M

    2012-01-01

    Hyponatremia can be defined like the low sodium concentration, lower that 135 mmol/l. It becomes really serious when the concentration is lower than 120 mmol/l. The most frequent causes of hyponatremia are: the extrarenal loss (GIT, skin, bleeding, sequestration), the renal loss (diuretics, nephritis with the salt loss, osmotical diuresis, the Addison disease), hypothyroidism, the lack of glucocorticoids, emotional stress, pain, pseudohyponatremia (incorrect taking, dyslipoproteinemia). There is fatigue, exhaustion, headache and vertigoes dominating in the clinical record file. By the deficit increasing a patient becomes delirious, comatose even with the shock development. It is necessary to separate sufficient supply of sodium from much more often reason, which is loss of sodium which can be caused by: excessive sweating, vomitting with the metabolical alkalosis development, diarrhoea with the metabolical acidosis development, renal losses (a phase of renal failure). Treatment of hyponatremia: intensive treatment starts at the level of plasmatic concentration of sodium under 120 mmol/l or when neurological symptoms of brain oedema are present. In the therapy it is necessary to avoid fast infusions of hypertonic saline solutions (3-5% NaCl solutions) because of the danger of the development of serious CNS complications (intracranial bleeding, etc.). It is recommended to adjust the plasmatic concentration of sodium up to 120 mmol/l during the first four hours and a subsequent correction should not be higher than 2 mmol per an hour. Treatment of the basic illness is very important. We present 2 case histories: a 74-year old female patient and a 69-year old female patient both with the hyponatremia caused by taking of carbamazepine. We want to inform and warn about not only a well known side effect during long-term treatment but about hyponatremia that arose within 48 hours after the start of taking medicine as well.

  5. Pre-enlistment hearing loss and hearing loss disability among US soldiers and marines.

    PubMed

    Gubata, Marlene E; Packnett, Elizabeth R; Feng, Xiaoshu; Cowan, David N; Niebuhr, David W

    2013-01-01

    Hearing loss is a common condition among US adults, with some evidence of increasing prevalence in young adults. Noise-induced hearing loss attributable to employment is a significant source of preventable morbidity world-wide. The US military population is largely comprised of young adult males serving in a wide variety of occupations, many in high noise-level conditions, at least episodically. To identify accession and service-related risk factors for hearing-related disability, matched case-control study of US military personnel was conducted. Individuals evaluated for hearing loss disability in the US Army and Marine Corps were frequency matched to controls without history of disability evaluation on service and enlistment year. Conditional logistic regression was used to examine the association between accession and service-related factors and hearing-related disability evaluations between October 2002 and September 2010. Individuals with medically disqualifying audiograms or hearing loss diagnoses at application for military service were 8 and 4 times more likely, respectively, to have a disability evaluation related to hearing loss, after controlling for relevant accession, demographic, and service-related factors. Conservative hearing loss thresholds on pre-enlistment audiograms, stricter hearing loss medical waiver policies or qualified baseline audiograms pre-enlistment are needed in the U.S military. Industrial corporations or labor unions may also benefit from identifying individuals with moderate hearing loss at the time of employment to ensure use of personal protective equipment and engineer controls of noise.

  6. Adjusting Permittivity by Blending Varying Ratios of SWNTs

    NASA Technical Reports Server (NTRS)

    Tour, James M.; Stephenson, Jason J.; Higginbotham, Amanda

    2012-01-01

    A new composite material of singlewalled carbon nanotubes (SWNTs) displays radio frequency (0 to 1 GHz) permittivity properties that can be adjusted based upon the nanotube composition. When varying ratios of raw to functionalized SWNTs are blended into the silicone elastomer matrix at a total loading of 0.5 percent by weight, a target real permittivity value can be obtained between 70 and 3. This has particular use for designing materials for microwave lenses, microstrips, filters, resonators, high-strength/low-weight electromagnetic interference (EMI) shielding, antennas, waveguides, and low-loss magneto-dielectric products for applications like radome construction.

  7. 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.

  8. 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.

  9. Diet in the management of weight loss

    PubMed Central

    Strychar, Irene

    2006-01-01

    Obesity is an established risk factor for numerous chronic diseases, and successful treatment will have an important impact on medical resources utilization, health care costs, and patient quality of life. With over 60% of our population being overweight, physicians face a major challenge in assisting patients in the process of weight loss and weight-loss maintenance. Low-calorie diets can lower total body weight by an average of 8% in the short term. These diets are well-tolerated and characterize successful strategies in maintaining significant weight loss over a 5-year period. Very-low-calorie diets produce a more rapid weight loss but should only be used for fewer than 16 weeks because of clinical adverse effects. Diets that are severely restricted in carbohydrates (3%–10% of total energy intake) and do not emphasize a reduction of energy intake may be effective in reducing weight in the short term, but there is no evidence that they are sustainable or innocuous in the long term because their high saturated-fat content may be atherogenic. Fat restriction in a weight-loss regimen is beneficial, but the optimal percentage has yet to be determined. Longitudinal trials are needed to resolve these issues. In this article I discuss the evidence for and pitfalls of various types of weight-loss diets and identify issues that physicians need to address in weight loss and weight-loss maintenance. PMID:16389240

  10. The relationship between childhood parental loss and metabolic syndrome in obese subjects.

    PubMed

    Alciati, Alessandra; Gesuele, Felice; Casazza, Giovanni; Foschi, Diego

    2013-02-01

    The increasing global trend of obesity is a fundamental contributor to the growing prevalence of metabolic syndrome, a cluster of medical abnormalities including impaired glucose and lipid metabolism, obesity and hypertension. Results from animal and human investigations have shown that early life stress can result in weight gain and metabolic changes. Our aim is to investigate whether a particular type of an early adverse event, i.e. parental loss during childhood, is associated with the development of metabolic syndrome in severely obese subjects. One hundred thirty-five consecutive obese patients who were seeking bariatric surgery were assessed for metabolic syndrome according to the Adult Treatment Panel (ATP) III criteria. Information regarding the experience of parental separation or bereavement before the age of 17 was collected with the use of a semi-structured interview. In our population, 31.1% of the subjects met the criteria for metabolic syndrome. No significant differences in demographic factors, health habits or psychiatric diagnosis were found between patients with and without coexisting metabolic syndrome. After adjusting for age and gender, multivariate logistic regression analysis revealed that both childhood loss of a parent and a body mass index (BMI) value greater than 50 were significant predictors of metabolic syndrome. This study provides preliminary evidence linking childhood parental loss to risk factors for the development of metabolic syndrome.

  11. [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).

  12. 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.

  13. Reporting on covariate adjustment in randomised controlled trials before and after revision of the 2001 CONSORT statement: a literature review

    PubMed Central

    2010-01-01

    Objectives To evaluate the use and reporting of adjusted analysis in randomised controlled trials (RCTs) and compare the quality of reporting before and after the revision of the CONSORT Statement in 2001. Design Comparison of two cross sectional samples of published articles. Data Sources Journal articles indexed on PubMed in December 2000 and December 2006. Study Selection Parallel group RCTs with a full publication carried out in humans and published in English Main outcome measures Proportion of articles reported adjusted analysis; use of adjusted analysis; the reason for adjustment; the method of adjustment and the reporting of adjusted analysis results in the main text and abstract. Results In both cohorts, 25% of studies reported adjusted analysis (84/355 in 2000 vs 113/422 in 2006). Compared with articles reporting only unadjusted analyses, articles that reported adjusted analyses were more likely to specify primary outcomes, involve multiple centers, perform stratified randomization, be published in general medical journals, and recruit larger sample sizes. In both years a minority of articles explained why and how covariates were selected for adjustment (20% to 30%). Almost all articles specified the statistical methods used for adjustment (99% in 2000 vs 100% in 2006) but only 5% and 10%, respectively, reported both adjusted and unadjusted results as recommended in the CONSORT guidelines. Conclusion There was no evidence of change in the reporting of adjusted analysis results five years after the revision of the CONSORT Statement and only a few articles adhered fully to the CONSORT recommendations. PMID:20482769

  14. Multi-adjustable headband. [for headsets

    NASA Technical Reports Server (NTRS)

    Toole, Pierce C. (Inventor); Chalson, Howard E. (Inventor); Bussey, Walter S. (Inventor)

    1988-01-01

    This invention relates to a headband for a headset having separate coarse and fine adjustment features. The adjustments may be to the axial distance between at least one earpiece element and a side support. Such adjustment to the axial distance varies the pressure exerted on the head of the user. The present fine adjustment feature may be used while the headset is being worn, thereby permitting a user to optimize the amount of pressure between the contending criteria of comfort and keeping the headset in place on the user's head.

  15. Standardization of age-adjusted mortality rates

    SciTech Connect

    Selvin, S.; Sacks, S.T.; Merrill, D.W.

    1980-02-01

    Because age is a significant variable in the occurrence and frequency of human disease, any comparison of disease or mortality rates, to be useful, must be age-specific or age-adjusted. Age-specific comparisons are not always appropriate or possible, however. A common method of eliminating the influence of age in comparing mortality rates from one community to another is to employ statistical methods of age-adjustment. While a variety of methods will accomplish this task, most are weighted averages of the age-specific rates. Two widely used adjustment procedures are direct and indirect age-adjustment.

  16. 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

  17. A review of studies comparing three laparoscopic procedures in bariatric surgery: sleeve gastrectomy, Roux-en-Y gastric bypass and adjustable gastric banding.

    PubMed

    Franco, Juan Victor A; Ruiz, Pablo Adrian; Palermo, Mariano; Gagner, Michel

    2011-09-01

    Obesity is a major worldwide problem in public health, reaching epidemic proportions in many countries, especially in urbanized regions. Bariatric procedures have been shown to be more effective in the management of morbid obesity, compared to medical treatments in terms of weight loss and its sustainability. The two most commonly performed procedures are laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic adjustable gastric banding (LAGB), and the novel laparoscopic sleeve gastrectomy (LSG). The MEDLINE database (cutoff date September 2010), LILACS, and the Cochrane Library were searched using the key words "gastric bypass," "sleeve gastrectomy," and "gastric banding." Only studies that compared at least two of the laparoscopic procedures were included. Reviews and meta-analysis, editorial letters or comments, case reports, animal or in vitro studies, comparisons with medical treatment, comparisons with open (non-laparoscopic) procedures were excluded. Most studies indicated that LRYGB and LSG could be more effective achieving weight loss than LAGB. However, LAGB seems to be a safer procedure with frequent, but less severe, long-term complications. Although not uniformly reported, a resolution of obesity-related comorbidities was achieved with most bariatric procedures. The three procedures have acceptable efficacy and safety. We believe that patients should be informed in detail on the advantages and disadvantages of each available procedure, possibly in several interviews and always accompanied by a specialized interdisciplinary team, warranting long-term follow-up.

  18. 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.

  19. 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.

  20. 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

  1. 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

  2. Pregnancy Loss and Miscarriage

    MedlinePlus

    ... Overview Condition Information What are common symptoms? How many people are ... Pregnancy Loss: Condition Information Skip sharing on social media links Share this: Page Content What is pregnancy ...

  3. A science of loss

    NASA Astrophysics Data System (ADS)

    Barnett, Jon; Tschakert, Petra; Head, Lesley; Adger, W. Neil

    2016-11-01

    Avoiding losses from climate change requires socially engaged research that explains what people value highly, how climate change imperils these phenomena, and strategies for embracing and managing grief.

  4. [Hearing loss in adults].

    PubMed

    Eshraghi, Adrien A; Frachet, Bruno; Van De Water, Tom R; Eter, Elias

    2009-05-20

    The management of hearing loss in adults depends of etiology and its severity. It can be as simple as treating an external otitis, removing an impacted cerumen or a more complex one such as a surgery for otosclerosis. The hearing loss is managed mainly by new advances in hearing aids technology and implantable hearing devices which include BAHA, middle ear implant and cochlear implants. The research is focused on developing new molecules for intracochlear drug therapy to treat noise induced hearing loss, drug ototoxicity as well as hearing loss related to cochlear implant insertion trauma. Antioxidant molecules, molecules against apoptosis are at this time the most promising molecules than need further investigations.

  5. Forecasting Medical Materiel Requirements for Contingency Operations

    DTIC Science & Technology

    2007-11-02

    Airborne Division, 2003). This comment was due to a perceived lack of sick call medications, most notably selective serotonin re-uptake inhibitors...SSRI), used for adjustment and mood disorders. (Interestingly, SSRIs are not listed on the current MES Sick Call unit assemblage (UA) listing. This...needed?) The 3d Infantry Division’s Combat Health Support (CHS) lessons observed echoed similar comments. According to this unit, sick call medications

  6. Recruitment and Retention for a Weight Loss Maintenance Trial Involving Weight Loss Prior to Randomization

    PubMed Central

    Grubber, J. M.; McVay, M. A.; Olsen, M. K.; Bolton, J.; Gierisch, J. M.; Taylor, S. S.; Maciejewski, M. L.; Yancy, W. S.

    2016-01-01

    Abstract Objective A weight loss maintenance trial involving weight loss prior to randomization is challenging to implement due to the potential for dropout and insufficient weight loss. We examined rates and correlates of non‐initiation, dropout, and insufficient weight loss during a weight loss maintenance trial. Methods The MAINTAIN trial involved a 16‐week weight loss program followed by randomization among participants losing at least 4 kg. Psychosocial measures were administered during a screening visit. Weight was obtained at the first group session and 16 weeks later to determine eligibility for randomization. Results Of 573 patients who screened as eligible, 69 failed to initiate the weight loss program. In adjusted analyses, failure to initiate was associated with lower age, lack of a support person, and less encouragement for making dietary changes. Among participants who initiated, 200 dropped out, 82 lost insufficient weight, and 222 lost sufficient weight for randomization. Compared to losing sufficient weight, dropping out was associated with younger age and tobacco use, whereas losing insufficient weight was associated with non‐White race and controlled motivation for physical activity. Conclusions Studies should be conducted to evaluate strategies to maximize recruitment and retention of subgroups that are less likely to initiate and be retained in weight loss maintenance trials. PMID:28090340

  7. 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.

  8. Medical Applications

    NASA Astrophysics Data System (ADS)

    Schieck, Hans Paetz Gen.

    The recent progress in medical imaging techniques such as magnetic-resonance imaging (nmr or mri), computer tomography (CT with X-rays), and positron-emission tomography (PET scanning using short-lived radioactive nuclei) has been impressive. Two areas where diagnostic tools lacked behind have been tomography of the blood vessels of the brain and of the bronchi.

  9. Medic Bleep.

    PubMed

    2017-03-15

    Medic Bleep is a secure instant messaging app that enables clinicians to discuss patient care quickly, securely and legally. It looks and feels like WhatsApp, but has been designed for the healthcare market to enable staff to communicate with each other, and to help speed up conversations between clinicians to increase efficiency.

  10. Medication Errors

    MedlinePlus

    ... common links HHS U.S. Department of Health and Human Services U.S. Food and Drug Administration A to Z Index Follow ... Practices National Patient Safety Foundation To Err is Human: ... Errors: Quality Chasm Series National Coordinating Council for Medication Error ...

  11. Glaucoma medications.

    PubMed

    Chae, Bora; Cakiner-Egilmez, Tulay; Desai, Manishi

    2013-01-01

    Glaucoma is a common eye condition that affects millions of individuals worldwide, making it the second-leading cause of blindness. Because glaucoma is associated with increased IOP level, the primary goal in treatment of glaucoma includes lowering IOP to prevent further progression of the disease. While various surgical interventions exist, medical therapy is currently the first line of treatment. Medical treatment of glaucoma includes topical beta-blockers, alpha-2 agonists, prostaglandins, parasympathomimetics and CAIs. Anti-glaucoma agents help reduce IOP by affecting the production of aqueous humor or increasing the outflow of aqueous through the trabecular or uveoscleral pathway. Choosing an appropriate medical regimen can be challenging and various factors such as efficacy, safety, cost and patient compliance must be considered. First-line treatment is often topical beta-blockers or prostaglandin analogs. However, beta-blocking agents can be associated with systemic side effects and need to be used cautiously in patients with serious concomitant cardiopulmonary disease. Alpha-2 agonists and parasympathomimetics are often considered second- or third-line treatment options but good adjunctive agents. Oral CAIs are often indicated for patients with elevated IOP in an acute setting or for patients resistant to other glaucoma medications and patients who are not good surgical candidates.

  12. [Medical geography].

    PubMed

    Hauri, D

    2007-10-17

    Hippocrates already noted that geographical factors such as climate, relief, geology but also settlement patterns had influenced the distribution of diseases. The task of medical geography is to investigate the associations between geographical factors and diseases. Thereby, geographic techniques and concepts are applied on health problems. Of particular importance is the mapping of diseases whose causes are environmental-related. In addition, epidemiological, ecological but also social scientific studies play an important part in the investigation of the associations between geographical factors and diseases. In order to understand the associations between the spatial distribution of diseases and environmental exposures, geographic information systems as well as statistical analyses have recently become more important. Some authors regard medical geography merely as supporting discipline of medicine. Nevertheless, as men and environment future and as they play an important part in the diffusion of diseases being regarded as defeated, medical geography will play an important part concerning medical questions. Especially travel medicine will rely on geographic knowledge, if a patient has to be consulted who plans to travel to an unknown country of which knowledge on the geographical distribution and ecology of diseases will be necessary.

  13. Medical tourism.

    PubMed

    Tompkins, Olga S

    2010-01-01

    Medical tourism is becoming popular as an alternative to the high cost of health care in the United States and as an inexpensive resource for cosmetic surgery. The occupational health nurse is an excellent resource to assist in the pre-decision due diligence and post-decision travel health counseling.

  14. 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.

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. Parenting Styles and Adjustment in Gifted Children

    ERIC Educational Resources Information Center

    Pilarinos, Vassiliki; Solomon, C. R.

    2017-01-01

    The present study examined the relationship between parenting styles and the psychosocial adjustment of 48 children aged 7 to 11 years, each of whom had been identified as gifted on the basis of a score of 130 or above on the Wechsler Intelligence Scale for Children--Fourth Edition. Parenting styles and child psychosocial adjustment were measured…

  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. Adjustable, Audible Continuity Tester For Delicate Circuits

    NASA Technical Reports Server (NTRS)

    Mcalister, William B.

    1988-01-01

    Unit adjustable to resistances up to 35 ohms. Adjustable, audible electrical-continuity tester gives audible indication. Used safely on circuit boards in which semiconductor components installed, and on complementary metal oxide/semiconductor integrated circuits. Tester compact and circuit simple. Built from inexpensive standard components.

  3. Adjustably Preloaded Quick-Release Pin

    NASA Technical Reports Server (NTRS)

    Reimers, Harold W.

    1992-01-01

    Modified adjustable-grip-length quick-release pin holds two bodies together. Threaded shaft of pin threaded in floating nut to pretension fastener. Pin connects and disconnects rapidly and adjusted to accommodate small differences between thicknesses of nominally identical sets of parts to be attached to each other.

  4. 78 FR 70080 - Market Dominant Price Adjustment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-22

    ... Market Dominant Price Adjustment AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The... market dominant products. The adjustments are scheduled to take effect January 26, 2014. This notice.... Ordering Paragraphs I. Overview A. Index-Based Price Changes for Market Dominant Classes of Mail...

  5. 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"…

  6. 34 CFR 36.2 - Penalty adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Title IV of the HEA, which authorizes the Federal Family Education Loan Program $35,000. 20 U.S.C. 1094... 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 §...

  7. 28 CFR 11.7 - Salary adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Salary adjustments. 11.7 Section 11.7 Judicial Administration DEPARTMENT OF JUSTICE DEBT COLLECTION Administration of Debt Collection § 11.7 Salary adjustments. The following debts shall not be subject to the salary offset procedures of §...

  8. 28 CFR 11.7 - Salary adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 1 2012-07-01 2012-07-01 false Salary adjustments. 11.7 Section 11.7 Judicial Administration DEPARTMENT OF JUSTICE DEBT COLLECTION Administration of Debt Collection § 11.7 Salary adjustments. The following debts shall not be subject to the salary offset procedures of §...

  9. 28 CFR 11.7 - Salary adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Salary adjustments. 11.7 Section 11.7 Judicial Administration DEPARTMENT OF JUSTICE DEBT COLLECTION Administration of Debt Collection § 11.7 Salary adjustments. The following debts shall not be subject to the salary offset procedures of §...

  10. 28 CFR 11.7 - Salary adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Salary adjustments. 11.7 Section 11.7 Judicial Administration DEPARTMENT OF JUSTICE DEBT COLLECTION Administration of Debt Collection § 11.7 Salary adjustments. The following debts shall not be subject to the salary offset procedures of §...

  11. 28 CFR 11.7 - Salary adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Salary adjustments. 11.7 Section 11.7 Judicial Administration DEPARTMENT OF JUSTICE DEBT COLLECTION Administration of Debt Collection § 11.7 Salary adjustments. The following debts shall not be subject to the salary offset procedures of §...

  12. 24 CFR 9.155 - Housing adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Housing adjustments. 9.155 Section 9.155 Housing and Urban Development Office of the Secretary, Department of Housing and Urban... THE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT § 9.155 Housing adjustments. (a) The agency...

  13. 24 CFR 9.155 - Housing adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Housing adjustments. 9.155 Section 9.155 Housing and Urban Development Office of the Secretary, Department of Housing and Urban... THE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT § 9.155 Housing adjustments. (a) The agency...

  14. 24 CFR 9.155 - Housing adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Housing adjustments. 9.155 Section 9.155 Housing and Urban Development Office of the Secretary, Department of Housing and Urban... THE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT § 9.155 Housing adjustments. (a) The agency...

  15. 24 CFR 9.155 - Housing adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Housing adjustments. 9.155 Section 9.155 Housing and Urban Development Office of the Secretary, Department of Housing and Urban... THE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT § 9.155 Housing adjustments. (a) The agency...

  16. 24 CFR 9.155 - Housing adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Housing adjustments. 9.155 Section 9.155 Housing and Urban Development Office of the Secretary, Department of Housing and Urban... THE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT § 9.155 Housing adjustments. (a) The agency...

  17. 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.

  18. 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...-term firm power contracts only as required to respond to changes in hydrology and river...

  19. 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...-term firm power contracts only as required to respond to changes in hydrology and river...

  20. 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...-term firm power contracts only as required to respond to changes in hydrology and river...

  1. 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...-term firm power contracts only as required to respond to changes in hydrology and river...

  2. Psychological Separation and Adjustment to College.

    ERIC Educational Resources Information Center

    Lapsley, Daniel K.; And Others

    1989-01-01

    Examined relationship between psychological separation and adjustment to college in freshmen (N=130) and upperclassmen (N=123). Found freshmen showed more psychological dependencies on parents than upperclassmen; separation appeared more strongly related to personal/emotional adjustment, particularly functional and emotional independence from…

  3. 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.…

  4. 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...

  5. 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...

  6. 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…

  7. 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...

  8. 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...

  9. 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....

  10. 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....

  11. 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....

  12. 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....

  13. A Digital Game for International Students' Adjustment

    ERIC Educational Resources Information Center

    Bisadi, Maryam; Chua, Alton Y. K; Keong, Lee Chu

    2013-01-01

    Although digital games have been developed for various subject areas, little attention has been focused on using digital games to address international students' adjustment issues. For this reason, this paper endeavors to explore the use of a digital game in facilitating international students acquire adjustment-related information. Specifically,…

  14. Adjustable Optical Mount Is More Rigid

    NASA Technical Reports Server (NTRS)

    Asbury, Bill G.; Coombs, David S.; Jones, Irby W.; Moore, Alvah S., Jr.

    1994-01-01

    Improved mount for lens or mirror in laser offers rigidity similar to that of nonadjustable optical mount. In comparison with older adjustable optical mounts, this one less susceptible to movements and distortions caused by vibrations and by thermal expansions and contractions. Mount contains neither adjustment rods (which grow or shrink as temperature varies) nor springs (which transmit vibrations to mounted optic).

  15. 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…

  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. 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...

  18. Interaction between weight and medications in psychological illnesses of children.

    PubMed

    Apter, Alan; Steingart, Lital

    2013-01-01

    Psychiatric medications have many implications on weight and growth. Stimulant medications may produce appetite loss and thus affect growth. Second-generation antipsychotics which are widely used for psychosis and many other indications may cause weight gain and subsequent metabolic disease. Weight loss such as that seen in anorexia nervosa may severely interfere with the efficacy of antidepressant agents.

  19. Medical Device Safety

    MedlinePlus

    ... Home Medical Devices Medical Device Safety Medical Device Safety Share Tweet Linkedin Pin it More sharing options ... 17 More Medical Device Recalls Recent Medical Device Safety Communications FDA analyses and recommendations for patients and ...

  20. Therapeutic outcome of adjustable gastric banding in morbid obese patients.

    PubMed

    Hotter, A; Mangweth, B; Kemmler, G; Fiala, M; Kinzl, J; Biebl, W

    2003-09-01

    We examined 77 obese patients treated with bariatric surgery in order to analyse treatment success, and compare those with a good or a poor outcome. The subjects, who were recruited one year after undergoing adjustable gastric banding, were asked questions concerning their sociodemographic status, postoperative course, past and present weight status, eating behaviours and difficulties in changing eating habits. Furthermore, we also used two body image questionnaires, and considered the patients' evaluations of positive and negative changes, as well as their wishes for the future. There were no preoperative differences between the 71% of patients in the good outcome group and the 29% in the poor outcome group. With regard to the postoperative course, the poor outcome group had more problems in adapting to new eating behaviours, experienced significantly more post-surgical complications, and had a persistently negative body evaluation. Both groups were satisfied with their achieved weight loss achieved, and their improved self-esteem and mobility. Adjustable gastric banding seems to be successful in inducing weight loss and allowing a better quality of life. However, factors such as postoperative complications, the ability and willingness to adopt new eating attitudes, and an improved body image seem to be crucial for therapeutic outcome.

  1. Help! It's Hair Loss!

    MedlinePlus

    ... los dientes Video: Getting an X-ray Help! It's Hair Loss! KidsHealth > For Kids > Help! It's Hair Loss! Print A A A What's in ... part above the skin, is dead. (That's why it doesn't hurt to get a haircut!) This ...

  2. Help! It's Hair Loss!

    MedlinePlus

    ... Emergency Room? What Happens in the Operating Room? Help! It's Hair Loss! KidsHealth > For Kids > Help! It's Hair Loss! A A A What's in ... a better look at what's going on to help decide what to do next. For a fungal ...

  3. Hearing Loss in Children

    MedlinePlus

    ... Español (Spanish) Recommend on Facebook Tweet Share Compartir Hearing loss can affect a child’s ability to develop communication, language, and social skills. The earlier children with hearing loss start getting services, the more likely they are ...

  4. 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.…

  5. 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…

  6. 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…

  7. Hearing loss and music

    MedlinePlus

    ... repeated exposure to loud noise and music can cause hearing loss. Decibels of Sound and Hearing Loss The decibel (dB) is a ... can make you unaware of the pain louder sounds can cause. Rest your ears for 24 hours after exposure ...

  8. 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…

  9. Common Weight Loss Challenges

    MedlinePlus

    ... to lose that we’ve been talking about weight-loss surgery. Is that something we should consider?” Although the ... have the operation should not be made hastily. Weight-loss surgery is only advisable for extremely overweight adolescents for ...

  10. 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

  11. 10 CFR 35.2605 - Records of installation, maintenance, adjustment, and repair of remote afterloader units...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Records of installation, maintenance, adjustment, and repair of remote afterloader units, teletherapy units, and gamma stereotactic radiosurgery units. 35.2605 Section 35.2605 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Records §...

  12. 10 CFR 35.2605 - Records of installation, maintenance, adjustment, and repair of remote afterloader units...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Records of installation, maintenance, adjustment, and repair of remote afterloader units, teletherapy units, and gamma stereotactic radiosurgery units. 35.2605 Section 35.2605 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Records §...

  13. 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…

  14. Common hair loss disorders.

    PubMed

    Springer, Karyn; Brown, Matthew; Stulberg, Daniel L

    2003-07-01

    Hair loss (alopecia) affects men and women of all ages and often significantly affects social and psychologic well-being. Although alopecia has several causes, a careful history, dose attention to the appearance of the hair loss, and a few simple studies can quickly narrow the potential diagnoses. Androgenetic alopecia, one of the most common forms of hair loss, usually has a specific pattern of temporal-frontal loss in men and central thinning in women. The U.S. Food and Drug Administration has approved topical minoxidil to treat men and women, with the addition of finasteride for men. Telogen effluvium is characterized by the loss of "handfuls" of hair, often following emotional or physical stressors. Alopecia areata, trichotillomania, traction alopecia, and tinea capitis have unique features on examination that aid in diagnosis. Treatment for these disorders and telogen effluvium focuses on resolution of the underlying cause.

  15. Acute loss of consciousness.

    PubMed

    Tristán, Bekinschtein; Gleichgerrcht, Ezequiel; Manes, Facundo

    2015-01-01

    Acute loss of consciousness poses a fascinating scenario for theoretical and clinical research. This chapter introduces a simple yet powerful framework to investigate altered states of consciousness. We then explore the different disorders of consciousness that result from acute brain injury, and techniques used in the acute phase to predict clinical outcome in different patient populations in light of models of acute loss of consciousness. We further delve into post-traumatic amnesia as a model for predicting cognitive sequels following acute loss of consciousness. We approach the study of acute loss of consciousness from a theoretical and clinical perspective to conclude that clinicians in acute care centers must incorporate new measurements and techniques besides the classic coma scales in order to assess their patients with loss of consciousness.

  16. [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.

  17. Exposure to Environmental Air Manganese and Medication ...

    EPA Pesticide Factsheets

    Manganese (Mn) is an essential element with natural low levels found in water, food, and air, but due to industrialized processes, both workplace and the environmental exposures to Mn have increased. Recently, environmental studies have reported physical and mental health problems associated with air-Mn exposure, but medical record reviews for exposed residents are rare in the literature. When medical records and clinical testing are unavailable, examination of residents’ prescribed medication use may be used as a surrogate of health effects associated with Mn. We examined medication use among adult Ohio residents in two towns with elevated air-Mn (n=185) and one unexposed control town (n=90). Study participants recorded medication use in a health questionnaire and brought their currently prescribed medication, over-the-counter and supplement lists to their interview. Two physicians (family and psychiatric medicine) reviewed the provided medication list and developed medical categories associated with the medications used. The exposed (E) and control (C) groups were compared on the established 12 medication and 1 supplement categories using chi-square tests. The significant medication categories were further analyzed using hierarchical binomial logistic regression adjusting for education, personal income, and years of residency. The two groups were primarily white (E:94.6%; C:96.7%) but differed on education (E:13.8; C:15.2 years), residence length in their re

  18. Cross-Cultural Adjustment of Chinese Students in Japan: School Adjustment and Educational Support

    ERIC Educational Resources Information Center

    Li, Yuan Xiang; Sano, Hideki; Ahn, Ruth

    2013-01-01

    This study investigates Chinese immigrant students' cross-cultural and school adjustment issues in Japanese schools. Using a quantitative method, a survey which collected students' demographic information, cross-cultural adjustment, and school adjustment questions was administered to 143 Chinese junior high and high school students in Tokyo and…

  19. 49 CFR 393.53 - Automatic brake adjusters and brake adjustment indicators.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... indicators. 393.53 Section 393.53 Transportation Other Regulations Relating to Transportation (Continued... brake adjustment indicators. (a) Automatic brake adjusters (hydraulic brake systems). Each commercial... vehicle at the time it was manufactured. (c) Brake adjustment indicator (air brake systems). On...

  20. 49 CFR 393.53 - Automatic brake adjusters and brake adjustment indicators.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... brake adjustment indicators. (a) Automatic brake adjusters (hydraulic brake systems). Each commercial motor vehicle manufactured on or after October 20, 1993, and equipped with a hydraulic brake system, shall meet the automatic brake adjustment system requirements of Federal Motor Vehicle Safety...