Science.gov

Sample records for adjusted risk ratio

  1. Evaluation of an automated safety surveillance system using risk adjusted sequential probability ratio testing

    PubMed Central

    2011-01-01

    Background Automated adverse outcome surveillance tools and methods have potential utility in quality improvement and medical product surveillance activities. Their use for assessing hospital performance on the basis of patient outcomes has received little attention. We compared risk-adjusted sequential probability ratio testing (RA-SPRT) implemented in an automated tool to Massachusetts public reports of 30-day mortality after isolated coronary artery bypass graft surgery. Methods A total of 23,020 isolated adult coronary artery bypass surgery admissions performed in Massachusetts hospitals between January 1, 2002 and September 30, 2007 were retrospectively re-evaluated. The RA-SPRT method was implemented within an automated surveillance tool to identify hospital outliers in yearly increments. We used an overall type I error rate of 0.05, an overall type II error rate of 0.10, and a threshold that signaled if the odds of dying 30-days after surgery was at least twice than expected. Annual hospital outlier status, based on the state-reported classification, was considered the gold standard. An event was defined as at least one occurrence of a higher-than-expected hospital mortality rate during a given year. Results We examined a total of 83 hospital-year observations. The RA-SPRT method alerted 6 events among three hospitals for 30-day mortality compared with 5 events among two hospitals using the state public reports, yielding a sensitivity of 100% (5/5) and specificity of 98.8% (79/80). Conclusions The automated RA-SPRT method performed well, detecting all of the true institutional outliers with a small false positive alerting rate. Such a system could provide confidential automated notification to local institutions in advance of public reporting providing opportunities for earlier quality improvement interventions. PMID:22168892

  2. 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.

  3. 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...

  4. 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...

  5. 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...

  6. A statistical test for the equality of differently adjusted incidence rate ratios.

    PubMed

    Hoffmann, Kurt; Pischon, Tobias; Schulz, Mandy; Schulze, Matthias B; Ray, Jennifer; Boeing, Heiner

    2008-03-01

    An incidence rate ratio (IRR) is a meaningful effect measure in epidemiology if it is adjusted for all important confounders. For evaluation of the impact of adjustment, adjusted IRRs should be compared with crude IRRs. The aim of this methodological study was to present a statistical approach for testing the equality of adjusted and crude IRRs and to derive a confidence interval for the ratio of the two IRRs. The method can be extended to compare two differently adjusted IRRs and, thus, to evaluate the effect of additional adjustment. The method runs immediately on existing software. To illustrate the application of this approach, the authors studied adjusted IRRs for two risk factors of type 2 diabetes using data from the European Prospective Investigation into Cancer and Nutrition-Potsdam Study from 2005. The statistical method described may be helpful as an additional tool for analyzing epidemiologic cohort data and for interpreting results obtained from Cox regression models with adjustment for different covariates.

  7. Risk adjustment for a children's capitation rate.

    PubMed

    Newhouse, J P; Sloss, E M; Manning, W G; Keeler, E B

    1993-01-01

    Few capitation arrangements vary premiums by a child's health characteristics, yielding an incentive to discriminate against children with predictably high expenditures from chronic diseases. In this article, we explore risk adjusters for the 35 percent of the variance in annual out-patient expenditure we find to be potentially predictable. Demographic factors such as age and gender only explain 5 percent of such variance; health status measures explain 25 percent, prior use and health status measures together explain 65 to 70 percent. The profit from risk selection falls less than proportionately with improved ability to adjust for risk. Partial capitation rates may be necessary to mitigate skimming and dumping.

  8. 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.

  9. 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...

  10. 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...

  11. Analysis of Case-Parent Trios Using a Loglinear Model with Adjustment for Transmission Ratio Distortion

    PubMed Central

    Huang, Lam O.; Infante-Rivard, Claire; Labbe, Aurélie

    2016-01-01

    Transmission of the two parental alleles to offspring deviating from the Mendelian ratio is termed Transmission Ratio Distortion (TRD), occurs throughout gametic and embryonic development. TRD has been well-studied in animals, but remains largely unknown in humans. The Transmission Disequilibrium Test (TDT) was first proposed to test for association and linkage in case-trios (affected offspring and parents); adjusting for TRD using control-trios was recommended. However, the TDT does not provide risk parameter estimates for different genetic models. A loglinear model was later proposed to provide child and maternal relative risk (RR) estimates of disease, assuming Mendelian transmission. Results from our simulation study showed that case-trios RR estimates using this model are biased in the presence of TRD; power and Type 1 error are compromised. We propose an extended loglinear model adjusting for TRD. Under this extended model, RR estimates, power and Type 1 error are correctly restored. We applied this model to an intrauterine growth restriction dataset, and showed consistent results with a previous approach that adjusted for TRD using control-trios. Our findings suggested the need to adjust for TRD in avoiding spurious results. Documenting TRD in the population is therefore essential for the correct interpretation of genetic association studies. PMID:27630667

  12. 77 FR 21775 - Risk Adjustment Meeting-May 7, 2012 and May 8, 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-11

    ... payments and charges, data collection approach, and the schedule for running risk adjustment. This meeting..., data collection approach, and the schedule for running risk adjustment. The Risk Adjustment...

  13. 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...

  14. Adjusted Age-Adjusted Charlson Comorbidity Index Score as a Risk Measure of Perioperative Mortality before Cancer Surgery

    PubMed Central

    Chang, Chun-Ming; Yin, Wen-Yao; Wei, Chang-Kao; Wu, Chin-Chia; Su, Yu-Chieh; Yu, Chia-Hui; Lee, Ching-Chih

    2016-01-01

    Background Identification of patients at risk of death from cancer surgery should aid in preoperative preparation. The purpose of this study is to assess and adjust the age-adjusted Charlson comorbidity index (ACCI) to identify cancer patients with increased risk of perioperative mortality. Methods We identified 156,151 patients undergoing surgery for one of the ten common cancers between 2007 and 2011 in the Taiwan National Health Insurance Research Database. Half of the patients were randomly selected, and a multivariate logistic regression analysis was used to develop an adjusted-ACCI score for estimating the risk of 90-day mortality by variables from the original ACCI. The score was validated. The association between the score and perioperative mortality was analyzed. Results The adjusted-ACCI score yield a better discrimination on mortality after cancer surgery than the original ACCI score, with c-statics of 0.75 versus 0.71. Over 80 years of age, 70–80 years, and renal disease had the strongest impact on mortality, hazard ratios 8.40, 3.63, and 3.09 (P < 0.001), respectively. The overall 90-day mortality rates in the entire cohort varied from 0.9%, 2.9%, 7.0%, and 13.2% in four risk groups stratifying by the adjusted-ACCI score; the adjusted hazard ratio for score 4–7, 8–11, and ≥ 12 was 2.84, 6.07, and 11.17 (P < 0.001), respectively, in 90-day mortality compared to score 0–3. Conclusions The adjusted-ACCI score helps to identify patients with a higher risk of 90-day mortality after cancer surgery. It might be particularly helpful for preoperative evaluation of patients over 80 years of age. PMID:26848761

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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....

  1. 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...

  2. 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...

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 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....

  15. 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...

  16. 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...

  17. 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....

  18. 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...

  19. 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....

  20. 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...

  1. 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...

  2. 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...

  3. Pollinating fig wasp Ceratosolen solmsi adjusts the offspring sex ratio to other foundresses.

    PubMed

    Hu, Hao-Yuan; Chen, Zhong-Zheng; Jiang, Zi-Feng; Huang, Da-Wei; Niu, Li-Ming; Fu, Yue-Guan

    2013-04-01

    Local mate competition theory predicts that offspring sex ratio in pollinating fig wasps is female-biased when there is only one foundress, and increased foundress density results in increased offspring sex ratio. Information of other foundresses and clutch size have been suggested to be the main proximate explanations for sex ratio adjustment under local mate competition. Our focus was to show the mechanism of sex ratio adjustment in a pollinating fig wasp, Ceratosolen solmsi Mayr, an obligate pollinator of the functionally dioecious fig, Ficus hispida Linn., with controlled experiments in the field. First, we obtained offspring from one pollinator and offspring at different oviposition sequences, and found that offspring sex ratio decreased with clutch size, and pollinators produced most of their male offspring at the start of bouts, followed by mostly females. Second, we found that offspring sex ratio increased with foundress density, and pollinators did adjust their offspring sex ratio to other females in the oviposition patches. We suggest that when oviposition sites are not limited, pollinators will mainly adjust their offspring sex ratio to other foundresses independent of clutch size changes, whereas adjusting clutch size may be used to adjust sex ratio when oviposition sites are limited.

  4. A stochastic version of the brass PF ratio adjustment of age-specific fertility schedules.

    PubMed

    Baker, Jack; Alcantara, Adélamar; Ruan, Xiaomin

    2011-01-01

    Estimates of age-specific fertility rates based on survey data are known to suffer down-bias associated with incomplete reporting. Previously, William Brass (1964, 1965, 1968) proposed a series of adjustments of such data to reflect more appropriate levels of fertility through comparison with data on children-ever-born by age, a measure of cohort-specific cumulative fertility. His now widely-used Parity/Fertility or PF ratio method makes a number of strong assumptions, which have been the focus of an extended discussion in the literature on indirect estimation. However, while it is clear that the measures used in making adjusted age-specific fertility estimates with this method are captured with statistical uncertainty, little discussion of the nature of this uncertainty around PF-ratio based estimates of fertility has been entertained in the literature. Since both age-specific risk of childbearing and cumulative parity (children ever born) are measured with statistical uncertainty, an unknown credibility interval must surround every PF ratio-based estimate. Using the standard approach, this is unknown, limiting the ability to make statistical comparisons of fertility between groups or to understand stochasticity in population dynamics. This paper makes use of approaches applied to similar problems in engineering, the natural sciences, and decision analysis--often discussed under the title of uncertainty analysis or stochastic modeling--to characterize this uncertainty and to present a new method for making PF ratio-based fertility estimates with 95 percent uncertainty intervals. The implications for demographic analysis, between-group comparisons of fertility, and the field of statistical demography are explored.

  5. Affordable Care Act risk adjustment: overview, context, and challenges.

    PubMed

    Kautter, John; Pope, Gregory C; Keenan, Patricia

    2014-01-01

    Beginning in 2014, individuals and small businesses will be able to purchase private health insurance through competitive marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge and the incentive for plans to avoid sicker enrollees. This article--the first of three in the Medicare & Medicaid Research Review--describes the key program goal and issues in the Department of Health and Human Services (HHS) developed risk adjustment methodology, and identifies key choices in how the methodology responds to these issues. The goal of the HHS risk adjustment methodology is to compensate health insurance plans for differences in enrollee health mix so that plan premiums reflect differences in scope of coverage and other plan factors, but not differences in health status. The methodology includes a risk adjustment model and a risk transfer formula that together address this program goal as well as three issues specific to ACA risk adjustment: 1) new population; 2) cost and rating factors; and 3) balanced transfers within state/market. The risk adjustment model, described in the second article, estimates differences in health risks taking into account the new population and scope of coverage (actuarial value level). The transfer formula, described in the third article, calculates balanced transfers that are intended to account for health risk differences while preserving permissible premium differences.

  6. Children's Adjustment Following Divorce: Risk and Resilience Perspectives.

    ERIC Educational Resources Information Center

    Kelly, Joan B.; Emery, Robert E.

    2003-01-01

    Reviews the empirical literature on the longer-term adjustment of children of divorce from the perspective of (a) the stressors and elevated risks that divorce presents for children and (b) protective factors associated with better adjustment. The resiliency demonstrated by the majority of children is discussed, as are controversies regarding the…

  7. Medicare's risk-adjusted capitation method.

    PubMed

    Grimaldi, Paul L

    2002-01-01

    Since 1997, the method to establish capitation rates for Medicare beneficiaries who are members of risk-bearing managed care plans has undergone several important developments. This includes the factoring of beneficiary health status into the rate-setting calculations. These changes were expected to increase the number of participating health plans, accelerate Medicare enrollment growth, and slice Medicare spending.

  8. 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

  9. Risk-adjusted outcomes in Medicare inpatient nephrectomy patients

    PubMed Central

    Fry, Donald E.; Pine, Michael; Nedza, Susan M.; Locke, David G.; Reband, Agnes M.; Pine, Gregory

    2016-01-01

    Abstract Without risk-adjusted outcomes of surgical care across both the inpatient and postacute period of time, hospitals and surgeons cannot evaluate the effectiveness of current performance in nephrectomy and other operations, and will not have objective metrics to gauge improvements from care redesign efforts. We compared risk-adjusted hospital outcomes following elective total and partial nephrectomy to demonstrate differences that can be used to improve care. We used the Medicare Limited Dataset for 2010 to 2012 for total and partial nephrectomy for benign and malignant neoplasms to create prediction models for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day relevant readmissions. From the 4 prediction models, total predicted adverse outcomes were determined for each hospital in the dataset that met a minimum of 25 evaluable cases for the study period. Standard deviations (SDs) for each hospital were used to identify specific z-scores. Risk-adjusted adverse outcomes rates were computed to permit benchmarking each hospital's performance against the national standard. Differences between best and suboptimal performing hospitals defined the potential margin of preventable adverse outcomes for this operation. A total of 449 hospitals with 23,477 patients were evaluated. Overall AO rate was 20.8%; 17 hospitals had risk-adjusted AO rates that were 2 SDs poorer than predicted and 8 were 2 SDs better. The top performing decile of hospitals had a risk-adjusted AO rate of 10.2% while the lowest performing decile had 32.1%. With a minimum of 25 cases for each study hospital, no statistically valid improvement in outcomes was seen with increased case volume. Inpatient and 90-day postdischarge risk-adjusted adverse outcomes demonstrated marked variability among study hospitals and illustrate the opportunities for care improvement. This analytic design is applicable for comparing

  10. Risk-adjusted outcomes in Medicare inpatient nephrectomy patients.

    PubMed

    Fry, Donald E; Pine, Michael; Nedza, Susan M; Locke, David G; Reband, Agnes M; Pine, Gregory

    2016-09-01

    Without risk-adjusted outcomes of surgical care across both the inpatient and postacute period of time, hospitals and surgeons cannot evaluate the effectiveness of current performance in nephrectomy and other operations, and will not have objective metrics to gauge improvements from care redesign efforts.We compared risk-adjusted hospital outcomes following elective total and partial nephrectomy to demonstrate differences that can be used to improve care. We used the Medicare Limited Dataset for 2010 to 2012 for total and partial nephrectomy for benign and malignant neoplasms to create prediction models for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day relevant readmissions. From the 4 prediction models, total predicted adverse outcomes were determined for each hospital in the dataset that met a minimum of 25 evaluable cases for the study period. Standard deviations (SDs) for each hospital were used to identify specific z-scores. Risk-adjusted adverse outcomes rates were computed to permit benchmarking each hospital's performance against the national standard. Differences between best and suboptimal performing hospitals defined the potential margin of preventable adverse outcomes for this operation.A total of 449 hospitals with 23,477 patients were evaluated. Overall AO rate was 20.8%; 17 hospitals had risk-adjusted AO rates that were 2 SDs poorer than predicted and 8 were 2 SDs better. The top performing decile of hospitals had a risk-adjusted AO rate of 10.2% while the lowest performing decile had 32.1%. With a minimum of 25 cases for each study hospital, no statistically valid improvement in outcomes was seen with increased case volume.Inpatient and 90-day postdischarge risk-adjusted adverse outcomes demonstrated marked variability among study hospitals and illustrate the opportunities for care improvement. This analytic design is applicable for comparing provider

  11. Experimental evolution of reduced sex ratio adjustment under local mate competition.

    PubMed

    Macke, Emilie; Magalhães, Sara; Bach, Fabien; Olivieri, Isabelle

    2011-11-25

    Theory predicts that local mate competition (LMC) favors the evolution of female-biased sex ratios. Empirical support of this prediction is indirect and comes from comparative studies or from studies showing that individuals can adjust their offspring sex ratio in response to varying LMC intensities. Replicate lines from a population of the spider mite Tetranychus urticae were selected under three LMC intensities for up to 54 generations. Within each selection regime, the final sex ratio matched theoretical predictions. Furthermore, the ability of individuals to adjust their offspring sex ratio diminished in females evolving under strict LMC, but not in females evolving under relaxed LMC levels. These results provide direct experimental evidence for the evolutionary process by which LMC modifies sex-allocation strategies and suggest that evolution under strict and constant LMC may lead to a loss of phenotypic plasticity.

  12. Non-quantitative adjustment of offspring sex ratios in pollinating fig wasps

    PubMed Central

    Wang, Rui-Wu; Sun, Bao-Fa; He, Jun-Zhou; Dunn, Derek W.

    2015-01-01

    Fig wasp is one of the most well known model systems in examining whether or not the parents could adjust their offspring sex ratio to maximize their gene frequency transmission in next generations. Our manipulative experiments showed that, in all of the five pollinator wasps of figs (Agaonidae) that have different averages of foundress numbers per syconium, almost the same proportions of male offspring are produced in the experiment that foundresses deposit one hour then are killed with ether (66.1%–70.1%) and over the lifespan of each foundress (14.0%–21.0%). The foundresses tend to deposit their male eggs prior to female eggs. The observed increase in the proportion of male offspring as a function of foundress number results from density-dependent interference competition among the foundresses. These results showed that the selection of gene frequency transmission through the behavioral adjustment in the evolution of sex ratio does not exist in these five fig wasps. The results here implied that genetic adjustment mechanisms of the sex ratio of fig wasps can only be triggered to be on or off and that the foundresses can not quantitatively adjust their sex ratio according to increased environmental selection pressure. PMID:26293349

  13. Non-quantitative adjustment of offspring sex ratios in pollinating fig wasps.

    PubMed

    Wang, Rui-Wu; Sun, Bao-Fa; He, Jun-Zhou; Dunn, Derek W

    2015-08-21

    Fig wasp is one of the most well known model systems in examining whether or not the parents could adjust their offspring sex ratio to maximize their gene frequency transmission in next generations. Our manipulative experiments showed that, in all of the five pollinator wasps of figs (Agaonidae) that have different averages of foundress numbers per syconium, almost the same proportions of male offspring are produced in the experiment that foundresses deposit one hour then are killed with ether (66.1%-70.1%) and over the lifespan of each foundress (14.0%-21.0%). The foundresses tend to deposit their male eggs prior to female eggs. The observed increase in the proportion of male offspring as a function of foundress number results from density-dependent interference competition among the foundresses. These results showed that the selection of gene frequency transmission through the behavioral adjustment in the evolution of sex ratio does not exist in these five fig wasps. The results here implied that genetic adjustment mechanisms of the sex ratio of fig wasps can only be triggered to be on or off and that the foundresses can not quantitatively adjust their sex ratio according to increased environmental selection pressure.

  14. 45 CFR 153.330 - State alternate risk adjustment methodology.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false State alternate risk adjustment methodology. 153.330 Section 153.330 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO... behavior among providers and health plans and discourages unfavorable behavior; (iv) Uses data that...

  15. Sensitivity of health risk estimates to air quality adjustment procedure

    SciTech Connect

    Whitfield, R.G.

    1997-06-30

    This letter is a summary of risk results associated with exposure estimates using two-parameter Weibull and quadratic air quality adjustment procedures (AQAPs). New exposure estimates were developed for children and child-occurrences, six urban areas, and five alternative air quality scenarios. In all cases, the Weibull and quadratic results are compared to previous results, which are based on a proportional AQAP.

  16. Granular risk adjustment may hasten reacceptance of capitation.

    PubMed

    2001-10-01

    Where did the notion of three-tier risk adjustment come from? What's magic about three groupings? EbenX asks why we don't do what the actuaries do and break a population into 32 groups--a change that would makes for better payment to physicians.

  17. A note on the empirical likelihood confidence band for hazards ratio with covariate adjustment.

    PubMed

    Zhu, Shihong; Yang, Yifan; Zhou, Mai

    2015-09-01

    In medical studies comparing two treatments in the presence of censored data, the stratified Cox model is an important tool that has the ability to flexibly handle non-proportional hazards while allowing parsimonious covariate adjustment. In order to capture the cumulative treatment effect, the ratio of the treatment specific cumulative baseline hazards is often used as a measure of the treatment effect. Pointwise and simultaneous confidence bands associated with the estimated ratio provide a global picture of how the treatment effect evolves over time. Recently, Dong and Matthews (2012, Biometrics 68, 408-418) proposed to construct a pointwise confidence interval for the ratio using a plug-in type empirical likelihood approach. However, their result on the limiting distribution of the empirical likelihood ratio is generally incorrect and the resulting confidence interval is asymptotically undercovering. In this article, we derive the correct limiting distribution for the likelihood ratio statistic. We also present simulation studies to demonstrate the effectiveness of our approach.

  18. Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

    PubMed Central

    Ellis, Randall P.; Fernandez, Juan Gabriel

    2013-01-01

    Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems. PMID:24284351

  19. Female starlings adjust primary sex ratio in response to aromatic plants in the nest.

    PubMed Central

    Polo, Vicente; Veiga, José P.; Cordero, Pedro J.; Viñuela, Javier; Monaghan, Pat

    2004-01-01

    Adjustment of offspring sex ratios should be favoured by natural selection when parents are capable of facultatively altering brood sex ratios and of recognizing the circumstances that predict the probable fitness benefit of producing sons and daughters. Although experimental studies have shown that female birds may adjust offspring sex ratios in response to changes in their own condition and in the external appearance of their mate, and male attributes other than his external morphology are also thought to act as signals of male quality, it is not known whether females will respond to changes in such signals, in the absence of any change in the appearance of the male himself. Here, we experimentally manipulated a male courtship display, the green plants carried to the nest by male spotless starlings (Sturnus unicolor), without changing any physical attributes of the male himself, and examined whether this influenced female decisions on offspring sex ratio. We found that in an environment in which female starlings were producing more daughters than sons, experimental enhancement of the green nesting material caused females to significantly increase the number of male eggs produced and thereby removed the female bias. This effect was consistent in 2 years and at two localities. This demonstrates that the green material, whose function has long puzzled biologists, conveys important information to the female and that she facultatively adjusts offspring production accordingly. PMID:15347516

  20. What's the Risk? A Simple Approach for Estimating Adjusted Risk Measures from Nonlinear Models Including Logistic Regression

    PubMed Central

    Kleinman, Lawrence C; Norton, Edward C

    2009-01-01

    Objective To develop and validate a general method (called regression risk analysis) to estimate adjusted risk measures from logistic and other nonlinear multiple regression models. We show how to estimate standard errors for these estimates. These measures could supplant various approximations (e.g., adjusted odds ratio [AOR]) that may diverge, especially when outcomes are common. Study Design Regression risk analysis estimates were compared with internal standards as well as with Mantel–Haenszel estimates, Poisson and log-binomial regressions, and a widely used (but flawed) equation to calculate adjusted risk ratios (ARR) from AOR. Data Collection Data sets produced using Monte Carlo simulations. Principal Findings Regression risk analysis accurately estimates ARR and differences directly from multiple regression models, even when confounders are continuous, distributions are skewed, outcomes are common, and effect size is large. It is statistically sound and intuitive, and has properties favoring it over other methods in many cases. Conclusions Regression risk analysis should be the new standard for presenting findings from multiple regression analysis of dichotomous outcomes for cross-sectional, cohort, and population-based case–control studies, particularly when outcomes are common or effect size is large. PMID:18793213

  1. Maladaptive sex ratio adjustment by a sex-changing shrimp in selective-fishing environments.

    PubMed

    Chiba, Susumu; Yoshino, Kenji; Kanaiwa, Minoru; Kawajiri, Toshifumi; Goshima, Seiji

    2013-05-01

    1. Selective harvesting is acknowledged as a serious concern in efforts to conserve wild animal populations. In fisheries, most studies have focused on gradual and directional changes in the life-history traits of target species. While such changes represent the ultimate response of harvested animals, it is also well known that the life history of target species plastically alters with harvesting. However, research on the adaptive significance of these types of condition-dependent changes has been limited. 2. We explored the adaptive significance of annual changes in the age at sex-change of the protandrous (male-first) hermaphroditic shrimp and examined how selective harvesting affects life-history variation, by conducting field observations across 13 years and a controlled laboratory experiment. In addition, we considered whether plastic responses by the shrimp would be favourable, negligible or negative with respect to the conservation of fishery resources. 3. The age at sex-change and the population structure of the shrimp fluctuated between years during the study period. The results of the field observations and laboratory experiment both indicated that the shrimp could plastically change the timing of sex-change in accordance with the age structure of the population. These findings provide the first concrete evidence of adult sex ratio adjustment by pandalid shrimp, a group that has been treated as a model in the sex allocation theory. 4. The sex ratio adjustment by the shrimp did not always seem to be sufficient, however, as the supplement of females is restricted by their annual somatic growth rate. In addition, adjusted sex ratios are further skewed by the unintentional female-selectivity of fishing activity prior to the breeding season, indicating that the occurrence of males that have postponed sex-change causes sex ratio adjustment to become unfavourable. 5. We conclude that the plastic responses of harvested animals in selective fishing environments

  2. A risk-adjusted approach to comparing the return on investment in health care programs.

    PubMed

    Sendi, Pedram; Al, Maiwenn J; Zimmermann, Heinz

    2004-09-01

    The league table approach to rank ordering health care programs according to the incremental cost-effectiveness ratio is a common method to guide policy makers in setting priorities for resource allocation. In the presence of uncertainty, however, ranking programs is complicated by the degree of variability associated with each program. Confidence intervals for cost-effectiveness ratios may be overlapping. Moreover, confidence intervals may include negative ratios and the interpretation of negative cost-effectiveness ratios is ambiguous. We suggest to rank mutually exclusive health care programs according to their rate of return which is defined as the net monetary benefit over the costs of the program. However, how does a program with a higher expected return but higher uncertainty compare to a program with a lower expected return but lower risk? In the present paper we propose a risk-adjusted measure to compare the return on investment in health care programs. Financing a health care program is treated as an investment in a risky asset. The risky asset is combined with a risk-free asset in order to construct a combined portfolio. The weights attributed to the risk-free and risky assets are chosen in such a manner that all programs under consideration exhibit the same degree of uncertainty. We can then compare the performance of the individual programs by constructing a risk-adjusted league table of expected returns.

  3. Risk adjustment and risk selection on the sickness fund insurance market in five European countries.

    PubMed

    van de Ven, Wynand P M M; Beck, Konstantin; Buchner, Florian; Chernichovsky, Dov; Gardiol, Lucien; Holly, Alberto; Lamers, Leida M; Schokkaert, Erik; Shmueli, Amir; Spycher, Stephan; Van de Voorde, Carine; van Vliet, René C J A; Wasem, Jürgen; Zmora, Irith

    2003-07-01

    From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a guaranteed periodic choice among risk-bearing sickness funds, who are responsible for purchasing their care or providing them with medical care. The rationale of this arrangement is to stimulate the sickness funds to improve efficiency in health care production and to respond to consumers' preferences. To achieve solidarity, all five countries have implemented a system of risk-adjusted premium subsidies (or risk equalization across risk groups), along with strict regulation of the consumers' direct premium contribution to their sickness fund. In this article we present a conceptual framework for understanding risk adjustment and comparing the systems in the five countries. We conclude that in the case of imperfect risk adjustment-as is the case in all five countries in the year 2001-the sickness funds have financial incentives for risk selection, which may threaten solidarity, efficiency, quality of care and consumer satisfaction. We expect that without substantial improvements in the risk adjustment formulae, risk selection will increase in all five countries. The issue is particularly serious in Germany and Switzerland. We strongly recommend therefore that policy makers in the five countries give top priority to the improvement of the system of risk adjustment. That would enhance solidarity, cost-control, efficiency and client satisfaction in a system of competing, risk-bearing sickness funds.

  4. Cumulative Family Risk Predicts Sibling Adjustment to Childhood Cancer

    PubMed Central

    Long, Kristin A.; Marsland, Anna L.; Alderfer, Melissa A.

    2013-01-01

    Background Prolonged, intensive treatment regimens often disrupt families of children with cancer. Siblings are at increased risk for distress, but factors underlying this risk have received limited empirical attention. This study examined associations between the family context and sibling distress. Methods Siblings of children with cancer (ages 8–18, N=209) and parents (186 mothers, 70 fathers) completed measures of sibling distress, family functioning, parenting, and parent posttraumatic stress. Associations between sibling distress and each family risk factor were evaluated. Then, family risks were considered simultaneously by calculating cumulative family risk index scores. Results After controlling for socio-demographic covariates, greater sibling distress was associated with more sibling-reported problems with family functioning and parental psychological control, lower sibling-reported maternal acceptance, and lower paternal self-reported acceptance. When risk factors were considered together, results supported a quadratic model in which associations between family risk and sibling distress were stronger at higher levels of risk. Conclusions Findings support a contextual model of sibling adjustment to childhood cancer in which elevated distress is predicted by family risk factors, alone and in combination. PMID:23576115

  5. Sex choice in plants: facultative adjustment of the sex ratio in the perennial herb Begonia gracilis.

    PubMed

    López, S; Domínguez, C A

    2003-11-01

    Sex allocation theory predicts that reproducing individuals will increase their fitness by facultatively adjusting their relative investment towards the rarer sex in response to population shifts in operational sex ratio (OSR). The evolution of facultative manipulation of sex ratio depends on the ability of the parents to track the conditions favouring skewed sex allocation and on the mechanism controlling sex allocation. In animals, which have well-developed sensorial mechanisms, facultative adjustment of sex ratios has been demonstrated on many occasions. In this paper, we show that plants have mechanisms that allow them to evaluate the population OSR. We simulated three different conditions of population OSR by manipulating the amount of pollen received by the female flowers of a monoecious herb, and examined the effect of this treatment on the allocation to male vs. female flowers. A shortage of pollen on the stigmas resulted in a more male-skewed sex allocation, whereas plants that experienced a relatively pollen rich environment tended to produce a more female-skewed sex allocation pattern. Our results for Begonia gracilis demonstrate that the individuals of this species are able to respond to the levels of pollination intensity experienced by their female flowers and adjust their patterns of sex allocation in accordance to the expectations of sex allocation theory.

  6. Favorable Selection, Risk Adjustment, and the Medicare Advantage Program

    PubMed Central

    Morrisey, Michael A; Kilgore, Meredith L; Becker, David J; Smith, Wilson; Delzell, Elizabeth

    2013-01-01

    Objectives To examine the effects of changes in payment and risk adjustment on (1) the annual enrollment and switching behavior of Medicare Advantage (MA) beneficiaries, and (2) the relative costliness of MA enrollees and disenrollees. Data From 1999 through 2008 national Medicare claims data from the 5 percent longitudinal sample of Parts A and B expenditures. Study Design Retrospective, fixed effects regression analysis of July enrollment and year-long switching into and out of MA. Similar regression analysis of the costliness of those switching into (out of) MA in the 6 months prior to enrollment (after disenrollment) relative to nonswitchers in the same county over the same period. Findings Payment generosity and more sophisticated risk adjustment were associated with substantial increases in MA enrollment and decreases in disenrollment. Claims experience of those newly switching into MA was not affected by any of the policy reforms, but disenrollment became increasingly concentrated among high-cost beneficiaries. Conclusions Enrollment is very sensitive to payment levels. The use of more sophisticated risk adjustment did not alter favorable selection into MA, but it did affect the costliness of disenrollees. PMID:23088500

  7. Developmental sexual dimorphism and the evolution of mechanisms for adjustment of sex ratios in mammals.

    PubMed

    Cameron, Elissa Z; Edwards, Amy M; Parsley, Laura M

    2017-02-01

    Sex allocation theory predicts biased offspring sex ratios in relation to local conditions if they would maximize parental lifetime reproductive return. In mammals, the extent of the birth sex bias is often unpredictable and inconsistent, leading some to question its evolutionary significance. For facultative adjustment of sex ratios to occur, males and females would need to be detectably different from an early developmental stage, but classic sexual dimorphism arises from hormonal influences after gonadal development. Recent advances in our understanding of early, pregonadal sexual dimorphism, however, indicate high levels of dimorphism in gene expression, caused by chromosomal rather than hormonal differences. Here, we discuss how such dimorphism would interact with and link previously hypothesized mechanisms for sex-ratio adjustment. These differences between males and females are sufficient for offspring sex both to be detectable to parents and to provide selectable cues for biasing sex ratios from the earliest stages. We suggest ways in which future research could use the advances in our understanding of sexually dimorphic developmental physiology to test the evolutionary significance of sex allocation in mammals. Such an approach would advance our understanding of sex allocation and could be applied to other taxa.

  8. Sex ratio adjustment by sex-specific maternal cannibalism in hamsters.

    PubMed

    Beery, Annaliese K; Zucker, Irving

    2012-10-10

    Mammalian offspring sex ratios can be biased via prenatal and postnatal mechanisms, including sperm selection, sex-specific embryo loss, and differential postnatal investment in males and females. Syrian hamsters routinely cannibalize some of their pups in the first days after birth. We present evidence that short day lengths, typically predictive of poor autumn and winter field conditions, are associated with male-biased sex ratios, achieved in part through selective perinatal maternal infanticide of female offspring. Higher peak litter sizes were associated with increased cannibalism rates, decreased final litter counts, and increased body mass of pups surviving to weaning. To our knowledge this is the first report of sex ratio adjustment by offspring cannibalism.

  9. The Impact of Extreme-Risk Cases on Hospitals’ Risk-Adjusted Percutaneous Coronary Intervention Mortality Ratings

    PubMed Central

    Sherwood, Matthew W.; Brennan, J. Matthew; Ho, Kalon K.; Masoudi, Frederick A.; Messenger, John C.; Weaver, W. Douglas; Dai, David; Peterson, Eric D.

    2017-01-01

    OBJECTIVES The goal of this study was to examine the calibration of a validated risk-adjustment model in very high-risk percutaneous coronary intervention (PCI) cases and assess whether sites’ case mix affects their performance ratings. BACKGROUND There are concerns that treating PCI patients with particularly high-risk features such as cardiogenic shock or prior cardiac arrest may adversely impact hospital performance ratings. However, there is little investigation on the validity of these concerns. METHODS We examined 624,286 PCI procedures from 1,168 sites that participated in the CathPCI Registry in 2010. Procedural risk was estimated using the recently published Version 4 National Cardiovascular Data Registry (NCDR) PCI risk-adjusted mortality (RAM) model. We calculated observed/expected mortality using several risk classification methods, and simulated hospital performance after combining their highest risk cases over 2 years into a single year. RESULTS In 2010, crude in-hospital PCI mortality was 1.4%. The NCDR model was generally well calibrated among high risk, however there was slight overprediction of risk in extreme cases. Hospitals treating the highest overall expected risk PCI patients or those treating the top 20% of high-risk cases had lower (better) RAM ratings than centers treating lower-risk cases (1.25% vs. 1.51%). The observed/expected ratio for top-risk quintile versus low-risk quintile was 0.91 (0.87 to 0.96) versus 1.10 (1.03 to 1.17). Combining all the high-risk patients over a 2-year period into a single year also did not negatively impact the site’s RAM ratings. CONCLUSIONS Evaluation of a contemporary sample of PCI cases across the United States showed no evidence that treating high-risk PCI cases adversely affects hospital RAM rates. PMID:25499301

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. Net Efficacy Adjusted for Risk (NEAR): A Simple Procedure for Measuring Risk:Benefit Balance

    PubMed Central

    Boada, José N.; Boada, Carlos; García-Sáiz, Mar; García, Marcelino; Fernández, Eduardo; Gómez, Eugenio

    2008-01-01

    Background Although several mathematical models have been proposed to assess the risk:benefit of drugs in one measure, their use in practice has been rather limited. Our objective was to design a simple, easily applicable model. In this respect, measuring the proportion of patients who respond favorably to treatment without being affected by adverse drug reactions (ADR) could be a suitable endpoint. However, remarkably few published clinical trials report the data required to calculate this proportion. As an approach to the problem, we calculated the expected proportion of this type of patients. Methodology/Principal Findings Theoretically, responders without ADR may be obtained by multiplying the total number of responders by the total number of subjects that did not suffer ADR, and dividing the product by the total number of subjects studied. When two drugs are studied, the same calculation may be repeated for the second drug. Then, by constructing a 2×2 table with the expected frequencies of responders with and without ADR, and non-responders with and without ADR, the odds ratio and relative risk with their confidence intervals may be easily calculated and graphically represented on a logarithmic scale. Such measures represent “net efficacy adjusted for risk” (NEAR). We assayed the model with results extracted from several published clinical trials or meta-analyses. On comparing our results with those originally reported by the authors, marked differences were found in some cases, with ADR arising as a relevant factor to balance the clinical benefit obtained. The particular features of the adverse reaction that must be weighed against benefit is discussed in the paper. Conclusion NEAR representing overall risk-benefit may contribute to improving knowledge of drug clinical usefulness. As most published clinical trials tend to overestimate benefits and underestimate toxicity, our measure represents an effort to change this trend. PMID:18974868

  15. Adjusting the Adjusted X[superscript 2]/df Ratio Statistic for Dichotomous Item Response Theory Analyses: Does the Model Fit?

    ERIC Educational Resources Information Center

    Tay, Louis; Drasgow, Fritz

    2012-01-01

    Two Monte Carlo simulation studies investigated the effectiveness of the mean adjusted X[superscript 2]/df statistic proposed by Drasgow and colleagues and, because of problems with the method, a new approach for assessing the goodness of fit of an item response theory model was developed. It has been previously recommended that mean adjusted…

  16. Speech perception at positive signal-to-noise ratios using adaptive adjustment of time compression.

    PubMed

    Schlueter, Anne; Brand, Thomas; Lemke, Ulrike; Nitzschner, Stefan; Kollmeier, Birger; Holube, Inga

    2015-11-01

    Positive signal-to-noise ratios (SNRs) characterize listening situations most relevant for hearing-impaired listeners in daily life and should therefore be considered when evaluating hearing aid algorithms. For this, a speech-in-noise test was developed and evaluated, in which the background noise is presented at fixed positive SNRs and the speech rate (i.e., the time compression of the speech material) is adaptively adjusted. In total, 29 younger and 12 older normal-hearing, as well as 24 older hearing-impaired listeners took part in repeated measurements. Younger normal-hearing and older hearing-impaired listeners conducted one of two adaptive methods which differed in adaptive procedure and step size. Analysis of the measurements with regard to list length and estimation strategy for thresholds resulted in a practical method measuring the time compression for 50% recognition. This method uses time-compression adjustment and step sizes according to Versfeld and Dreschler [(2002). J. Acoust. Soc. Am. 111, 401-408], with sentence scoring, lists of 30 sentences, and a maximum likelihood method for threshold estimation. Evaluation of the procedure showed that older participants obtained higher test-retest reliability compared to younger participants. Depending on the group of listeners, one or two lists are required for training prior to data collection.

  17. Health-Based Capitation Risk Adjustment in Minnesota Public Health Care Programs

    PubMed Central

    Gifford, Gregory A.; Edwards, Kevan R.; Knutson, David J.

    2004-01-01

    This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues. Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment. Phased implementation of capitation risk adjustment for these programs began January 1, 2000. Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model. PMID:25372356

  18. Quantifying the relative risk of sex offenders: risk ratios for static-99R.

    PubMed

    Hanson, R Karl; Babchishin, Kelly M; Helmus, Leslie; Thornton, David

    2013-10-01

    Given the widespread use of empirical actuarial risk tools in corrections and forensic mental health, it is important that evaluators and decision makers understand how scores relate to recidivism risk. In the current study, we found strong evidence for a relative risk interpretation of Static-99R scores using 8 samples from Canada, United Kingdom, and Western Europe (N = 4,037 sex offenders). Each increase in Static-99R score was associated with a stable and consistent increase in relative risk (as measured by an odds ratio or hazard ratio of approximately 1.4). Hazard ratios from Cox regression were used to calculate risk ratios that can be reported for Static-99R. We recommend that evaluators consider risk ratios as a useful, nonarbitrary metric for quantifying and communicating risk information. To avoid misinterpretation, however, risk ratios should be presented with recidivism base rates.

  19. A new technology for producing hydrogen and adjustable ratio syngas from coke oven gas

    SciTech Connect

    Jun Shen; Zhi-zhong Wang; Huai-wang Yang; Run-sheng Yao

    2007-12-15

    About 15 billion Nm{sup 3} coke oven gas (COG) is emitted into the air in Shanxi Province in China as air pollutants. It is also a waste of precious chemical resources. In this study, COG was purified respectively by four methods including refrigeration, fiberglass, silica gel, and molecular sieve. Purified COG was separated by a prism membrane into two gas products. One consists mainly of H{sub 2} ({gt}90 vol %) and the other is rich in CH{sub 4} ({gt}60 vol %) with their exact compositions to vary with the membrane separation pressure and outlet gas flow ratio. The gas rich in CH{sub 4} was partially oxidized with oxygen in a high-temperature fixed-bed quartz reactor charged with coke particles of 10 mm size. At 1200-1300{sup o}C, a CH{sub 4} conversion of {gt}99% could be obtained. The H{sub 2}/CO ratio in the synthesis product gas can be adjusted in the range 0.3-1.4, very favorable for further C1 synthesis. 10 refs., 17 figs., 1t ab.

  20. Stroke volume-to-wall stress ratio as a load-adjusted and stiffness-adjusted indicator of ventricular systolic performance in chronic loading

    PubMed Central

    Chemaly, Elie R.; Chaanine, Antoine H.; Sakata, Susumu

    2012-01-01

    Load-adjusted measures of left ventricle (LV) systolic performance are limited by dependence on LV stiffness and afterload. To our knowledge, no stiffness-adjusted and afterload-adjusted indicator was tested in models of pressure (POH) and volume overload hypertrophy (VOH). We hypothesized that wall stress reflects changes in loading, incorporating chamber stiffness and afterload; therefore, stroke volume-to-wall stress ratio more accurately reflects systolic performance. We used rat models of POH (ascending aortic banding) and VOH (aorto-cava shunt). Animals underwent echocardiography and pressure-volume analysis at baseline and dobutamine challenge. We achieved extreme bidirectional alterations in LV systolic performance, end-systolic elastance (Ees), passive stiffness, and arterial elastance (Ea). In POH with LV dilatation and failure, some load-independent indicators of systolic performance remained elevated compared with controls, while some others failed to decrease with wide variability. In VOH, most, but not all indicators, including LV ejection fraction, were significantly reduced compared with controls, despite hyperdynamic circulation, lack of heart failure, and preserved contractile reserve. We related systolic performance to Ees adjusted for Ea and LV passive stiffness in multivariate models. Calculated residual Ees was not reduced in POH with heart failure and was reduced in VOH, while it positively correlated to dobutamine dose. Conversely, stroke volume-to-wall stress ratio was normal in compensated POH, markedly decreased in POH with heart failure, and, in contrast with LV ejection fraction, normal in VOH. Our results support stroke volume-to-wall stress ratio as a load-adjusted and stiffness-adjusted indicator of systolic function in models of POH and VOH. PMID:22923502

  1. Using sightability-adjusted brood-pair ratios to estimate waterfowl productivity

    USGS Publications Warehouse

    Pagano, Anthony M.; Amundson, Courtney; Pieron, Matthew R.; Arnold, Todd W.; Kimmel, Timothy C.

    2014-01-01

    Historically, biologists used brood-pair ratios (BPRs) as an index to waterfowl productivity to help guide management decisions and evaluate conservation practices. However, BPRs are biased by imperfect detection probabilities, especially for broods. We conducted roadside surveys for breeding waterfowl pairs on 7–8 study sites in the springs of 2006–2008 in northeastern North Dakota, USA. Later each year, we conducted replicate counts of broods on the same wetlands and used mark–recapture methods to estimate sightability-adjusted BPRs (SA-BPRs). Traditional roadside brood surveys detected only 30–45% of the available broods, depending on species. We explored the potential for using SA-BPRs to measure hen success (i.e., the probability a female hatches ≥1 egg across all nesting attempts) for mallards (Anas platyrhynchos) and other upland-nesting dabbling ducks (Anas spp.). We found that SA-BPRs explained 40% of the variation in hen success over 5 species of dabbling ducks, and we were able to detect an effect of predator reduction on hen success in combined dabblers, but not in mallards alone. However, we found no relationship between SA-BPRs and mallard fledging rates (hen success × initial brood size × duckling survival). Our results suggest that SA-BPRs can provide a cost-effective alternative to traditional measures of productivity such as nesting success, but not to measures of duckling survival. Nevertheless, SA-BPRs may be useful in areas where traditional measures of waterfowl productivity are logistically or financially challenging.

  2. Regression Trees Identify Relevant Interactions: Can This Improve the Predictive Performance of Risk Adjustment?

    PubMed

    Buchner, Florian; Wasem, Jürgen; Schillo, Sonja

    2017-01-01

    Risk equalization formulas have been refined since their introduction about two decades ago. Because of the complexity and the abundance of possible interactions between the variables used, hardly any interactions are considered. A regression tree is used to systematically search for interactions, a methodologically new approach in risk equalization. Analyses are based on a data set of nearly 2.9 million individuals from a major German social health insurer. A two-step approach is applied: In the first step a regression tree is built on the basis of the learning data set. Terminal nodes characterized by more than one morbidity-group-split represent interaction effects of different morbidity groups. In the second step the 'traditional' weighted least squares regression equation is expanded by adding interaction terms for all interactions detected by the tree, and regression coefficients are recalculated. The resulting risk adjustment formula shows an improvement in the adjusted R(2) from 25.43% to 25.81% on the evaluation data set. Predictive ratios are calculated for subgroups affected by the interactions. The R(2) improvement detected is only marginal. According to the sample level performance measures used, not involving a considerable number of morbidity interactions forms no relevant loss in accuracy. Copyright © 2015 John Wiley & Sons, Ltd.

  3. Cumulative Family Risk Predicts Increases in Adjustment Difficulties across Early Adolescence

    ERIC Educational Resources Information Center

    Buehler, Cheryl; Gerard, Jean M.

    2013-01-01

    Family is an important socialization context for youth as they move through early adolescence. A significant feature of this complex socialization context is the accumulation of potential family risk factors that may compromise youth adjustment. This study examined cumulative family risk and adolescents' adjustment difficulties in 416 two-parent…

  4. Do insurers respond to risk adjustment? A long-term, nationwide analysis from Switzerland.

    PubMed

    von Wyl, Viktor; Beck, Konstantin

    2016-03-01

    Community rating in social health insurance calls for risk adjustment in order to eliminate incentives for risk selection. Swiss risk adjustment is known to be insufficient, and substantial risk selection incentives remain. This study develops five indicators to monitor residual risk selection. Three indicators target activities of conglomerates of insurers (with the same ownership), which steer enrollees into specific carriers based on applicants' risk profiles. As a proxy for their market power, those indicators estimate the amount of premium-, health care cost-, and risk-adjustment transfer variability that is attributable to conglomerates. Two additional indicators, derived from linear regression, describe the amount of residual cost differences between insurers that are not covered by risk adjustment. All indicators measuring conglomerate-based risk selection activities showed increases between 1996 and 2009, paralleling the establishment of new conglomerates. At their maxima in 2009, the indicator values imply that 56% of the net risk adjustment volume, 34% of premium variability, and 51% cost variability in the market were attributable to conglomerates. From 2010 onwards, all indicators decreased, coinciding with a pre-announced risk adjustment reform implemented in 2012. Likewise, the regression-based indicators suggest that the volume and variance of residual cost differences between insurers that are not equaled out by risk adjustment have decreased markedly since 2009 as a result of the latest reform. Our analysis demonstrates that risk-selection, especially by conglomerates, is a real phenomenon in Switzerland. However, insurers seem to have reduced risk selection activities to optimize their losses and gains from the latest risk adjustment reform.

  5. 12 CFR Appendix B to Part 3 - Risk-Based Capital Guidelines; Market Risk Adjustment

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... safe and sound banking practices. (3) The OCC may exclude a national bank otherwise meeting the... deems it consistent with safe and sound banking practices. (c) Scope. The capital requirements of this... maturity) if the payment would cause the issuing bank's risk-based capital ratio to fall or remain...

  6. New ventures require accurate risk analyses and adjustments.

    PubMed

    Eastaugh, S R

    2000-01-01

    For new business ventures to succeed, healthcare executives need to conduct robust risk analyses and develop new approaches to balance risk and return. Risk analysis involves examination of objective risks and harder-to-quantify subjective risks. Mathematical principles applied to investment portfolios also can be applied to a portfolio of departments or strategic business units within an organization. The ideal business investment would have a high expected return and a low standard deviation. Nonetheless, both conservative and speculative strategies should be considered in determining an organization's optimal service line and helping the organization manage risk.

  7. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Contract type risk and... CONTRACTING BY NEGOTIATION Contract Pricing 215.404-71-3 Contract type risk and working capital adjustment. (a) Description. The contract type risk factor focuses on the degree of cost risk accepted by the contractor...

  8. Association between ratio indexes of body composition phenotypes and metabolic risk in Italian adults.

    PubMed

    Powell, M; Lara, J; Mocciaro, G; Prado, C M; Battezzati, A; Leone, A; Tagliabue, A; de Amicis, R; Vignati, L; Bertoli, S; Siervo, M

    2016-12-01

    The ratio between fat mass (FM) and fat-free mass (FFM) has been used to discriminate individual differences in body composition and improve prediction of metabolic risk. Here, we evaluated whether the use of a visceral adipose tissue-to-fat-free mass index (VAT:FFMI) ratio was a better predictor of metabolic risk than a fat mass index to fat-free mass index (FMI:FFMI) ratio. This is a cross-sectional study including 3441 adult participants (age range 18-81; men/women: 977/2464). FM and FFM were measured by bioelectrical impedance analysis and VAT by ultrasonography. A continuous metabolic risk Z score and harmonised international criteria were used to define cumulative metabolic risk and metabolic syndrome (MetS), respectively. Multivariate logistic and linear regression models were used to test associations between body composition indexes and metabolic risk. In unadjusted models, VAT:FFMI was a better predictor of MetS (OR 8.03, 95%CI 6.69-9.65) compared to FMI:FFMI (OR 2.91, 95%CI 2.45-3.46). However, the strength of association of VAT:FFMI and FMI:FFMI became comparable when models were adjusted for age, gender, clinical and sociodemographic factors (OR 4.06, 95%CI 3.31-4.97; OR 4.25, 95%CI 3.42-5.27, respectively). A similar pattern was observed for the association of the two indexes with the metabolic risk Z score (VAT:FFMI: unadjusted b = 0.69 ± 0.03, adjusted b = 0.36 ± 0.03; FMI:FFMI: unadjusted b = 0.28 ± 0.028, adjusted b = 0.38 ± 0.02). Our results suggest that there is no real advantage in using either VAT:FFMI or FMI:FFMI ratios as a predictor of metabolic risk in adults. However, these results warrant confirmation in longitudinal studies.

  9. A Review on Methods of Risk Adjustment and their Use in Integrated Healthcare Systems

    PubMed Central

    Juhnke, Christin; Bethge, Susanne

    2016-01-01

    Introduction: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The objective of this review was to obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed. Theory and methods: A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines. Results: In general, several distinctions can be made: in terms of risk horizons, in terms of risk factors or in terms of the combination of indicators included. Within these, another differentiation by three levels seems reasonable: methods based on mortality risks, methods based on morbidity risks as well as those based on information on (self-reported) health status. Conclusions and discussion: After the final examination of different methods of risk adjustment it was shown that the methodology used to adjust risks varies. The models differ greatly in terms of their included morbidity indicators. The findings of this review can be used in the evaluation of integrated healthcare delivery systems and can be integrated into quality- and patient-oriented reimbursement of care providers in the design of healthcare contracts. PMID:28316544

  10. Coherent Risk-Adjusted Decisions Over Time: a Bilevel Programming Approach

    DTIC Science & Technology

    2015-03-23

    AFRL-AFOSR-VA-TR-2015-0310 Coherent Risk -Adjusted Decisions Over Time: a Bilevel Programming Approach Jonathan Eckstein RUTGERS THE STATE UNIVERSITY...14/2015 4. TITLE AND SUBTITLE Final Project Report: Coherent Risk -Adjusted Decisions over Time: a Bilevel Programming Approach 5a. CONTRACT NUMBER...tested two techniques for approximating a time-inconsistent risk -averse objective function with a time-consistent one. We also investigated rolling

  11. Neutrophil-to-lymphocyte ratio: an inflammation marker related to cardiovascular risk in children.

    PubMed

    Prats-Puig, Anna; Gispert-Saüch, Montserrat; Díaz-Roldán, Ferran; Carreras-Badosa, Gemma; Osiniri, Inés; Planella-Colomer, Montserrat; Mayol, Lluís; de Zegher, Francis; Ibánez, Lourdes; Bassols, Judit; López-Bermejo, Abel

    2015-10-01

    Low-grade chronic inflammation plays a pathogenic role in cardiovascular disease. An increase in the ratio of circulating neutrophils to lymphocytes (N/L ratio) may serve as a marker of cardiovascular risk in adults. It was the study objective to study whether N/L ratio associates with vascular parameters in children. Subjects were 501 prepubertal and early pubertal Caucasian children (mean age 8.0 years; mean body mass index (BMI) Z-score 0.2 ± 0.9; 266 boys and 235 girls) recruited within an ongoing population-based study. The subjects were stratified into three groups according to age. Neutrophil, lymphocyte, BMI, waist circumference, systolic blood pressure (SBP) and carotid intima-media thickness (cIMT), assessed in all children. The N/L ratio, derived from the absolute neutrophil and lymphocyte counts. In children aged < 7 years (n=190, all prepubertal), no associations were observed between N/L ratio and either anthropometric or cardiovascular parameters. In children aged 7-9 years (n=171, 1.7% early pubertal), higher N/L ratio associated with higher BMI Z-score and waist circumference (p=0.008 to p < 0.0001). In children aged >9 years (n=140, 29.2% early pubertal), N/L ratio associated again with BMI Z-score and waist circumference and also positively with SBP and cIMT (all p=0.008 to p<0.0001). These associations remained significant in linear regression models following adjustment for possible confounding variables such as age, gender, fasting triglycerides, C-reactive protein and puberty (and for SBP and cIMT, adjustment also for BMI). In conclusion, our results provide the first evidence that a higher N/L ratio is associated with a less favourable cardiovascular profile in children and delineate the development of these associations from late childhood onwards.

  12. Femtosecond laser high-efficiency drilling of high-aspect-ratio microholes based on free-electron-density adjustments.

    PubMed

    Jiang, Lan; Fang, Juqiang; Cao, Qiang; Zhang, Kaihu; Wang, Peng; Yu, Yanwu; Huang, Qiang; Lu, Yongfeng

    2014-11-01

    We studied the micromachining of high-aspect-ratio holes in poly(methylmethacrylate) using a visible double-pulse femtosecond laser based on free-electron-density adjustments. Hole depth and aspect ratio increased simultaneously upon decreasing the wavelength in the visible-light zone. When the pulse energy reached a high level, the free-electron density was adjusted by using a double-pulse laser, which induced fewer free electrons, a lower reflectivity plasma plume, and more pulse energy deposition in the solid bottom. Thus, the aspect ratio of the hole was improved considerably. At a moderate pulse energy level, a 1.3-1.4 times enhancement of both the ablation depth and the aspect ratio was observed when the double-pulse delay was set between 100 and 300 fs, probably due to an enhanced photon-electron coupling effect through adjusting the free-electron density. At a lower pulse energy level, this effect also induced the generation of a submicrometer string. In addition, the ablation rate was improved significantly by using visible double pulses.

  13. 78 FR 70623 - Adjustment of Nationwide Significant Risk Threshold

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-26

    ... zone in comparison to the Risk Index With Horns, which is defined in 49 CFR 222.9 as a measure of risk... appendix D to 49 CFR part 222. In making this recalculation, FRA noted that the total number of...

  14. 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.

  15. Appraisal and coping as mediators of the effects of cumulative risk on preadolescent adjustment.

    PubMed

    Thompson, Stephanie F; Lengua, Liliana J; Garcia, Connie Meza

    2016-05-01

    This study examined the concurrent and longitudinal relations among cumulative risk, appraisal, coping, and adjustment. Longitudinal path models were tested in a community sample of 316 children in preadolescence to examine hypotheses that threat appraisal and avoidant coping mediate the effects of cumulative risk on child adjustment, whereas positive appraisal and active coping were hypothesized to predict better adjustment independently. Children and their mothers were assessed during in-home interviews at three time points at one-year intervals. Children reported on appraisal and coping strategies. Mothers and children reported on child adjustment problems and positive adjustment. Rank-order changes in appraisal and coping predicted rank-order changes in adjustment. Cumulative risk was concurrently related to higher threat appraisal and avoidant coping at each time point. Threat appraisal and avoidant coping mediated the relations of cumulative risk to rank-order changes in adjustment. There is specificity in the relations of cumulative risk to threat appraisal and avoidant coping, whereas positive appraisal and active coping are independent of risk and operate as individual resource factors.

  16. An Adjusted Likelihood Ratio Approach Analysing Distribution of Food Products to Assist the Investigation of Foodborne Outbreaks

    PubMed Central

    Norström, Madelaine; Kristoffersen, Anja Bråthen; Görlach, Franziska Sophie; Nygård, Karin; Hopp, Petter

    2015-01-01

    In order to facilitate foodborne outbreak investigations there is a need to improve the methods for identifying the food products that should be sampled for laboratory analysis. The aim of this study was to examine the applicability of a likelihood ratio approach previously developed on simulated data, to real outbreak data. We used human case and food product distribution data from the Norwegian enterohaemorrhagic Escherichia coli outbreak in 2006. The approach was adjusted to include time, space smoothing and to handle missing or misclassified information. The performance of the adjusted likelihood ratio approach on the data originating from the HUS outbreak and control data indicates that the adjusted approach is promising and indicates that the adjusted approach could be a useful tool to assist and facilitate the investigation of food borne outbreaks in the future if good traceability are available and implemented in the distribution chain. However, the approach needs to be further validated on other outbreak data and also including other food products than meat products in order to make a more general conclusion of the applicability of the developed approach. PMID:26237468

  17. Risk algorithms that include pathology adjustment for HER2 amplification need to make further downward adjustments in likelihood scores.

    PubMed

    Evans, D G; Woodward, E R; Howell, S J; Verhoef, S; Howell, A; Lalloo, F

    2017-04-01

    To assess the need for adjustment in the likelihood of germline BRCA1/2 mutations in women with HER2+ breast cancers. We analysed primary mutation screens on women with breast cancer with unequivocal HER2 overexpression and assessed the likelihood of BRCA1/BRCA2 mutations by age, oestrogen receptor status and Manchester score. Of 1111 primary BRCA screens with confirmed HER2 status only 4/161 (2.5%) of women with HER2 amplification had a BRCA1 mutation identified and 5/161 (3.1%) a BRCA2 mutation. The pathology adjusted Manchester score between 10 and 19% and 20%+ thresholds resulted in a detection rate of only 6.5 and 15% respectively. BOADICEA examples appeared to make even less downward adjustment. There is a very low detection rate of BRCA1 and BRCA2 mutations in women with HER2 amplified breast cancers. The Manchester score and BOADICEA do not make sufficient downward adjustment for HER2 amplification. For unaffected women, assessment of breast cancer risk and BRCA1/2 probability should take into account the pathology of the most relevant close relative. Unaffected women undergoing mutation testing for BRCA1/2 should be advised that there is limited reassurance from a negative test result if their close relative had a HER2+ breast cancer.

  18. 75 FR 82136 - Adjustment of Nationwide Significant Risk Threshold

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... alternative, a community can establish its quiet zone in comparison to the Risk Index With Horns, which is a... making this recalculation, FRA noted that the total number of gated, non-whistle-ban crossings was...

  19. 77 FR 546 - Adjustment of Nationwide Significant Risk Threshold

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-05

    ... community can establish its quiet zone in comparison to the Risk Index With Horns, which is a corridor... total number of gated, non-whistle-ban crossings was 42,150. ] TN05JA12.011 Applying the fatality...

  20. Cancer risk assessment on trihalomethanes and haloacetic acids in drinking water of China using disability-adjusted life years.

    PubMed

    Pan, Shenling; An, Wei; Li, Hongyan; Su, Ming; Zhang, Jinliang; Yang, Min

    2014-09-15

    The cancer risks from exposure to trihalomethanes (THMs) and haloacetic acids (HAAs) through multiple pathways were assessed based on the result of a water quality survey in 35 major cities of China. To express the risks in disability-adjusted life years (DALYs), the excess cancer incidence estimates were combined with a two-stage disease model for calculation. The median total cancer risk of THMs and HAAs was calculated as 7.34 × 10(-7) DALYs per person-year (ppy), lower than the reference level of risk (10(-6)DALYsppy) set by WHO. The risk from ingestion and inhalation exposures contributed 93.6% and 6.3% of the total risk respectively, while dermal contact made a negligible contribution. The median risk of trichloroacetic acid (TCAA) (2.12 × 10(-7)DALYsppy) was highest among the disinfection by-products (DBPs) considered. The risk ratio of total HAAs (THAA) to total THMs (TTHM) was 1.12. The risk was highest in northeast China while lowest in northwest China. As for the 35 cities, Tianjin had the highest risk while Yinchuan had the lowest. This study attempted to use DALYs for the risk assessment of DBPs, which will provide useful information for risk comparison and prioritization of hazards in drinking water.

  1. The development of a risk-adjusted capitation payment system: the Maryland Medicaid model.

    PubMed

    Weiner, J P; Tucker, A M; Collins, A M; Fakhraei, H; Lieberman, R; Abrams, C; Trapnell, G R; Folkemer, J G

    1998-10-01

    This article describes the risk-adjusted payment methodology employed by the Maryland Medicaid program to pay managed care organizations. It also presents an empirical simulation analysis using claims data from 230,000 Maryland Medicaid recipients. This simulation suggests that the new payment model will help adjust for adverse or favorable selection. The article is intended for a wide audience, including state and national policy makers concerned with the design of managed care Medicaid programs and actuaries, analysts, and researchers involved in the design and implementation of risk-adjusted capitation payment systems.

  2. [Sex ratio adjustment of a non-pollinating fig wasp species on Ficus semicordata in Xishuangbanna].

    PubMed

    Song, Bo; Peng, Yan-Qiong; Guan, Jun-Ming; Yang, Pei; Yang, Da-Rong

    2008-03-01

    Through controlling the number of ovipositing foundresses inside a fig, and combining with the observation of ovipositing behavior and mating behavior, this paper studied the sex ratio of Apocryptophagus sp., a species of non-pollinating fig wasps hosted on Ficus semicordata in Xishuangbanna. The results showed that female Apocryptophagus sp. started to visit the fig on the 3rd day after pollinator Ceratosolen gravelyi oviposited. Apocryptaphagus sp. oviposited on the outside of the fig, and the ovipositing lasted for 2 days. Male Apocryptophagus sp. emerged at the same time with pollinators. The males opened a small hole on the wall of gall where the females developed, and mated with the females. Mated females emerged from their development fig, and left for a new receptive fig. The sex ratio of Apocryptaphagus sp. was in agreement with local mate competition theory, i. e., it was female-biased. Meanwhile, the total number of offspring increased with increasing foundress number. In contrast, the average number of offspring per foundress decreased. At individual level, when a female laid eggs inside a fig, the sex ratio of offspring correlated negatively with the number of offspring.

  3. Environmental sex reversal, Trojan sex genes, and sex ratio adjustment: conditions and population consequences.

    PubMed

    Stelkens, Rike B; Wedekind, Claus

    2010-02-01

    The great diversity of sex determination mechanisms in animals and plants ranges from genetic sex determination (GSD, e.g. mammals, birds, and most dioecious plants) to environmental sex determination (ESD, e.g. many reptiles) and includes a mixture of both, for example when an individual's genetically determined sex is environmentally reversed during ontogeny (ESR, environmental sex reversal, e.g. many fish and amphibia). ESD and ESR can lead to widely varying and unstable population sex ratios. Populations exposed to conditions such as endocrine-active substances or temperature shifts may decline over time due to skewed sex ratios, a scenario that may become increasingly relevant with greater anthropogenic interference on watercourses. Continuous exposure of populations to factors causing ESR could lead to the extinction of genetic sex factors and may render a population dependent on the environmental factors that induce the sex change. However, ESR also presents opportunities for population management, especially if the Y or W chromosome is not, or not severely, degenerated. This seems to be the case in many amphibians and fish. Population growth or decline in such species can potentially be controlled through the introduction of so-called Trojan sex genes carriers, individuals that possess sex chromosomes or genes opposite from what their phenotype predicts. Here, we review the conditions for ESR, its prevalence in natural populations, the resulting physiological and reproductive consequences, and how these may become instrumental for population management.

  4. The mechanism of sex ratio adjustment in a pollinating fig wasp.

    PubMed

    Raja, Shazia; Suleman, Nazia; Compton, Stephen G; Moore, Jamie C

    2008-07-22

    Sex ratio strategies in species subject to local mate competition (LMC), and in particular their fit to quantitative theoretical predictions, provide insight into constraints upon adaptation. Pollinating fig wasps are widely used in such studies because their ecology resembles theory assumptions, but the cues used by foundresses to assess potential LMC have not previously been determined. We show that Liporrhopalum tentacularis females (foundresses) use their clutch size as a cue. First, we make use of species ecology (foundresses lay multiple clutches, with second clutches smaller than first) to show that increases in sex ratio in multi-foundress figs occur only when foundresses are oviposition site limited, i.e. that there is no direct response to foundress density. Second, we introduce a novel technique to quantify foundress oviposition sequences and show, consistent with the theoretical predictions concerning clutch size-only strategies, that they produce mainly male offspring at the start of bouts, followed by mostly females interspersed by a few males. We then discuss the implications of our findings for our understanding of the limits of the ability of natural selection to produce 'perfect' organisms, and for our understanding of when different cue use patterns evolve.

  5. The mechanism of sex ratio adjustment in a pollinating fig wasp

    PubMed Central

    Raja, Shazia; Suleman, Nazia; Compton, Stephen G; Moore, Jamie C

    2008-01-01

    Sex ratio strategies in species subject to local mate competition (LMC), and in particular their fit to quantitative theoretical predictions, provide insight into constraints upon adaptation. Pollinating fig wasps are widely used in such studies because their ecology resembles theory assumptions, but the cues used by foundresses to assess potential LMC have not previously been determined. We show that Liporrhopalum tentacularis females (foundresses) use their clutch size as a cue. First, we make use of species ecology (foundresses lay multiple clutches, with second clutches smaller than first) to show that increases in sex ratio in multi-foundress figs occur only when foundresses are oviposition site limited, i.e. that there is no direct response to foundress density. Second, we introduce a novel technique to quantify foundress oviposition sequences and show, consistent with the theoretical predictions concerning clutch size-only strategies, that they produce mainly male offspring at the start of bouts, followed by mostly females interspersed by a few males. We then discuss the implications of our findings for our understanding of the limits of the ability of natural selection to produce ‘perfect’ organisms, and for our understanding of when different cue use patterns evolve. PMID:18430647

  6. Child effects and child care: Implications for risk and adjustment.

    PubMed

    Snell, Emily K; Hindman, Annemarie H; Belsky, Jay

    2015-11-01

    Evocative effects of child characteristics on the quality and quantity of child care were assessed in two studies using longitudinal data from the NICHD Study of Early Child Care. We focus on the influence of child characteristics on two important aspects of the child care experience: language stimulation provided by caregivers and quantity of care. In Study 1, associations between the developmental status of children aged 15 to 54 months and the language stimulation provided by their caregivers were examined using path models, and longitudinal child effects were detected across the earliest time points of the study. In Study 2, the associations among child behavior, temperament, development, and time in care were examined. Little evidence was found for such child effects on time in care. The results are discussed in terms of the effects of child care on child development and implications for developmental processes, particularly for children at greatest risk for developmental delay or psychopathology.

  7. The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study

    PubMed Central

    Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

    2016-01-01

    Background When a country’s health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. Objectives This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). Materials and Methods This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Results Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people’s behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. Conclusions With regard to the current challenges in Iran’s health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system’s features. However, future research should focus on the development of the risk-adjusted capitation model. PMID:27340558

  8. Signal enhancement ratio (SER) quantified from breast DCE-MRI and breast cancer risk

    NASA Astrophysics Data System (ADS)

    Wu, Shandong; Kurland, Brenda F.; Berg, Wendie A.; Zuley, Margarita L.; Jankowitz, Rachel C.; Sumkin, Jules; Gur, David

    2015-03-01

    Breast magnetic resonance imaging (MRI) is recommended as an adjunct to mammography for women who are considered at elevated risk of developing breast cancer. As a key component of breast MRI, dynamic contrast-enhanced MRI (DCE-MRI) uses a contrast agent to provide high intensity contrast between breast tissues, making it sensitive to tissue composition and vascularity. Breast DCE-MRI characterizes certain physiologic properties of breast tissue that are potentially related to breast cancer risk. Studies have shown that increased background parenchymal enhancement (BPE), which is the contrast enhancement occurring in normal cancer-unaffected breast tissues in post-contrast sequences, predicts increased breast cancer risk. Signal enhancement ratio (SER) computed from pre-contrast and post-contrast sequences in DCE-MRI measures change in signal intensity due to contrast uptake over time and is a measure of contrast enhancement kinetics. SER quantified in breast tumor has been shown potential as a biomarker for characterizing tumor response to treatments. In this work we investigated the relationship between quantitative measures of SER and breast cancer risk. A pilot retrospective case-control study was performed using a cohort of 102 women, consisting of 51 women who had diagnosed with unilateral breast cancer and 51 matched controls (by age and MRI date) with a unilateral biopsy-proven benign lesion. SER was quantified using fully-automated computerized algorithms and three SER-derived quantitative volume measures were compared between the cancer cases and controls using logistic regression analysis. Our preliminary results showed that SER is associated with breast cancer risk, after adjustment for the Breast Imaging Reporting and Data System (BI-RADS)-based mammographic breast density measures. This pilot study indicated that SER has potential for use as a risk factor for breast cancer risk assessment in women at elevated risk of developing breast cancer.

  9. Antipsychotics and Mortality: Adjusting for Mortality Risk Scores to Address Confounding by Terminal Illness

    PubMed Central

    Park, Yoonyoung; Franklin, Jessica M.; Schneeweiss, Sebastian; Levin, Raisa; Crystal, Stephen; Gerhard, Tobias; Huybrechts, Krista F.

    2014-01-01

    OBJECTIVES Earlier studies have documented a greater mortality risk associated with conventional compared with atypical antipsychotics. Concern remains that the association is not causal, but due to residual confounding by differences in underlying health. To address this concern, we evaluated whether adjustment for prognostic indices specifically developed fornursing home (NH) populations affected the magnitude of the previously observed associations. DESIGN Cohort study SETTING A merged dataset of Medicaid, Medicare, the Minimum Data Set (MDS), the Online Survey Certification and Reporting system (OSCAR), and the National Death Index in the US for 2001-2005 PARTICIPANTS Dual eligible subjects ≥ 65 years who initiated antipsychotic treatment in a NH (n=75,445). MEASUREMENTS Three mortality risk scores (MRIS, MMRI-R, and ADEPT) were derived for each patient using baseline MDS data, and their performance was assessed using c-statistics and goodness-of-fit tests. The impact of adjusting for these indices in addition to propensity scores (PS) on the antipsychotic-mortality association was evaluated using Cox models with and without adjustment for risk scores. RESULTS Each risk score showed moderate discrimination for 6-month mortality with c-statistics ranging from 0.61 to 0.63. There was no evidence of lack of fit. Imbalances in risk scores between conventional and atypical antipsychotic users in the full cohort, suggesting potential confounding, were greatly reduced within PS deciles. Accounting for each score in the Cox model did not change the relative risk estimates: 2.24 with PS only adjustment vs. 2.20, 2.20, 2.22 after further adjustment for the three risk scores. CONCLUSION Although causality cannot be proven based on non-randomized studies, this study adds to the body of evidence rejecting alternative explanations for the increased mortality risk associated with conventional antipsychotics. PMID:25752911

  10. The HHS-HCC Risk Adjustment Model for Individual and Small Group Markets under the Affordable Care Act

    PubMed Central

    Kautter, John; Pope, Gregory C; Ingber, Melvin; Freeman, Sara; Patterson, Lindsey; Cohen, Michael; Keenan, Patricia

    2014-01-01

    Beginning in 2014, individuals and small businesses are able to purchase private health insurance through competitive Marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge. The risk adjustment methodology includes the risk adjustment model and the risk transfer formula. This article is the second of three in this issue of the Review that describe the Department of Health and Human Services (HHS) risk adjustment methodology and focuses on the risk adjustment model. In our first companion article, we discuss the key issues and choices in developing the methodology. In this article, we present the risk adjustment model, which is named the HHS-Hierarchical Condition Categories (HHS-HCC) risk adjustment model. We first summarize the HHS-HCC diagnostic classification, which is the key element of the risk adjustment model. Then the data and methods, results, and evaluation of the risk adjustment model are presented. Fifteen separate models are developed. For each age group (adult, child, and infant), a model is developed for each cost sharing level (platinum, gold, silver, and bronze metal levels, as well as catastrophic plans). Evaluation of the risk adjustment models shows good predictive accuracy, both for individuals and for groups. Lastly, this article provides examples of how the model output is used to calculate risk scores, which are an input into the risk transfer formula. Our third companion paper describes the risk transfer formula. PMID:25360387

  11. Persistent sex-by-environment effects on offspring fitness and sex-ratio adjustment in a wild bird population

    PubMed Central

    Bowers, E. Keith; Thompson, Charles F.; Sakaluk, Scott K.

    2014-01-01

    Summary A major component of sex-allocation theory, the Trivers-Willard Model (TWM), posits that sons and daughters are differentially affected by variation in the rearing environment. In many species, the amount of parental care received is expected to have differing effects on the fitness of males and females. When this occurs, the TWM predicts that selection should favour adjustment of the offspring sex ratio in relation to the expected fitness return from offspring. However, evidence for sex-by-environment effects is mixed and little is known about the adaptive significance of producing either sex. Here, we test whether offspring sex ratios vary according to predictions of the TWM in the house wren (Troglodytes aedon, Vieillot). We also test the assumption of a sex-by-environment effect on offspring using two experiments, one in which we manipulated age-differences among nestlings within broods, and another in which we held nestling age constant but manipulated brood size. As predicted, females with high investment ability over-produced sons relative to those with lower ability. Males were also over-produced early within breeding seasons. In our experiments, the body mass of sons was more strongly affected by the sibling-competitive environment and resource availability than that of daughters: males grew heavier than females when reared in good conditions but were lighter than females when in poor conditions. Parents rearing broods with 1:1 sex ratios were more productive than parents rearing broods biased more strongly towards sons or daughters, suggesting that selection favours the production of mixed-sex broods. However, differences in the condition of offspring as neonates persisted to adulthood, and their reproductive success as adults varied with the body mass of sons, but not daughters, prior to independence from parental care. Thus, selection should favour slight but predictable variations in the sex ratio in relation to the quality of offspring that

  12. Risk adjusting survival outcomes of hospitals that treat cancer patients without information on cancer stage

    PubMed Central

    Pfister, David G.; Rubin, David M.; Elkin, Elena B.; Neill, Ushma S.; Duck, Elaine; Radzyner, Mark; Bach, Peter B.

    2016-01-01

    Importance Instituting widespread measurement of outcomes for cancer hospitals using administrative data is difficult due to the lack of cancer specific information such as disease stage. Objective To evaluate the performance of hospitals that treat cancer patients using Medicare data for outcome ascertainment and risk adjustment, and to assess whether hospital rankings based on these measures are influenced by the addition of cancer-specific information. Design Risk adjusted cumulative mortality of patients with cancer captured in Medicare claims from 2005–2009 nationally were assessed at the hospital level. Similar analyses were conducted in the Surveillance, Epidemiology and End Result (SEER)-Medicare data for the subset of the US covered by the SEER program to determine whether the exclusion of cancer specific information (only available in cancer registries) from risk adjustment altered measured hospital performance. Setting Administrative claims data and SEER cancer registry data Participants Sample of 729,279 fee-for-service Medicare beneficiaries treated for cancer in 2006 at hospitals treating 10+ patients with each of the following cancers, according to Medicare claims: lung, prostate, breast, colon. An additional sample of 18,677 similar patients in SEER-Medicare administrative data. Main Outcomes and Measures Risk-adjusted mortality overall and by cancer type, stratified by type of hospital; measures of correlation and agreement between hospital-level outcomes risk adjusted using Medicare data alone and Medicare data with SEER data. Results There were large outcome differences between different types of hospitals that treat Medicare patients with cancer. At one year, cumulative mortality for Medicare-prospective-payment-system exempt hospitals was 10% lower than at community hospitals (18% versus 28%) across all cancers, the pattern persisted through five years of follow-up and within specific cancer types. Performance ranking of hospitals was

  13. Prior event rate ratio adjustment for hidden confounding in observational studies of treatment effectiveness: a pairwise Cox likelihood approach.

    PubMed

    Lin, Nan Xuan; Henley, William Edward

    2016-12-10

    Observational studies provide a rich source of information for assessing effectiveness of treatment interventions in many situations where it is not ethical or practical to perform randomized controlled trials. However, such studies are prone to bias from hidden (unmeasured) confounding. A promising approach to identifying and reducing the impact of unmeasured confounding is prior event rate ratio (PERR) adjustment, a quasi-experimental analytic method proposed in the context of electronic medical record database studies. In this paper, we present a statistical framework for using a pairwise approach to PERR adjustment that removes bias inherent in the original PERR method. A flexible pairwise Cox likelihood function is derived and used to demonstrate the consistency of the simple and convenient alternative PERR (PERR-ALT) estimator. We show how to estimate standard errors and confidence intervals for treatment effect estimates based on the observed information and provide R code to illustrate how to implement the method. Assumptions required for the pairwise approach (as well as PERR) are clarified, and the consequences of model misspecification are explored. Our results confirm the need for researchers to consider carefully the suitability of the method in the context of each problem. Extensions of the pairwise likelihood to more complex designs involving time-varying covariates or more than two periods are considered. We illustrate the application of the method using data from a longitudinal cohort study of enzyme replacement therapy for lysosomal storage disorders. © 2016 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

  14. Estimation of the standardized risk difference and ratio in a competing risks framework: application to injection drug use and progression to AIDS after initiation of antiretroviral therapy.

    PubMed

    Cole, Stephen R; Lau, Bryan; Eron, Joseph J; Brookhart, M Alan; Kitahata, Mari M; Martin, Jeffrey N; Mathews, William C; Mugavero, Michael J

    2015-02-15

    There are few published examples of absolute risk estimated from epidemiologic data subject to censoring and competing risks with adjustment for multiple confounders. We present an example estimating the effect of injection drug use on 6-year risk of acquired immunodeficiency syndrome (AIDS) after initiation of combination antiretroviral therapy between 1998 and 2012 in an 8-site US cohort study with death before AIDS as a competing risk. We estimate the risk standardized to the total study sample by combining inverse probability weights with the cumulative incidence function; estimates of precision are obtained by bootstrap. In 7,182 patients (83% male, 33% African American, median age of 38 years), we observed 6-year standardized AIDS risks of 16.75% among 1,143 injection drug users and 12.08% among 6,039 nonusers, yielding a standardized risk difference of 4.68 (95% confidence interval: 1.27, 8.08) and a standardized risk ratio of 1.39 (95% confidence interval: 1.12, 1.72). Results may be sensitive to the assumptions of exposure-version irrelevance, no measurement bias, and no unmeasured confounding. These limitations suggest that results be replicated with refined measurements of injection drug use. Nevertheless, estimating the standardized risk difference and ratio is straightforward, and injection drug use appears to increase the risk of AIDS.

  15. Continuing Bonds, Risk Factors for Complicated Grief, and Adjustment to Bereavement

    ERIC Educational Resources Information Center

    Field, Nigel P.; Filanosky, Charles

    2010-01-01

    This study examined type of continuing bonds (CB) expression in relation to risk factors for complicated grief and measures of bereavement-related adjustment. Externalized CB expressions involving illusions and hallucinations with the deceased were distinguished from internalized CB expressions involving use of the deceased as an autonomy…

  16. School Adjustment of Pupils with ADHD: Cognitive, Emotional and Temperament Risk Factors

    ERIC Educational Resources Information Center

    Sanchez-Perez, Noelia; Gonzalez-Salinas, Carmen

    2013-01-01

    From different research perspectives, the cognitive and emotional characteristics associated with ADHD in children have been identified as risk factors for the development of diverse adjustment problems in the school context. Research in nonclinical population can additionally help in understanding ADHD deficits, since children with specific…

  17. Comparison of the Properties of Regression and Categorical Risk-Adjustment Models

    PubMed Central

    Averill, Richard F.; Muldoon, John H.; Hughes, John S.

    2016-01-01

    Clinical risk-adjustment, the ability to standardize the comparison of individuals with different health needs, is based upon 2 main alternative approaches: regression models and clinical categorical models. In this article, we examine the impact of the differences in the way these models are constructed on end user applications. PMID:26945302

  18. Adjustment before Learning: The Curricular Dilemma in Programs for At-Risk Students.

    ERIC Educational Resources Information Center

    Smith, Gregory A.

    This paper argues that programs for at-risk youth tend to overemphasize student adjustment and the mastery of institutional customs at the expense of instilling learning dispositions that might lead to the postsecondary educational training now required to find adequate adult employment. Programs often focus on drawing students into a more…

  19. Assessing At-Risk Youth Using the Reynolds Adolescent Adjustment Screening Inventory with a Latino Population

    ERIC Educational Resources Information Center

    Balkin, Richard S.; Cavazos, Javier, Jr.; Hernandez, Arthur E.; Garcia, Roberto; Dominguez, Denise L.; Valarezo, Alexandra

    2013-01-01

    Factor analyses were conducted on scores from the Reynolds Adolescent Adjustment Screening Inventory (RAASI; Reynolds, 2001) representing at-risk Latino youth. The 4-factor model of the RAASI did not exhibit a good fit. However, evidence of generalizability for Latino youth was noted. (Contains 3 tables.)

  20. Measuring Profitability Impacts of Information Technology: Use of Risk Adjusted Measures.

    ERIC Educational Resources Information Center

    Singh, Anil; Harmon, Glynn

    2003-01-01

    Focuses on understanding how investments in information technology are reflected in the income statements and balance sheets of firms. Shows that the relationship between information technology investments and corporate profitability is much better explained by using risk-adjusted measures of corporate profitability than using the same measures…

  1. Risk-Adjustment Simulation: Plans May Have Incentives To Distort Mental Health And Substance Use Coverage

    PubMed Central

    Montz, Ellen; Layton, Tim; Busch, Alisa B.; Ellis, Randall P.; Rose, Sherri; McGuire, Thomas G.

    2016-01-01

    Under the Affordable Care Act, the risk-adjustment program is designed to compensate health plans for enrolling people with poorer health status so that plans compete on cost and quality rather than the avoidance of high-cost individuals. This study examined health plan incentives to limit covered services for mental health and substance use disorders under the risk-adjustment system used in the health insurance Marketplaces. Through a simulation of the program on a population constructed to reflect Marketplace enrollees, we analyzed the cost consequences for plans enrolling people with mental health and substance use disorders. Our assessment points to systematic underpayment to plans for people with these diagnoses. We document how Marketplace risk adjustment does not remove incentives for plans to limit coverage for services associated with mental health and substance use disorders. Adding mental health and substance use diagnoses used in Medicare Part D risk adjustment is one potential policy step toward addressing this problem in the Marketplaces. PMID:27269018

  2. Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences

    PubMed Central

    2014-01-01

    Background This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response. Methods Health-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic and socioeconomic characteristics, as well as usage of health services by the subjects were collected. The attitude towards risk was evaluated by collecting risky behaviors data, by the subject’s self-evaluation, and through lottery games. Results Six hundred and sixty two subjects participated and 449 stated a utility inferior to 1. WTP/QALY ratios varied significantly when payments with personal money (mean €10,119; median €673) or through taxes (mean €28,187; median €915) were suggested. Family income, area income, higher education level, greater use of healthcare services, and the number of co-inhabitants were associated with greater WTP/QALY ratios. Age and female gender were associated with lower WTP/QALY ratios. Risk inclination was independently associated with a greater WTP/QALY when “out of pocket” payments were suggested. Clear discrepancies were demonstrated between linearity and neutrality towards risk assumptions and experimental results. Conclusions WTP/QALY ratios vary noticeably based on demographic and socioeconomic characteristics of the subject, but also on their attitude towards risk. Knowing the expression of preferences by patients from this outcome measurement can be of interest for health service planning. PMID:24989615

  3. Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study

    PubMed Central

    Bjørnevik, Kjetil; Riise, Trond; Cortese, Marianna; Holmøy, Trygve; Kampman, Margitta T; Magalhaes, Sandra; Myhr, Kjell-Morten; Wolfson, Christina; Pugliatti, Maura

    2016-01-01

    Background: Several recent studies have found a higher risk of multiple sclerosis (MS) among people with a low level of education. This has been suggested to reflect an effect of smoking and lower vitamin D status in the social class associated with lower levels of education. Objective: The objective of this paper is to investigate the association between level of education and MS risk adjusting for the known risk factors smoking, infectious mononucleosis, indicators of vitamin D levels and body size. Methods: Within the case-control study on Environmental Factors In MS (EnvIMS), 953 MS patients and 1717 healthy controls from Norway reported educational level and history of exposure to putative environmental risk factors. Results: Higher level of education were associated with decreased MS risk (p trend = 0.001) with an OR of 0.53 (95% CI 0.41–0.68) when comparing those with the highest and lowest level of education. This association was only moderately reduced after adjusting for known risk factors (OR 0.61, 95% CI 0.44–0.83). The estimates remained similar when cases with disease onset before age 28 were excluded. Conclusion: These findings suggest that factors related to lower socioeconomic status other than established risk factors are associated with MS risk. PMID:26014605

  4. Risk Adjustment, Reinsurance Improved Financial Outcomes For Individual Market Insurers With The Highest Claims.

    PubMed

    Jacobs, Paul D; Cohen, Michael L; Keenan, Patricia

    2017-04-01

    The Affordable Care Act (ACA) reformed the individual health insurance market. Because insurers can no longer vary their offers of coverage based on applicants' health status, the ACA established a risk adjustment program to equalize health-related cost differences across plans. The ACA also established a temporary reinsurance program to subsidize high-cost claims. To assess the impact of these programs, we compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments. Before these payments were included, for the 30 percent of insurers with the highest claims costs, claims (not including administrative expenses) exceeded premium revenues by $90-$397 per enrollee per month. The effect was reversed after these payments were included, with revenues exceeding claims costs by $0-$49 per month. The risk adjustment and reinsurance programs were relatively well targeted in the first two years. While there is ongoing discussion regarding the future of the ACA, our findings can shed light on how risk-sharing programs can address risk selection among insurers-a pervasive issue in all health insurance markets.

  5. Understanding relative risk, odds ratio, and related terms: as simple as it can get.

    PubMed

    Andrade, Chittaranjan

    2015-07-01

    Risk, and related measures of effect size (for categorical outcomes) such as relative risks and odds ratios, are frequently presented in research articles. Not all readers know how these statistics are derived and interpreted, nor are all readers aware of their strengths and limitations. This article examines several measures, including absolute risk, attributable risk, attributable risk percent, population attributable risk percent, relative risk, odds, odds ratio, and others. The concept and method of calculation are explained for each of these in simple terms and with the help of examples. The interpretation of each is presented in plain English rather than in technical language. Clinically useful notes are provided, wherever necessary.

  6. 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.

  7. Developmental risks and psychosocial adjustment among low-income Brazilian youth.

    PubMed

    Raffaelli, Marcela; Koller, Silvia H; Cerqueira-Santos, Elder; De Morais, Normanda Araújo

    2007-01-01

    Exposure to developmental risks in three domains (community, economic, and family), and relations between risks and psychosocial well-being, were examined among 918 impoverished Brazilian youth aged 14-19 (M = 15.8 years, 51.9% female) recruited in low-income neighborhoods in one city in Southern Brazil. High levels of developmental risks were reported, with levels and types of risks varying by gender, age, and (to a lesser extent) race. Associations between levels of risks in the various domains and indicators of psychological (e.g., self-esteem, negative emotionality) and behavioral (e.g., substance use) adjustment differed for male and female respondents. Findings build on prior research investigating the development of young people in conditions of pervasive urban poverty and reinforce the value of international research in this endeavor.

  8. Using Quantile and Asymmetric Least Squares Regression for Optimal Risk Adjustment.

    PubMed

    Lorenz, Normann

    2016-06-13

    In this paper, we analyze optimal risk adjustment for direct risk selection (DRS). Integrating insurers' activities for risk selection into a discrete choice model of individuals' health insurance choice shows that DRS has the structure of a contest. For the contest success function (csf) used in most of the contest literature (the Tullock-csf), optimal transfers for a risk adjustment scheme have to be determined by means of a restricted quantile regression, irrespective of whether insurers are primarily engaged in positive DRS (attracting low risks) or negative DRS (repelling high risks). This is at odds with the common practice of determining transfers by means of a least squares regression. However, this common practice can be rationalized for a new csf, but only if positive and negative DRSs are equally important; if they are not, optimal transfers have to be calculated by means of a restricted asymmetric least squares regression. Using data from German and Swiss health insurers, we find considerable differences between the three types of regressions. Optimal transfers therefore critically depend on which csf represents insurers' incentives for DRS and, if it is not the Tullock-csf, whether insurers are primarily engaged in positive or negative DRS. Copyright © 2016 John Wiley & Sons, Ltd.

  9. Fire-related cognitions moderate the impact of risk factors on adjustment following wildfire disaster.

    PubMed

    Scher, Christine D; Ellwanger, Joel

    2009-10-01

    This study builds upon current understanding of risk and protective factors for post-disaster adjustment by examining relationships between disaster-related cognitions, three empirically supported risk factors for poorer adjustment (i.e., greater disaster impact, female gender, and racial/ethnic minority status), and three common post-disaster outcomes (i.e., depression, anxiety, and somatic complaints). Participants were 200 students exposed to wildfire disaster. Simultaneous hierarchical regression analyses revealed that, during the acute stress period: (1) disaster-related cognitions in interaction with fire impact and minority status, as well as gender, were related to anxiety symptoms, (2) cognitions were related to depression symptoms, and (3) cognitions in interaction with minority status, as well as fire impact, were related to somatic symptoms. No examined variables predicted symptom change.

  10. Impact of Serum Leptin to Adiponectin Ratio on Regression of Metabolic Syndrome in High-Risk Individuals: The ARIRANG Study

    PubMed Central

    Kang, Dae Ryong; Yadav, Dhananjay; Koh, Sang-Baek; Kim, Jang-Young

    2017-01-01

    Purpose The ratio of serum leptin to adiponectin (L/A ratio) could be used as a marker for insulin resistance. However, few prospective studies have investigated the impact of L/A ratio on improvement of metabolic components in high-risk individuals with metabolic syndrome. We examined the association between L/A ratio and the regression of metabolic syndrome in a population-based longitudinal study. Materials and Methods A total of 1017 subjects (431 men and 586 women) with metabolic syndrome at baseline (2005–2008) were examined and followed (2008–2011). Baseline serum levels of leptin and adiponectin were analyzed by radioimmunoassay. Area under the receiver operating characteristics curve (AUROC) analyses were used to assess the predictive ability of L/A ratio for the regression of metabolic syndrome. Results During an average of 2.8 years of follow-up, metabolic syndrome disappeared in 142 men (32.9%) and 196 women (33.4%). After multivariable adjustment, the odds ratios (95% confidence interval) for regression of metabolic syndrome in comparisons of the lowest to the highest tertiles of L/A ratio were 1.84 (1.02–3.31) in men and 2.32 (1.37–3.91) in women. In AUROC analyses, L/A ratio had a greater predictive power than serum adiponectin for the regression of metabolic syndrome in both men (p=0.024) and women (p=0.019). Conclusion Low L/A ratio is a predictor for the regression of metabolic syndrome. The L/A ratio could be a useful clinical marker for management of high-risk individuals with metabolic syndrome. PMID:28120564

  11. Evolving Adjustments to External (Gamma) Slope Factors for CERCLA Risk and Dose Assessments - 12290

    SciTech Connect

    Walker, Stuart

    2012-07-01

    To model the external exposure pathway in risk and dose assessments of radioactive contamination at Superfund sites, the U.S. Environmental Protection Agency (EPA) uses slope factors (SFs), also known as risk coefficients, and dose conversion factors (DCFs). Without any adjustment these external radiation exposure pathways effectively assumes that an individual is exposed to a source geometry that is effectively an infinite slab. The concept of an 'infinite slab' means that the thickness of the contaminated zone and its aerial extent are so large that it behaves as if it were infinite in its physical dimensions. EPA has been making increasingly complex adjustments to account for the extent of the contamination and its corresponding radiation field to provide more accurate risk and dose assessment modeling when using its calculators. In most instances, the more accurate modeling results derived from these gamma adjustments are less conservative. The notable exception are for some radionuclides in rooms with contaminated walls, ceiling, and floors, and the receptor is in location of the room with the highest amount of radiation exposure, usually the corner of small rooms and the center of large conference rooms. (authors)

  12. The public health hazards of risk avoidance associated with public reporting of risk-adjusted outcomes in coronary intervention.

    PubMed

    Resnic, Frederic S; Welt, Frederick G P

    2009-03-10

    Public reporting of risk-adjusted outcomes for percutaneous coronary intervention (PCI) procedures has been mandated in New York State for more than a decade. During that time there has been a significant decline in the unadjusted mortality after such procedures. Massachusetts joined New York in 2003 as only the second state to require case level reporting of every coronary interventional procedure performed. In this review, we explore the differences in the populations reported by the 2 states and consider possible risks of public reporting of clinical outcomes after PCI procedures, including the risk of increasing conservatism in the treatment of the sickest patients. We offer a conceptual framework to understand the potential risk-averse behavior of interventional cardiologists subject to public reporting, and offer several proposals to counteract this potential deleterious effect of reporting programs.

  13. The public health hazards of risk avoidance associated with public reporting of risk adjusted outcomes in coronary intervention

    PubMed Central

    Resnic, Frederic S.; Welt, Frederick G. P.

    2009-01-01

    Public reporting of risk adjusted outcomes for percutaneous coronary interventional (PCI) procedures has been mandated in New York State for more than a decade. Over that time there has been a significant decline in the unadjusted mortality following such procedures. Massachusetts joined New York in 2003 as only the second state to require case level reporting of every coronary interventional procedure performed. In this review, we explore the differences in the populations reported by the two states, and consider possible risks of public reporting of clinical outcomes following PCI procedures including the risk of increasing conservatism in the treatment of the sickest patients. We offer a conceptual framework to understand the potential risk-averse behavior of interventional cardiologists subject to public reporting, and offer several proposals to counteract this potential deleterious effect of reporting programs. PMID:19264236

  14. One idea of portfolio risk control for absolute return strategy risk adjustments by signals from correlation behavior

    NASA Astrophysics Data System (ADS)

    Nishiyama, N.

    2001-12-01

    Absolute return strategy provided from fund of funds (FOFs) investment schemes is the focus in Japanese Financial Community. FOFs investment mainly consists of hedge fund investment and it has two major characteristics which are low correlation against benchmark index and little impact from various external changes in the environment given maximizing return. According to the historical track record of survival hedge funds in this business world, they maintain a stable high return and low risk. However, one must keep in mind that low risk would not be equal to risk free. The failure of Long-term capital management (LTCM) that took place in the summer of 1998 was a symbolized phenomenon. The summer of 1998 exhibited a certain limitation of traditional value at risk (VaR) and some possibility that traditional VaR could be ineffectual to the nonlinear type of fluctuation in the market. In this paper, I try to bring self-organized criticality (SOC) into portfolio risk control. SOC would be well known as a model of decay in the natural world. I analyzed nonlinear type of fluctuation in the market as SOC and applied SOC to capture complicated market movement using threshold point of SOC and risk adjustments by scenario correlation as implicit signals. Threshold becomes the control parameter of risk exposure to set downside floor and forecast extreme nonlinear type of fluctuation under a certain probability. Simulation results would show synergy effect of portfolio risk control between SOC and absolute return strategy.

  15. Identifying Military and Combat-Specific Risk Factors for Child Adjustment: Comparing High and Low Risk Military Families and Civilian Families

    DTIC Science & Technology

    2013-06-01

    0034 TITLE: Identifying Military and Combat-Specific Risk Factors for Child Adjustment: Comparing High and Low Risk Military Families and...From - To) 15 May 2012- 14 May 2013 Identifying Military and Combat-Specific Risk Factors for Child Adjustment: Comparing High and Low Risk...N=200) whose spouse/partner is currently deployed and has a child between the age of 3 and 7 and comparison groups of civilain single parent

  16. Ratio

    NASA Astrophysics Data System (ADS)

    Webster, Nathan A. S.; Pownceby, Mark I.; Madsen, Ian C.; Studer, Andrew J.; Manuel, James R.; Kimpton, Justin A.

    2014-12-01

    Effects of basicity, B (CaO:SiO2 ratio) on the thermal range, concentration, and formation mechanisms of silico-ferrite of calcium and aluminum (SFCA) and SFCA-I iron ore sinter bonding phases have been investigated using an in situ synchrotron X-ray diffraction-based methodology with subsequent Rietveld refinement-based quantitative phase analysis. SFCA and SFCA-I phases are the key bonding materials in iron ore sinter, and improved understanding of the effects of processing parameters such as basicity on their formation and decomposition may assist in improving efficiency of industrial iron ore sintering operations. Increasing basicity significantly increased the thermal range of SFCA-I, from 1363 K to 1533 K (1090 °C to 1260 °C) for a mixture with B = 2.48, to ~1339 K to 1535 K (1066 °C to 1262 °C) for a mixture with B = 3.96, and to ~1323 K to 1593 K (1050 °C to 1320 °C) at B = 4.94. Increasing basicity also increased the amount of SFCA-I formed, from 18 wt pct for the mixture with B = 2.48 to 25 wt pct for the B = 4.94 mixture. Higher basicity of the starting sinter mixture will, therefore, increase the amount of SFCA-I, considered to be more desirable of the two phases. Basicity did not appear to significantly influence the formation mechanism of SFCA-I. It did, however, affect the formation mechanism of SFCA, with the decomposition of SFCA-I coinciding with the formation of a significant amount of additional SFCA in the B = 2.48 and 3.96 mixtures but only a minor amount in the highest basicity mixture. In situ neutron diffraction enabled characterization of the behavior of magnetite after melting of SFCA produced a magnetite plus melt phase assemblage.

  17. Development and Validation of a Risk-Adjustment Tool in Acute Asthma

    PubMed Central

    Tsai, Chu-Lin; Clark, Sunday; Sullivan, Ashley F; Camargo, Carlos A

    2009-01-01

    Objective To develop and prospectively validate a risk-adjustment tool in acute asthma. Data Sources Data were obtained from two large studies on acute asthma, the Multicenter Airway Research Collaboration (MARC) and the National Emergency Department Safety Study (NEDSS) cohorts. Both studies involved >60 emergency departments (EDs) and were performed during 1996–2001 and 2003–2006, respectively. Both included patients aged 18–54 years presenting to the ED with acute asthma. Study Design Retrospective cohort studies. Data Collection Clinical information was obtained from medical record review. The risk index was derived in the MARC cohort and then was prospectively validated in the NEDSS cohort. Principle Findings There were 3,515 patients in the derivation cohort and 3,986 in the validation cohort. The risk index included nine variables (age, sex, current smoker, ever admitted for asthma, ever intubated for asthma, duration of symptoms, respiratory rate, peak expiratory flow, and number of beta-agonist treatments) and showed satisfactory discrimination (area under the receiver operating characteristic curve, 0.75) and calibration (p=.30 for Hosmer–Lemeshow test) when applied to the validation cohort. Conclusions We developed and validated a novel risk-adjustment tool in acute asthma. This tool can be used for health care provider profiling to identify outliers for quality improvement purposes. PMID:19619246

  18. Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking.

    PubMed

    Rose, Sherri; Zaslavsky, Alan M; McWilliams, J Michael

    2016-03-01

    Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients.

  19. Increased Waist-to-height Ratio May Contribute to Age-related Increase in Cardiovascular Risk Factors

    PubMed Central

    Akhlaghi, Masoumeh; Kamali, Majid; Dastsouz, Farideh; Sadeghi, Fatemeh; Amanat, Sassan

    2016-01-01

    Background: The risk of cardiovascular diseases (CVDs) increases with age. The objective was to determine whether lifestyle and dietary behaviors and anthropometric measures, which are affected by these behaviors, contribute to the increase of CVD risk factors across age categories of 20–50-year-old. Methods: In a cross-sectional design, 437 adults aged 20–50-year-old were selected from households living in Shiraz. Risk factors of CVD, including body mass index (BMI), waist-to-height ratio (WHtR), blood pressure, fasting blood glucose (FBG), serum triglycerides, total cholesterol, and low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively) as well as lifestyle behaviors (physical activity and smoking), dietary habits, and food intakes were assessed across the age categories of 20–29, 30–39, and 40–50 years. Linear regression was used to examine the contribution of different variables to the age-related increase of CVD risk factors. Results: All CVD risk factors, except for HDL-C, significantly increased across age categories. Older subjects had healthier dietary habits and food intakes, but they possessed nonsignificantly lower physical activity and higher smoking rate compared to younger adults. Adjusting for physical activity, smoking, and BMI did not change the significant positive association between age and CVD risk factors but adjusting for WHtR disappeared associations for blood pressure, triglycerides, and metabolic syndrome although significant associations remained for FBG and total and LDL-C. Conclusions: Age-related increase of CVD risk factors occurred independent of lifestyle habits. WHtR, but not BMI, may partially contribute to the age-related increase in CVD risk factors. PMID:27195100

  20. Plasma triglyceride/HDL-cholesterol ratio, insulin resistance, and cardiometabolic risk in young adults

    PubMed Central

    Murguía-Romero, Miguel; Jiménez-Flores, J. Rafael; Sigrist-Flores, Santiago C.; Espinoza-Camacho, Miguel A.; Jiménez-Morales, Mayra; Piña, Enrique; Méndez-Cruz, A. René; Villalobos-Molina, Rafael; Reaven, Gerald M.

    2013-01-01

    Studies in mature adults suggest that the plasma concentration ratio of triglyceride (TG)/HDL-cholesterol (HDL-C) provides a simple way to identify apparently healthy individuals who are insulin resistant (IR) and at increased cardiometabolic risk. This study extends these observations by examining the clinical utility of the TG/HDL-C ratio and the metabolic syndrome (MetS) in 2,244 healthy college students (17–24 years old) of Mexican Mestizo ancestry. The TG/HDL-C ratio separating the 25% with the highest value was used to identify IR and increased cardiometabolic risk. Cardiometabolic risk factors were more adverse in men and women whose TG/HDL-C ratios exceeded 3.5 and 2.5, respectively, and approximately one third were identified as being IR. The MetS identified fewer individuals as being IR, but their risk profile was accentuated. In conclusion, both a higher TG/HDL-C ratio and a diagnosis of the MetS identify young IR individuals with an increased cardiometabolic risk profile. The TG/HDL-C ratio identified a somewhat greater number of “high risk” subjects, whereas the MetS found a group whose risk profile was somewhat magnified. These findings suggest that the TG/HDL-C ratio may serve as a simple and clinically useful approach to identify apparently healthy, young individuals who are IR and at increased cardiometabolic risk. PMID:23863983

  1. 12 CFR Appendix B to Part 3 - Risk-Based Capital Guidelines; Market Risk Adjustment

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... internal model may use any generally accepted measurement techniques, such as variance-covariance models, historical simulations, or Monte Carlo simulations. However, the level of sophistication and accuracy of a... from business trading units. (2) The bank's internal risk measurement model must be integrated into...

  2. 12 CFR Appendix B to Part 3 - Risk-Based Capital Guidelines; Market Risk Adjustment

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Basle Committee on Banking Supervision and endorsed by the Group of Ten Central Bank Governors. The... trading activity 2 (on a worldwide consolidated basis) equals: 2 Trading activity means the gross sum of...) The bank must have a risk control unit that reports directly to senior management and is...

  3. Need for risk adjustment in adapting episode grouping software to Medicare data.

    PubMed

    MaCurdy, Thomas; Kerwin, Jason; Theobald, Nick

    2009-01-01

    Episode grouper software offers a potential framework for developing important components of a pay-for-performance system for healthcare providers. If the costs for treating health conditions can be computed, then policymakers can in principle benchmark different providers' cost distributions and reward the most efficient. This article applies two of the most prominent commercial groupers and examines the properties of the cost distributions calculated for their constructed episodes. The analysis reveals that episode cost distributions exhibit substantial variation and skewness, suggesting the need for innovative risk adjustment methods prior to utilizing groupers for the purpose of physician profiling.

  4. Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protective Factors

    ERIC Educational Resources Information Center

    Walton, Katherine M.; Ingersoll, Brooke R.

    2015-01-01

    This study compared sibling adjustment and relationships in siblings of children with Autism Spectrum Disorder (ASD-Sibs; n = 69) and siblings of children with typical development (TD-Sibs; n = 93). ASD-Sibs and TD-Sibs demonstrated similar emotional/behavioral adjustment. Older male ASD-Sibs were at increased risk for difficulties. Sibling…

  5. Breeds of risk-adjusted fundamentalist strategies in an order-driven market

    NASA Astrophysics Data System (ADS)

    LiCalzi, Marco; Pellizzari, Paolo

    2006-01-01

    This paper studies an order-driven stock market where agents have heterogeneous estimates of the fundamental value of the risky asset. The agents are budget-constrained and follow a value-based trading strategy which buys or sells depending on whether the price of the asset is below or above its risk-adjusted fundamental value. This environment generates returns that are remarkably leptokurtic and fat-tailed. By extending the study over a grid of different parameters for the fundamentalist trading strategy, we exhibit the existence of monotone relationships between the bid-ask spread demanded by the agents and several statistics of the returns. We conjecture that this effect, coupled with positive dependence of the risk premium on the volatility, generates positive feedbacks that might explain volatility bursts.

  6. A Bayesian adaptive blinded sample size adjustment method for risk differences.

    PubMed

    Hartley, Andrew Montgomery

    2015-01-01

    Adaptive sample size adjustment (SSA) for clinical trials consists of examining early subsets of on trial data to adjust estimates of sample size requirements. Blinded SSA is often preferred over unblinded SSA because it obviates many logistical complications of the latter and generally introduces less bias. On the other hand, current blinded SSA methods for binary data offer little to no new information about the treatment effect, ignore uncertainties associated with the population treatment proportions, and/or depend on enhanced randomization schemes that risk partial unblinding. I propose an innovative blinded SSA method for use when the primary analysis is a non-inferiority or superiority test regarding a risk difference. The method incorporates evidence about the treatment effect via the likelihood function of a mixture distribution. I compare the new method with an established one and with the fixed sample size study design, in terms of maximization of an expected utility function. The new method maximizes the expected utility better than do the comparators, under a range of assumptions. I illustrate the use of the proposed method with an example that incorporates a Bayesian hierarchical model. Lastly, I suggest topics for future study regarding the proposed methods.

  7. Synthesis gas production with an adjustable H{sub 2}/CO ratio through the coal gasification process: effects of coal ranks and methane addition

    SciTech Connect

    Yan Cao; Zhengyang Gao; Jing Jin; Hongchang Zhou; Marten Cohron; Houying Zhao; Hongying Liu; Weiping Pan

    2008-05-15

    Direct production of synthesis gas using coal as a cheap feedstock is attractive but challenging due to its low H{sub 2}/CO ratio of generated synthesis gas. Three typical U.S. coals of different ranks were tested in a 2.5 in. coal gasifier to investigate their gasification reactivity and adjustability on H{sub 2}/CO ratio of generated synthesis gas with or without the addition of methane. Tests indicated that lower-rank coals (lignite and sub-bituminous) have higher gasification reactivity than bituminous coals. The coal gasification reactivity is correlated to its synthesis-gas yield and the total percentage of H{sub 2} and CO in the synthesis gas, but not to the H{sub 2}/CO ratio. The H{sub 2}/CO ratio of coal gasification was found to be correlated to the rank of coals, especially the H/C ratio of coals. Methane addition into the dense phase of the pyrolysis and gasification zone of the cogasification reactor could make the best use of methane in adjusting the H{sub 2}/CO ratio of the generated synthesis gas. The maximum methane conversion efficiency, which was likely correlated to its gasification reactivity, could be achieved by 70% on average for all tested coals. The actual catalytic effect of generated coal chars on methane conversion seemed coal-dependent. The coal-gasification process benefits from methane addition and subsequent conversion on the adjustment of the H{sub 2}/CO ratio of synthesis gas. The methane conversion process benefits from the use of coal chars due to their catalytic effects. This implies that there were likely synergistic effects on both. 25 refs., 3 figs., 3

  8. Quantifying Geographic Variation in Health Care Outcomes in the United States before and after Risk-Adjustment

    PubMed Central

    Matheson, David H. M.; Ringel, Michael; VonAchen, Paige; Lesser, Richard I.; Li, Yue; Dimick, Justin B.; Gawande, Atul A.; Larsson, Stefan H.; Moses, Hamilton

    2016-01-01

    Background Despite numerous studies of geographic variation in healthcare cost and utilization at the local, regional, and state levels across the U.S., a comprehensive characterization of geographic variation in outcomes has not been published. Our objective was to quantify variation in US health outcomes in an all-payer population before and after risk-adjustment. Methods and Findings We used information from 16 independent data sources, including 22 million all-payer inpatient admissions from the Healthcare Cost and Utilization Project (which covers regions where 50% of the U.S. population lives) to analyze 24 inpatient mortality, inpatient safety, and prevention outcomes. We compared outcome variation at state, hospital referral region, hospital service area, county, and hospital levels. Risk-adjusted outcomes were calculated after adjusting for population factors, co-morbidities, and health system factors. Even after risk-adjustment, there exists large geographical variation in outcomes. The variation in healthcare outcomes exceeds the well publicized variation in US healthcare costs. On average, we observed a 2.1-fold difference in risk-adjusted mortality outcomes between top- and bottom-decile hospitals. For example, we observed a 2.3-fold difference for risk-adjusted acute myocardial infarction inpatient mortality. On average a 10.2-fold difference in risk-adjusted patient safety outcomes exists between top and bottom-decile hospitals, including an 18.3-fold difference for risk-adjusted Central Venous Catheter Bloodstream Infection rates. A 3.0-fold difference in prevention outcomes exists between top- and bottom-decile counties on average; including a 2.2-fold difference for risk-adjusted congestive heart failure admission rates. The population, co-morbidity, and health system factors accounted for a range of R2 between 18–64% of variability in mortality outcomes, 3–39% of variability in patient safety outcomes, and 22–70% of variability in

  9. The risk-adjusted vision beyond casemix (DRG) funding in Australia. International lessons in high complexity and capitation.

    PubMed

    Antioch, Kathryn M; Walsh, Michael K

    2004-06-01

    Hospitals throughout the world using funding based on diagnosis-related groups (DRG) have incurred substantial budgetary deficits, despite high efficiency. We identify the limitations of DRG funding that lack risk (severity) adjustment for State-wide referral services. Methods to risk adjust DRGs are instructive. The average price in casemix funding in the Australian State of Victoria is policy based, not benchmarked. Average cost weights are too low for high-complexity DRGs relating to State-wide referral services such as heart and lung transplantation and trauma. Risk-adjusted specified grants (RASG) are required for five high-complexity respiratory, cardiology and stroke DRGs incurring annual deficits of $3.6 million due to high casemix complexity and government under-funding despite high efficiency. Five stepwise linear regressions for each DRG excluded non-significant variables and assessed heteroskedasticity and multicollinearlity. Cost per patient was the dependent variable. Significant independent variables were age, length-of-stay outliers, number of disease types, diagnoses, procedures and emergency status. Diagnosis and procedure severity markers were identified. The methodology and the work of the State-wide Risk Adjustment Working Group can facilitate risk adjustment of DRGs State-wide and for Treasury negotiations for expenditure growth. The Alfred Hospital previously negotiated RASG of $14 million over 5 years for three trauma and chronic DRGs. Some chronic diseases require risk-adjusted capitation funding models for Australian Health Maintenance Organizations as an alternative to casemix funding. The use of Diagnostic Cost Groups can facilitate State and Federal government reform via new population-based risk adjusted funding models that measure health need.

  10. Acute anticoagulation adjustment in patients with atrial fibrillation at risk for stroke: approaches, strategies, risks and benefits.

    PubMed

    Olshansky, Brian; Guo, Hongsheng

    2005-07-01

    The acute management of anticoagulation in patients with atrial fibrillation to prevent stroke and other thromboembolic complications includes the use of individualized strategies tailored to the patient and based on the situation (cardioversion, surgeries, dental procedures, cardiac interventions, other invasive procedures and initiation of, or adjustment to, warfarin dosing). The vast range of choices can cause confusion and few randomized controlled clinical trials in this area provide adequate guidance. Chronic anticoagulation management is more straightforward since clinical evidence is ample, randomized clinical trial data provides cogent informaiton and guidelines have been established. Acute management of anticoagulation in patients with atrial fibrillation to prevent thromboembolic complications is often unrecognized but is emerging as a crucial, but challenging, and increasingly complex aspect of the care of patients with atrial fibrillation. This review addresses issues regarding such patients who may be at risk for stroke and require acute adjustments of anticoagulation (in light of, or in lieu of, chronic anticoagulation). Several promising new strategies are considered in light of established medical care. This analysis provides practical recommendations based on available data and presents results from recent investigations that may provide insight into future strategies.

  11. Adjustment of offspring sex ratios in relation to the availability of resources for philopatric offspring in the common brushtail possum.

    PubMed Central

    Johnson, C. N.; Clinchy, M.; Taylor, A. C.; Krebs, C. J.; Jarman, P. J.; Payne, A.; Ritchie, E. G.

    2001-01-01

    The local-resource-competition hypothesis predicts that where philopatric offspring compete for resources with their mothers, offspring sex ratios will be biased in favour of the dispersing sex. This should produce variation in sex ratios between populations in relation to differences in the availability of resources for philopatric offspring. However, previous tests of local resource competition in mammals have used indirect measures of resource availability and have focused on sex-ratio variation between species or individuals rather than between local populations. Here, we show that the availability of den sites predicts the offspring sex ratio in populations of the common brushtail possum. Female possums defend access to dens, and daughters, but not sons, occupy dens within their mother's range. However, the abundances of possums in our study areas were determined principally by food availability. Consequently, in food-rich areas with a high population density, the per-capita availability of dens was low, and the cost of having a daughter should have been high. This cost was positively correlated with male bias in the sex ratio at birth. Low per capita availability of dens was correlated with male bias in the sex ratio at birth. PMID:11571046

  12. Characterization of the human kinetic adjustment factor for the health risk assessment of environmental contaminants.

    PubMed

    Valcke, Mathieu; Krishnan, Kannan

    2014-03-01

    A default uncertainty factor of 3.16 (√10) is applied to account for interindividual variability in toxicokinetics when performing non-cancer risk assessments. Using relevant human data for specific chemicals, as WHO/IPCS suggests, it is possible to evaluate, and replace when appropriate, this default factor by quantifying chemical-specific adjustment factors for interindividual variability in toxicokinetics (also referred to as the human kinetic adjustment factor, HKAF). The HKAF has been determined based on the distributions of pharmacokinetic parameters (e.g., half-life, area under the curve, maximum blood concentration) in relevant populations. This article focuses on the current state of knowledge of the use of physiologically based algorithms and models in characterizing the HKAF for environmental contaminants. The recent modeling efforts on the computation of HKAF as a function of the characteristics of the population, chemical and its mode of action (dose metrics), as well as exposure scenario of relevance to the assessment are reviewed here. The results of these studies, taken together, suggest the HKAF varies as a function of the sensitive subpopulation and dose metrics of interest, exposure conditions considered (route, duration, and intensity), metabolic pathways involved and theoretical model underlying its computation. The HKAF seldom exceeded the default value of 3.16, except in very young children (i.e., <≈ 3 months) and when the parent compound is the toxic moiety. Overall, from a public health perspective, the current state of knowledge generally suggest that the default uncertainty factor is sufficient to account for human variability in non-cancer risk assessments of environmental contaminants.

  13. Exact inference for the risk ratio with an imperfect diagnostic test.

    PubMed

    Reiczigel, J; Singer, J; Lang, Z S

    2017-01-01

    The risk ratio quantifies the risk of disease in a study population relative to a reference population. Standard methods of estimation and testing assume a perfect diagnostic test having sensitivity and specificity of 100%. However, this assumption typically does not hold, and this may invalidate naive estimation and testing for the risk ratio. We propose procedures that control for sensitivity and specificity of the diagnostic test, given the risks are measured by proportions, as it is in cross-sectional studies or studies with fixed follow-up times. These procedures provide an exact unconditional test and confidence interval for the true risk ratio. The methods also cover the case when sensitivity and specificity differ in the two groups (differential misclassification). The resulting test and confidence interval may be useful in epidemiological studies as well as in clinical and vaccine trials. We illustrate the method with real-life examples which demonstrate that ignoring sensitivity and specificity of the diagnostic test may lead to considerable bias in the estimated risk ratio.

  14. Contextual, Ecological and Organizational Variations in Risk-Adjusted COPD and Asthma Hospitalization Rates of Rural Medicare Beneficiaries.

    PubMed

    Wan, Thomas T H; Lin, Yi-Ling; Ortiz, Judith

    2016-01-01

    The purpose of this study is to examine what factors contributing to the variability in chronic obstructive pulmonary disorder (COPD) and asthma hospitalization rates when the influence of patient characteristics is being simultaneously considered by applying a risk adjustment method. A longitudinal analysis of COPD and asthma hospitalization of rural Medicare beneficiaries in 427 rural health clinics (RHCs) was conducted utilizing administrative data and inpatient and outpatient claims from Region 4. The repeated measures of risk-adjusted COPD and asthma admission rate were analyzed by growth curve modeling. A generalized estimating equation (GEE) method was used to identify the relevance of selected predictors in accounting for the variability in risk-adjusted admission rates for COPD and asthma. Both adjusted and unadjusted rates of COPD admission showed a slight decline from 2010 to 2013. The growth curve modeling showed the annual rates of change were gradually accentuated through time. GEE revealed that a moderate amount of variance (marginal R(2) = 0.66) in the risk-adjusted hospital admission rates for COPD and asthma was accounted for by contextual, ecological, and organizational variables. The contextual, ecological, and organizational factors are those associated with RHCs, not hospitals. We cannot infer how the variability in hospital practices in RHC service areas may have contributed to the disparities in admissions. Identification of RHCs with substantially higher rates than an average rate can portray the need for further enhancement of needed ambulatory or primary care services for the specific groups of RHCs. Because the risk-adjusted rates of hospitalization do not very by classification of rural area, future research should address the variation in a specific COPD and asthma condition of RHC patients. Risk-adjusted admission rates for COPD and asthma are influenced by the synergism of multiple contextual, ecological, and organizational factors

  15. Population-Adjusted Street Connectivity, Urbanicity and Risk of Obesity in the U.S

    PubMed Central

    Wang, Fahui; Wen, Ming; Xu, Yanqing

    2013-01-01

    Street connectivity, defined as the number of (3-way or more) intersections per area unit, is an important index of built environments as a proxy for walkability in a neighborhood. This paper examines its geographic variations across the rural-urban continuum (urbanicity), major racial-ethnic groups and various poverty levels. The population-adjusted street connectivity index is proposed as a better measure than the regular index for a large area such as county due to likely concentration of population in limited space within the large area. Based on the data from the Behavioral Risk Factor Surveillance System (BRFSS), this paper uses multilevel modeling to analyze its association with physical activity and obesity while controlling for various individual and county-level variables. Analysis of data subsets indicates that the influences of individual and county-level variables on obesity risk vary across areas of different urbanization levels. The positive influence of street connectivity on obesity control is limited to the more but not the mostly urbanized areas. This demonstrates the value of obesogenic environment research in different geographic settings, helps us reconcile and synthesize some seemingly contradictory results reported in different studies, and also promotes that effective policies need to be highly sensitive to the diversity of demographic groups and geographically adaptable. PMID:23667278

  16. Historical cohort study of US man-made vitreous fiber production workers: VI. Respiratory system cancer standardized mortality ratios adjusted for the confounding effect of cigarette smoking.

    PubMed

    Marsh, G M; Buchanich, J M; Youk, A O

    2001-09-01

    To date, the US cohort study of man-made vitreous fiber workers has provided no consistent evidence of a relationship between man-made vitreous fiber exposure and mortality from malignant or non-malignant respiratory disease. Nevertheless, there have been small, overall excesses in respiratory system cancer (RSC) among workers from the fiberglass and rock/slag wool production plants included in the study that were unexplained by estimated worker exposures to respirable fiber or other agents present in the plants. The present investigation was designed to provide a quantitative estimate of the extent to which the overall excess in RSC mortality observed at the total cohort level among male fiberglass and rock/slag wool workers is a result of the positive confounding effects of cigarette smoking. Because cigarette-smoking data were neither available nor obtainable at the individual level for all members of the fiberglass and rock/slag wool cohorts, we used the "indirect" method to adjust RSC standardized mortality ratios (SMRs) at the group (cohort and plant) level. Our adjustment suggested that cigarette smoking accounts for all of the 7% and 24% excesses in RSC observed, respectively, for the male fiberglass and rock/slag wool cohorts in the latest mortality updates. The same conclusion was reached regardless of which of several alternative formulations were used to adjust local rate-based RSC SMRs. We found that our smoking adjustments were robust with respect to several alternative characterizations and (with the exception of one fiberglass plant) produced adjusted RSC SMRs that were lower than their unadjusted counterparts. Further, all statistically significantly elevated unadjusted SMRs were reduced to not statistically significant levels. These results reaffirm that RSC SMRs based on US and local rates must take into account the potential confounding effects of cigarette smoking. They also suggest that the use of local county mortality rate-based SMRs may not

  17. Relations of Growth in Effortful Control to Family Income, Cumulative Risk, and Adjustment in Preschool-age Children

    PubMed Central

    Lengua, Liliana J.; Moran, Lyndsey; Zalewski, Maureen; Ruberry, Erika; Kiff, Cara; Thompson, Stephanie

    2014-01-01

    The study examined growth in effortful control (executive control, delay ability) in relation to income, cumulative risk (aggregate of demographic and psychosocial risk factors), and adjustment in 306 preschool-age children (50% girls, 50% boys) from families representing a range of income (29% at- or near-poverty; 28% lower-income; 25% middle-income; 18% upper-income), with 4 assessments starting at 36–40 mos. Income was directly related to levels of executive control and delay ability. Cumulative risk accounted for the effects of income on delay ability but not executive control. Higher initial executive control and slope of executive control and delay ability predicted academic readiness, whereas levels, but not growth, of executive control and delay ability predicted social competence and adjustment problems. Low income is a marker for lower effortful control, which demonstrates additive or mediating effects in the relation of income to children’s preschool adjustment. PMID:25253079

  18. Relations of growth in effortful control to family income, cumulative risk, and adjustment in preschool-age children.

    PubMed

    Lengua, Liliana J; Moran, Lyndsey; Zalewski, Maureen; Ruberry, Erika; Kiff, Cara; Thompson, Stephanie

    2015-05-01

    The study examined growth in effortful control (executive control, delay ability) in relation to income, cumulative risk (aggregate of demographic and psychosocial risk factors), and adjustment in 306 preschool-age children (50 % girls, 50 % boys) from families representing a range of income (29 % at- or near-poverty; 28 % lower-income; 25 % middle-income; 18 % upper-income), with 4 assessments starting at 36-40 month. Income was directly related to levels of executive control and delay ability. Cumulative risk accounted for the effects of income on delay ability but not executive control. Higher initial executive control and slope of executive control and delay ability predicted academic readiness, whereas levels, but not growth, of executive control and delay ability predicted social competence and adjustment problems. Low income is a marker for lower effortful control, which demonstrates additive or mediating effects in the relation of income to children's preschool adjustment.

  19. The Effect of Complementary and Alternative Medicine Claims on Risk Adjustment

    PubMed Central

    Lind, Bonnie K.; Abrams, Chad; Lafferty, William E.; Kiehr, Paula K.; Grembowski, David E.

    2006-01-01

    Objective To assess how the inclusion of diagnoses from complementary and alternative medicine (CAM) providers affects measures of morbidity burden and expectations of health care resource use for insured patients. Methods Claims data from Washington State were used to create two versions of a case-mix index. One version included claims from all provider types; the second version omitted claims from CAM providers who are covered under commercial insurance. Expected resource use was also calculated. The distribution of expected and actual resource use was then compared for the two indices. Results Inclusion of CAM providers shifts many patients into higher morbidity categories; 54% of 61,914 CAM users had higher risk scores in the index which included CAM providers. When expected resource use categories were defined based on all providers, CAM users in the highest morbidity category had average (± s.d.) annual expenditures of $6661 (± $13,863). This was less than those in the highest morbidity category when CAM providers were not included in the index ($8562 ± $16,354), and was also lower than the highest morbidity patients who did not use any CAM services ($8419 ± $18,885). Conclusions Inclusion of services from CAM providers under third party payment increases risk scores for their patients but expectations of costs for this group are lower than expected had costs been estimated based only on services from traditional providers. Additional work is needed to validate risk adjustment indices when adding services from provider groups not included in the development of the index. PMID:17122711

  20. Adjusting for risk selection in state health insurance exchanges will be critically important and feasible, but not easy.

    PubMed

    Weiner, Jonathan P; Trish, Erin; Abrams, Chad; Lemke, Klaus

    2012-02-01

    The Affordable Care Act calls for the establishment of state-level health insurance exchanges. The viability and success of these exchanges will require effective risk-adjustment strategies to compensate for differences in enrollees' health status across health plans. This article describes why the Affordable Care Act could lead to favorable or adverse risk selection across plans. It reviews provisions in the act and recent proposed regulations intended to mitigate the problem of risk selection. We performed a simulation that showed that under the premium rating restrictions in the law, large incentives for insurers to attract healthier enrollees will be likely to persist-resulting in substantial overpayment to plans with very healthy enrollees and underpayment to plans with very sick members. We conclude that risk adjustment based on patients' diagnoses, such as will be in place from 2014 on, will yield payments to insurers that will be more accurate than what will come solely from the age-adjusted and other rating allowed by the act. We also describe additional challenges of implementing risk adjustment.

  1. Waist-to-Height Ratio and Body Mass Index as Indicators of Cardiovascular Risk in Youth

    ERIC Educational Resources Information Center

    Keefer, Daniel J.; Caputo, Jennifer L.; Tseh, Wayland

    2013-01-01

    Background: The purpose of this investigation was to determine if waist-to-height ratio (WHTR) or body mass index (BMI) is the better indicator of cardiovascular disease risk in children and adolescents of varying ages. Methods: Data from children and adolescents (N?=?2300) who were part of the 2003-2004 National Health and Nutrition Examination…

  2. A simple procedure for estimating pseudo risk ratios from exposure to non-carcinogenic chemical mixtures.

    PubMed

    Scinicariello, Franco; Portier, Christopher

    2016-03-01

    Non-cancer risk assessment traditionally assumes a threshold of effect, below which there is a negligible risk of an adverse effect. The Agency for Toxic Substances and Disease Registry derives health-based guidance values known as Minimal Risk Levels (MRLs) as estimates of the toxicity threshold for non-carcinogens. Although the definition of an MRL, as well as EPA reference dose values (RfD and RfC), is a level that corresponds to "negligible risk," they represent daily exposure doses or concentrations, not risks. We present a new approach to calculate the risk at exposure to specific doses for chemical mixtures, the assumption in this approach is to assign de minimis risk at the MRL. The assigned risk enables the estimation of parameters in an exponential model, providing a complete dose-response curve for each compound from the chosen point of departure to zero. We estimated parameters for 27 chemicals. The value of k, which determines the shape of the dose-response curve, was moderately insensitive to the choice of the risk at the MRL. The approach presented here allows for the calculation of a risk from a single substance or the combined risk from multiple chemical exposures in a community. The methodology is applicable from point of departure data derived from quantal data, such as data from benchmark dose analyses or from data that can be transformed into probabilities, such as lowest-observed-adverse-effect level. The individual risks are used to calculate risk ratios that can facilitate comparison and cost-benefit analyses of environmental contamination control strategies.

  3. Gender Ratio Imbalance Effects on HIV Risk Behaviors in African American Women

    PubMed Central

    Newsome, Valerie; Airhihenbuwa, Collins O.

    2015-01-01

    Although literature suggests that African American women are no more likely to engage in risky sex than their White counterparts, they are more likely to have sex partners with higher HIV risk. Thus, it is not solely an individual’s behavior that determines their risk, but also the behavior of their partner and their position within a sexual network. For this reason, it is important to consider the dynamics of heterosexual relationships in the African American community. An important area of concern regarding African American heterosexual relationships is that of partner availability. A shortage of available African American men for potential partnerships exists and is reportedly due to poorer health and higher mortality rates. Some have argued that gender-ratio imbalance may be responsible for increased HIV vulnerability for African American women. This article reviews the literature on gender ratio imbalance and HIV risk in the African American community, and presents implications and suggestions for future research and intervention. PMID:23041754

  4. Anticipatory postural adjustments during cutting manoeuvres in football and their consequences for knee injury risk.

    PubMed

    Mornieux, Guillaume; Gehring, Dominic; Fürst, Patrick; Gollhofer, Albert

    2014-01-01

    Anticipatory postural adjustments (APAs), i.e. preparatory positioning of the head, the trunk and the foot, are essential to initiate cutting manoeuvres during football games. The aim of the present study was to determine how APA strategies during cutting manoeuvres are influenced by a reduction of the time available to prepare the movement. Thirteen football players performed different cutting tasks, with directions of cutting either known prior to the task or indicated by a light signal occurring 850, 600 or 500 ms before ground contact. With less time available to prepare the cutting manoeuvre, the head was less orientated towards the cutting direction (P = 0.033) and the trunk was even more rotated in the opposite direction (P = 0.002), while the foot placement was not significantly influenced. Moreover, the induced higher lateral trunk flexion correlated with the increased knee abduction moment (r = 0.41; P = 0.009). Increasing lateral trunk flexion is the main strategy used to successfully perform a cutting manoeuvre when less time is available to prepare the movement. However, higher lateral trunk flexion was associated with an increased knee abduction moment and therefore an increased knee injury risk. Reducing lateral trunk flexion during cutting manoeuvres should be part of training programs seeking the optimisation of APAs.

  5. Effortful control as a moderator of the relation between contextual risk factors and growth in adjustment problems.

    PubMed

    Lengua, Liliana J; Bush, Nicole R; Long, Anna C; Kovacs, Erica A; Trancik, Anika M

    2008-01-01

    Effortful control was examined as a moderator of the relations of three domains of contextual risk factors to growth in internalizing and externalizing problems in a community sample (N = 189) of children (8-12 years at Time 1). Socioeconomic, maternal, and environmental risk factors were examined as predictors of initial levels and growth in children's adjustment problems across 3 years. The effects of the risk factors depended on children's level of effortful control. For children lower in effortful control, socioeconomic risk was related to significantly higher initial levels of internalizing and externalizing problems and decreases over time. However, children lower in effortful control had higher levels of problems at all three time points than children higher in effortful control. Maternal risk was associated with increases in internalizing for children lower in effortful control, and environmental risk was related to increases in internalizing and externalizing problems for children lower in effortful control, but not those higher in effortful control. Children who were lower in effortful control appeared to experience more adverse effects of contextual risk than those higher in effortful control, suggesting that interventions aimed at improving children's effortful control might serve to protect children from increased risk of adjustment problems associated with contextual risk factors.

  6. A methodological approach to identify external factors for indicator-based risk adjustment illustrated by a cataract surgery register

    PubMed Central

    2014-01-01

    Background Risk adjustment is crucial for comparison of outcome in medical care. Knowledge of the external factors that impact measured outcome but that cannot be influenced by the physician is a prerequisite for this adjustment. To date, a universal and reproducible method for identification of the relevant external factors has not been published. The selection of external factors in current quality assurance programmes is mainly based on expert opinion. We propose and demonstrate a methodology for identification of external factors requiring risk adjustment of outcome indicators and we apply it to a cataract surgery register. Methods Defined test criteria to determine the relevance for risk adjustment are “clinical relevance” and “statistical significance”. Clinical relevance of the association is presumed when observed success rates of the indicator in the presence and absence of the external factor exceed a pre-specified range of 10%. Statistical significance of the association between the external factor and outcome indicators is assessed by univariate stratification and multivariate logistic regression adjustment. The cataract surgery register was set up as part of a German multi-centre register trial for out-patient cataract surgery in three high-volume surgical sites. A total of 14,924 patient follow-ups have been documented since 2005. Eight external factors potentially relevant for risk adjustment were related to the outcome indicators “refractive accuracy” and “visual rehabilitation” 2–5 weeks after surgery. Results The clinical relevance criterion confirmed 2 (“refractive accuracy”) and 5 (“visual rehabilitation”) external factors. The significance criterion was verified in two ways. Univariate and multivariate analyses revealed almost identical external factors: 4 were related to “refractive accuracy” and 7 (6) to “visual rehabilitation”. Two (“refractive accuracy”) and 5 (“visual rehabilitation”) factors

  7. A Proportional Hazards Regression Model for the Sub-distribution with Covariates Adjusted Censoring Weight for Competing Risks Data

    PubMed Central

    HE, PENG; ERIKSSON, FRANK; SCHEIKE, THOMAS H.; ZHANG, MEI-JIE

    2015-01-01

    With competing risks data, one often needs to assess the treatment and covariate effects on the cumulative incidence function. Fine and Gray proposed a proportional hazards regression model for the subdistribution of a competing risk with the assumption that the censoring distribution and the covariates are independent. Covariate-dependent censoring sometimes occurs in medical studies. In this paper, we study the proportional hazards regression model for the subdistribution of a competing risk with proper adjustments for covariate-dependent censoring. We consider a covariate-adjusted weight function by fitting the Cox model for the censoring distribution and using the predictive probability for each individual. Our simulation study shows that the covariate-adjusted weight estimator is basically unbiased when the censoring time depends on the covariates, and the covariate-adjusted weight approach works well for the variance estimator as well. We illustrate our methods with bone marrow transplant data from the Center for International Blood and Marrow Transplant Research (CIBMTR). Here cancer relapse and death in complete remission are two competing risks. PMID:27034534

  8. Associations of apolipoprotein B/apolipoprotein A-I ratio with pre-diabetes and diabetes risks: a cross-sectional study in Chinese adults

    PubMed Central

    Zheng, Shuang; Han, Tingting; Xu, Hua; Zhou, Huan; Ren, Xingxing; Wu, Peihong; Zheng, Jun; Wang, Lihua; Zhang, Ming; Jiang, Yihong; Chen, Yawen; Qiu, Huiying; Liu, Wei; Hu, Yaomin

    2017-01-01

    Background Apolipoprotein B/apolipoprotein A-I (ApoB/ApoA-I) ratio is a useful predictor of cardiovascular risk. However, the association between the ApoB/ApoA-I ratio and the risk of type 2 diabetes mellitus (T2DM) is still obscure. Aims To investigate the associations between the ApoB/ApoA-I ratio and the risk of T2DM and pre-diabetes in a Chinese population, and to assess the role of gender in these associations. Methods A stratified random sampling design was used in this cross-sectional study which included 264 men and 465 women with normal glucose tolerance (NGT), pre-diabetes or T2DM. Serum ApoB, ApoA-I and other lipid and glycaemic traits were measured. Pearson's partial correlation and multivariable logistic analysis were used to evaluate the associations between ApoB/ApoA-I ratio and the risk of T2DM and pre-diabetes. Results The ApoB/ApoA-I ratios were significantly increased across the spectrum of NGT, pre-diabetes and T2DM. Women showed higher levels of ApoB/ApoA-I ratio and ApoB than men in the pre-diabetic and T2DM groups, but not in the NGT group. The ApoB/ApoA-I ratio was closely related with triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and other glycaemic traits. Moreover, in women, the risk of diabetes and pre-diabetes in the top and middle tertiles of the ApoB/ApoA-I ratio were 3.65-fold (95% CI 1.69 to 6.10) and 2.19-fold (95% CI 1.38 to 2.84) higher than in the bottom tertile, respectively, after adjusting for potential confounding factors. However, the associations disappeared in men after adjusting for other factors. Conclusions The ApoB/ApoA-I ratio showed positive associations with the risk of diabetes and pre-diabetes in Chinese women. PMID:28110289

  9. Adjustments of the Pesticide Risk Index Used in Environmental Policy in Flanders

    PubMed Central

    Fevery, Davina; Peeters, Bob; Lenders, Sonia; Spanoghe, Pieter

    2015-01-01

    Indicators are used to quantify the pressure of pesticides on the environment. Pesticide risk indicators typically require weighting environmental exposure by a no effect concentration. An indicator based on spread equivalents (ΣSeq) is used in environmental policy in Flanders (Belgium). The pesticide risk for aquatic life is estimated by weighting active ingredient usage by the ratio of their maximum allowable concentration and their soil halflife. Accurate estimates of total pesticide usage in the region are essential in such calculations. Up to 2012, the environmental impact of pesticides was estimated on sales figures provided by the Federal Government. Since 2013, pesticide use is calculated based on results from the Farm Accountancy Data Network (FADN). The estimation of pesticide use was supplemented with data for non-agricultural use based on sales figures of amateur use provided by industry and data obtained from public services. The Seq-indicator was modified to better reflect reality. This method was applied for the period 2009-2012 and showed differences between estimated use and sales figures of pesticides. The estimated use of pesticides based on accountancy data is more accurate compared to sales figures. This approach resulted in a better view on pesticide use and its respective environmental impact in Flanders. PMID:26046655

  10. Adjustments of the Pesticide Risk Index Used in Environmental Policy in Flanders.

    PubMed

    Fevery, Davina; Peeters, Bob; Lenders, Sonia; Spanoghe, Pieter

    2015-01-01

    Indicators are used to quantify the pressure of pesticides on the environment. Pesticide risk indicators typically require weighting environmental exposure by a no effect concentration. An indicator based on spread equivalents (ΣSeq) is used in environmental policy in Flanders (Belgium). The pesticide risk for aquatic life is estimated by weighting active ingredient usage by the ratio of their maximum allowable concentration and their soil halflife. Accurate estimates of total pesticide usage in the region are essential in such calculations. Up to 2012, the environmental impact of pesticides was estimated on sales figures provided by the Federal Government. Since 2013, pesticide use is calculated based on results from the Farm Accountancy Data Network (FADN). The estimation of pesticide use was supplemented with data for non-agricultural use based on sales figures of amateur use provided by industry and data obtained from public services. The Seq-indicator was modified to better reflect reality. This method was applied for the period 2009-2012 and showed differences between estimated use and sales figures of pesticides. The estimated use of pesticides based on accountancy data is more accurate compared to sales figures. This approach resulted in a better view on pesticide use and its respective environmental impact in Flanders.

  11. Preparation of hydrophilic interaction/ion-exchange mixed-mode chromatographic stationary phase with adjustable selectivity by controlling different ratios of the co-monomers.

    PubMed

    Bo, Chunmiao; Wang, Xiaomeng; Wang, Chaozhan; Wei, Yinmao

    2017-03-03

    Development of mixed-mode chromatography (MMC) stationary phase with adjustable selectivity is beneficial to meet the needs of complex samples. In this work, surface-initiated atom transfer radical polymerization (SI-ATRP) using the mixture of two functional monomers was proposed as a new preparation strategy for MMC stationary phase with adjustable selectivity. The mixture of sodium 4-styrenesulfonate (NASS) and dimethylaminoethyl methacrylate (DMAEMA) underwent SI-ATRP to bond poly(NASS-co-DMAEMA) on the surface of silica to prepare hydrophilic interaction/ion-exchange mixed-mode stationary phase. Various analytes (neutral, acidic, basic analytes and strong polar nucleosides) were employed to investigate the retention behaviors. The influences of water content and pH of the mobile phase on the retention validated the mixed-mode retention mechanisms of HILIC and ion-exchange. The charge and polarity of stationary phase as well as the separation selectivity were conveniently manipulated by the ratio of NASS to DMAEMA monomer, and the use of DMAEMA in the mixture additionally endowed the column with the temperature-responsive characteristics. Moreover, the application of the developed column was demonstrated by the successful separation of nucleosides, β-agonists and safflower injection. In a word, the proposed strategy can be potentially applied in the controllable preparation of MMC stationary phase with adjustable selectivity.

  12. Risk assessment of diesel exhaust and lung cancer: combining human and animal studies after adjustment for biases in epidemiological studies

    PubMed Central

    2011-01-01

    Background Risk assessment requires dose-response data for the evaluation of the relationship between exposure to an environmental stressor and the probability of developing an adverse health effect. Information from human studies is usually limited and additional results from animal studies are often needed for the assessment of risks in humans. Combination of risk estimates requires an assessment and correction of the important biases in the two types of studies. In this paper we aim to illustrate a quantitative approach to combining data from human and animal studies after adjusting for bias in human studies. For our purpose we use the example of the association between exposure to diesel exhaust and occurrence of lung cancer. Methods Firstly, we identify and adjust for the main sources of systematic error in selected human studies of the association between occupational exposure to diesel exhaust and occurrence of lung cancer. Evidence from selected animal studies is also accounted for by extrapolating to average ambient, occupational exposure concentrations of diesel exhaust. In a second stage, the bias adjusted effect estimates are combined in a common effect measure through meta-analysis. Results The random-effects pooled estimate (RR) for exposure to diesel exhaust vs. non-exposure was found 1.37 (95% C.I.: 1.08-1.65) in animal studies and 1.59 (95% C.I.: 1.09-2.10) in human studies, whilst the overall was found equal to 1.49 (95% C.I.: 1.21-1.78) with a greater contribution from human studies. Without bias adjustment in human studies, the pooled effect estimate was 1.59 (95% C.I.: 1.28-1.89). Conclusions Adjustment for the main sources of uncertainty produced lower risk estimates showing that ignoring bias leads to risk estimates potentially biased upwards. PMID:21481231

  13. Multi-nutrient supplement improves hormone ratio associated with cancer risk

    PubMed Central

    2013-01-01

    Background Gynecological cancers are among the most common in women and are directly related to a variety of hormonal factors. One potential risk factor associated with developing a gynecological malignancy is the ratio of two hormone metabolites, 2-Hydroxyestrone (2-HE) and 16alpha-Hydroxyestrone (16alpha-HE). A number of botanical constituents such as indoles, flavonoids, and resveratrol have been shown to have a favorable effect on the metabolic pathways that affect this ratio. The present study was designed to evaluate if a multi-nutrient supplement containing targeted botanical constituents would affect the 2-HE/16 alpha-HE ratio in middle-aged women. Methods A retrospective analysis was performed on 76 female patients (mean age 54 years) who received 2-HE/16 alpha-HE ratio assessments at two separate time points. The ratio assessment was part of standard care for women who presented with risk indicators associated with a high proliferative state. All patients who completed pre and post assessments were included. Sixty-five of the patients received a multi-nutrient supplement, Lucentia Peak®, during the study period. Eleven patients chose not to take the supplement, but did receive ratio assessments at similar time points as the treatment group, allowing for between group comparisons. Paired t-tests were used to compare the changes in the 2-HE and 16alpha-HE measures as well as their ratio, both within groups and between groups. Results The results demonstrated a significant increase in the 2-HE/16alpha-HE ratio in the treated group (pre 0.38 to post 0.57, p<0.0001), and was significantly different (p=0.02) compared to the change in the control group (pre 0.65 to post 0.64). This change appears to be mediated primarily by an increase in the 2-HE level. Individually, 54 patients given Lucentia Peak® had increased ratios while 11 patients had a decrease. In the control group, 3 patients had an increase in their ratio and 8 patients had a decrease. Conclusions

  14. Adjustment of costly extra-group paternity according to inbreeding risk in a cooperative mammal

    PubMed Central

    Cant, Michael A.; Sanderson, Jennifer L.

    2015-01-01

    Females of many animal species seek mating opportunities with multiple males, despite being able to obtain sufficient sperm to father their offspring from a single male. In animals that live in stable social groups, females often choose to mate outside their group resulting in extra-group paternity (EGP). One reason proposed to explain female choice for extra-group males is to obtain compatible genes, for example, in order to avoid inbreeding depression in offspring. The benefits of such extra-group paternities could be substantial if they result in fitter, outbred offspring. However, avoiding inbreeding in this way could be costly for females, for example, through retaliation by cuckolded males or through receiving aggression while prospecting for extra-group mating opportunities. We investigate the costs and benefits of EGP in the banded mongoose Mungos mungo, a cooperatively breeding mammal in which within-group mates are sometimes close relatives. We find that pups born to females that mate with extra-group males are more genetically heterozygous are heavier and are more likely to survive to independence than pups born to females that mate within their group. However, extra-group matings also involve substantial costs as they occur during violent encounters that sometimes result in injury and death. This appears to lead femalebanded mongooses to adaptively adjust EGP levels according to the current risk of inbreeding associated with mating within the group. For group-living animals, the costs of intergroup interactions may help to explain variation in both inbreeding rates and EGP within and between species. PMID:26609201

  15. Exact Confidence Intervals for the Relative Risk and the Odds Ratio

    PubMed Central

    Wang, Weizhen; Shan, Guogen

    2015-01-01

    Summary For comparison of proportions there are three commonly used measurements: the difference, the relative risk and the odds ratio. Significant effort has been spent on exact confidence intervals for the difference. In this paper, we focus on the relative risk and the odds ratio when data are collected from a matched-pairs design or a two-arm independent binomial experiment. Exact one-sided and two-sided confidence intervals are proposed for each configuration of two measurements and two types of data. The one-sided intervals are constructed using an inductive order, they are the smallest under the order, and are admissible under the set inclusion criterion. The two-sided intervals are the intersection of two one-sided intervals. R codes are developed to implement the intervals. Supplementary materials for this article are available online. PMID:26228945

  16. An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity

    PubMed Central

    Simopoulos, Artemis P.

    2016-01-01

    In the past three decades, total fat and saturated fat intake as a percentage of total calories has continuously decreased in Western diets, while the intake of omega-6 fatty acid increased and the omega-3 fatty acid decreased, resulting in a large increase in the omega-6/omega-3 ratio from 1:1 during evolution to 20:1 today or even higher. This change in the composition of fatty acids parallels a significant increase in the prevalence of overweight and obesity. Experimental studies have suggested that omega-6 and omega-3 fatty acids elicit divergent effects on body fat gain through mechanisms of adipogenesis, browning of adipose tissue, lipid homeostasis, brain-gut-adipose tissue axis, and most importantly systemic inflammation. Prospective studies clearly show an increase in the risk of obesity as the level of omega-6 fatty acids and the omega-6/omega-3 ratio increase in red blood cell (RBC) membrane phospholipids, whereas high omega-3 RBC membrane phospholipids decrease the risk of obesity. Recent studies in humans show that in addition to absolute amounts of omega-6 and omega-3 fatty acid intake, the omega-6/omega-3 ratio plays an important role in increasing the development of obesity via both AA eicosanoid metabolites and hyperactivity of the cannabinoid system, which can be reversed with increased intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). A balanced omega-6/omega-3 ratio is important for health and in the prevention and management of obesity. PMID:26950145

  17. An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity.

    PubMed

    Simopoulos, Artemis P

    2016-03-02

    In the past three decades, total fat and saturated fat intake as a percentage of total calories has continuously decreased in Western diets, while the intake of omega-6 fatty acid increased and the omega-3 fatty acid decreased, resulting in a large increase in the omega-6/omega-3 ratio from 1:1 during evolution to 20:1 today or even higher. This change in the composition of fatty acids parallels a significant increase in the prevalence of overweight and obesity. Experimental studies have suggested that omega-6 and omega-3 fatty acids elicit divergent effects on body fat gain through mechanisms of adipogenesis, browning of adipose tissue, lipid homeostasis, brain-gut-adipose tissue axis, and most importantly systemic inflammation. Prospective studies clearly show an increase in the risk of obesity as the level of omega-6 fatty acids and the omega-6/omega-3 ratio increase in red blood cell (RBC) membrane phospholipids, whereas high omega-3 RBC membrane phospholipids decrease the risk of obesity. Recent studies in humans show that in addition to absolute amounts of omega-6 and omega-3 fatty acid intake, the omega-6/omega-3 ratio plays an important role in increasing the development of obesity via both AA eicosanoid metabolites and hyperactivity of the cannabinoid system, which can be reversed with increased intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). A balanced omega-6/omega-3 ratio is important for health and in the prevention and management of obesity.

  18. Toward the Development of Integrative Risk-Adjusted Measures of Quality Using Large Clinical Data Bases: The Case of Anesthesia Services.

    ERIC Educational Resources Information Center

    Fleming, Steven T.

    1992-01-01

    The concept of risk-adjusted measures of quality is discussed, and a methodology is proposed for risk-adjusting and integrating multiple adverse outcomes of anesthesia services into measures for quality assurance and quality improvement programs. Although designed for a new anesthesiology database, the methods should apply to other health…

  19. Altering dietary lysine: arginine ratio has little effect on cardiovascular risk factors and vascular reactivity in moderately hypercholesterolemic adults

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Background: The effect of dietary protein type on cardiovascular risk factors and vascular reactivity, with specific focus on the lysine to arginine (Lys:Arg) ratio, has been studied sporadically. Objective: Determine effect of dietary Lys:Arg ratio on cardiovascular risk factors and vascular reacti...

  20. Adjusting for reverse causation to estimate the effect of obesity on mortality after incident heart failure in the Atherosclerosis Risk in Communities (ARIC) study

    PubMed Central

    2016-01-01

    OBJECTIVES: The lower mortality rate of obese patients with heart failure (HF) has been partly attributed to reverse causation bias due to weight loss caused by disease. Using data about weight both before and after HF, this study aimed to adjust for reverse causation and examine the association of obesity both before and after HF with mortality. METHODS: Using the Atherosclerosis Risk in Communities (ARIC) study, 308 patients with data available from before and after the incidence of HF were included. Pre-morbid and post-morbid obesity were defined based on body mass index measurements at least three months before and after incident HF. The associations of pre-morbid and post-morbid obesity and weight change with survival after HF were evaluated using a Cox proportional hazard model. RESULTS: Pre-morbid obesity was associated with higher mortality (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.04 to 2.49) but post-morbid obesity was associated with increased survival (HR, 0.57; 95% CI, 0.37 to 0.88). Adjusting for weight change due to disease as a confounder of the obesity-mortality relationship resulted in the absence of any significant associations between post-morbid obesity and mortality. CONCLUSIONS: This study demonstrated that controlling for reverse causality by adjusting for the confounder of weight change may remove or reverse the protective effect of obesity on mortality among patients with incident HF. PMID:27283142

  1. Do mothers prefer helpers or smaller litters? Birth sex ratio and litter size adjustment in cotton-top tamarins (Saguinus oedipus)

    PubMed Central

    Boulton, Rebecca A; Fletcher, Alison W

    2015-01-01

    Sex allocation theory has been a remarkably productive field in behavioral ecology with empirical evidence regularly supporting quantitative theoretical predictions. Across mammals in general and primates in particular, however, support for the various hypotheses has been more equivocal. Population-level sex ratio biases have often been interpreted as supportive, but evidence for small-scale facultative adjustment has rarely been found. The helper repayment (HR) also named the local resource enhancement (LRE) hypothesis predicts that, in cooperatively breeding species, mothers invest more in the sex which assists with rearing future offspring and that this bias will be more pronounced in mothers who require extra assistance (i.e., due to inexperience or a lack of available alloparents). We tested these hypotheses in captive cotton-top tamarins (Saguinus oedipus) utilizing the international studbook and birth records obtained through a questionnaire from ISIS-registered institutions. Infant sex, litter size, mother's age, parity, and group composition (presence of nonreproductive subordinate males and females) were determined from these records. The HR hypothesis was supported over the entire population, which was significantly biased toward males (the “helpful” sex). We found little support for helper repayment at the individual level, as primiparous females and those in groups without alloparents did not exhibit more extreme tendencies to produce male infants. Primiparous females were, however, more likely to produce singleton litters. Singleton births were more likely to be male, which suggests that there may be an interaction between litter size adjustment and sex allocation. This may be interpreted as supportive of the HR hypothesis, but alternative explanations at both the proximate and ultimate levels are possible. These possibilities warrant further consideration when attempting to understand the ambiguous results of primate sex ratio studies so far

  2. Do mothers prefer helpers or smaller litters? Birth sex ratio and litter size adjustment in cotton-top tamarins (Saguinus oedipus).

    PubMed

    Boulton, Rebecca A; Fletcher, Alison W

    2015-02-01

    Sex allocation theory has been a remarkably productive field in behavioral ecology with empirical evidence regularly supporting quantitative theoretical predictions. Across mammals in general and primates in particular, however, support for the various hypotheses has been more equivocal. Population-level sex ratio biases have often been interpreted as supportive, but evidence for small-scale facultative adjustment has rarely been found. The helper repayment (HR) also named the local resource enhancement (LRE) hypothesis predicts that, in cooperatively breeding species, mothers invest more in the sex which assists with rearing future offspring and that this bias will be more pronounced in mothers who require extra assistance (i.e., due to inexperience or a lack of available alloparents). We tested these hypotheses in captive cotton-top tamarins (Saguinus oedipus) utilizing the international studbook and birth records obtained through a questionnaire from ISIS-registered institutions. Infant sex, litter size, mother's age, parity, and group composition (presence of nonreproductive subordinate males and females) were determined from these records. The HR hypothesis was supported over the entire population, which was significantly biased toward males (the "helpful" sex). We found little support for helper repayment at the individual level, as primiparous females and those in groups without alloparents did not exhibit more extreme tendencies to produce male infants. Primiparous females were, however, more likely to produce singleton litters. Singleton births were more likely to be male, which suggests that there may be an interaction between litter size adjustment and sex allocation. This may be interpreted as supportive of the HR hypothesis, but alternative explanations at both the proximate and ultimate levels are possible. These possibilities warrant further consideration when attempting to understand the ambiguous results of primate sex ratio studies so far.

  3. Ratio of Monocytes to Lymphocytes in Peripheral Blood Identifies Adults at Risk of Incident Tuberculosis Among HIV-Infected Adults Initiating Antiretroviral Therapy

    PubMed Central

    Naranbhai, Vivek; Hill, Adrian V. S.; Abdool Karim, Salim S.; Naidoo, Kogieleum; Abdool Karim, Quarraisha; Warimwe, George M.; McShane, Helen; Fletcher, Helen

    2014-01-01

    Background. Eight decades ago, the ratio of monocytes to lymphocytes (hereafter, the “ML ratio”) was noted to affect outcomes of mycobacterial infection in rabbits. Recent transcriptomic studies support a role for relative proportions of myeloid and lymphoid transcripts in tuberculosis outcomes. The ML ratio in peripheral blood is known to be governed by hematopoietic stem cells with distinct biases. Methods. The predictive value of the baseline ML ratio was modeled in 2 prospective cohorts of HIV-infected adults starting cART in South Africa (primary cohort, 1862 participants; replication cohort, 345 participants). Incident tuberculosis was diagnosed with clinical, radiographic, and microbiologic methods per contemporary guidelines. Kaplan-Meier survival analyses and Cox proportional hazards modeling were conducted. Results. The incidence rate of tuberculosis differed significantly by baseline ML ratio: 32.61 (95% confidence interval [CI], 15.38–61.54), 16.36 (95% CI, 12.39–21.23), and 51.80 (95% CI, 23.10–101.71) per 1000 patient-years for ML ratios of less than the 5th percentile, between the 5th and 95th percentiles, and greater than the 95th percentile, respectively (P = .007). Neither monocyte counts nor lymphocyte counts alone were associated with tuberculosis. After adjustment for sex, World Health Organization human immunodeficiency virus disease stage, CD4+ T-cell counts, and previous history of tuberculosis, hazards of disease were significantly higher for patients with ML ratios of less than the 5th percentile or greater than the 95th percentile (adjusted hazard ratio, 2.47; 95% CI, 1.39–4.40; P = .002). Conclusions. The ML ratio may be a useful, readily available tool to stratify the risk of tuberculosis and suggests involvement of hematopoietic stem cell bias in tuberculosis pathogenesis. PMID:24041796

  4. Usefulness of neutrophil-to-lymphocyte ratio in risk stratification of patients with advanced heart failure.

    PubMed

    Benites-Zapata, Vicente A; Hernandez, Adrian V; Nagarajan, Vijaiganesh; Cauthen, Clay A; Starling, Randall C; Tang, W H Wilson

    2015-01-01

    Elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in patients with acute heart failure (HF) and neoplastic diseases. We investigated the association between NLR and mortality or cardiac transplantation in a retrospective cohort of 527 patients presented to the Cleveland Clinic for evaluation of advanced HF therapy options from 2007 to 2010. Patients were divided according to low, intermediate, and high tertiles of NLR and were followed longitudinally for time to all-cause mortality or heart transplantation (primary outcome). The median NLR was 3.9 (interquartile range 2.5 to 6.5). In univariate analysis, intermediate and highest tertiles of NLR had a higher risk than the lowest tertile for the primary outcome and all-causes mortality. Compared with the lowest tertile, there was no difference in the risk of heart transplantation for intermediate and high tertiles. In multivariate analysis, compared with the lowest tertile, the intermediate and high NLR tertiles remained significantly associated with the primary outcome (hazard ratio [HR] = 1.61, 95% confidence interval [CI] 1.10 to 2.37 and HR = 1.55, 95% CI 1.02 to 2.36, respectively) and all-cause mortality (HR = 1.83, 95% CI 1.07 to 3.14 and HR = 2.16, 95% CI 1.21 to 3.83, respectively). In conclusion, elevated NLR is associated with increased mortality or heart transplantation risk in patients with advanced HF.

  5. 17 CFR 229.503 - (Item 503) Prospectus summary, risk factors, and ratio of earnings to fixed charges.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., risk factors, and ratio of earnings to fixed charges. 229.503 Section 229.503 Commodity and Securities... ratio of earnings to fixed charges. The registrant must furnish this information in plain English. See... into or exercisable for common equity securities. (d) Ratio of earnings to fixed charges. If...

  6. 17 CFR 229.503 - (Item 503) Prospectus summary, risk factors, and ratio of earnings to fixed charges.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., risk factors, and ratio of earnings to fixed charges. 229.503 Section 229.503 Commodity and Securities... ratio of earnings to fixed charges. The registrant must furnish this information in plain English. See... into or exercisable for common equity securities. (d) Ratio of earnings to fixed charges. If...

  7. Classroom risks and resources: Teacher burnout, classroom quality and children's adjustment in high needs elementary schools.

    PubMed

    Hoglund, Wendy L G; Klingle, Kirsten E; Hosan, Naheed E

    2015-10-01

    The current paper presents two related sets of findings on the classroom context in high needs elementary schools. First, we investigated change over one school term in teacher burnout (emotional exhaustion, depersonalization, personal accomplishment) and classroom quality (emotional and instructional support, organization) and assessed the degree to which burnout and classroom quality co-varied over the term with each other and with aggregate externalizing behaviors (average child externalizing behaviors in the classroom). These analyses describe the classroom context in which the children are nested. Second, we examined change over one school term in children's social adjustment (relationship quality with teachers and friends) and academic adjustment (school engagement, literacy skills) and assessed how adjustment co-varied over time with child externalizing behaviors and was predicted by teacher burnout, classroom quality and aggregate externalizing behaviors. These models were tested with a sample of low-income, ethnically diverse children in kindergarten to grade 3 and their teachers. The children and teachers were assessed three times over one school term. Personal accomplishment co-varied positively with overall classroom quality. Reciprocally, classroom organization co-varied positively with overall teacher burnout. Aggregate externalizing behaviors co-varied positively with depersonalization and negatively with personal accomplishment and overall classroom quality, including emotional support and organization. In turn, teacher burnout interacted with aggregate externalizing behaviors to predict change in child social and academic adjustment. Alternatively, classroom quality interacted with aggregate and child externalizing behaviors to predict change in child social and academic adjustment.

  8. Ambient Fine Particulate Matter Exposure and Risk of Cardiovascular Mortality: Adjustment of the Meteorological Factors

    PubMed Central

    Luo, Kai; Li, Wenjing; Zhang, Ruiming; Li, Runkui; Xu, Qun; Cao, Yang

    2016-01-01

    Few studies have explicitly explored the impacts of the extensive adjustment (with a lag period of more than one week) of temperature and humidity on the association between ambient fine particulate matter (PM2.5) and cardiovascular mortality. In a time stratified case-crossover study, we used a distributed lag nonlinear model to assess the impacts of extensive adjustments of temperature and humidity for longer lag periods (for 7, 14, 21, 28 and 40 days) on effects of PM2.5 on total cardiovascular mortality and mortality of cerebrovascular and ischemic heart disease and corresponding exposure-response relationships in Beijing, China, between 2008 and 2011. Compared with results only controlled for temperature and humidity for 2 days, the estimated effects of PM2.5 were smaller and magnitudes of exposure-response curves were decreased when longer lag periods of temperature and relative humidity were included for adjustments, but these changes varied across subpopulation, with marked decreases occurring in males and the elderly who are more susceptible to PM2.5-related mortalities. Our findings suggest that the adjustment of meteorological factors using lag periods shorter than one week may lead to overestimated effects of PM2.5. The associations of PM2.5 with cardiovascular mortality in susceptible populations were more sensitive to further adjustments for temperature and relative humidity. PMID:27827945

  9. Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study

    PubMed Central

    Okayama, Akira; Okuda, Nagako; Miura, Katsuyuki; Okamura, Tomonori; Hayakawa, Takehito; Akasaka, Hiroshi; Ohnishi, Hirofumi; Saitoh, Shigeyuki; Arai, Yusuke; Kiyohara, Yutaka; Takashima, Naoyuki; Yoshita, Katsushi; Fujiyoshi, Akira; Zaid, Maryam; Ohkubo, Takayoshi; Ueshima, Hirotsugu

    2016-01-01

    Objectives To evaluate the impact of dietary sodium and potassium (Na–K) ratio on mortality from total and subtypes of stroke, cardiovascular disease (CVD) and all causes, using 24-year follow-up data of a representative sample of the Japanese population. Setting Prospective cohort study. Participants In the 1980 National Cardiovascular Survey, participants were followed for 24 years (NIPPON DATA80, National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged). Men and women aged 30–79 years without hypertensive treatment, history of stroke or acute myocardial infarction (n=8283) were divided into quintiles according to dietary Na–K ratio assessed by a 3-day weighing dietary record at baseline. Age-adjusted and multivariable-adjusted HRs were calculated using the Mantel-Haenszel method and Cox proportional hazards model. Primary outcome measures Mortality from total and subtypes of stroke, CVD and all causes. Results A total of 1938 deaths from all causes were observed over 176 926 person-years. Na–K ratio was significantly and non-linearly related to mortality from all stroke (p=0.002), CVD (p=0.005) and total mortality (p=0.001). For stroke subtypes, mortality from haemorrhagic stroke was positively related to Na–K ratio (p=0.024). Similar relationships were observed for men and women. The observed relationships remained significant after adjustment for other risk factors. Quadratic non-linear multivariable-adjusted HRs (95% CI) in the highest quintile versus the lowest quintile of Na–K ratio were 1.42 (1.07 to 1.90) for ischaemic stroke, 1.57 (1.05 to 2.34) for haemorrhagic stroke, 1.43 (1.17 to 1.76) for all stroke, 1.39 (1.20 to 1.61) for CVD and 1.16 (1.06 to 1.27) for all-cause mortality. Conclusions Dietary Na–K ratio assessed by a 3-day weighing dietary record was a significant risk factor for mortality from haemorrhagic stroke, all stroke, CVD and all causes among a Japanese population

  10. Interpersonal Circumplex Descriptions of Psychosocial Risk Factors for Physical Illness: Application to Hostility, Neuroticism, and Marital Adjustment

    PubMed Central

    Smith, Timothy W.; Traupman, Emily K.; Uchino, Bert N.; Berg, Cynthia A.

    2016-01-01

    Personality risk factors for physical illness are typically studied individually and apart from risk factors reflecting the social environment, potentially fostering a piecemeal understanding of psychosocial influences on health. Because it can be used to describe both personality and social relationship processes, the interpersonal circumplex (IPC) provides an integrative approach to psychosocial risk. In 301 married couples we examined IPC correlates of three risk factor domains: anger, hostility, and aggressiveness; neuroticism; and marital adjustment. Risk factors displayed IPC locations ranging from hostile dominance (e.g., verbal aggressiveness, marital conflict) to hostility (e.g., anger) to hostile submissiveness (e.g., anxiety, depression); protective factors (marital satisfaction and support) reflected warmth or friendliness in the IPC. Similar descriptions were found using self-reports and spouse ratings of IPC dimensions, indicating that interpersonal styles associated with risk factors do not simply reflect common method variance. Findings identify interpersonal processes reflecting low affiliation or high hostility as a common component of risk and indicate distinctions among risk factors along the dominance dimension. PMID:20573134

  11. Interpersonal circumplex descriptions of psychosocial risk factors for physical illness: application to hostility, neuroticism, and marital adjustment.

    PubMed

    Smith, Timothy W; Traupman, Emily K; Uchino, Bert N; Berg, Cynthia A

    2010-06-01

    Personality risk factors for physical illness are typically studied individually and apart from risk factors reflecting the social environment, potentially fostering a piecemeal understanding of psychosocial influences on health. Because it can be used to describe both personality and social relationship processes, the interpersonal circumplex (IPC) provides an integrative approach to psychosocial risk. In 301 married couples we examined IPC correlates of 3 risk factor domains: anger, hostility, and aggressiveness; neuroticism; and marital adjustment. Risk factors displayed IPC locations ranging from hostile dominance (e.g., verbal aggressiveness, marital conflict) to hostility (e.g., anger) to hostile submissiveness (e.g., anxiety, depression); protective factors (marital satisfaction and support) reflected warmth or friendliness in the IPC. Similar descriptions were found using self-reports and spouse ratings of IPC dimensions, indicating that interpersonal styles associated with risk factors do not simply reflect common method variance. Findings identify interpersonal processes reflecting low affiliation or high hostility as a common component of risk and indicate distinctions among risk factors along the dominance dimension.

  12. Simple and cost-effective fabrication of solid biodegradable polymer microneedle arrays with adjustable aspect ratio for transdermal drug delivery using acupuncture microneedles

    NASA Astrophysics Data System (ADS)

    Cha, Kyoung Je; Kim, Taewan; Jea Park, Sung; Kim, Dong Sung

    2014-11-01

    Polymer microneedle arrays (MNAs) have received much attention for their use in transdermal drug delivery and microneedle therapy systems due to the advantages they offer, such as low cost, good mechanical properties, and a versatile choice of materials. Here, we present a simple and cost-effective method for the fabrication of a biodegradable polymer MNA in which the aspect ratio of each microneedle is adjustable using commercially available acupuncture microneedles. In our process, a master template with acupuncture microneedles, whose shape will be the final MNA, was carefully prepared by fixing them onto a plastic substrate with selectively drilled holes which, in turn, determine the aspect ratios of the microneedles. A polylactic acid (PLA; a biodegradable polymer) MNA was fabricated by a micromolding process with a polydimethylsiloxane (PDMS) mold containing the cavity of the microneedles, which was obtained by the PDMS replica molding against the master template. The mechanical force and degradation behavior of the replicated PLA MNA were characterized with the help of a compression test and an accelerated degradation test, respectively. Finally, the transdermal drug delivery performance of the PLA MNA was successfully simulated by two different methods of penetration and staining, using the skin of a pig cadaver. These results indicated that the proposed method can be effectively used for the fabrication of polymer MNAs which can be used in various microneedle applications.

  13. Evaluating the Investment Benefit of Multinational Enterprises' International Projects Based on Risk Adjustment: Evidence from China

    ERIC Educational Resources Information Center

    Chen, Chong

    2016-01-01

    This study examines the international risks faced by multinational enterprises to understand their impact on the evaluation of investment projects. Moreover, it establishes a 'three-dimensional' theoretical framework of risk identification to analyse the composition of international risk indicators of multinational enterprises based on the theory…

  14. Favourable changes of the risk-benefit ratio in alpine skiing.

    PubMed

    Burtscher, Martin; Ruedl, Gerhard

    2015-05-29

    During the past five decades recreational alpine skiing has become increasingly safer. The numerous annual media reports on ski injuries have to be interpreted on the basis of the tremendous numbers of skiers. These favourable changes seem primarily be due to the introduction of short carving skis, more rigid and comfortable ski boots, the use of protective gear like helmets, and the optimized preparation of ski slopes. The associated health benefits from skiing, especially arising from its association with a healthier life style, and possibly also from effects related to hypoxia preconditioning and increasing subjective vitality by natural elements clearly outweigh the health hazards. Technical improvements will likely help further reducing the injury risk. At least hypothetically, each individual skier could help to prevent injuries by the development of an appropriate physical fitness and responsible behaviour on ski slopes thereby optimizing the risk-benefit ratio of alpine skiing.

  15. Favourable Changes of the Risk-Benefit Ratio in Alpine Skiing

    PubMed Central

    Burtscher, Martin; Ruedl, Gerhard

    2015-01-01

    During the past five decades recreational alpine skiing has become increasingly safer. The numerous annual media reports on ski injuries have to be interpreted on the basis of the tremendous numbers of skiers. These favourable changes seem primarily be due to the introduction of short carving skis, more rigid and comfortable ski boots, the use of protective gear like helmets, and the optimized preparation of ski slopes. The associated health benefits from skiing, especially arising from its association with a healthier life style, and possibly also from effects related to hypoxia preconditioning and increasing subjective vitality by natural elements clearly outweigh the health hazards. Technical improvements will likely help further reducing the injury risk. At least hypothetically, each individual skier could help to prevent injuries by the development of an appropriate physical fitness and responsible behaviour on ski slopes thereby optimizing the risk-benefit ratio of alpine skiing. PMID:26035659

  16. Pathways of Parenting Style on Adolescents' College Adjustment, Academic Achievement, and Alcohol Risk

    ERIC Educational Resources Information Center

    Kenney, Shannon R.; Lac, Andrew; Hummer, Justin F.; Grimaldi, Elizabeth M.; LaBrie, Joseph W.

    2015-01-01

    This study examined the pathways of parenting style (permissive, authoritarian, and authoritative) to alcohol consumption and consequences through the mediators of college adjustment and academic achievement (grade point average [GPA]). Participants were 289 students from a private, mid-size, West Coast university (mean age 19.01 years, 58.8%…

  17. Long-Term Ambient Residential Traffic–Related Exposures and Measurement Error–Adjusted Risk of Incident Lung Cancer in the Netherlands Cohort Study on Diet and Cancer

    PubMed Central

    Spiegelman, Donna; Beelen, Rob; Hoek, Gerard; Brunekreef, Bert; Schouten, Leo J.; van den Brandt, Piet

    2015-01-01

    Background The International Agency for Research on Cancer (IARC) recently declared air pollution carcinogenic to humans. However, no study of air pollution and lung cancer to date has incorporated adjustment for exposure measurement error, and few have examined specific histological subtypes. Objectives Our aim was to assess the association of air pollution and incident lung cancer in the Netherlands Cohort Study on Diet and Cancer and the impact of measurement error on these associations. Methods The cohort was followed from 1986 through 2003, and 3,355 incident cases were identified. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals, for long-term exposures to nitrogen dioxide (NO2), black smoke (BS), PM2.5 (particulate matter with diameter ≤ 2.5 μm), and measures of roadway proximity and traffic volume, adjusted for potential confounders. Information from a previous validation study was used to correct the effect estimates for measurement error. Results We observed elevated risks of incident lung cancer with exposure to BS [hazard ratio (HR) = 1.16; 95% CI: 1.02, 1.32, per 10 μg/m3], NO2 (HR = 1.29; 95% CI: 1.08, 1.54, per 30 μg/m3), PM2.5 (HR = 1.17; 95% CI: 0.93, 1.47, per 10 μg/m3), and with measures of traffic at the baseline address. The exposures were positively associated with all lung cancer subtypes. After adjustment for measurement error, the HRs increased and the 95% CIs widened [HR = 1.19 (95% CI: 1.02, 1.39) for BS and HR = 1.37 (95% CI: 0.86, 2.17) for PM2.5]. Conclusions These findings add support to a growing body of literature on the effects of air pollution on lung cancer. In addition, they highlight variation in measurement error by pollutant and support the implementation of measurement error corrections when possible. Citation Hart JE, Spiegelman D, Beelen R, Hoek G, Brunekreef B, Schouten LJ, van den Brandt P. 2015. Long-term ambient residential traffic–related exposures and

  18. Imbalanced sex ratios, men's sexual behavior, and risk of sexually transmitted infection in China.

    PubMed

    South, Scott J; Trent, Katherine

    2010-12-01

    China has been experiencing pronounced changes in its sex ratio, but little research has explored the consequences of these changes for sexual behavior and health. We merge data from the 1999-2000 Chinese Health and Family Life Survey with community-level data from the 1982, 1990, and 2000 Chinese censuses to examine the relationship between the local sex ratio and several dimensions of men's sexual behavior and sexual health. Multilevel logistic regression models show that, when faced with a relative abundance of age-matched women in their community, Chinese men are slightly less likely to have intercourse with commercial sex workers, but are more likely to engage in premarital noncommercial intercourse and to test positive for a sexually transmitted infection. These findings are consistent with hypotheses derived from demographic-opportunity theory, which suggests that an abundance of opposite-sex partners will increase the risk of early, frequent, and multi-partner sex and, through this, sexually transmitted infection risk.

  19. Use of domperidone as a galactagogue drug: a systematic review of the benefit-risk ratio.

    PubMed

    Paul, Catherine; Zénut, Marie; Dorut, Agnès; Coudoré, Marie-Ange; Vein, Julie; Cardot, Jean-Michel; Balayssac, David

    2015-02-01

    Breastfeeding is the optimal method for feeding a newborn. However, some mothers may have difficulties lactating. Domperidone is widely used as a galactagogue but to the best of our knowledge has not been approved by any health authority. The objective of this review was to assess the benefit-risk ratio of domperidone for stimulating lactation. The benefit-risk ratio of domperidone as a galactagogue was assessed following a literature search of the PubMed database up to July 2013. Four studies were selected to assess domperidone efficacy and demonstrated an increased milk production. The limited data (60 mother-baby pairs) and the moderate methodological quality of 1 study remain insufficient to conclude on domperidone efficacy. Regarding the safety of domperidone, 7 studies were selected that exposed 113 infants to domperidone through breastfeeding. No adverse effects were observed in 85 infants, and no information was provided for the remaining 28. The limited data available remain in favor of a safe domperidone profile in infants and mothers. However, in large studies focused on gastrointestinal disorders, domperidone is responsible for drug-induced long QT syndrome and sudden cardiac death. The use of domperidone as a galactagogue is worrisome as drug-induced long QT syndrome occurred mostly in women. In these circumstances, an improvement of breastfeeding practices seems to be more effective and safer than the use of an off-label domperidone treatment.

  20. Selenium/mercury molar ratios in freshwater, marine, and commercial fish from the USA: variation, risk, and health management.

    PubMed

    Burger, Joanna; Gochfeld, Michael

    2013-01-01

    Fish provide healthy protein as well as recreational and cultural benefits, but can also contain mercury (Hg), polychlorinated biphenyls (PCBs), and other contaminants that have adverse effects on humans and other organisms, particularly developing fetuses. Recently, some authors have suggested that a molar excess of selenium (Se) [e.g., selenium/mercury (Se/Hg) molar ratio >1] confers protection from Hg toxicity derived from fish consumption. Herein, we review our studies of Hg and Se in freshwater, marine, and commercial fish (mainly marine), examining the following: (1) whether and how Se/Hg molar ratios vary among species; (2) whether and how the molar ratios vary within species; (3) whether the molar ratios differ between freshwater and saltwater fish; (4) whether mean molar ratio values provide a reliable indication of potential risk to fish consumers; and (5) whether mean Se/Hg molar ratios are sufficiently constant (e.g., low variation) to allow for use in risk assessment, risk management, or risk communication. In saltwater fish, mean Se/Hg molar ratios varied from 0.3 in mako shark to 68.1 in whiting. For freshwater fish, the mean ratios varied from 0.68 in bowfin to 20.8 in black crappie. Commercial seafood (mainly saltwater) showed great variation in ratios; shrimp and scallops had very high ratios. There was somewhat less variability in the ratios for freshwater fish compared with the fish from saltwater, but there was no overall predictable difference in variation in Se/Hg molar ratios. For both saltwater and freshwater fish, some species with mean molar ratios above 1 had a significant proportion of individual fish with molar ratios below 1. Overall, this indicates great variation in measures of central tendencies and in measures of dispersion. We suggest that relying on the Se/Hg molar ratio as a method of predicting reduced risk from Hg toxicity is problematic because of the great variation among and within fish species, and the variation is not

  1. 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...

  2. 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...

  3. Implications of Public Reporting of Risk-Adjusted Mortality Following Percutaneous Coronary Intervention: Misperceptions and Potential Consequences for High-Risk Patients Including Nonsurgical Patients.

    PubMed

    Gupta, Anuj; Yeh, Robert W; Tamis-Holland, Jacqueline E; Patel, Shalin H; Guyton, Robert A; Klein, Lloyd W; Rab, Tanveer; Kirtane, Ajay J

    2016-10-24

    Assessment of clinical outcomes such as 30-day mortality following coronary revascularization procedures has historically been used to spur quality improvement programs. Public reporting of risk-adjusted outcomes is already mandated in several states, and proposals to further expand public reporting have been put forward as a means of increasing transparency and potentially incentivizing high quality care. However, for public reporting of outcomes to be considered a useful surrogate of procedural quality of care, several prerequisites must be met. First, the reporting measure must be truly representative of the quality of the procedure itself, rather than be dominated by other underlying factors, such as the overall level of illness of a patient. Second, to foster comparisons among physicians and institutions, the metric requires accurate ascertainment of and adjustment for differences in patient risk profiles. This is particularly relevant for high-risk clinical patient scenarios. Finally, the potential deleterious consequences of public reporting of a quality metric should be considered prior to expanding the use of public reporting more broadly. In this viewpoint, the authors review in particular the characterization of high-risk patients currently treated by percutaneous coronary interventional procedures, assessing the adequacy of clinical risk models used in this population. They then expand upon the limitations of 30-day mortality as a quality metric for percutaneous coronary intervention, addressing the strengths and limitations of this metric, as well as offering suggestions to enhance its future use in public reporting.

  4. Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protective Factors.

    PubMed

    Walton, Katherine M; Ingersoll, Brooke R

    2015-09-01

    This study compared sibling adjustment and relationships in siblings of children with Autism Spectrum Disorder (ASD-Sibs; n = 69) and siblings of children with typical development (TD-Sibs; n = 93). ASD-Sibs and TD-Sibs demonstrated similar emotional/behavioral adjustment. Older male ASD-Sibs were at increased risk for difficulties. Sibling relationships of ASD-Sibs involved less aggression, less involvement, and more avoidance than those of TD-Sibs. Partial support for a diathesis-stress conceptualization of sibling difficulties was found for ASD-Sibs. For TD-Sibs, broader autism phenotype (BAP) was related to psychosocial difficulties regardless of family stressors. For ASD-Sibs, BAP was related to difficulties only when family stressors were present. This suggests that having a sibling with ASD may be a protective factor that attenuates the negative impact of sibling BAP.

  5. Usefulness of Neutrophil-to-Lymphocyte Ratio in Risk Stratification of Patients with Advanced Heart Failure

    PubMed Central

    Benites-Zapata, Vicente A.; Hernandez, Adrian V.; Nagarajan, Vijaiganesh; Cauthen, Clay A.; Starling, Randall C.; Tang, W. H. Wilson

    2014-01-01

    Elevated neutrophil-to-lymphocyte Ratio (NLR) has been associated with increased mortality in patients with acute heart failure (HF) as well as in neoplastic diseases. We investigated the association between NLR and mortality or cardiac transplantation in a retrospective cohort of 527 patients presented to the Cleveland Clinic for evaluation of advanced HF therapy options between 2007 and 2010. Patients were divided according to low, intermediate, and high tertiles of NLR, and were followed longitudinally for time to all-causes mortality or heart transplantation (primary outcome). The median NLR was 3.9 (IQR 2.5, 6.5). In univariate analysis, intermediate and highest tertiles of NLR had a higher risk than the lowest tertile for the primary outcome and all-causes mortality. Compared to the lowest tertile, there was no difference in the risk of heart transplantation for intermediate and high tertiles. In multivariate analysis, when compared to the lowest tertile, the intermediate and high NLR tertiles remained significantly associated with the primary outcome (HR=1.61 [95%CI 1.10 to 2.37] and HR=1.55 [95%CI 1.02 to 2.36], respectively), and all-causes mortality (HR=1.83 [95%CI 1.07 to 3.14] and HR=2.16 [95%CI 1.21 to 3.83], respectively). In conclusion, elevated NLR is associated with increased mortality or heart transplantation risk in patients with advanced HF. PMID:25456873

  6. Are Chinese consumers at risk due to exposure to metals in crayfish? A bioaccessibility-adjusted probabilistic risk assessment.

    PubMed

    Peng, Qian; Nunes, Luís M; Greenfield, Ben K; Dang, Fei; Zhong, Huan

    2016-03-01

    Freshwater crayfish, the world's third largest crustacean species, has been reported to accumulate high levels of metals, while the current knowledge of potential risk associated with crayfish consumption lags behind that of finfish. We provide the first estimate of human health risk associated with crayfish (Procambarus clarkii) consumption in China, the world's largest producer and consumer of crayfish. We performed Monte Carlo Simulation on a standard risk model parameterized with local data on metal concentrations, bioaccessibility (φ), crayfish consumption rate, and consumer body mass. Bioaccessibility of metals in crayfish was found to be variable (68-95%) and metal-specific, suggesting a potential influence of metal bioaccessibility on effective metal intake. However, sensitivity analysis suggested risk of metals via crayfish consumption was predominantly explained by consumption rate (explaining >92% of total risk estimate variability), rather than metals concentration, bioaccessibility, or body mass. Mean metal concentrations (As, Cd, Cu, Ni, Pb, Se and Zn) in surveyed crayfish samples from 12 provinces in China conformed to national safety standards. However, risk calculation of φ-modified hazard quotient (HQ) and hazard index (HI) suggested that crayfish metals may pose a health risk for very high rate consumers, with a HI of over 24 for the highest rate consumers. Additionally, the φ-modified increased lifetime risk (ILTR) for carcinogenic effects due to the presence of As was above the acceptable level (10(-5)) for both the median (ILTR=2.5×10(-5)) and 90th percentile (ILTR=1.8×10(-4)), highlighting the relatively high risk of As in crayfish. Our results suggest a need to consider crayfish when assessing human dietary exposure to metals and associated health risks, especially for high crayfish-consuming populations, such as in China, USA and Sweden.

  7. Why and when is ethnic harassment a risk for immigrant adolescents' school adjustment? understanding the processes and conditions.

    PubMed

    Bayram Özdemir, Sevgi; Stattin, Håkan

    2014-08-01

    Ethnically harassed immigrant youth are at risk for experiencing a wide range of school adjustment problems. However, it is still unclear why and under what conditions experiencing ethnic harassment leads to school adjustment difficulties. To address this limitation in the literature, we examined two important questions. First, we investigated whether self-esteem and/or depressive symptoms would mediate the associations between ethnic harassment and poor school adjustment among immigrant youth. Second, we examined whether immigrant youths' perception of school context would play a buffering role in the pathways between ethnic harassment and school adjustment difficulties. The sample (n = 330; M age = 14.07, SD = .90; 49% girls at T1) was drawn from a longitudinal study in Sweden. The results revealed that experiencing ethnic harassment led to a decrease in immigrant youths' self-esteem over time, and that youths' expectations of academic failure increased. Further, youths' relationships with their teachers and their perceptions of school democracy moderated the mediation processes. Specifically, when youth had poor relationships with their teachers or perceived their school context as less democratic, being exposed to ethnic harassment led to a decrease in their self-esteem. In turn, they reported low school satisfaction and perceived themselves as being unsuccessful in school. Such indirect effects were not observed when youth had high positive relationships with their teachers or perceived their school as offering a democratic environment. These findings highlight the importance of understanding underlying processes and conditions in the examination of the effects of ethnic devaluation experiences in order to reach a more comprehensive understanding of immigrant youths' school adjustment.

  8. Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk

    PubMed Central

    2016-01-01

    The waist-to-height ratio (WHtR), calculated by dividing the waist circumference (WC) by height, has recently gained attention as an anthropometric index for central adiposity. It is an easy-to-use and less age-dependent index to identify individuals with increased cardiometabolic risk. A WHtR cutoff of 0.5 can be used in different sex and ethnic groups and is generally accepted as a universal cutoff for central obesity in children (aged ≥6 years) and adults. However, the WHtR has not been validated in preschool children, and the routine use of WHtR in children under age 6 is not recommended. Prospective studies and meta-analysis in adults revealed that the WHtR is equivalent to or slightly better than WC and superior to body mass index (BMI) in predicting higher cardiometabolic risk. In children and adolescents, studies have shown that the WHtR is similar to both BMI and WC in identifying those at an increased cardiometabolic risk. Additional use of WHtR with BMI or WC may be helpful because WHtR considers both height and central obesity. WHtR may be preferred because of its simplicity and because it does not require sex- and age-dependent cutoffs; additionally, the simple message 'keep your WC to less than half your height' may be particularly useful. This review article summarizes recent publications on the usefulness of using WHtR especially when compared to BMI and WC as a screening tool for obesity and related cardiometabolic risks, and recommends the use of WHtR in clinical practice for obesity screening in children and adolescents. PMID:27895689

  9. Large-scale synthesis of monodisperse SiC nanoparticles with adjustable size, stoichiometric ratio and properties by fluidized bed chemical vapor deposition

    NASA Astrophysics Data System (ADS)

    Liu, Rongzheng; Liu, Malin; Chang, Jiaxing

    2017-02-01

    A facile fluidized bed chemical vapor deposition method was proposed for the synthesis of monodisperse SiC nanoparticles by using the single precursor of hexamethyldisilane (HMDS). SiC nanoparticles with average particle size from 10 to 200 nm were obtained by controlling the temperature and the gas ratio. An experimental chemical vapor deposition phase diagram of SiC in the HMDS-Ar-H2 system was obtained and three regions of SiC-Si, SiC and SiC-C can be distinguished. The BET surface area and the photoluminescence properties of the SiC nanoparticles can be adjusted by changing the nanoparticle size. For the SiC nanospheres with free carbon, a novel hierarchical structure with 5 8 nm SiC nanoparticles embedded into the graphite matrix was obtained. The advantages of fluidized bed technology for the preparation of SiC nanoparticles were proposed based on the features of homogenous reaction zone, narrow temperature distribution, ultra-short reactant residence time and mass production.

  10. Association Between Sitting Time and Cardiometabolic Risk Factors After Adjustment for Cardiorespiratory Fitness, Cooper Center Longitudinal Study, 2010–2013

    PubMed Central

    Shuval, Kerem; Balasubramanian, Bijal A.; Kendzor, Darla E.; Radford, Nina B.; DeFina, Laura F.; Gabriel, Kelley Pettee

    2016-01-01

    Introduction Objective estimates, based on waist-worn accelerometers, indicate that adults spend over half their day (55%) in sedentary behaviors. Our study examined the association between sitting time and cardiometabolic risk factors after adjustment for cardiorespiratory fitness (CRF). Methods A cross-sectional analysis was conducted with 4,486 men and 1,845 women who reported daily estimated sitting time, had measures for adiposity, blood lipids, glucose, and blood pressure, and underwent maximal stress testing. We used a modeling strategy using logistic regression analysis to assess CRF as a potential effect modifier and to control for potential confounding effects of CRF. Results Men who sat almost all of the time (about 100%) were more likely to be obese whether defined by waist girth (OR, 2.61; 95% CI, 1.25–5.47) or percentage of body fat (OR, 3.33; 95% CI, 1.35–8.20) than were men who sat almost none of the time (about 0%). Sitting time was not significantly associated with other cardiometabolic risk factors after adjustment for CRF level. For women, no significant associations between sitting time and cardiometabolic risk factors were observed after adjustment for CRF and other covariates. Conclusion As health professionals struggle to find ways to combat obesity and its health effects, reducing sitting time can be an initial step in a total physical activity plan that includes strategies to reduce sedentary time through increases in physical activity among men. In addition, further research is needed to elucidate the relationships between sitting time and CRF for women as well as the underlying mechanisms involved in these relationships. PMID:28033088

  11. 78 FR 32255 - HHS-Operated Risk Adjustment Data Validation Stakeholder Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-29

    ... information that we obtain through this meeting may aid future policy-making for the HHS-operated risk... knives), and dogs or other animals (except service animals). Once cleared for entry to the...

  12. 75 FR 10973 - Hazardous Materials: Risk-Based Adjustment of Transportation Security Plan Requirements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-09

    ... Transportation Pipeline and Hazardous Materials Safety Administration 49 CFR Part 172 Hazardous Materials: Risk... security plan requirements applicable to the commercial transportation of hazardous materials by air, rail... Requirements The federal hazardous materials transportation law (federal hazmat law, 49......

  13. Parent birds assess nest predation risk and adjust their reproductive strategies

    USGS Publications Warehouse

    Fontaine, J.J.; Martin, T.E.

    2006-01-01

    Avian life history theory has long assumed that nest predation plays a minor role in shaping reproductive strategies. Yet, this assumption remains conspicuously untested by broad experiments that alter environmental risk of nest predation, despite the fact that nest predation is a major source of reproductive failure. Here, we examined whether parents can assess experimentally reduced nest predation risk and alter their reproductive strategies. We experimentally reduced nest predation risk and show that in safer environments parents increased investment in young through increased egg size, clutch mass, and the rate they fed nestlings. Parents also increased investment in female condition by increasing the rates that males fed incubating females at the nest, and decreasing the time that females spent incubating. These results demonstrate that birds can assess nest predation risk at large and that nest predation plays a key role in the expression of avian reproductive strategies. ?? 2006 Blackwell Publishing Ltd/CNRS.

  14. Risk-adjusted impact of administrative costs on the distribution of terminal wealth for long-term investment.

    PubMed

    Guillén, Montserrat; Jarner, Søren Fiig; Nielsen, Jens Perch; Pérez-Marín, Ana M

    2014-01-01

    The impact of administrative costs on the distribution of terminal wealth is approximated using a simple formula applicable to many investment situations. We show that the reduction in median returns attributable to administrative fees is usually at least twice the amount of the administrative costs charged for most investment funds, when considering a risk-adjustment correction over a reasonably long-term time horizon. The example we present covers a number of standard cases and can be applied to passive investments, mutual funds, and hedge funds. Our results show investors the potential losses they face in performance due to administrative costs.

  15. Risk and Resilience Factors for Combat-Related Posttraumatic Psychopathology and Post Combat Adjustment

    DTIC Science & Technology

    2010-06-01

    Agoraphobia  without  a  History  of  Panic  Disorder...or  II   Adjustment  Disorder   Agoraphobia  without  a  History  of  Panic  Disorder   Obsessive  Compulsive  Disorder...disorder,  specific  phobia,  panic  disorder,  obsessive  compulsive  disorder,   agoraphobia  with  a  history  of  

  16. The adjustment of children with divorced parents: a risk and resiliency perspective.

    PubMed

    Hetherington, E M; Stanley-Hagan, M

    1999-01-01

    This review addresses major questions about divorce, around which much contemporary research is oriented. These involve questions of the consequences of divorce for the adjustment of children and the vulnerability and resiliency of children in coping with divorce, whether children are better off in a conflictual intact family situation or a divorced family, and how mothers, fathers, and clinical or educational interventions can moderate the effects of divorce. Although research in the past decade has yielded considerable information about these questions, issues that need further investigation are also presented.

  17. High self-control protects the link between social support and positivity ratio for Israeli students exposed to contextual risk.

    PubMed

    Orkibi, Hod; Ronen, Tammie

    2015-08-01

    This study examined how Israeli students, despite exposure to contextual risk factors, may experience a high ratio of self-reported positive to negative emotions (i.e., positivity ratio). Self-control skills and perceived social support were tested as protective factors, where each was posited to moderate the relation between risk status and positivity ratio. The participants were 460 Israeli students (51% girls) in grades 8-10. Contrary to expectations, students attending a school with high contextual risks did not differ from students attending a school with low contextual risks in their scores on self-control skills, perceived social support, or positivity ratio. However, an exploratory follow-up moderation analysis revealed a significant three-way interaction, indicating that while low self-control skills eliminate the link between social support and positivity ratio for students attending the school defined as at-risk, high self-control protects this link. These results suggest that neither contextual risk in itself nor initial differences in self-control or social support account for differences in students' positivity ratio. Rather, it is the way these factors interact with each other that matters. Study limitations and implications are discussed.

  18. Behavioral adjustments of African herbivores to predation risk by lions: spatiotemporal variations influence habitat use.

    PubMed

    Valeix, M; Loveridge, A J; Chamaillé-Jammes, S; Davidson, Z; Murindagomo, F; Fritz, H; Macdonald, D W

    2009-01-01

    Predators may influence their prey populations not only through direct lethal effects, but also through indirect behavioral changes. Here, we combined spatiotemporal fine-scale data from GPS radio collars on lions with habitat use information on 11 African herbivores in Hwange National Park (Zimbabwe) to test whether the risk of predation by lions influenced the distribution of herbivores in the landscape. Effects of long-term risk of predation (likelihood of lion presence calculated over four months) and short-term risk of predation (actual presence of lions in the vicinity in the preceding 24 hours) were contrasted. The long-term risk of predation by lions appeared to influence the distributions of all browsers across the landscape, but not of grazers. This result strongly suggests that browsers and grazers, which face different ecological constraints, are influenced at different spatial and temporal scales in the variation of the risk of predation by lions. The results also show that all herbivores tend to use more open habitats preferentially when lions are in their vicinity, probably an effective anti-predator behavior against such an ambush predator. Behaviorally induced effects of lions may therefore contribute significantly to structuring African herbivore communities, and hence possibly their effects on savanna ecosystems.

  19. Psychological adjustment to familial genetic risk assessment: differences in two longitudinal samples.

    PubMed

    Ritvo, P; Robinson, G; Irvine, J; Brown, L; Matthew, A; Murphy, K J; Stewart, D S; Styra, R; Wang, C; Mullen, M; Cole, D; Rosen, B

    2000-05-01

    Heritable cancer risk assessment is an increasingly common method of deriving valuable information relevant to deciding on appropriate screening regimens and preventive treatments. Assessments of heritable risk typically include familial-genetic evaluation, where analyses relate family pedigree to cancer risk, and DNA testing, where analyses indicate genetic mutations associated with cancer risk (e.g., BRCA1/BRCA2 mutations) or their absence. In this paper we report on the psychological responses of women given familial-genetic evaluations for ovarian cancer risk. The baseline and 6 to 12 follow-up assessments of an initial clinic-attending cohort of 65 women are compared with the baseline and 9 to 12 follow-up assessments of a second clinic-attending cohort of 60 women. Sizeable differences were found in the prevalence of clinically significant depression in these two physician or self-referred populations, as assessed by the Center for Epidemiological Studies Depression scale and in the mean scores. Hypotheses accounting for these differences are discussed.

  20. Using the Risk Ratio to Assess Racial/Ethnic Disproportionality in Special Education at the School-District Level

    ERIC Educational Resources Information Center

    Bollmer, Julie; Bethel, James; Garrison-Mogren, Roberta; Brauen, Marsha

    2007-01-01

    The issue of the disproportionate identification and placement of racial/ethnic minorities in special education has been investigated extensively. One of the most useful tools in this research is the risk ratio, which compares one racial/ethnic group's risk of receiving special education and related services to that of all other students. The risk…

  1. Body Fatness and Risk for Elevated Blood Pressure, Total Cholesterol, and Serum Lipoprotein Ratios in Children and Adolescents.

    ERIC Educational Resources Information Center

    Williams, Daniel P.; And Others

    1992-01-01

    Examines the relationship between body fat percent and risk for elevated blood pressure, serum total cholesterol, and serum lipoprotein ratios in 1,230 African-American and 2,090 white 5-18 year olds (1,667 males and 1,653 females). Results support body fatness standards in children and adolescents as cardiovascular risk factors. (SLD)

  2. Educational Attainment, Teacher-Student Ratios, and the Risk of Adult Incarceration among U.S. Birth Cohorts since 1910

    ERIC Educational Resources Information Center

    Arum, Richard; LaFree, Gary

    2008-01-01

    Little is known about the relationship between school characteristics, such as teacher-student ratios, and the risk of incarceration in adulthood. Educational skeptics argue that investment in schools has little effect on outcomes, such as criminality or the risk of incarceration, because criminal propensities are fixed at an early age and…

  3. Generic Considerations in Adjusting Curriculum and Instruction for At Risk Students.

    ERIC Educational Resources Information Center

    Klumb, Kelly

    This document presents 28 accepted principles for modifying instruction to better meet needs of handicapped and at risk students. The principles include, among others: get to know the individual student in an informal manner; examine the patterns of children's errors; sequence skills to reduce error rates; vary response, testing, and grading…

  4. Maternal Adjustment and Infant Outcome in Medically Defined High-Risk Pregnancy.

    ERIC Educational Resources Information Center

    Levy-Shiff, Rachel; Lerman, Maya; Har-Even, Dov; Hod, Moshe

    2002-01-01

    Explored relation of biological and psychosocial risk factors to infant development among pregnant women who had pregestational diabetes, gestational diabetes, or were nondiabetic. Found that infants of diabetic mothers scored lower on the Bayley Scales at 1 year and revealed fewer positive and more negative behaviors than infants of nondiabetic…

  5. Socioenvironmental Risk and Adjustment in Latino Youth: The Mediating Effects of Family Processes and Social Competence

    ERIC Educational Resources Information Center

    Prelow, Hazel M.; Loukas, Alexandra; Jordan-Green, Lisa

    2007-01-01

    The direct and mediated effects of socioenvironmental risk on internalizing and externalizing problems among Latino youth aged 10-14 were examined using prospective analyses. Participants in this study were 464 Latino mother and child dyads surveyed as part of the "Welfare, Children & Families: A Three City Study." It was hypothesized that…

  6. Calculating disability-adjusted life years (DALY) as a measure of excess cancer risk following radiation exposure.

    PubMed

    Shimada, K; Kai, M

    2015-12-01

    This paper has proposed that disability-adjusted life year (DALY) can be used as a measure of radiation health risk. DALY is calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). This multidimensional concept can be expressed as a risk index without a probability measure to avoid the misuse of the current radiation detriment at low doses. In this study, we calculated YLL and YLD using Japanese population data by gender. DALY for all cancers in Japan per 1 Gy per person was 0.84 year in men and 1.34 year in women. The DALY for all cancers in the Japanese baseline was 4.8 in men and 3.5 in women. When we calculated the ICRP detriment from the same data, DALYs for the cancer sites were similar to the radiation detriment in the cancer sites, excluding leukemia, breast and thyroid cancer. These results suggested that the ICRP detriment overestimate the weighting fraction of leukemia risk and underestimate the weighting fraction of breast and thyroid cancer. A big advantage over the ICRP detriment is that DALY can calculate the risk components for non-fatal diseases without the data of lethality. This study showed that DALY is a practical tool that can compare many types of diseases encountered in public health.

  7. Risk and Resilience Factors for Combat-Related Posttraumatic Psychopathology and Post Combat Adjustment

    DTIC Science & Technology

    2012-05-01

    SUBJECT TERMS Risk, Resilience, Combat, Posttraumatic Stress Disorder, Ohio National Guard, Mental Health, Genetics, Alcohol Use Disorders, Suicide 16...have continued to focus on alcohol use disorders and suicide as areas of unmet need in the National Guard. For example, 10% of our study sample...qualified for wave 1 depression, and 9% of those soldiers had suicidal ideation at the 1-year follow-up, as compared to only 2% among those with no

  8. Adjusting for Risk Associated with Pediatric and Congenital Cardiac Catheterization: A Report from the NCDR® IMPACT™ Registry

    PubMed Central

    Jayaram, Natalie; Beekman, Robert H.; Benson, Lee; Holzer, Ralf; Jenkins, Kathy; Kennedy, Kevin F.; Martin, Gerard R.; Moore, John W.; Ringel, Richard; Rome, Jonathan; Spertus, John A.; Vincent, Robert; Bergersen, Lisa

    2016-01-01

    Background As US healthcare increasingly focuses upon outcomes as a means for quantifying quality, there is a growing demand for risk models that can account for the variability of patients treated at different hospitals so that equitable comparisons between institutions can be made. We sought to apply aspects of prior risk-standardization methodology in order to begin development of a risk-standardization tool for the NCDR® IMPACT™ (Improving Pediatric and Adult Congenital Treatment) Registry. Methods and Results Using IMPACT, all patients undergoing diagnostic or interventional cardiac catheterization between January 2011 and March 2013 were identified. Multivariable hierarchical logistic regression was used to identify patient and procedural characteristics predictive of experiencing a major adverse event following cardiac catheterization. A total of 19,608 cardiac catheterizations were performed between January 2011 and March 2013. Amongst all cases, a major adverse event occurred in 378 (1.9%) of all cases. After multivariable adjustment, eight variables were identified as critical for risk-standardization: patient age, renal insufficiency, single-ventricle physiology, procedure-type risk group, low systemic saturation, low mixed venous saturation, elevated systemic ventricular end diastolic pressure, and elevated main pulmonary artery pressures. The model had good discrimination (C-statistic of 0.70), confirmed by bootstrap validation (validation C-statistic of 0.69). Conclusions Using prior risk-standardization efforts as a foundation, we developed and internally validated a model to predict the occurrence of a major adverse event following cardiac catheterization for congenital heart disease. Future efforts should be directed towards further refinement of the model variables within this large, multicenter dataset. PMID:26481778

  9. A pilot study of risk adjustment for benchmarking antibiotic use between hospitals in Sweden.

    PubMed

    Norberg, Signe; Struwe, Johan; Grunewald, Maria; Ternhag, Anders

    2014-03-01

    There is no established standard for comparing overall antibiotic use between hospitals taking patient characteristics into account. The objective of this study was to investigate whether there is a correlation between surrogate markers for patient morbidity, namely case mix index (CMI), mean length of hospital stay (LoS) and mean cost per admission, and antibiotic use in a sample of Swedish hospitals. All primary and secondary hospitals in three counties with high and three counties with low consumption of antibiotics were selected. Data from 16 hospitals were included. A regression analysis was used to evaluate whether there was a linear trend between defined daily doses (DDD) of antibiotics per 100 bed-days and the surrogate markers for morbidity. No correlation could be found between any of the measures of morbidity and total antibiotic consumption. However, a correlation was found between CMI and the proportion of narrow-spectrum antibiotics: the higher the CMI, the lower the proportional use of β-lactamase-sensitive penicillins. In conclusion, it was found that CMI, mean LoS and mean cost per admission did not appears to be useful factors to adjust for when comparing antibiotic use in this subset of primary and secondary care hospitals. Based on this limited study, we suggest that DDD/100 bed-days can still be used as an appropriate metric to benchmark antibiotic use in primary and secondary hospitals until a better marker for variation of patients and activities is identified.

  10. Changes over calendar time in the risk of specific first AIDS-defining events following HIV seroconversion, adjusting for competing risks

    PubMed Central

    Babiker, Abdel; Darbyshire, Janet; Pezzotti, Patrizio; Porter, Kholoud; Rezza, Giovanni; Walker, Sarah A; Beral, Valerie; Coutinho, Roel; Del Amo, Julia; Gill, Noël; Lee, Christine; Meyer, Laurence; Tyrer, Freya; Dabis, François; Thiébaut, Rodolphe; Lawson-Aye, Sylvie; Boufassa, Faroudy; Hamouda, Osamah; Fischer, Klaus; Pezzotti, Patrizio; Touloumi, Giota; Hatzakis, Angelos; Karafoulidou, Anastasia; Katsarou, Olga; Brettle, Ray; Del Romero, Jorge; Prins, Maria; Van Benthem, Birgit; Kirk, Ole; Pederson, Court; Hernández Aguado, Idelfonso; Pérez-Hoyos, Santiago; Eskild, Anne; Bruun, Johan N; Sannes, Mette; Sabin, Caroline; Johnson, Anne M; Phillips, Andrew N; Francioli, Patrick; Vanhems, Philippe; Egger, Mathias; Rickenbach, Martin; Cooper, David; Kaldor, John; Ashton, Lesley; Vizzard, Jeanette; Muga, Roberto; Day, Nicholas E; De Angelis, Daniela

    2002-01-01

    Background Although studies have reported large reductions in the risks of AIDS and death since the introduction of potent anti-retroviral therapies, few have evaluated whether this has been similar for all AIDS-defining diseases. We wished to evaluate changes over time in the risk of specific AIDS-defining diseases, as first events, using data from individuals with known dates of HIV seroconversion. Methods Using a competing risks proportional hazards model on pooled data from 20 cohorts (CASCADE), we evaluated time from HIV seroconversion to each first AIDS-defining disease (16 groups) and to death without AIDS for four calendar periods, adjusting for exposure category, age, sex, acute infection, and stratifying by cohort. We compared results to those obtained from a cause-specific hazards model. Results Of 6941, 2021 (29%) developed AIDS and 437 (6%) died without AIDS. The risk of AIDS or death remained constant to 1996 then reduced; relative hazard = 0.89 (95% CI: 0.77–1.03); 0.90 (95% CI: 0.81–1.01); and 0.32 (95% CI: 0.28–0.37) for 1979–1990, 1991–1993, and 1997–2001, respectively, compared to 1994–1996. Significant risk reductions in 1997–2001 were observed in all but two AIDS-defining groups and death without AIDS in a competing risks model (with similar results from a cause-specific model). There was significant heterogeneity in the risk reduction across events; from 96% for cryptosporidiosis, to 17% for death without AIDS (P < 0.0001). Conclusion These findings suggest that studies reporting a stable trend for particular AIDS diseases over the period 1979–2001 may not have accounted for the competing risks among other events or lack the power to detect smaller trends. PMID:12435766

  11. Comparing Two Waist-to-Height Ratio Measurements with Cardiometabolic Risk Factors among Youth with Diabetes

    PubMed Central

    Liu, Lenna L.; Kahn, Henry S.; Pettitt, David J.; Fino, Nora F.; Morgan, Tim; Maahs, David M.; Crimmins, Nancy A.; Lamichhane, Archana P.; Liese, Angela D.; D’Agostino, Ralph B.; Bell, Ronny A.

    2017-01-01

    Background Waist circumference (WC) is commonly measured by either the World Health Organization (WHO) or National Health and Nutrition Examination Survey (NHANES) protocol. Objective Compare the associations of WHO vs. NHANES WC-to-height ratio (WHtR) protocols with cardiometabolic risk factors (CMRFs) in a sample of youth with diabetes. Methods For youth (10–19 years old with type 1 [N=3082] or type 2 [N=533] diabetes) in the SEARCH for Diabetes in Youth Study, measurements were obtained of WC (by two protocols), weight, height, fasting lipids (total cholesterol, triglycerides, HDL cholesterol, Non-HDL cholesterol) and blood pressures. Associations of CMRFs with WHO and NHANES WHtR were modeled stratified by body mass index (BMI) percentiles for age/sex: lower BMI (<85th BMI percentile; N=2071) vs. higher BMI (≥85th percentile; N=1594). Results Among lower-BMI participants, both NHANES and WHO WHtR were associated (p<0.005) with all CMRFs except blood pressure. Among higher-BMI participants, both NHANES and WHO WHtR were associated (p<0.05) with all CMRFs. WHO WHtR was more strongly associated (p<0.05) than NHANES WHtR with triglycerides, non-HDL cholesterol, and systolic blood pressure in lower-BMI participants. Among high-BMI participants, WHO WHtR was more strongly associated (p<0.05) than NHANES WHtR with triglycerides and systolic blood pressure. Conclusion Among youth with diabetes, WHtR calculated from either WC protocol captures cardiometabolic risk. The WHO WC protocol may be preferable to NHANES WC. PMID:28232855

  12. 12 CFR 615.5330 - Minimum surplus ratios.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false Minimum surplus ratios. 615.5330 Section 615... surplus ratios. (a) Total surplus. (1) Each institution shall achieve and at all times maintain a ratio of... institution shall achieve and at all times maintain a ratio of core surplus to the risk-adjusted asset base...

  13. 12 CFR 615.5330 - Minimum surplus ratios.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Minimum surplus ratios. 615.5330 Section 615... surplus ratios. (a) Total surplus. (1) Each institution shall achieve and at all times maintain a ratio of... institution shall achieve and at all times maintain a ratio of core surplus to the risk-adjusted asset base...

  14. 12 CFR 615.5330 - Minimum surplus ratios.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Minimum surplus ratios. 615.5330 Section 615... surplus ratios. (a) Total surplus. (1) Each institution shall achieve and at all times maintain a ratio of... institution shall achieve and at all times maintain a ratio of core surplus to the risk-adjusted asset base...

  15. 12 CFR 615.5330 - Minimum surplus ratios.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Minimum surplus ratios. 615.5330 Section 615... surplus ratios. (a) Total surplus. (1) Each institution shall achieve and at all times maintain a ratio of... institution shall achieve and at all times maintain a ratio of core surplus to the risk-adjusted asset base...

  16. 12 CFR 615.5330 - Minimum surplus ratios.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false Minimum surplus ratios. 615.5330 Section 615... surplus ratios. (a) Total surplus. (1) Each institution shall achieve and at all times maintain a ratio of... institution shall achieve and at all times maintain a ratio of core surplus to the risk-adjusted asset base...

  17. Intermediate-Risk Chronic Stable Angina: Neutrophil-Lymphocyte Ratio and Fibrinogen Levels Improved Predicting Angiographically-Detected Coronary Artery Disease

    PubMed Central

    Haybar, Habib; Ahmadzadeh, Ahmad; Assareh, Ahmadreza; Afshari, Nader; Bozorgmanesh, Mohammadreza; Vakili, Mahdis

    2016-01-01

    Background Coronary heart disease (CHD) is the leading cause of death worldwide. Research indicates that coronary atherosclerosis is the most frequent cause of CHD. Evidence is scarce concerning the clinical efficacy of fibrinogen or neutrophil-lymphocyte ratio (NLR) measurement in risk-stratifying patients with chronic stable angina. Objectives To examine the independent and incremental prognostic value of fibrinogen and neutrophil-lymphocyte ratio (NLR) for angiographically-detected coronary artery disease (CAD). Patients and Methods In this cross-sectional study, angiography was performed for 183 Iranian patients with chronic stable angina with exercise ECG-determined intermediate risk. Generalized estimated equations were used to obtain the odd ratio (OR) of CAD for a 1-unit increase in log-NLR and a 1-SD increase in plasma fibrinogen. Models were adjusted for established CAD risk factors. Integrated discriminatory improvement index (IDI) and net reclassification improvement index (NRI) were used as measures of predictive ability for CAD, combined with traditional risk factors by NLR and fibrinogen. Results The mean age of the participants was 57.5, with 51.9% being male. Only 12% of participants had angiographically-determined patent coronary arteries. The number of participants with one, two, and three-vessel stenosis were 76, 31, 31, respectively, while 45 did not have stenosed vessels. NLR and fibrinogen levels were significantly higher in patients with stenosis in two (2.4 and 512 mg.dL-1) or three (2.6 and 517 mg.dL-1) coronary arteries, as compared to the group of patients with no significant involvement (2 and 430 mg.dL-1) (all P < 0.01). Patients with a higher NLR and a higher fibrinogen levels were more likely to have higher grades of CAD. OR log-NLR = 1.36 (95% CI: 1.05 - 1.94) and OR Z-Fibrinogen = 1.61 (95% CI: 1.18 - 2.22). When NLR and fibrinogen were added to the traditional risk factors separately, the NRIs were 0.170 (0.023 - 0.324) and 0

  18. Adding Laboratory Data to Hospital Claims Data to Improve Risk Adjustment of Inpatient/30-Day Postdischarge Outcomes.

    PubMed

    Pine, Michael; Fry, Donald E; Hannan, Edward L; Naessens, James M; Whitman, Kay; Reband, Agnes; Qian, Feng; Schindler, Joseph; Sonneborn, Mark; Roland, Jaclyn; Hyde, Linda; Dennison, Barbara A

    Numerical laboratory data at admission have been proposed for enhancement of inpatient predictive modeling from administrative claims. In this study, predictive models for inpatient/30-day postdischarge mortality and for risk-adjusted prolonged length of stay, as a surrogate for severe inpatient complications of care, were designed with administrative data only and with administrative data plus numerical laboratory variables. A comparison of resulting inpatient models for acute myocardial infarction, congestive heart failure, coronary artery bypass grafting, and percutaneous cardiac interventions demonstrated improved discrimination and calibration with administrative data plus laboratory values compared to administrative data only for both mortality and prolonged length of stay. Improved goodness of fit was most apparent in acute myocardial infarction and percutaneous cardiac intervention. The emergence of electronic medical records should make the addition of laboratory variables to administrative data an efficient and practical method to clinically enhance predictive modeling of inpatient outcomes of care.

  19. Ethnic identity, achievement, and psychological adjustment: Examining risk and resilience among youth from immigrant Chinese families in Canada.

    PubMed

    Costigan, Catherine L; Koryzma, Céline M; Hua, Josephine M; Chance, Lauren J

    2010-04-01

    Ethnic identity, achievement, and psychological adjustment were examined among 95 youth from immigrant Chinese families in Canada (mean age 12 years). Utilizing cross-sectional data, promotive effects of ethnic identity were observed; higher ethnic identity was associated with above average achievement and self-esteem and below average levels of depressive symptoms. Vulnerability effects of ethnic identity were fewer; lower ethnic identity was associated with above average depressive symptoms and, for males only, below average self-esteem. Findings also suggested that higher ethnic identity might buffer the stress of poor achievement, indicating a possible protective effect of ethnic identity. Although requiring replication, these preliminary findings illustrate the utility of adopting a risk and resilience framework and suggest the value of promoting strong ethnic identities.

  20. Interleukin-6 and ratio of plasma interleukin-6/interleukin-10 as risk factors of symptomatic lumbar osteoarthritis

    PubMed Central

    Suyasa, I Ketut; Kawiyana, I Ketut Siki; Bakta, I Made; Widiana, I Gde Raka

    2017-01-01

    AIM To determine the role of cartilage oligomeric matrix protein (COMP), interleukin (IL)-6, IL-10 and ratio of IL-6/IL-10 as risk factors of symptomatic lumbar osteoarthritis (OA) in postmenopausal women with estrogen deficiency. METHODS Case-control study had been conducted in Sanglah General Hospital from October 2015 until March 2016. The blood samples were obtained and analyzed by enzyme-linked immunosorbent assay (ELISA). RESULTS From 44 pairs of samples which divided into 44 samples as case group and 44 samples as control group showed that high level of COMP in estrogen deficiency postmenopausal women were not at risk (OR = 0.7; 95%CI: 0.261-1.751; P = 0.393) for symptomatic lumbar OA (cut-off point 0.946). Estrogen deficiency in postmenopausal women with the high level of IL-6 had 2.7 times risk (OR = 2.7; 95%CI: 0.991-8.320; P = 0.033) for symptomatic lumbar OA from the low level of IL-6 (cut-off point 2.264). At lower level of IL-10, there was no risk for symptomatic lumbar OA (OR = 0.6; 95%CI: 0.209-1.798; P = 0.345) than with the higher level of IL-10 (cut-off point 6.049). While the high ratio of IL-6/IL-10 level in estrogen deficiency postmenopausal women gave 3.4 times risk (OR = 3.4; 95%CI: 1.204-11.787; P = 0.011) for symptomatic lumbar OA than the low ratio of IL-6/IL-10 level (cut-off point 0.364). CONCLUSION High ratio of IL-6/IL-10 plasma level was the highest risk factor for causing symptomatic lumbar OA in postmenopausal women with estrogen deficiency. PMID:28251065

  1. Increased PD-1/STAT1 ratio may account for the survival benefit in decitabine therapy for lower risk myelodysplastic syndrome.

    PubMed

    Zhang, Zheng; Chang, Chun-Kang; He, Qi; Guo, Juan; Tao, Ying; Wu, Ling-Yun; Xu, Feng; Wu, Dong; Zhou, Li-Yu; Su, Ji-Ying; Song, Lu-Xi; Xiao, Chao; Li, Xiao

    2017-04-01

    Decitabine is an effective therapy for patients with lower risk myelodysplastic syndrome (MDS). However, the mechanisms of decitabine's therapeutic effect are not well established. Forty-four lower risk MDS patients received decitabine therapy. 59.1% patients achieved treatment response, and 53.8% patients who were RBC/platelet-dependent cast off the transfusion burden. The median overall survival (OS) was 19.0 months after decitabine treatment. Moreover, polarization toward type 1 in the CD8 + subset was enhanced, and a significantly increased expression of the PD-1, PD-L1, and PD-1/STAT1 ratio was observed in these lower risk MDS. The patients with amplification of PD-1/STAT1 ratio (2-4) achieved longer OS. Thus, our results suggest that the effect mechanism of decitabine toward lower risk MDS may be the moderate increase of PD-1/STAT1, which contributes to hematopoietic improvement. These findings suggest that a different PD-1-related strategy from those used to treat higher risk patients could be used for lower risk MDS patients.

  2. 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.

  3. Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients

    PubMed Central

    Kim, Eun-Jung; Choi, Myung-Jin; Lee, Jeoung-Hwan; Oh, Ji-Eun; Seo, Jang-Won; Lee, Young-Ki; Yoon, Jong-Woo; Kim, Hyung-Jik; Noh, Jung-Woo

    2017-01-01

    Background In hemodialysis patients, fluid overload and malnutrition are accompanied by extracellular fluid (ECF) expansion and intracellular fluid (ICF) depletion, respectively. We investigated the relationship between ECF/ICF ratio (as an integrated marker reflecting both fluid overload and malnutrition) and survival and cardiovascular disease (CVD) in the context of malnutrition-inflammation-arteriosclerosis (MIA) complex. Methods Seventy-seven patients from a single hemodialysis unit were prospectively enrolled. The ECF/ICF volume was measured by segmental multi-frequency bioimpedance analysis. MIA and volume status were measured by serum albumin, C-reactive protein (CRP), pulse wave velocity (PWV) and plasma B-type natriuretic peptide (BNP), respectively. Results The mean ECF/ICF ratio was 0.56±0.06 and the cut-off value for maximum discrimination of survival was 0.57. Compared with the low ECF/ICF group, the high ECF/ICF group (ratio≥0.57, 42%) had higher all-cause mortality, CVD, CRP, PWV, and BNP, but lower serum albumin. During the 5-year follow-up, 24 all-cause mortality and 38 CVD occurred (18 and 24, respectively, in the high ECF/ICF group versus 6 and 14 respectively in the low ECF/ICF group, P<0.001). In the adjusted Cox analysis, the ECF/ICF ratio nullifies the effects of the MIA and volume status on survival and CVD and was an independent predictor of all-cause mortality and CVD: hazard ratio (95% confidence interval); 1.12 (1.01–1.25) and 1.09 (1.01–1.18) for a 0.01 increase in the ECF/ICF ratio. The degree of malnutrition (albumin), inflammation (CRP), arteriosclerosis (PWV), and fluid overload (BNP) were correlated well with the ECF/ICF ratio. Conclusions Hemodialysis patients with high ECF/ICF ratio are not only fluid overloaded, but malnourished and have stiff artery with more inflammation. The ECF/ICF ratio is highly related to the MIA complex, and is a major risk indicator for all-cause mortality and CVD. PMID:28099511

  4. The Effectiveness of Functional Family Therapy in Reducing Adolescent Mental Health Risk and Family Adjustment Difficulties in an Irish Context.

    PubMed

    Hartnett, Dan; Carr, Alan; Sexton, Thomas

    2016-06-01

    To evaluate the effectiveness of Functional Family Therapy (FFT) 42 cases were randomized to FFT and 55 to a waiting-list control group. Minimization procedures controlled the effects of potentially confounding baseline variables. Cases were treated by a team of five therapists who implemented FFT with a moderate degree of fidelity. Rates of clinical recovery were significantly higher in the FFT group than in the control group. Compared to the comparison group, parents in the FFT group reported significantly greater improvement in adolescent problems on the Strengths and Difficulties Questionnaire (SDQ) and both parents and adolescents reported improvements in family adjustment on the Systemic Clinical Outcomes and Routine Evaluation (SCORE). In addition, 93% of youth and families in the treatment condition completed FFT. Improvements shown immediately after treatment were sustained at 3-month follow-up. Results provide a current demonstration of FFT's effectiveness for youth with behavior problems in community-based settings, expand our understanding of the range of positive outcomes of FFT to include mental health risk and family-defined problem severity and impact, and suggests that it is an effective intervention when implemented in an Irish context.

  5. Altering dietary lysine:arginine ratio has little effect on cardiovascular risk factors and vascular reactivity in moderately hypercholesterolemic adults

    PubMed Central

    Vega-López, Sonia; Matthan, Nirupa R.; Ausman, Lynne M.; Harding, Scott V.; Rideout, Todd C.; Ai, Masumi; Otokozawa, Seiko; Freed, Alicia; Kuvin, Jeffrey T; Jones, Peter J; Schaefer, Ernst J; Lichtenstein, Alice H.

    2010-01-01

    Background Information is scarce regarding the effect of dietary protein type, with specific focus on the lysine to arginine (Lys:Arg) ratio, on cardiovascular risk factors and vascular reactivity in humans. Objective Determine effect of dietary Lys:Arg ratio on cardiovascular risk factors and vascular reactivity in moderately hypercholesterolemic adults. Design Randomized cross-over design of two 35-day diet phases; thirty adults (21 females and 9 males, ≥50 y, LDL cholesterol ≥120 mg/dL). Diets had 20% energy (E) protein, 30%E fat, 50%E carbohydrate and were designed to have low (0.7) or high (1.4) Lys:Arg ratio. Measures included fasting and postprandial lipid, lipoprotein, apolipoprotein concentrations; fasting high sensitivity C-reactive protein (hsCRP), small dense LDL (sdLDL)-cholesterol, remnant lipoprotein cholesterol (RemLC), glycated albumin, adiponectin and immunoreactive insulin concentrations, endogenous cholesteryl ester transfer protein (CETP) and lecithin:cholesterol acyl transferase (LCAT) activities; cholesterol fractional synthesis rate (FSR); and flow mediated dilation (FMD) and peripheral artery tonometry (PAT). Results No differences were observed in fasting and/or postprandial total, LDL, HDL and sdLDL cholesterol, RemLC, Lp(a) or apo B concentrations, LCAT and CETP activities, FSR, glycated albumin, immunoreactive insulin, FMD or PAT. The low, relative to the high, Lys:Arg ratio diet resulted in lower postprandial VLDL cholesterol (−24%, P=0.001) and triglycerides (−23%, P=0.001), and small but significant differences in fasting (−3%, P=0.003) and postprandial (−3%, P=0.018) apo AI, and fasting adiponectin concentrations (+7%, P=0.035). Fasting and postprandial hsCRP concentrations were 23% lower after the low Lys:Arg ratio diet (P=0.020 for both). Conclusions Diets differing in Lys:Arg ratios had no or small effects on cardiovascular risk factors and vascular reactivity. PMID:20042191

  6. Children's Positive Adjustment to First Grade in Risk-Filled Communities: A Case Study of the Role of School Ecologies in South Africa and Finland

    ERIC Educational Resources Information Center

    Kumpulainen, Kristiina; Theron, Linda; Kahl, Carlien; Bezuidenhout, Carla; Mikkola, Anna; Salmi, Saara; Khumalo, Tumi; Uusitalo-Malmivaara, Lotta

    2016-01-01

    This article presents a comparative case study on the ways in which children's school ecologies facilitate their adjusting positively to first grade in risk-filled contexts in South Africa and Finland. The insights of two children (one South African, one Finnish) from socio-economically disadvantaged communities, their teachers, parents and…

  7. Optimization of heat transfer by adjusting power ratios between top and side heaters for casting high-performance multi-crystalline silicon ingots

    NASA Astrophysics Data System (ADS)

    Chen, Wenliang; Wu, Zhiyong; Zhong, Genxiang; Ding, Junjing; Yu, Yunyang; Zhou, Xucheng; Huang, Xinming

    2016-10-01

    Numerical simulations were applied to analyze the effects of the power ratios between top and side heaters on the crystal-melt (c-m) interface and the thermal stress distribution during the solidification process. The simulation results showed that among the different increase velocities of the power ratio, increasing the power ratio uniformly provided a most favorable solidification process: a slightly convex c-m interface shape and low thermal stress were obtained. The optimized design was implemented in casting experiments, which showed that the high-performance multi-crystalline silicon ingot had a vertical columnar structure and a lower dislocation density. The average conversion efficiency of solar cells was about 0.08% higher with this design (18.24%) than with the original design (18.16%).

  8. Cardiometabolic risk assessments by body mass index z-score or waist-to-height ratio in a multiethnic sample of sixth-graders.

    PubMed

    Kahn, Henry S; El ghormli, Laure; Jago, Russell; Foster, Gary D; McMurray, Robert G; Buse, John B; Stadler, Diane D; Treviño, Roberto P; Baranowski, Tom

    2014-01-01

    Convention defines pediatric adiposity by the body mass index z-score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations (R (2)) and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR), lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. For HOMA-IR, R (2) attributed to BMIz or WHtR was 19%-28% among high-fatness and 8%-13% among lower-fatness students. R (2) for lipid variables was 4%-9% among high-fatness and 2%-7% among lower-fatness students. In the lower-fatness subpopulations, the standardized coefficients for total cholesterol/HDL cholesterol and triglycerides tended to be weaker for BMIz (0.13-0.20) than for WHtR (0.17-0.28). Among high-fatness students, BMIz and WHtR correlated with blood pressures for Hispanics and whites, but not black boys (systolic) or girls (systolic and diastolic). In 11-12 year olds, assessments by WHtR can provide cardiometabolic risk estimates similar to conventional BMIz without requiring reference to a normative growth chart.

  9. Cardiometabolic Risk Assessments by Body Mass Index z-Score or Waist-to-Height Ratio in a Multiethnic Sample of Sixth-Graders

    PubMed Central

    Kahn, Henry S.; El ghormli, Laure; Jago, Russell; Foster, Gary D.; McMurray, Robert G.; Buse, John B.; Stadler, Diane D.; Treviño, Roberto P.; Baranowski, Tom; HEALTHY Study Group

    2014-01-01

    Convention defines pediatric adiposity by the body mass index z-score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations (R2) and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR), lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. For HOMA-IR, R2 attributed to BMIz or WHtR was 19%–28% among high-fatness and 8%–13% among lower-fatness students. R2 for lipid variables was 4%–9% among high-fatness and 2%–7% among lower-fatness students. In the lower-fatness subpopulations, the standardized coefficients for total cholesterol/HDL cholesterol and triglycerides tended to be weaker for BMIz (0.13–0.20) than for WHtR (0.17–0.28). Among high-fatness students, BMIz and WHtR correlated with blood pressures for Hispanics and whites, but not black boys (systolic) or girls (systolic and diastolic). In 11-12 year olds, assessments by WHtR can provide cardiometabolic risk estimates similar to conventional BMIz without requiring reference to a normative growth chart. PMID:25132986

  10. Sex Ratio Bias and Extinction Risk in an Isolated Population of Tuatara (Sphenodon punctatus)

    PubMed Central

    Grayson, Kristine L.; Mitchell, Nicola J.; Monks, Joanne M.; Keall, Susan N.; Wilson, Joanna N.; Nelson, Nicola J.

    2014-01-01

    Understanding the mechanisms underlying population declines is critical for preventing the extinction of endangered populations. Positive feedbacks can hasten the process of collapse and create an ‘extinction vortex,’ particularly in small, isolated populations. We provide a case study of a male-biased sex ratio creating the conditions for extinction in a natural population of tuatara (Sphenodon punctatus) on North Brother Island in the Cook Strait of New Zealand. We combine data from long term mark-recapture surveys, updated model estimates of hatchling sex ratio, and population viability modeling to measure the impacts of sex ratio skew. Results from the mark-recapture surveys show an increasing decline in the percentage of females in the adult tuatara population. Our monitoring reveals compounding impacts on female fitness through reductions in female body condition, fecundity, and survival as the male-bias in the population has increased. Additionally, we find that current nest temperatures are likely to result in more male than female hatchlings, owing to the pattern of temperature-dependent sex determination in tuatara where males hatch at warmer temperatures. Anthropogenic climate change worsens the situation for this isolated population, as projected temperature increases for New Zealand are expected to further skew the hatchling sex ratio towards males. Population viability models predict that without management intervention or an evolutionary response, the population will ultimately become entirely comprised of males and functionally extinct. Our study demonstrates that sex ratio bias can be an underappreciated threat to population viability, particularly in populations of long-lived organisms that appear numerically stable. PMID:24714691

  11. Numeracy, Ratio Bias, and Denominator Neglect in Judgments of Risk and Probability

    ERIC Educational Resources Information Center

    Reyna, Valerie F.; Brainerd, Charles J.

    2008-01-01

    "Numeracy," so-called on analogy with literacy, is essential for making health and other social judgments in everyday life [Reyna, V. F., & Brainerd, C. J. (in press). The importance of mathematics in health and human judgment: Numeracy, risk communication, and medical decision making. "Learning and Individual Differences."]. Recent research on…

  12. Contractualist reasoning, HIV cure clinical trials, and the moral (ir)relevance of the risk/benefit ratio

    PubMed Central

    Kumar, Rahul

    2017-01-01

    Institutional review boards (IRB) normally require of a morally defensible clinical trial that any trial participant will benefit from the inquiry, or at least not be exposed to a significant risk of having their prospects worsened by participating. Stage 1 HIV cure trials tend not to meet this requirement. Does that show them to be morally indefensible? Utilitarian thinking about this question supports a negative answer. But one might reasonably expect a Kantian moral theory to support the conclusion that exposing trial participants to a significant risk of their prospects being worsened by their participation to be morally indefensible, on grounds that this would be a clear case of using a person as a mere means. In this paper, I argue, drawing on Kantian contractualist thinking, that requiring the risk/benefit ratio for participants be positive if a trial is to be morally defensible does not in fact gain any support from Kantian thinking about morality. PMID:27590492

  13. Contractualist reasoning, HIV cure clinical trials, and the moral (ir)relevance of the risk/benefit ratio.

    PubMed

    Kumar, Rahul

    2017-02-01

    Institutional review boards (IRB) normally require of a morally defensible clinical trial that any trial participant will benefit from the inquiry, or at least not be exposed to a significant risk of having their prospects worsened by participating. Stage 1 HIV cure trials tend not to meet this requirement. Does that show them to be morally indefensible? Utilitarian thinking about this question supports a negative answer. But one might reasonably expect a Kantian moral theory to support the conclusion that exposing trial participants to a significant risk of their prospects being worsened by their participation to be morally indefensible, on grounds that this would be a clear case of using a person as a mere means. In this paper, I argue, drawing on Kantian contractualist thinking, that requiring the risk/benefit ratio for participants be positive if a trial is to be morally defensible does not in fact gain any support from Kantian thinking about morality.

  14. A note on calculating asymptotic confidence intervals for the adjusted risk difference and number needed to treat in the Cox regression model.

    PubMed

    Laubender, Ruediger P; Bender, Ralf

    2014-02-28

    Recently, Laubender and Bender (Stat. Med. 2010; 29: 851-859) applied the average risk difference (RD) approach to estimate adjusted RD and corresponding number needed to treat measures in the Cox proportional hazards model. We calculated standard errors and confidence intervals by using bootstrap techniques. In this paper, we develop asymptotic variance estimates of the adjusted RD measures and corresponding asymptotic confidence intervals within the counting process theory and evaluated them in a simulation study. We illustrate the use of the asymptotic confidence intervals by means of data of the Düsseldorf Obesity Mortality Study.

  15. Body mass index, waist circumference, and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk? Evidence from an individual-participant meta-analysis of 82,864 participants from nine cohort studies

    PubMed Central

    Czernichow, Sébastien; Kengne, Andre-Pascal; Stamatakis, Emmanuel; Hamer, Mark; Batty, G. David

    2014-01-01

    Few studies have examined both the relative magnitude of association and the discriminative capability of multiple indicators of obesity with cardiovascular disease (CVD) mortality risk. We conducted an individual-participant meta-analysis of 9 cohort studies of men and women drawn from the British general population resulted in sample of 82,864 individuals. Body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) were measured directly. There were 6,641 deaths (1,998 CVD) during a mean of 8.1 years of follow-up. After adjustment, a one SD higher in WHR and WC was related to a higher risk of CVD mortality (HR (95% CI)): 1.15 (1.05-1.25) and 1.15 (1.04-1.27), respectively. The risk of CVD also increased linearly across quintiles of both these abdominal obesity markers with a 66% increased risk in the highest quintile of WHR. In age- and sex-adjusted models only, BMI was related to CVD mortality but not in any other analyses. No major differences were revealed in the discrimination capabilities of models with BMI, WC or WHR for cardiovascular or total mortality outcomes. In conclusion, measures of abdominal adiposity, but not BMI, were related to an increased risk of cardiovascular disease mortality. No difference was observed in discrimination capacities between adiposity markers. PMID:21521449

  16. Is the Ratio of Antibodies Against Oxidized LDL to Oxidized LDL an Indicator of Cardiovascular Risk in Psoriasis?

    PubMed Central

    Rajappa, Medha; Mohan Thappa, Devinder; Chandrashekar, Laxmisha; Munisamy, Malathi; Revathy, G.

    2016-01-01

    Objectives Psoriasis is a chronic inflammatory skin disease. Chronic inflammation results in increased oxidative stress and oxidizes lipoproteins, increasing their atherogenicity. This study sought to estimate the levels of oxidized low-density lipoprotein (ox-LDL) and antibodies against oxidized LDL (anti-ox-LDL) and compute the ratio of anti-ox-LDL/ox-LDL as a single composite parameter to assess the oxidative lipoprotein burden as an indicator of cardiovascular risk in patients with psoriasis. Methods This cross-sectional study included 45 patients with psoriasis. All patients were given a psoriasis severity index score and their ox-LDL and anti-ox-LDL estimated using ELISA. Results The results of this study show an elevation in the ratio of anti-ox-LDL to ox-LDL in patients with psoriasis, which initiate and perpetuate the pathogenesis of psoriasis and its comorbidity, atherosclerotic cardiovascular disease. Conclusions Our results suggest that an elevated ratio of anti-ox-LDL/ox-LDL can serve as a composite parameter reflecting the total oxidative lipoprotein burden and cardiovascular risk in psoriasis patients. PMID:27602197

  17. Parental dysphoria and children's adjustment: marital conflict styles, children's emotional security, and parenting as mediators of risk.

    PubMed

    Du Rocher Schudlich, Tina D; Cummings, E Mark

    2007-08-01

    Dimensions of martial conflict, children's emotional security regarding interparental conflict, and parenting style were examined as mediators between parental dysphoria and child adjustment. A community sample of 262 children, ages 8-16, participated with their parents. Behavioral observations were made of parents' interactions during marital conflict resolution tasks, which children later observed to assess their emotional security. Questionnaires assessed parents' dysphoria, parenting, and children's adjustment. Structural equation modeling indicated that parental dysphoria was linked with child adjustment through specific and distinct mediating family processes, including marital conflict and parenting. Children's emotional security in the context of particular marital conflict styles also mediated relations between parental dysphoria and child adjustment problems, with similar pathways found for mothers and fathers. These pathways remained significant even after significant parenting contributions were considered.

  18. The evolution of combined oral contraception: improving the risk-to-benefit ratio.

    PubMed

    Burkman, Ronald; Bell, Carrie; Serfaty, David

    2011-07-01

    Since its introduction in 1960, the combined oral contraceptive (COC) pill has become one of the most widely and frequently used methods of contraception worldwide. Although highly effective, early COC formulations were associated with significant adverse effects and unacceptable cardiovascular risk. Improvements in tolerability and safety have been achieved, without compromises in effectiveness, primarily via hormone dosage reductions and the development of several new progestins. Multiphasic COCs and extended-/continuous-cycle COCs have also been introduced, although the clinical advantages of these formulations vs. traditional COCs have yet to be established. Inclusion of natural estrogens such as estradiol valerate and 17β-estradiol with selective progestins in new combinations that maintain good cycle control is the most recent evolutionary step designed to improve COC tolerability and safety. Vigorous research needs to continue to help guarantee that the unmet need for safe and effective contraception is satisfied in future generations.

  19. Selenium and mercury molar ratios in commercial fish from New Jersey and Illinois: Variation within species and relevance to risk communication

    PubMed Central

    Burger, Joanna; Gochfeld, Michael

    2015-01-01

    There is an emerging consensus that people consuming large amounts of fish with selenium:mercury ratios below 1 may be at higher risk from mercury toxicity. As the relative amount of selenium increases compared to mercury, risk may be lowered, but it is unclear how much excess selenium is required. It would be useful if the selenium:mercury ratio was relatively consistent within a species, but this has not been the case in our studies of wild-caught fish. Since most people in developed countries and urban areas obtain their fish and other seafood commercially, we examined selenium:mercury molar ratios in commercial fish purchased in stores and fish markets in central New Jersey and Chicago. There was substantial interspecific and intraspecific variation in molar ratios. Across species the selenium:mercury molar ratio decreased with increasing mean mercury levels, but selenium variation also contributed to the ratio. Few samples had selenium:mercury molar ratios below 1, but there was a wide range in ratios, complicating the interpretation for use in risk management and communication. Before ratios can be used in risk management, more information is needed on mercury:selenium interactions and mutual bioavailability, and on the relationship between molar ratios and health outcomes. Further, people who are selenium deficient may be more at risk from mercury toxicity than others. PMID:23541437

  20. 'Designer oils' low in n-6:n-3 fatty acid ratio beneficially modifies cardiovascular risks in mice.

    PubMed

    Riediger, Natalie D; Azordegan, Nazila; Harris-Janz, Sydney; Ma, David W L; Suh, Miyoung; Moghadasian, Mohammed H

    2009-08-01

    Cardiovascular benefits of dietary n-3 fatty acids have been shown. However, benefits of n-3 fatty acids as part of a high fat, low n-6:n-3 fatty acid ratio diet has not been fully characterized. Aim of this study is to investigate cardiovascular and metabolic benefits of 'designer oils' containing a low ratio of n-6:n-3 fatty acids in C57BL/6 mice. Three groups of C57BL/6 mice were fed an atherogenic diet supplemented with either a fish oil- or flaxseed oil-based 'designer oil' with an approximate n-6:n-3 fatty acid ratio of 2:1 (treated groups, n = 6 each) or with a safflower oil-based formulation with a high ratio (25:1) of n-6:n-3 fatty acids (control group, n = 6) for 6 weeks. Food intake, body weight, and blood lipid levels were monitored regularly. Fatty acid profile of the heart tissues was assessed. Histological assessment of liver samples was conducted. At the end of the study body weight and food intake was significantly higher in the flax group compared to control. The levels of 20:5n-3 and 22:6n-3 was significantly increased in the heart phospholipids in both flax and fish groups compared to control; tissue 20:4n-6 was significantly reduced in the fish group compared to control. Significant liver pathology was observed in the control group only. Lowering dietary ratio of n-6:n-3 fatty acids may significantly reduce cardiovascular and metabolic risks in mice regardless of the source of n-3 fatty acids.

  1. The Predictive Relationship between Temperament, School Adjustment, and Academic Achievement: A 2-Year Longitudinal Study of Children At-Risk

    ERIC Educational Resources Information Center

    Al-Hendawi, Maha

    2010-01-01

    Individual differences in temperament can be a risk or a protective factor for a child, especially for children at-risk who possess single or multiple risk factors that may interfere with their educational success and affect their healthy development and their life-long outcomes. This research study examined the concurrent and longitudinal…

  2. Possible Association of High Urinary Magnesium and Taurine to Creatinine Ratios with Metabolic Syndrome Risk Reduction in Australian Aboriginals

    PubMed Central

    Hamada, Atsumi; Taguchi, Takashi; Mori, Hideki; Thorpe, Marjorie; Yamori, Yukio; Mori, Mari

    2011-01-01

    Background. Because of the epidemic of metabolic syndrome (MS) in Australian Aboriginals known for their higher cardiovascular mortality and shorter life expectancy, we analyzed the possible relationship of their MS risks with the current dietary custom. Methods. The subjects were 84 people aged 16–79 years. The health examination was conducted according to the basic protocol of WHO-CARDIAC (Cardiovascular Diseases and Alimentary Comparison) Study. Results. The highest prevalence among MS risks was abdominal obesity (over 60%). After controlling for age and sex, the odds of obesity decreased significantly with high level of urinary magnesium/creatinine ratio (Mg/cre) (OR, 0.11; 95% CI, 0.02–0.57; P < .05). The significant inverse associations of fat intake with Mg/cre and of fast food intake with urinary taurine/creatinine ratio were revealed. Conclusions. The high prevalence of obesity in the Aboriginal people of this area may partly be due to the reduction of beneficial nutrients intake including Mg and taurine. PMID:21738855

  3. Reducing Monte Carlo error in the Bayesian estimation of risk ratios using log-binomial regression models.

    PubMed

    Salmerón, Diego; Cano, Juan A; Chirlaque, María D

    2015-08-30

    In cohort studies, binary outcomes are very often analyzed by logistic regression. However, it is well known that when the goal is to estimate a risk ratio, the logistic regression is inappropriate if the outcome is common. In these cases, a log-binomial regression model is preferable. On the other hand, the estimation of the regression coefficients of the log-binomial model is difficult owing to the constraints that must be imposed on these coefficients. Bayesian methods allow a straightforward approach for log-binomial regression models and produce smaller mean squared errors in the estimation of risk ratios than the frequentist methods, and the posterior inferences can be obtained using the software WinBUGS. However, Markov chain Monte Carlo methods implemented in WinBUGS can lead to large Monte Carlo errors in the approximations to the posterior inferences because they produce correlated simulations, and the accuracy of the approximations are inversely related to this correlation. To reduce correlation and to improve accuracy, we propose a reparameterization based on a Poisson model and a sampling algorithm coded in R.

  4. Early Developmental and Psychosocial Risks and Longitudinal Behavioral Adjustment Outcomes for Preschool-Age Girls Adopted from China

    ERIC Educational Resources Information Center

    Tan, Tony Xing; Marfo, Kofi; Dedrick, Robert F.

    2010-01-01

    The central goal of this longitudinal study was to examine behavioral adjustment outcomes in a sample of preschool-age adopted Chinese girls. Research examining the effects of institutional deprivation on post-adoption behavioral outcomes for internationally adopted children has been constrained by the frequent unavailability of data on the…

  5. Psychosocial Adjustment over a Two-Year Period in Children Referred for Learning Problems: Risk, Resilience, and Adaptation.

    ERIC Educational Resources Information Center

    Sorensen, Lisa G.; Forbes, Peter W.; Bernstein, Jane H.; Weiler, Michael D.; Mitchell, William M.; Waber, Deborah P.

    2003-01-01

    A 2-year study evaluated the relationship among psychosocial adjustment, changes in academic skills, and contextual factors in 100 children (ages 7-11) with learning problems. Contextual variables were significantly associated with psychosocial adaptation, including the effectiveness of the clinical assessment, extent of academic support, and the…

  6. Parental Dysphoria and Children's Adjustment: Marital Conflict Styles, Children's Emotional Security, and Parenting as Mediators of Risk

    ERIC Educational Resources Information Center

    Du Rocher Schudlich, Tina D.; Cummings, E. Mark

    2007-01-01

    Dimensions of martial conflict, children's emotional security regarding interparental conflict, and parenting style were examined as mediators between parental dysphoria and child adjustment. A community sample of 262 children, ages 8-16, participated with their parents. Behavioral observations were made of parents' interactions during marital…

  7. Assessing Changes in Socioemotional Adjustment across Early School Transitions--New National Scales for Children at Risk

    ERIC Educational Resources Information Center

    McDermott, Paul A.; Watkins, Marley W.; Rovine, Michael J.; Rikoon, Samuel H.

    2013-01-01

    This article reports the development and evidence for validity and application of the Adjustment Scales for Early Transition in Schooling (ASETS). Based on primary analyses of data from the Head Start Impact Study, a nationally representative sample (N = 3077) of randomly selected children from low-income households is configured to inform…

  8. Sexual dimorphism in ratio of second and fourth digits and its relationship with metabolic syndrome indices and cardiovascular risk factors

    PubMed Central

    Oyeyemi, Bolaji Fatai; Iyiola, Oluyinka Ajibola; Oyeyemi, Adekunle Wahab; Oricha, Kokori Audu; Anifowoshe, Abass Toba; Alamukii, Nanfizat Abiket

    2014-01-01

    Background: Ratio of second and fourth digit (2D:4D) is known to be germane in analyzing utero concentrations of testosterone and estrogen in human and other vertebrates. 2D:4D had been linked to several traits like athletes’ abilities, reproductive success, risk of cancer and cardiovascular disease (CVD). Metabolic syndrome (MetS) is a clustering of several cardiovascular risk factors. Waist circumference (WC), neck circumference (NC), body mass index (BMI) and waist-to-height ratio (WHtR) are important in measuring MetS. This study investigated sexual dimorphism in 2D:4D and its relationship with MetS indices and CVD factors among adult residing in Ilorin, North central Nigeria. Materials and Methods: This is a cross-sectional, stratified multi-staged sampling study. Participants residing in different neighborhoods were visited at home where finger lengths and anthropometric traits were measured. Participants include 801 healthy adults aged 18-44 years (56% male) who had been living in the area for more than 3 years. Results: Males showed significantly lower 2D:4D than females (unpaired t-test; t [699] = 11.49, P = 0.001). A significant positive correlation was observed in MetS markers and 2D:4D. WHtR showed the highest correlation with 2D:4D in male (r = 0.461, P ≤ 0.001) and female (r = 0.408, P ≤ 0.001) when compared with BMI, NC and WC. All positive correlations recorded in this study were high in male and right hand. Conclusion: Our results showed that 2D:4D is sexual dimorphic and right hand 2D:4D as a predictor of MetS is better. We concluded that 2D:4D is a proxy for MetS and CVD risk factors in Ilorin. PMID:24949031

  9. Narrative story stems with high risk six year-olds: differential associations with mother- and teacher-reported psycho-social adjustment.

    PubMed

    Page, Timothy; Boris, Neil W; Heller, Sherryl; Robinson, Lara; Hawkins, Shantice; Norwood, Rhonda

    2011-07-01

    Children's responses on a Narrative Story Stem Technique (NSST) were coded using scales reflecting essential attachment constructs, specifically, attachment, exploratory, sociability, and caregiving behavioral systems, as originally conceived by Bowlby ( 1973 , 1982 ) and elaborated upon by his followers (Cassidy, 2008 ). NSST responses were examined in relation to both mother- and teacher-reported psycho-social adjustment and risk using the MacArthur Health & Behavior Questionnaire (HBQ). Forty-six children participated (average age 6 years 10 months), 19 of whom had high-risk backgrounds, and the rest demographically matched. Findings indicate that NSST scales were associated with behavior on certain HBQ scales, in expected directions. NSST responses appeared to differentiate socially competent children from children with the specific psycho-social risks of externalizing behavior problems and social isolation, according to mother-reports, on the one hand, and peer vulnerability and internalizing problems, according to teacher-reports, on the other. Implications for clinical applications are discussed.

  10. Children's intellectual and emotional-behavioral adjustment at 4 years as a function of cocaine exposure, maternal characteristics, and environmental risk.

    PubMed

    Bennett, David S; Bendersky, Margaret; Lewis, Michael

    2002-09-01

    The authors examined 223 children at age 4 years for the effects of prenatal cocaine exposure, exposure to other substances, maternal and environmental risk factors, and neonatal medical problems on IQ, externalizing problems, and internalizing problems. Regression analyses showed that maternal verbal IQ and low environmental risk predicted child IQ. Cocaine exposure negatively predicted children's overall IQ and verbal reasoning scores, but only for boys. Cocaine exposure also predicted poorer short-term memory. Maternal harsh discipline, maternal depressive symptoms, and increased environmental risk predicted externalizing problems. In contrast, only maternal depressive symptoms predicted internalizing problems. These findings indicate that early exposure to substances is largely unrelated to subsequent IQ or adjustment, particularly for girls.

  11. Increasing the recipient benefit/donor risk ratio by lowering the graft size requirement for living donor liver transplantation.

    PubMed

    Chan, See Ching; Fan, Sheung Tat; Chok, Kenneth S H; Sharr, William W; Dai, Wing Chiu; Fung, James Y Y; Chan, Kwok Yin; Balsarkar, Dharmesh J; Lo, Chung Mau

    2012-09-01

    In living donor liver transplantation (LDLT), a right liver graft is larger than a left liver graft and hence leads to better recipient survival. However, in comparison with donor left hepatectomy, donor right hepatectomy carries a higher donor risk. We estimated the expansion of the applicability of left liver living donor liver transplantation (LLDLT) by lowering the graft weight (GW)/standard liver volume (SLV) ratio in increments of 5%. Consecutive LDLT cases were included in this study. The results of computed tomography volumetry provided the graft volume measurements, and the GW was derived from the graft volume with the conversion factor of 1.19 mL/g. We tried to estimate how many more times LLDLT would have been feasible if the GW/SLV requirement had been lowered to 40%, 35%, 30%, or 25%. In all, 361 consecutive donor-recipient pairs underwent LDLT. Right liver living donor liver transplantation (RLDLT) accounted for 95% of the LDLT cases. Most recipients were male (74.2%), and most donors were female (60.4%). The median GW/SLV ratio was 46% (47% for RLDLT and 37% for LLDLT, P < 0.001). Two of the 218 female donors donated the left liver, and 12 of the 93 female recipients received a left liver. In 147 of the 173 cases (85%) when the donor was female and the recipient was male, the GW/SLV ratio did not reach 30%. LLDLT could have been performed more often than 5% of the time if a lower GW/SLV requirement had been adopted. With GW/SLV ratios ≥ 40%, ≥ 35%, ≥ 30%, and ≥ 25%, the proportion of LLDLT cases would have risen from 5% to 5.8%, 12.5%, 29.1%, and 62.3%, respectively. LLDLT could have been performed approximately twice as often with every 5% reduction of the GW/SLV requirement. In conclusion, lowering the graft size requirement could improve the applicability of LLDLT and hence reduce donor risk.

  12. An Exploratory Study of the Relationship Between Digit Ratio, Illusion of Control, and Risk-Taking Behavior Among Chinese College Students.

    PubMed

    Lam, Desmond; Ozorio, Bernadete

    2015-12-01

    Previous studies on the relationship between digit ratio and risk-taking mainly focused on western subjects. Moreover, no researcher has examined the concurrent effect of digit ratio and illusion of control on gambling behavior. This exploratory study investigates the relationship between digit ratio, illusion of control and risk-taking behavior of Chinese subjects. Sixty-six students from a Chinese university were invited to answer a questionnaire and play a purposefully-designed betting game. The results show that the subjects' risk-taking level, measured in terms of average betting amount, is negatively correlated to their digit ratio but not to their illusion of control score. Moreover, there is no significant association between the subjects' digit ratio and illusion of control score. These preliminary findings will have useful implications to gaming regulators and businesses.

  13. Benefit-risk ratio of canned pacific saury (Cololabis saira) intake: Essential fatty acids vs. heavy metals.

    PubMed

    Anishchenko, O V; Sushchik, N N; Makhutova, O N; Kalachova, G S; Gribovskaya, I V; Morgun, V N; Gladyshev, M I

    2017-03-01

    Fatty acid (FA) and element contents were studied in 14 brands of canned (in its own juice and with sunflower oil) saury (Cololabis saira), a popular product of Russian market. Canned saury is a valuable source of essential polyunsaturated FA - eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3). To obtain personal daily dose of EPA + DHA of 1 g for prevention of cardiovascular diseases, neural and inflammatory disorders one needs to intake from 26 to 76 g of canned saury, as was calculated for studied brands. ICP-OES analysis of 24 elements showed that Pb concentration in one brand and Cd content in most of studied saury samples exceeded standards for fish meat established by the European Commission. However, values of hazard quotient, HQEFA, which estimate benefit-risk ratio of fish intake, indicate that canned saury is safe product for human nutrition.

  14. Immediate Postoperative Intraocular Pressure Adjustment Reduces Risk of Cystoid Macular Edema after Uncomplicated Micro Incision Coaxial Phacoemulsification Cataract Surgery

    PubMed Central

    Jarstad, Allison R.; Chung, Gary W.; Tester, Robert A.; Day, Linda E.

    2017-01-01

    Purpose To determine the accuracy of visual estimation of immediate postoperative intraocular pressure (IOP) following microincision cataract surgery (MICS) and the effect of immediate postoperative IOP adjustment on prevention of cystoid macular edema (CME). Setting Ambulatory surgical center. Methods Prospective, randomized analysis of 170 eyes in 135 patients with MICS, performed in a Medicare approved outpatient ambulatory surgery center. Surgical parameters included a keratome incision of 1.5 mm to 2.8 mm, topical anesthetic, case completion IOP estimation by palpation and patient visualization of light, and IOP adjustment before exiting the operating theater. IOPs were classified into three groups: low (<16 mmHg), normal (16 to 21 mmHg), and elevated (>21 to 30 mmHg). IOP measurements were repeated 1 day after surgery. Optical coherence tomography (Stratus OCT, Zeiss) was measured at 2 weeks. An increase in foveal thickness greater than 15 µm was used to indicate CME. Statistical analysis was performed using one- and two-tailed Student's t-tests. Results Mean minimal foveal thickness averaged 207.15 µm in the low pressure group, 205.14 µm in the normal IOP group, and 210.48 µm in the elevated IOP group 2 weeks following surgery. CME occurred in 14 of 170 eyes (8.2%) at 2 weeks (low IOP, 35.7%; normal IOP, 14.2%; elevated IOP, 50.0%). Change in IOP from the operating theater to 1 day after surgery was within +/−5 mmHg in 54 eyes (31.7%), elevated by 6 to 15 mmHg in 22 eyes (12.9%), and elevated more than 15 mmHg in four eyes (2.3%). IOP was reduced by 6 mmHg to 15 mmHg in 39 eyes (22.9%) and reduced by more than 15 mmHg in nine eyes (5.3%). Conclusions Immediate postoperative adjustment of IOP may prevent CME in MICS. Physicians can improve their ability to estimate postoperative IOP with experience in tonometry to verify immediate postoperative IOP. There are patient safety and economic benefits to immediate IOP adjustment in the operating theater

  15. Metastatic lymph node ratio can further stratify risk for mortality in medullary thyroid cancer patients: A population-based analysis

    PubMed Central

    Lu, Zhong-wu; Liao, Tian; Wen, Duo; Sun, Guo-hua; Li, Duan-shu; Ji, Qing-hai

    2016-01-01

    Medullary thyroid cancer (MTC) has a propensity to cervical lymph node metastases (LNM). Recent studies have shown that both the number of involved lymph nodes (LNs) and the metastatic lymph node ratio (MLNR) confer prognostic information. This study was to determine the predictive value of MLNR on cancer-specific survival (CSS) in SEER (Surveillance, Epidemiology and End Results)-registered MTC patients treated with thyroidectomy and lymphadenectomy between 1991 and 2012, investigate the cutoff points for MLNR in stratifying risk of mortality and provide evidence for selection of appropriate treatment strategies. X-tile program determined 0.5 as optimal cut-off value for MLNR in terms of CSS in 890 MTC patients. According to multivariate Cox regression analysis, MLNR (0.50–1.00) is a significant independent prognostic factor for CSS (hazard ratio 2.161, 95% confidence interval 1.327–3.519, p=0.002). MLNR (0.50–1.00) has a greater prognostic impact on CSS in female, non-Hispanic white, T3/4, N1b and M1 patients. The lymph node yield (LNY) influences the effect of MLNR on CSS; LNY ≥9 results in MLNR (0.50–1.00) having a higher HR for CSS than MLNR (0.00-0.49). In conclusion, higher MLNRs predict poorer survival in MTC patients. Eradication of involved nodes ensures accurate staging and maximizes the ability of MLNR to predict prognosis. PMID:27588396

  16. The relationship between neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and thrombolysis in myocardial infarction risk score in patients with ST elevation acute myocardial infarction before primary coronary intervention

    PubMed Central

    Ertaş, Faruk; Bilik, Mehmet Zihni; Akıl, Mehmet Ata; Özyurtlu, Ferhat; Aydın, Mesut; Oylumlu, Mustafa; Polat, Nihat; Yüksel, Murat; Yıldız, Abdulkadir; Kaya, Hasan; Akyüz, Abdurrahman; Ayçiçek, Hilal; Özbek, Mehmet; Toprak, Nizamettin

    2015-01-01

    Introduction The thrombolysis in myocardial infarction (TIMI) risk score is calculated as the sum of independent predictors of mortality and ischemic events in ST elevation acute myocardial infarction (STEMI). Several studies show that the neutrophil to lymphocyte ratio (NLR) is a prognostic inflammatory marker. In preliminary studies, platelet to lymphocyte ratio (PLR) has been proposed as a pro-thrombotic marker. The relationship between NLR, PLR and TIMI risk score for STEMI has never been studied. Aim To evaluate the association between TIMI-STEMI risk score and NLR, PLR and other biochemical indices in STEMI. Material and methods In this retrospective study, we evaluated 390 patients who presented with STEMI within 12 h of symptom onset. Patients were grouped according to low and high TIMI risk scores. Results We enrolled 390 patients (mean age 61.9 ±13.6 years; 73% were men). The NLR, platelet distribution width (PDW) and uric acid level (UA) were significantly associated with a high TIMI-STEMI risk score (p = 0.016, p = 0.008, p = 0.030, respectively), but PLR was not associated with a high TIMI-STEMI risk score. Left ventricular ejection fraction was an independent predictor of TIMI-STEMI risk score. A cut-off point of TIMI-STEMI score of > 4 predicted in-hospital mortality (sensitivity 75%, specificity 70%, p < 0.001). We found that NLR, PDW, and UA level were associated with TIMI-STEMI risk score. Conclusions Neutrophil to lymphocyte ratio, PDW and UA level are convenient, inexpensive and reproducible biomarkers for STEMI prognosis before primary angioplasty when these indicators are combined with the TIMI-STEMI risk score. We believe that these significant findings can guide further clinical practice. PMID:26161105

  17. Current strategies in antiplatelet therapy--does identification of risk and adjustment of therapy contribute to more effective, personalized medicine in cardiovascular disease?

    PubMed

    Geisler, Tobias; Gawaz, Meinrad; Steinhubl, Steven R; Bhatt, Deepak L; Storey, Robert F; Flather, Marcus

    2010-08-01

    There is a wide consensus that intensified antiplatelet therapy contributes to the reduction of major atherothrombotic complications in cardiovascular (CV) disease. In the setting of PCI (percutaneous coronary intervention) and acute coronary syndromes, dual antiplatelet therapy at optimal dosing and timing has significantly lowered the risk of thrombotic complications. There is a growing body of evidence that there is variability in response to antiplatelet treatments and this represents a potentially important clinical problem. Understanding the mechanisms underlying this phenomenon is important in improving patient care, but due to the diversity of factors involved, a clear predictive model for responsiveness to antiplatelet therapy is still missing. Attempts have been made to characterize the efficacy of antiplatelet therapy using platelet function testing but based on current information, its routine use is not recommended particularly as costs and cost effectiveness have not been established and agreement between laboratory methods is lacking. Hence, it is necessary to identify risk factors for decreased efficacy of standard antiplatelet drug treatment. It may be useful to adjust antiplatelet therapy based on individual risk assessment, especially as new platelet inhibitors are being introduced or are in development including prasugrel as well as the non-thienopyridines, ticagrelor, elinogrel, the ATP analog cangrelor, and thrombin receptor antagonists. This article focuses on antiplatelet therapy in patients at high risk for cardiovascular events and discusses the options for individual risk assessment and strategies to personalize therapy in the light of the large number of recent developments.

  18. The relationship between effectiveness and costs measured by a risk-adjusted case-mix system: multicentre study of Catalonian population data bases

    PubMed Central

    Sicras-Mainar, Antoni; Navarro-Artieda, Ruth; Blanca-Tamayo, Milagrosa; Velasco-Velasco, Soledad; Escribano-Herranz, Esperanza; Llopart-López, Josep Ramon; Violan-Fors, Concepción; Vilaseca-Llobet, Josep Maria; Sánchez-Fontcuberta, Encarna; Benavent-Areu, Jaume; Flor-Serra, Ferran; Aguado-Jodar, Alba; Rodríguez-López, Daniel; Prados-Torres, Alejandra; Estelrich-Bennasar, Jose

    2009-01-01

    Background The main objective of this study is to measure the relationship between morbidity, direct health care costs and the degree of clinical effectiveness (resolution) of health centres and health professionals by the retrospective application of Adjusted Clinical Groups in a Spanish population setting. The secondary objectives are to determine the factors determining inadequate correlations and the opinion of health professionals on these instruments. Methods/Design We will carry out a multi-centre, retrospective study using patient records from 15 primary health care centres and population data bases. The main measurements will be: general variables (age and sex, centre, service [family medicine, paediatrics], and medical unit), dependent variables (mean number of visits, episodes and direct costs), co-morbidity (Johns Hopkins University Adjusted Clinical Groups Case-Mix System) and effectiveness. The totality of centres/patients will be considered as the standard for comparison. The efficiency index for visits, tests (laboratory, radiology, others), referrals, pharmaceutical prescriptions and total will be calculated as the ratio: observed variables/variables expected by indirect standardization. The model of cost/patient/year will differentiate fixed/semi-fixed (visits) costs of the variables for each patient attended/year (N = 350,000 inhabitants). The mean relative weights of the cost of care will be obtained. The effectiveness will be measured using a set of 50 indicators of process, efficiency and/or health results, and an adjusted synthetic index will be constructed (method: percentile 50). The correlation between the efficiency (relative-weights) and synthetic (by centre and physician) indices will be established using the coefficient of determination. The opinion/degree of acceptance of physicians (N = 1,000) will be measured using a structured questionnaire including various dimensions. Statistical analysis: multiple regression analysis (procedure

  19. Applying risk adjusted cost-effectiveness (RAC-E) analysis to hospitals: estimating the costs and consequences of variation in clinical practice.

    PubMed

    Karnon, Jonathan; Caffrey, Orla; Pham, Clarabelle; Grieve, Richard; Ben-Tovim, David; Hakendorf, Paul; Crotty, Maria

    2013-06-01

    Cost-effectiveness analysis is well established for pharmaceuticals and medical technologies but not for evaluating variations in clinical practice. This paper describes a novel methodology--risk adjusted cost-effectiveness (RAC-E)--that facilitates the comparative evaluation of applied clinical practice processes. In this application, risk adjustment is undertaken with a multivariate matching algorithm that balances the baseline characteristics of patients attending different settings (e.g., hospitals). Linked, routinely collected data are used to analyse patient-level costs and outcomes over a 2-year period, as well as to extrapolate costs and survival over patient lifetimes. The study reports the relative cost-effectiveness of alternative forms of clinical practice, including a full representation of the statistical uncertainty around the mean estimates. The methodology is illustrated by a case study that evaluates the relative cost-effectiveness of services for patients presenting with acute chest pain across the four main public hospitals in South Australia. The evaluation finds that services provided at two hospitals were dominated, and of the remaining services, the more effective hospital gained life years at a low mean additional cost and had an 80% probability of being the most cost-effective hospital at realistic cost-effectiveness thresholds. Potential determinants of the estimated variation in costs and effects were identified, although more detailed analyses to identify specific areas of variation in clinical practice are required to inform improvements at the less cost-effective institutions.

  20. Cumulative Socioeconomic Status Risk, Allostatic Load, and Adjustment: A Prospective Latent Profile Analysis with Contextual and Genetic Protective Factors

    ERIC Educational Resources Information Center

    Brody, Gene H.; Yu, Tianyi; Chen, Yi-Fu; Kogan, Steven M.; Evans, Gary W.; Beach, Steven R. H.; Windle, Michael; Simons, Ronald L.; Gerrard, Meg; Gibbons, Frederick X.; Philibert, Robert A.

    2013-01-01

    The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental…

  1. Acculturation and Adjustment in Latino Adolescents: How Cultural Risk Factors and Assets Influence Multiple Domains of Adolescent Mental Health

    ERIC Educational Resources Information Center

    Smokowski, Paul; Buchanan, Rachel L.; Bacallao, Martica L.

    2009-01-01

    The purpose of this study was to examine the relationships among risk factors, cultural assets, and Latino adolescent mental health outcomes. We extend past research by using a longitudinal design and evaluating direct and moderated acculturation effects across a range of internalizing, externalizing, and academic engagement outcomes. The sample…

  2. Appropriate LDL-C-to-HDL-C Ratio Cutoffs for Categorization of Cardiovascular Disease Risk Factors among Uygur Adults in Xinjiang, China.

    PubMed

    Chen, Qing-Jie; Lai, Hong-Mei; Chen, Bang-Dang; Li, Xiao-Mei; Zhai, Hui; He, Chun-Hui; Pan, Shuo; Luo, Jun-Yi; Gao, Jing; Liu, Fen; Ma, Yi-Tong; Yang, Yi-Ning

    2016-02-19

    Elevated LDL-C/HDL-C ratio has been shown to be a marker of lipid metabolism as well as a good predictor of coronary artery disease (CAD). Thus, the aim of this study was to investigate whether the LDL-C/HDL-C ratio is useful for detecting cardiovascular disease (CVD) risk factors in general healthy Uygur adults in Xinjiang. A total of 4047 Uygur subjects aged ≥35 years were selected from the Cardiovascular Risk Survey (CRS) study which was carried out from October 2007 to March 2010. Anthropometric data, blood pressure, lipid profile and fasting glucose were measured in all participants. The prevalence, sensitivity, specificity and distance on the receiver operating characteristic (ROC) curve of each LDL-C/HDL-C ratio were calculated. The prevalence of high LDL-C and low HDL-C cholesterol was high and positively correlated with higher LDL-C/HDL-C ratio in the Uygur population. In both men and women, we detected a slight apparent trend of high prevalence of hypertension and hypercholesterolemia with higher LDL-C/HDL-C ratio. Our study also demonstrated that the discriminatory power of the LDL-C/HDL-C ratio for CVD risk factors was slightly stronger in men than in women. Analysis of the shortest distance in the ROC curves for hypertension, dyslipidemia, diabetes, or ≥two of these risk factors suggested a LDL-C/HDL-C ratio cutoff of 2.5 for both men and women. The results of this study showed that a LDL-C/HDL-C ratio cut-off of 2.5 might be used as the predictive marker to detect CVD risk factors among Uygur adults in Xinjiang.

  3. 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 ...

  4. 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 ...

  5. Compensatory Postural Adjustments in an Oculus Virtual Reality Environment and the Risk of Falling in Alzheimer's Disease

    PubMed Central

    Gago, Miguel F.; Yelshyna, Darya; Bicho, Estela; Silva, Hélder David; Rocha, Luís; Lurdes Rodrigues, Maria; Sousa, Nuno

    2016-01-01

    Background/Aims Alzheimer's disease (AD) patients have an impaired ability to quickly reweight central sensory dependence in response to unexpected body perturbations. Herein, we aim to study provoked compensatory postural adjustments (CPAs) in a conflicting sensory paradigm with unpredictable visual displacements using virtual reality goggles. Methods We used kinematic time-frequency analyses of two frequency bands: a low-frequency band (LB; 0.3-1.5 Hz; mechanical strategy) and a high-frequency band (HB; 1.5-3.5 Hz; cognitive strategy). We enrolled 19 healthy subjects (controls) and 21 AD patients, divided according to their previous history of falls. Results The AD faller group presented higher-power LB CPAs, reflecting their worse inherent postural stability. The AD patients had a time lag in their HB CPA reaction. Conclusion The slower reaction by CPA in AD may be a reflection of different cognitive resources including body schema self-perception, visual motion, depth perception, or a different state of fear and/or anxiety. PMID:27489559

  6. Hepatic Fibrosis Progression in HIV-Hepatitis C Virus Co-Infection – The Effect of Sex on Risk of Significant Fibrosis Measured by Aspartate-to-Platelet Ratio Index

    PubMed Central

    Rollet-Kurhajec, Kathleen C.; Moodie, Erica E. M.; Walmsley, Sharon; Cooper, Curtis; Pick, Neora; Klein, Marina B.

    2015-01-01

    Background In Hepatitis C virus (HCV) mono-infection, male sex is associated with faster liver fibrosis progression but the effects of sex have not been well studied in HIV-HCV co-infected patients. We examined the influence of sex on progression to significant liver fibrosis in HIV-HCV co-infected adults receiving antiretroviral therapy (ART) using the aspartate aminotransferase-to-platelet ratio index (APRI) as a surrogate biomarker of liver fibrosis. Methods We evaluated 308 HIV infected, HCV RNA positive participants of a Canadian multicentre prospective cohort receiving antiretrovirals and without significant liver fibrosis or end-stage liver disease at baseline. We used multivariate discrete-time proportional hazards models to assess the effect of sex on time to significant fibrosis (APRI≥1.5) adjusting for baseline age, alcohol use, cigarette smoking, HCV duration, and APRI and time-updated CD4 count and HIV RNA. Results Overall, 55 (18%) participants developed an APRI ≥ 1.5 over 544 person-years of at-risk follow-up time; 18 (21%) women (incidence rate (IR)=14.0/100 PY; 7.5-20.4) and 37 (17%) men (IR=8.9/100 PY; 6.0-11.8). Women had more favourable profiles with respect to traditional risk factors for liver disease progression (younger, shorter duration of HCV infection and less alcohol use). Despite this, female sex was associated with a greater than two-fold increased risk of fibrosis progression (adjusted hazard rate (HR) =2.23; 1.22-4.08). Conclusions HIV-HCV co-infected women receiving antiretroviral therapy were at significantly greater risk of progressing to liver fibrosis as measured by APRI compared with men. Enhanced efforts to engage and treat co-infected women for HCV are needed. PMID:26090666

  7. 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.

  8. A decreasing CD4/CD8 ratio over time and lower CSF-penetrating antiretroviral regimens are associated with a higher risk of neurocognitive deterioration, independently of viral replication.

    PubMed

    Vassallo, Matteo; Fabre, R; Durant, J; Lebrun-Frenay, C; Joly, H; Ticchioni, M; DeSalvador, F; Harvey-Langton, A; Dunais, B; Laffon, M; Cottalorda, J; Dellamonica, P; Pradier, C

    2017-04-01

    Persistent immune activation is one of the suspected causes of HIV-associated neurocognitive disorders (HAND) in cART era. The CD4/CD8 ratio has been recently showed as a marker of immune activation and HAND. Our aim was to analyze if a decrease in the CD4/CD8 ratio over time could have an impact on neurocognitive deterioration. Randomly selected HIV-infected patients were followed for neuropsychological (NP) testing during a period of almost 2 years. Tests were adjusted for age, gender, and education. Patients were divided into 5 groups: normal tests (NT), neuropsychological deficit (ND, one impaired cognitive domain), asymptomatic neurocognitive disorders (ANI), mild neurocognitive disorders (MND), and HIV-associated dementia (HAD). Risk factors for neurocognitive deterioration were analyzed. Two hundred fifty-six patients underwent NP tests and 94 participated in the follow-up. The groups were comparable. Upon neuropsychological re-testing, six patients showed clinical improvement, 30 had worsened, and 58 were stable, resulting in 42 patients presenting with HAND (45 %). The majority of HAND cases consisted of ANI (26 %) and MND (16 %). In patients whose NP performance worsened, CPE 2010 score was lower at inclusion (7.13 vs 8.00, p = 0.003) and CD4/CD8 decrease more frequent (60 vs 31 %, p = 0.008) than in those who were stable or improved. Multivariate analysis confirmed these results. A decreasing CD4/CD8 ratio during a longitudinal follow-up of randomly selected HIV-infected patients and lower CSF-penetrating regimens were independently associated with cognitive decline. Monitoring trends in CD4/CD8 ratio could contribute to identifying patients at higher risk of neurocognitive deterioration.

  9. Evaluating the effects of variation in clinical practice: a risk adjusted cost-effectiveness (RAC-E) analysis of acute stroke services

    PubMed Central

    2012-01-01

    Background Methods for the cost-effectiveness analysis of health technologies are now well established, but such methods may also have a useful role in the context of evaluating the effects of variation in applied clinical practice. This study illustrates a general methodology for the comparative analysis of applied clinical practice at alternative institutions – risk adjusted cost-effectiveness (RAC-E) analysis – with an application that compares acute hospital services for stroke patients admitted to the main public hospitals in South Australia. Methods Using linked, routinely collected data on all South Australian hospital separations from July 2001 to June 2008, an analysis of the RAC-E of services provided at four metropolitan hospitals was undertaken using a decision analytic framework. Observed (plus extrapolated) and expected lifetime costs and survival were compared across patient populations, from which the relative cost-effectiveness of services provided at the different hospitals was estimated. Results Unadjusted results showed that at one hospital patients incurred fewer costs and gained more life years than at the other hospitals (i.e. it was the dominant hospital). After risk adjustment, the cost minimizing hospital incurred the lowest costs, but with fewer life-years gained than one other hospital. The mean incremental cost per life-year gained of services provided at the most effective hospital was under $20,000, with an associated 65% probability of being cost-effective at a $50,000 per life year monetary threshold. Conclusions RAC-E analyses can be used to identify important variation in the costs and outcomes associated with clinical practice at alternative institutions. Such data provides an impetus for further investigation to identify specific areas of variation, which may then inform the dissemination of best practice service delivery and organisation. PMID:22905669

  10. Response bias, weighting adjustments, and design effects in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

    PubMed

    Kessler, Ronald C; Heeringa, Steven G; Colpe, Lisa J; Fullerton, Carol S; Gebler, Nancy; Hwang, Irving; Naifeh, James A; Nock, Matthew K; Sampson, Nancy A; Schoenbaum, Michael; Zaslavsky, Alan M; Stein, Murray B; Ursano, Robert J

    2013-12-01

    The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi-component epidemiological and neurobiological study designed to generate actionable recommendations to reduce US Army suicides and increase knowledge about determinants of suicidality. Three Army STARRS component studies are large-scale surveys: one of new soldiers prior to beginning Basic Combat Training (BCT; n = 50,765 completed self-administered questionnaires); another of other soldiers exclusive of those in BCT (n = 35,372); and a third of three Brigade Combat Teams about to deploy to Afghanistan who are being followed multiple times after returning from deployment (n = 9421). Although the response rates in these surveys are quite good (72.0-90.8%), questions can be raised about sample biases in estimating prevalence of mental disorders and suicidality, the main outcomes of the surveys based on evidence that people in the general population with mental disorders are under-represented in community surveys. This paper presents the results of analyses designed to determine whether such bias exists in the Army STARRS surveys and, if so, to develop weights to correct for these biases. Data are also presented on sample inefficiencies introduced by weighting and sample clustering and on analyses of the trade-off between bias and efficiency in weight trimming.

  11. Response bias, weighting adjustments, and design effects in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

    PubMed Central

    Kessler, Ronald C.; Heeringa, Steven G.; Colpe, Lisa J.; Fullerton, Carol S.; Gebler, Nancy; Hwang, Irving; Naifeh, James A.; Nock, Matthew K.; Sampson, Nancy A.; Schoenbaum, Michael; Zaslavsky, Alan M.; Stein, Murray B.; Ursano, Robert J.

    2014-01-01

    The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi-component epidemiological and neurobiological study designed to generate actionable recommendations to reduce U.S. Army suicides and increase knowledge about determinants of suicidality. Three Army STARRS component studies are large-scale surveys: one of new soldiers prior to beginning Basic Combat Training (BCT; n=50,765 completed self-administered questionnaires); another of other soldiers exclusive of those in BCT (n=35,372); and a third of three Brigade Combat Teams about to deploy to Afghanistan who are being followed multiple times after returning from deployment (n= 9,421). Although the response rates in these surveys are quite good (72.0-90.8%), questions can be raised about sample biases in estimating prevalence of mental disorders and suicidality, the main outcomes of the surveys based on evidence that people in the general population with mental disorders are under-represented in community surveys. This paper presents the results of analyses designed to determine whether such bias exists in the Army STARRS surveys and, if so, to develop weights to correct for these biases. Data are also presented on sample inefficiencies introduced by weighting and sample clustering and on analyses of the trade-off between bias and efficiency in weight trimming. PMID:24318218

  12. Relation among the plasma triglyceride/high-density lipoprotein cholesterol concentration ratio, insulin resistance, and associated cardio-metabolic risk factors in men and women.

    PubMed

    Salazar, Martin R; Carbajal, Horacio A; Espeche, Walter G; Leiva Sisnieguez, Carlos E; Balbín, Eduardo; Dulbecco, Carlos A; Aizpurúa, Marcelo; Marillet, Alberto G; Reaven, Gerald M

    2012-06-15

    Results of recent studies using the ratio of plasma triglyceride (TG) to high-density lipoprotein (HDL) cholesterol concentration to identify insulin-resistant patients at increased cardiometabolic risk have emphasized that the cut point used for this purpose will vary with race. Because TG and HDL cholesterol concentrations vary with gender, this analysis was initiated to define gender-specific plasma TG/HDL cholesterol concentration ratios that best identified high-risk subjects among women (n = 1,102) and men (n = 464) of primarily European ancestry. Insulin resistance was defined as the 25% of the population with the highest values for fasting plasma insulin concentration and homeostasis model assessment of insulin resistance. Using TG/HDL concentration ratios >2.5 in women and >3.5 in men identified subgroups of men and women that were comparable in terms of insulin resistance and associated cardiometabolic risk, with significantly higher values for fasting plasma insulin, homeostasis model assessment of insulin resistance, blood pressure, body mass index, waist circumference, and glucose and TG concentrations and lower HDL cholesterol concentrations than in women and men below these cut points. The sensitivity and specificity of these gender-specific cut points to identify insulin-resistant subjects were about 40% and about 80%, respectively. In conclusion, the plasma TG/HDL cholesterol concentration ratio that identifies patients who are insulin resistant and at significantly greater cardiometabolic risk varies between men and women.

  13. Soluble receptor for advanced glycation end-product (sRAGE)/pentosidine ratio: a potential risk factor determinant for type 2 diabetic retinopathy.

    PubMed

    Ng, Zhi Xiang; Chua, Kek Heng; Iqbal, Tajunisah; Kuppusamy, Umah Rani

    2013-04-03

    This study aims to investigate potential diabetic retinopathy (DR) risk factors by evaluating the circulating levels of pentosidine, soluble receptor for advanced glycation end-product (sRAGE), advanced oxidation protein product (AOPP) as well as glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities in DR patients. A total of 235 healthy controls, 171 type 2 diabetic without retinopathy (DNR) and 200 diabetic retinopathy (DR) patients were recruited. Plasma was extracted for the estimation of pentosidine, sRAGE, AOPP levels and GPx activity whereas peripheral blood mononuclear cells were disrupted for SOD activity measurement. DNR and DR patients showed significantly higher levels of plasma pentosidine, sRAGE and AOPP but lower GPx and SOD activities when compared to healthy controls. The sRAGE/pentosidine ratio in DR patients was significantly lower than the ratio detected in DNR patients. Proliferative DR patients had significantly higher levels of plasma pentosidine, sRAGE, AOPP and sRAGE/pentosidine ratio than non-proliferative DR patients. High HbA1c level, long duration of diabetes and low sRAGE/pentosidine ratio were determined as the risk factors for DR. This study suggests that sRAGE/pentosidine ratio could serve as a risk factor determinant for type 2 DR as it has a positive correlation with the severity of DR.

  14. Improved in silico prediction of carcinogenic potency (TD50) and the risk specific dose (RSD) adjusted Threshold of Toxicological Concern (TTC) for genotoxic chemicals and pharmaceutical impurities.

    PubMed

    Contrera, Joseph F

    2011-02-01

    The Threshold of Toxicological Concern (TTC) is a level of exposure to a genotoxic impurity that is considered to represent a negligible risk to humans. The TTC was derived from the results of rodent carcinogenicity TD50 values that are a measure of carcinogenic potency. The TTC currently sets a default limit of 1.5 μg/day in food contact substances and pharmaceuticals for all genotoxic impurities without carcinogenicity data. Bercu et al. (2010) used the QSAR predicted TD50 to calculate a risk specific dose (RSD) which is a carcinogenic potency adjusted TTC for genotoxic impurities. This promising approach is currently limited by the software used, a combination of MC4PC (www.multicase.com) and a Lilly Inc. in-house software (VISDOM) that is not available to the public. In this report the TD50 and RSD were predicted using a commercially available software, SciQSAR (formally MDL-QSAR, www.scimatics.com) employing the same TD50 training data set and external validation test set that was used by Bercu et al. (2010). The results demonstrate the general applicability of QSAR predicted TD50 values to determine the RSDs for genotoxic impurities and the improved performance of SciQSAR for predicting TD50 values.

  15. The Correlation between the Triglyceride to High Density Lipoprotein Cholesterol Ratio and Computed Tomography-Measured Visceral Fat and Cardiovascular Disease Risk Factors in Local Adult Male Subjects

    PubMed Central

    Park, Hye-Rin; Han, A Lum; Jeong, Yong Joon

    2015-01-01

    Background We studied the association between the triglyceride to high-density lipoprotein cholesterol ratio and computed tomography-measured visceral fat as well as cardiovascular risk factors among Korean male adults. Methods We measured triglycerides, high density lipoprotein cholesterol, body mass, waist circumference, fasting plasma glucose, hemoglobin A1c, systolic blood pressure, diastolic blood pressure, visceral fat, and subcutaneous fat among 372 Korean men. The visceral fat and subcutaneous fat areas were measured by computed tomography using a single computed tomography slice at the L4-5 lumbar level. We analyzed the association between the triglyceride to high density lipoprotein cholesterol ratio and visceral fat as well as cardiovascular risk factors. Results A positive correlation was found between the triglyceride to high density lipoprotein cholesterol ratio and variables such as body mass index, waist circumference, fasting plasma glucose, hemoglobin A1c, visceral fat, and the visceral-subcutaneous fat ratio. However, there was no significant correlation between the triglyceride to high density lipoprotein cholesterol ratio and subcutaneous fat or blood pressure. Multiple logistic regression analyses revealed significant associations between a triglyceride to high density lipoprotein cholesterol ratio ≥3 and diabetes, a body mass index ≥25 kg/m2, a waist circumference ≥90 cm, and a visceral fat area ≥100 cm2. The triglyceride to high density lipoprotein cholesterol ratio was not significantly associated with hypertension. Conclusion There were significant associations between the triglyceride to high density lipoprotein cholesterol ratio and body mass, waist circumference, diabetes, and visceral fat among a clinical sample of Korean men. In the clinical setting, the triglyceride to high density lipoprotein cholesterol ratio may be a simple and useful indicator for visceral obesity and cardiovascular disease. PMID:26634102

  16. Medicare program: request for public comments on implementation of risk adjusted payment for the Medicare+Choice program and announcement of public meeting--HCFA. Solicitation of comments; announcement of meeting.

    PubMed

    1998-09-08

    This notice solicits further public comments on issues related to the implementation of risk adjusted payment of Medicare+Choice organizations. Section 1853(a)(3) of the Social Security Act (the Act) requires the Secretary to implement a risk adjustment methodology that accounts for variation in per capita costs based on health status and demographic factors for payments no later than January 1, 2000. The methodology is to apply uniformly to all Medicare+Choice plans. This notice outlines our proposed approach to implementing risk adjusted payment. In order to carry out risk adjustment, section 1853(a)(3) of the Act also requires Medicare+Choice organizations, as well as other organizations with risk sharing contracts, to submit encounter data. Inpatient hospital data are required for discharges on or after July 1, 1997. Other data, as the Secretary deems necessary, may be required beginning July 1998. The Medicare+Choice interim final rule published on June 26, 1998 (63 FR 34968) describes the general process for the collection of encounter data. We also included a schedule for the collection of additional encounter data. Physician, outpatient hospital, skilled nursing facility, and home health data will be collected no earlier than October 1, 1999, and all other data we deem necessary no earlier than October 1, 2000. Given any start date, comprehensive risk adjustment will be made about three years after the year of initial collection of outpatient hospital and physician encounter data. Comments on the process for encounter data collection are requested in that interim final rule. We intend to consider comments received in response to this solicitation as we develop the final methodology for implementation of risk adjustment. This notice also informs the public of a meeting on September 17, 1998, to discuss risk adjustment and the collection of encounter data. The meeting will be held at the Health Care Financing Administration headquarters, located at 7500

  17. 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.

  18. 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.

  19. The gender ratio imbalance and its relationship to risk of HIV/AIDS among African American women at historically black colleges and universities.

    PubMed

    Ferguson, Y Owens; Quinn, S Crouse; Eng, E; Sandelowski, M

    2006-05-01

    African American women are at increased risk of HIV transmission through heterosexual contact. HIV/AIDS is the leading cause of death among African American women between 25 to 34 years of age, and many of these women were likely infected while in college. Four focus groups were conducted with African American students attending Historically Black Colleges and Universities (HBCUs) in order to learn about the college dating environment and how it influenced women's risk of HIV infection. We used constant comparison techniques and visual display matrixes to analyse the data. Students identified the gender ratio imbalance of more women to men on campus as a key element of the campus dating environment and described how it places women at an increased risk for HIV infection. Primary consequences of this gender ratio imbalance were men having multiple female sexual partners during the same time period and women complying with men's condom use preferences. HIV preventive intervention programmes at HBCUs must address the gender ratio imbalance and its consequences to reduce women's risk of contracting the infection.

  20. Importance of android/gynoid fat ratio in predicting metabolic and cardiovascular disease risk in normal weight as well as overweight and obese children.

    PubMed

    Samsell, Lennie; Regier, Michael; Walton, Cheryl; Cottrell, Lesley

    2014-01-01

    Numerous studies have shown that android or truncal obesity is associated with a risk for metabolic and cardiovascular disease, yet there is evidence that gynoid fat distribution may be protective. However, these studies have focused on adults and obese children. The purpose of our study was to determine if the android/gynoid fat ratio is positively correlated with insulin resistance, HOMA2-IR, and dislipidemia in a child sample of varying body sizes. In 7-13-year-old children with BMI percentiles ranging from 0.1 to 99.6, the android/gynoid ratio was closely associated with insulin resistance and combined LDL + VLDL-cholesterol. When separated by sex, it became clear that these relationships were stronger in boys than in girls. Subjects were stratified into BMI percentile based tertiles. For boys, the android/gynoid ratio was significantly related to insulin resistance regardless of BMI tertile with and LDL + VLDL in tertiles 1 and 3. For girls, only LDL + VLDL showed any significance with android/gynoid ratio and only in tertile 2. We conclude that the android/gynoid fat ratio is closely associated with insulin resistance and LDL + VLDL-, "bad," cholesterol in normal weight boys and may provide a measurement of metabolic and cardiovascular disease risk in that population.

  1. Improving Results of Elective Abdominal Aortic Aneurysm Repair at a Low-Volume Hospital by Risk-Adjusted Selection of Treatment in the Endovascular Era

    SciTech Connect

    Wibmer, Andreas; Meyer, Bernhard; Albrecht, Thomas; Buhr, Heinz-Johannes; Kruschewski, Martin

    2009-09-15

    open repair was reduced from 8.5% to 3.7% (p = 0.414). In conclusion, by risk-adjusted selection of treatment and frequent application of EVAR, it is possible to improve perioperative outcome of elective AAA repair at a low-volume hospital. Mortality figures are similar to those of recent trials at high-volume centers, as reported in the literature.

  2. The role of city income inequality, sex ratio and youth mortality rates in the effect of violent victimization on health-risk behaviors in Brazilian adolescents.

    PubMed

    Ramos, Dandara de Oliveira; Daly, Martin; Seidl-de-Moura, Maria Lucia; Nadanovsky, Paulo

    2017-03-27

    This study integrates insights from evolutionary psychology and social epidemiology to present a novel approach to contextual effects on health-risk behaviors (unprotected sex, drunkenness episodes, drugs and tobacco experimentation) among adolescents. Using data from the 2012 Brazilian National Survey of Adolescent Health (PeNSE), we first analyzed the effects of self-reported violent victimization on health-risk behaviors of 47,371 adolescents aged 10-19 nested in the 26 Brazilian state capitals and the Federal District. We then explored whether the magnitude of these associations was correlated with cues of environmental harshness and unpredictability (youth external mortality and income inequality) and mating competition (sex ratio) from the city level. Results indicated that self-reported violent victimization is associated with an increased chance of engagement in health-risk behaviors in all Brazilian state capitals, for both males and females, but the magnitude of these associations varies in relation to broader environmental factors, such as the cities' age-specific mortality rates, and specifically for females, income inequality and sex ratio. In addition to introducing a novel theoretical and empirical approach to contextual effects on adolescent health-risk behaviors, our findings reinforce the need to consider synergies between people's life experiences and the conditions where they live, when studying health-risk behaviors in adolescence.

  3. Evolution of stalk/spore ratio in a social amoeba: cell-to-cell interaction via a signaling chemical shaped by cheating risk.

    PubMed

    Uchinomiya, Kouki; Iwasa, Yoh

    2013-11-07

    The social amoeba (or cellular slime mold) is a model system for cell cooperation. When food is depleted in the environment, cells aggregate together. Some of these cells become stalks, raising spores to aid in their dispersal. Differentiation-inducing factor-1 (DIF-1) is a signaling chemical produced by prespore cells and decomposed by prestalk cells. It affects the rate of switching between prestalk and prespore cells, thereby achieving a stable stalk/spore ratio. In this study we analyzed the evolution of the stalk/spore ratio. Strains may differ in the production and decomposition rates of the signaling chemical, and in the sensitivity of cells to switch in response to the signaling chemical exposure. When two strains with the same stalk/spore ratio within their own fruiting body are combined into a single fruiting body, one strain may develop into prespores to a greater degree than the other. Direct evolutionary simulations and quantitative genetic dynamics demonstrate that if a fruiting body is always formed by a single strain, the cells evolve to produce less signaling chemical and become more sensitive to the signaling chemical due to the cost of producing the chemical. In contrast, if a fruiting body is formed by multiple strains, the cells evolve to become less sensitive to the signaling chemical and produce more signaling chemical in order to reduce the risk of being exploited. In contrast, the stalk-spore ratio is less likely to be affected by small cheating risk.

  4. Interaction between Single Nucleotide Polymorphism and Urinary Sodium, Potassium, and Sodium-Potassium Ratio on the Risk of Hypertension in Korean Adults

    PubMed Central

    Park, Yeong Mi; Kwock, Chang Keun; Kim, Kyunga; Kim, Jihye; Yang, Yoon Jung

    2017-01-01

    Hypertension is a complex disease explained with diverse factors including environmental factors and genetic factors. The objectives of this study were to determine the interaction effects between gene variants and 24 h estimated urinary sodium and potassium excretion and sodium-potassium excretion ratios on the risk of hypertension. A total of 8839 participants were included in the genome-wide association study (GWAS) to find genetic factors associated with hypertension. Tanaka and Kawasaki formulas were applied to estimate 24 h urinary sodium and potassium excretion. A total of 4414 participants were included in interaction analyses to identify the interaction effects of gene variants according to 24 h estimated urinary factors on the risk of hypertension. CSK rs1378942 and CSK-MIR4513 rs3784789 were significantly modified by urinary sodium-potassium excretion ratio. In addition, MKLN rs1643270 with urinary potassium excretion, LOC101929750 rs7554672 with urinary sodium and potassium excretion, and TENM4 rs10466739 with urinary sodium-potassium excretion ratio showed significant interaction effects. The present study results indicated that the mutant alleles of CSK rs1378942 and CSK-MIR4513 rs3784789 had the strongest protective effects against hypertension in the middle group of 24 h estimated urinary sodium-potassium excretion ratio. Further studies are needed to replicate these analyses in other populations. PMID:28273873

  5. Comparison of waist-to-hip ratio and other obesity indices as predictors of cardiovascular disease risk in people with type 2 diabetes: a prospective cohort study from ADVANCE

    PubMed Central

    Czernichow, Sébastien; Kengne, Andre-Pascal; Huxley, Rachel R.; Batty, G David; de Galan, Bastiaan; Grobbee, Diederick; Pillai, Avinesh; Zoungas, Sophia; Marre, Michel; Woodward, Mark; Neal, Bruce; Chalmers, John

    2014-01-01

    Aims The aim of this study was to compare the strength of associations and discrimination capability of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with cardiovascular disease risk in individuals with type-2-diabetes. Methods and results 11,140 men and women were followed for a mean of 4.8 years. Cox proportional hazard models were used to compute the hazard ratios (HR) and 95% confidence intervals (95% CI) for one standard deviation (SD) increase in baseline BMI (SD: 5 kg/m2), WC (SD: 13 cm) and WHR (SD: 0.08) with cardiovascular disease risk. After adjustment, HR (95% CI) for WC were 1.10 (1.03-1.18) for cardiovascular events, 1.13 (1.03-1.24) for coronary events, and 1.08 (0.98-1.19) for cardiovascular deaths. Estimates for WHR were 1.12 (1.05-1.19), 1.17 (1.08-1.28) and 1.19 (1.09-1.31). BMI was not related to any of these outcomes. While the receiver operating characteristic curve could not differentiate between anthropometric variables (p-values ≥ 0.24), the relative integrated discrimination improvement statistic showed an enhancement in the discrimination capabilities of models using WHR for cardiovascular outcomes, except for cerebrovascular events. Conclusion Strengths of associations and discrimination statistics suggested that WHR was the best predictor of cardiovascular events and mortality in patients with type-2-diabetes and BMI the worst. PMID:20628304

  6. Differences in Eccentricity Index and Systolic-Diastolic Ratio in Extremely Low Birth Weight Infants with Bronchopulmonary Dysplasia at Risk of Pulmonary Hypertension

    PubMed Central

    McCrary, AW; Malowitz, JR; Hornik, CP; Hill, KD; Cotten, CM; Tatum, GH; Barker, PC

    2017-01-01

    Objective To compare the left ventricular Eccentricity Index (EI) and tricuspid valve systolic:diastolic (SD) ratio in infants at risk of bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). Study Design Review of echocardiograms performed on infants born at ≤28 weeks postmenstrual age, categorized into three cohorts: BPD and PH (n=13); BPD only (n=16); and controls (n=59). EI was measured from a parasternal short axis 2D image. The SD ratio was measured from the continuous wave Doppler tracing. Groups were compared using Kruskal-Wallis and Wilcoxon rank sum tests. Result EI and SD ratio were successfully measured in all infants. There were no differences between controls and BPD cohort. In contrast, the BPD and PH cohort had increased systolic EI (1.46 vs 1.00–1.01), diastolic EI (1.47 vs 1.00), and SD ratio (1.12 vs 0.97–1.00) compared to controls and BPD only cohort (P≤0.01 for all). Conclusion The EI and SD ratio may be useful as a screening tool for PH in this population. PMID:26171597

  7. Genetic Variants Associated with Optic Nerve Vertical Cup-to-Disc Ratio Are Risk Factors for Primary Open Angle Glaucoma in a US Caucasian Population

    PubMed Central

    Fan, Bao Jian; Wang, Dan Yi; Pasquale, Louis R.; Haines, Jonathan L.

    2011-01-01

    Purpose. Genetically complex disorders, such as primary open angle glaucoma (POAG), may include highly heritable quantitative traits as part of the overall phenotype, and mapping genes influencing the related quantitative traits may effectively identify genetic risk factors predisposing to the complex disease. Recent studies have identified SNPs associated with optic nerve area and vertical cup-to-disc ratio (VCDR). The purpose of this study was to evaluate the association between these SNPs and POAG in a US Caucasian case-control sample. Methods. Five SNPs previously associated with optic disc area, or VCDR, were genotyped in 539 POAG cases and 336 controls. Genotype data were analyzed for single SNP associations and SNP interactions with VCDR and POAG. Results. SNPs associated with VCDR rs1063192 (CDKN2B) and rs10483727 (SIX1/SIX6) were also associated with POAG (P = 0.0006 and P = 0.0043 for rs1063192 and rs10483727, respectively). rs1063192, associated with smaller VCDR, had a protective effect (odds ratio [OR] = 0.73; 95% confidence interval [CI], 0.58–0.90), whereas rs10483727, associated with larger VCDR, increased POAG risk (OR = 1.33; 95% CI, 1.08–1.65). POAG risk associated with increased VCDR was significantly influenced by the C allele of rs1900004 (ATOH7), associated with increased optic nerve area (P-interaction = 0.025; OR = 1.89; 95% CI, 1.22–2.94). Conclusions. Genetic variants influencing VCDR are associated with POAG in a US Caucasian population. Variants associated with optic nerve area are not independently associated with disease but can influence the effects of VCDR variants suggesting that increased optic disc area can significantly contribute to POAG risk when coupled with risk factors controlling VCDR. PMID:21398277

  8. Component Separation vs. Bridged Repair for Large Ventral Hernias: A Multi-Institutional Risk-Adjusted Comparison, Systematic Review, and Meta-Analysis

    PubMed Central

    Askenasy, Eric P.; Greenberg, Jacob A.; Keith, Jerrod N.; Martindale, Robert G.; Roth, J. Scott; Mo, Jiandi; Ko, Tien C.; Kao, Lillian S.; Liang, Mike K.

    2016-01-01

    Abstract Background: Repair of large ventral hernia defects is associated with high rates of surgical site occurrences (SSO), including surgical site infection (SSI), site dehiscence, seroma, hematoma, and site necrosis. Two common operative strategies exist: Component separation (CS) with primary fascial closure and mesh reinforcement (PFC-CS) and bridged repair (mesh spanning the hernia defect). We hypothesized that: (1) ventral hernia repair (VHR) of large defects with bridged repair is associated with more SSOs than is PFC, and (2) anterior CS is associated with more SSOs than is endoscopic, perforator-sparing, or posterior CS. Methods: Part I of this study was a review of a multi-center database of patients who underwent VHR of a defect ≥8 cm from 2010–2011 with at least one month of follow-up. The primary outcome was SSO. The secondary outcome was recurrence. Part II of this study was a systematic review and meta-analysis of studies comparing bridged repair with PFC and studies comparing different kinds of CS. Results: A total of 108 patients were followed for a median of 16 months (range 1–50 months), of whom 84 underwent PFC-CS and 24 had bridged repairs. Unadjusted results demonstrated no differences between the groups in SSO or recurrence; however, the study was underpowered for this purpose. On meta-analysis, PFC was associated with a lower risk of SSO (odds ratio [OR] = 0.569; 95% confidence interval [CI] = 0.34–0.94) and recurrence (OR = 0.138; 95% CI = 0.08–0.23) compared with bridged repair. On multiple-treatments meta-analysis, both endoscopic and perforator-sparing CS were most likely to be the treatments with the lowest risk of SSO and recurrence. Conclusions: Bridged repair was associated with more SSOs than was PFC, and PFC should be used whenever feasible. Endoscopic and perforator-sparing CS were associated with the fewest complications; however, these conclusions are limited by heterogeneity between studies and

  9. TNF-α/IL-10 Ratio Correlates with Burn Severity and May Serve as a Risk Predictor of Increased Susceptibility to Infections

    PubMed Central

    Tsurumi, Amy; Que, Yok-Ai; Ryan, Colleen M.; Tompkins, Ronald G.; Rahme, Laurence G.

    2016-01-01

    Severe burn injury renders patients susceptible to multiple infection episodes; however, identifying specific patient groups at high risk remains challenging. Burn-induced inflammatory response dramatically modifies the levels of various cytokines. Whether these changes could predict susceptibility to infections remains unknown. The aim of this study was to determine the early changes in the pro- to anti-inflammatory cytokine ratio and investigate its ability to predict susceptibility to repeated infections after severe burn trauma. The patient population consisted of 34 adult patients having early (≤48 h since injury) blood draws following severe (≥20% total burn surface area (TBSA)) burn injury and suffering from a first infection episode at least 1 day after blood collection. Plasma TNF-α and IL-10 levels were measured to explore the association between the TNF-α/IL-10 ratio, hypersusceptibility to infections, burn size (TBSA), and common severity scores (Acute Physiology and Chronic Health Evaluation II (APACHEII), Baux, modified Baux (R-Baux), Ryan Score, and Abbreviated Burn Severity Index (ABSI)). TNF-α/IL10 plasma ratio measured shortly after burn trauma was inversely correlated with burn size and the injury severity scores investigated, and was predictive of repeated infections (≥3 infection episodes) outcome (AUROC [95%CI] of 0.80 [0.63–0.93]). Early measures of circulating TNF-α/IL10 ratio may be a previously unidentified biomarker associated with burn injury severity and predictive of the risk of hypersusceptibility to repeated infections. PMID:27761434

  10. Aliphatic and polycyclic aromatic hydrocarbons (PAHs) in soils of the northwest Qinling Mountains: Patterns, potential risk and an appraisal of the PAH ratios to infer their source.

    PubMed

    Liu, Yanhong; Wu, Yingqin; Xia, Yanqing; Lei, Tianzhu; Tian, Chuntao; Hou, Xiaohuan

    2017-03-21

    Surface soils from the tourist areas of the northwest Qinling Mountains were analyzed to determine the concentrations, probable sources and potential risks of hydrocarbons. Concentrations of aliphatic and aromatic hydrocarbons ranged from 4.18 to 3240 ng g(-1) and 0.0462 to 101 ng g(-1) dry weight, respectively. The extent of soil contamination by hydrocarbons was generally typified by unpolluted to slightly polluted levels. The incremental lifetime cancer risks (ILCRs) for exposure to soil-borne PAHs indicated complete safety for tourists. Early diagenesis of natural products, bacteria activities and petroleum were the three main sources of aliphatic hydrocarbons, while the transport of air pollutants from pyrolytic processes was the main origin of PAHs. Because the photochemical reaction of PAHs in the atmosphere would produce lower ratios for Ant/(Ant + Phe), BaA/(BaA + Chr) and IcdP/(IcdP + BghiP), but a higher ratio for Fla/(Fla + Pyr), the source classification highly depended on the diagnostic ratios chosen. The plot of ΣCOM/Σ13PAH vs. ΣLMW/ΣHMWPAH provide additional information to distinguish the origins of PAHs, and it showed a cluster of pyrogenic sources except for sample JFS-8. Four sources were resolved by principal component analysis: (1) a low temperature pyrogenic process related to the use of fossil fuel and biomass, such as charcoal, straw and wood, which contributes 63.1% of the measured PAHs; (2) the potential contribution of diagenetic processes, contributing 18.4%; (3) traffic emissions, contributing 9.27%; and (4) bioconversion/bacterial action, contributing 5.82%. Additionally, there was a good exponential relationship (r(2) = 0.969) between the natural n-alkanes ratio (NAR) and carbon preference index for C23-C35 (CPI23-35) for all samples, which is of great use for the determination of the origins of aliphatic hydrocarbon.

  11. Apolipoprotein A1, B levels, and their ratio and the risk of a first stroke: a meta-analysis and case-control study.

    PubMed

    Dong, Hongli; Chen, Wei; Wang, Xiangyu; Pi, Fuhua; Wu, Yubin; Pang, Shaojie; Xie, Yuqing; Xia, Fangfang; Zhang, Qingying

    2015-12-01

    The associations of levels of apolipoprotein A1 (ApoA1) and apolipoprotein B and ApoB/A1 ratio and risk of a first stroke have not been reliably documented. We performed a meta-analysis to summarize the relationships and confirmed them in a case-control study. We identified relevant publications in PubMed and Embase databases up to June 1, 2015. A Dersimonian-Laird random effects model was used to compute summary relative risks (RRs) and 95 % confidence intervals (CIs). A case-control study was conducted in a southern Chinese population. We included 8 cohort and 4 case-control studies (222,774 subjects; 10,032 first stroke events) in the meta-analysis. Reduced ApoA1 level and increased ApoB level and ApoB/A1 ratio was associated with a first stroke in cohort studies (RR 0.86 [95 % CI 0.79-0.94], 1.66 [1.62-1.69], and 1.66 [1.63-1.70], respectively) and reduced ApoA1 level and increased ApoB/A1 ratio in case-control studies (0.68 [0.47-0.99] and 1.76 [1.50-2.06], respectively). When stratified by stroke type in cohort studies, the RR for ischemic stroke was 0.83 (0.76-0.90), 1.36 (1.32-1.40), and 1.38 (1.35-1.42) for the 3 factors, respectively. In our case-control study (1013 cases; 1029 controls), the OR for a first ischemic stroke was 0.83 (0.74-0.92), 1.33 (1.18-1.48) and 2.10 (1.76-2.51), respectively, with increased ApoA1 level associated with hemorrhagic stroke (1.37 [1.06-1.78]). Meta-analysis suggests that reduced ApoA1 level and increased ApoB level and ApoB/A1 ratio are risk factors for a first ischemic but not hemorrhagic stroke. Elevated ApoA1 level may be a risk factor for a first hemorrhagic stroke.

  12. 2D:4D Ratio in children at familial high-risk for eating disorders: The role of prenatal testosterone exposure

    PubMed Central

    Kothari, Radha; Gafton, Joseph; Treasure, Janet; Micali, Nadia

    2014-01-01

    Objectives Markers of prenatal hormone exposure have been associated with the development of eating disorder (ED) behaviors. Our aim was to determine whether 2D:4D ratio, a marker for in utero testosterone exposure, is associated with risk for ED in a large population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). Methods This is the first study to investigate prenatal testosterone exposure in children at high-risk for ED, using 2D:4D as a marker. We compared children whose mothers reported a lifetime ED (anorexia, bulimia, or both; N = 446) to children whose mothers did not (n = 5,367). Results Daughters of women with lifetime bulimia nervosa (BN) had lower 2D:4D ratio (B: −0.01, 95% CI: −0.02 to −0.002, P = 0.02), indicating higher prenatal testosterone exposure, than daughters of mothers unaffected by ED. No differences were observed in the male children of women with an ED. Conclusions Findings suggest that children at high-risk for BN may be exposed to higher levels of testosterone in utero. Fetal exposure to androgen excess is thought to be causal in the development of polycystic ovary syndrome (PCOS), a disorder which is highly comorbid with binge eating and BN. Future research should investigate the potential role of testosterone exposure in utero as a risk factor for BN and binge eating. Am. J. Hum. Biol. 26:176–182, 2014. © 2013 Wiley Periodicals, Inc. PMID:24323736

  13. Mucosal cuff length to penile length ratio may affect the risk of premature ejaculation in circumcised males.

    PubMed

    Yuruk, E; Temiz, M Z; Colakerol, A; Muslumanoglu, A Y

    2016-01-01

    Data regarding the relation between premature ejaculation (PE) and post-circumcision mucosal cuff length are controversial. The aim of this study is to analyze the relation between post-circumcision mucosal cuff length/penile length ratio (MCR) and PE. After exclusion of patients with erectile dysfunction, penile deformity, history of penile surgery and severe lower urinary tract symptoms, 49 circumcised men with PE were included. The control group is constituted of 50 healthy volunteers with normal ejaculatory function. Self-estimated intravaginal ejaculation latency time (IELT) and premature ejaculation profile (PEP) measures of all subjects were recorded, and the MCRs of patients and controls were compared. The mean age of PE patients and controls was 35.82 ± 7.73 (range 23-54) and 38.78 ± 13.42 (range 19-71) years, respectively (P=0.183). Although mucosal cuff length was not associated with either self-estimated IELT (r=-0.185, P=0.067) or PEP (r=-0.098, P=0.336), there was a negative correlation between MCR and self-estimated IELT (r=-0.205, P=0.0001) and PEP measures (r=-0.308, P=0.002). The length of the mucosal cuff after circumcision may have an impact on ejaculatory function. Surgeons should avoid leaving excessive amount of mucosa during circumcision.

  14. Modeling the Arabidopsis seed shape by a cardioid: efficacy of the adjustment with a scale change with factor equal to the Golden Ratio and analysis of seed shape in ethylene mutants.

    PubMed

    Cervantes, Emilio; Javier Martín, José; Ardanuy, Ramón; de Diego, Juana G; Tocino, Angel

    2010-03-15

    A new model for the description of Arabidopsis seed shape based on the comparison of the outline of its longitudinal section with a transformed cardioid is presented. The transformation consists of scaling the horizontal axis by a factor equal to the Golden Ratio. The elongated cardioid approximates the shape of the Arabidopsis seed with more accuracy than other figures. The length to width ratio in wild-type Columbia Arabidopsis dry seeds is close to the Golden Ratio and decreases over the course of imbibition. Dry seeds of etr1-1 mutants presented a reduced length to width ratio. Application of the new model based on the cardioid allows for comparison of shape between wild-type and mutant genotypes, revealing other general alterations in the seeds in ethylene signaling pathway mutants (etr1-1).

  15. Effect of aerobic exercise on risk factors of cardiovascular disease and the apolipoprotein B / apolipoprotein a-1 ratio in obese woman.

    PubMed

    Kim, Dae-Young; Jung, Sun-Young

    2014-11-01

    [Purpose] The objective of this study was to confirm whether consistent aerobic exercise has an effect on the apolipoprotein B/apolipoprotein A-1 ratio or reduces the risk of cardiovascular disease in obese women. [Subjects and Methods] The participants included 32 obese women between the ages of 40 and 49. Subjects were randomly divided into two groups (n = 16 in each group): the control group and the exercise group. The exercise program in this study corresponded to an intensity of 50 to 60% of the maximum volume of minute oxygen consumption and was performed three times per week over 12 weeks. Physical measurements, measurement of cardiorespiratory fitness and blood pressure, and blood collection were done before and after the 12 weeks of exercise at the same time and under the same conditions. [Results] Based on the results of this study, there were significant interaction effects in both time and group weight, for body mass index, percent body fat, maximum volume of minute oxygen consumption, high-density lipoprotein cholesterol, and the apolipoprotein B/apolipoprotein A-1 ratio. Moreover, waist circumference, total cholesterol, and the atherogenic index decreased significantly after 12 weeks of aerobic exercise. [Conclusion] Regular aerobic exercise effectively improved cardiovascular risk factors and decreased the obesity index in obese women.

  16. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis.

    PubMed

    Ashwell, M; Gunn, P; Gibson, S

    2012-03-01

    Our aim was to differentiate the screening potential of waist-to-height ratio (WHtR) and waist circumference (WC) for adult cardiometabolic risk in people of different nationalities and to compare both with body mass index (BMI). We undertook a systematic review and meta-analysis of studies that used receiver operating characteristics (ROC) curves for assessing the discriminatory power of anthropometric indices in distinguishing adults with hypertension, type-2 diabetes, dyslipidaemia, metabolic syndrome and general cardiovascular outcomes (CVD). Thirty one papers met the inclusion criteria. Using data on all outcomes, averaged within study group, WHtR had significantly greater discriminatory power compared with BMI. Compared with BMI, WC improved discrimination of adverse outcomes by 3% (P < 0.05) and WHtR improved discrimination by 4-5% over BMI (P < 0.01). Most importantly, statistical analysis of the within-study difference in AUC showed WHtR to be significantly better than WC for diabetes, hypertension, CVD and all outcomes (P < 0.005) in men and women. For the first time, robust statistical evidence from studies involving more than 300 000 adults in several ethnic groups, shows the superiority of WHtR over WC and BMI for detecting cardiometabolic risk factors in both sexes. Waist-to-height ratio should therefore be considered as a screening tool.

  17. Effects of physical activity, body mass index, waist-to-hip ratio and waist circumference on total mortality risk in the Swedish National March Cohort.

    PubMed

    Bellocco, Rino; Jia, Chongqi; Ye, Weimin; Lagerros, Ylva Trolle

    2010-11-01

    The health benefits of physical activity (PA) have been well documented. However, there is less research investigating whether or not these health benefits might differ among males and females or among subjects characterized by different levels of body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC). Baseline total PA, BMI, WHR and waist circumference were measured in 14,585 men and 26,144 women who participated in the Swedish National March. Their effects on all-cause mortality were analyzed with a follow-up time of almost 10 years. Sedentary men with a BMI ≥ 30 had a 98% (95% CI: 30-201%) increased risk of mortality compared to normal weight men with a high level of total PA. The same trend was observed for sedentary men with high WHR or waist circumference, compared to lean and highly active men. Sedentary women with a waist circumference of 88 cm or more had almost doubled, i.e. 97% (95% CI: 35-189%) increased mortality risk compared to physically active women with a waist circumference below 80 cm. BMI in men, but waist circumference in women better forecast all-cause mortality. We found no substantial effect modification between different measures of adiposity and physical activity-physical inactivity and obesity seem to increase total mortality risk independently and additively.

  18. Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: a meta-analysis.

    PubMed

    Lo, K; Wong, M; Khalechelvam, P; Tam, W

    2016-12-01

    Waist-to-height ratio (WHtR) is superior to body mass index and waist circumference for measuring adult cardio-metabolic risk factors. However, there is no meta-analysis to evaluate its discriminatory power in children and adolescents. A meta-analysis was conducted using multiple databases, including Embase and Medline. Studies were included that utilized receiver-operating characteristics curve analysis and published area under the receiver-operating characteristics curves (AUC) for adiposity indicators with hyperglycaemia, elevated blood pressure, dyslipidemia, metabolic syndrome and other cardio-metabolic outcomes. Thirty-four studies met the inclusion criteria. AUC values were extracted and pooled using a random-effects model and were weighted using the inverse variance method. The mean AUC values for each index were greater than 0.6 for most outcomes including hypertension. The values were the highest when screening for metabolic syndrome (AUC > 0.8). WHtR did not have significantly better screening power than other two indexes in most outcomes, except for elevated triglycerides when compared with body mass index and high metabolic risk score when compared with waist circumference. Although not being superior in discriminatory power, WHtR is convenient in terms of measurement and interpretation, which is advantageous in practice and allows for the quick identification of children with cardio-metabolic risk factors at an early age.

  19. Low albumin levels and high impedance ratio as risk factors for worsening kidney function during hospitalization of decompensated heart failure patients

    PubMed Central

    Valdespino-Trejo, Adrian; Orea-Tejeda, Arturo; Castillo-Martínez, Lilia; Keirns-Davis, Candace; Montañez-Orozco, Álvaro; Ortíz-Suárez, Gerson; Delgado-Pérez, D Alejandro; Marquez-Zepeda, Bianka

    2013-01-01

    BACKGROUND: Patients hospitalized for decompensated heart failure (DHF) frequently experience worsening of renal function (WRF), leading to volume overload and resistance to diuretics. OBJECTIVE: To investigate whether albumin levels and whole-body impedance ratio, as an indicator of water distribution, were associated with WRF in patients with DHF. Methods: A total of 80 patients hospitalized for DHF were consecutively included in the present longitudinal study. WRF during hospitalization was defined as an increase of ≥0.3 mg/dL (≥26.52 μmol/L) or 25% of baseline serum creatinine. Clinical and echocardiographic characteristics were assessed at baseline. Whole-body bioelectrical impedance was measured using tetrapolar and multiple-frequency equipment to obtain the ratio of impedance at 200 kHz to that at 5 kHz. Serum albumin levels were also evaluated. Baseline characteristics were compared between patients with and without deteriorating renal function using a t test or χ2 test. Subsequently, a logistic regression analysis was performed to obtain the independent variables associated with WRF. RESULTS: The incidence of WRF during hospitalization was 26%. Independent risk factors associated with WRF were low serum albumin (RR=0.11; P=0.04); impedance ratio >0.85 (RR=5.3; P=0.05), systolic blood pressure >160 mmHg (RR=12; P=0.02) and maximum dose of continuous intravenous furosemide required >80 mg/day during hospitalization (RR=5.7, P=0.015). CONCLUSIONS: WRF is frequent in patients with DHF. It results from the inability to effectively regulate volume status because hypoalbuminemia induces water loss from the vascular space (high impedance ratio), and high diuretic doses lower circulatory volumes and reduce renal blood flow, leading to a decline in renal filtration function. PMID:23940434

  20. Reciprocal influences between maternal parenting and child adjustment in a high-risk population: a 5-year cross-lagged analysis of bidirectional effects.

    PubMed

    Barbot, Baptiste; Crossman, Elizabeth; Hunter, Scott R; Grigorenko, Elena L; Luthar, Suniya S

    2014-09-01

    This study examines longitudinally the bidirectional influences between maternal parenting (behaviors and parenting stress) and mothers' perceptions of their children's adjustment, in a multivariate approach. Data was gathered from 361 low-income mothers (many with psychiatric diagnoses) reporting on their parenting behavior, parenting stress, and their child's adjustment, in a 2-wave longitudinal study over 5 years. Measurement models were developed to derive 4 broad parenting constructs (involvement, control, rejection, and stress) and 3 child adjustment constructs (internalizing problems, externalizing problems, and social competence). After measurement invariance of these constructs was confirmed across relevant groups and over time, both measurement models were integrated in a single crossed-lagged regression analysis of latent constructs. Multiple reciprocal influences were observed between parenting and perceived child adjustment over time: Externalizing and internalizing problems in children were predicted by baseline maternal parenting behaviors, and child social competence was found to reduce parental stress and increase parental involvement and appropriate monitoring. These findings on the motherhood experience are discussed in light of recent research efforts to understand mother-child bidirectional influences and their potential for practical applications.

  1. A Best Evidence Synthesis of Literacy Instruction on the Social Adjustment of Students with or At-Risk for Behavior Disorders

    ERIC Educational Resources Information Center

    Nelson, J. Ron; Lane, Kathleen L.; Benner, Gregory J.; Kim, Ockjean

    2011-01-01

    The findings of a best-evidence synthesis of the collateral effect of literacy instruction on the social adjustment of students are reported. The goal of the synthesis was to extend the work of Wanzek, Vaughn, Kim, and Cavanaugh (2006) by (a) reviewing treatment-outcomes conducted using group design methodology; (b) focusing on a more defined set…

  2. Teacher-Student Relationships among Behaviorally At-Risk African American Youth from Low-Income Backgrounds: Student Perceptions, Teacher Perceptions, and Socioemotional Adjustment Correlates

    ERIC Educational Resources Information Center

    Murray, Christopher; Zvoch, Keith

    2011-01-01

    This investigation examines teacher-student relationships among African American youth from low-income backgrounds (N = 193). Students and their teachers completed measures of teacher-student relationship quality and measures pertaining to emotional, behavioral, and school-related adjustment. Results indicated that African American youth who fell…

  3. Reciprocal Influences Between Maternal Parenting and Child Adjustment in a High-risk Population: A Five-Year Cross-Lagged Analysis of Bidirectional Effects

    PubMed Central

    Barbot, Baptiste; Crossman, Elizabeth; Hunter, Scott R.; Grigorenko, Elena L.; Luthar, Suniya S.

    2014-01-01

    This study examines longitudinally the bidirectional influences between maternal parenting (behaviors and parenting stress) and mothers' perceptions of their children's adjustment, in a multivariate approach. Data was gathered from 361 low-income mothers (many with psychiatric diagnoses) reporting on their parenting behavior, parenting stress and their child's adjustment, in a two-wave longitudinal study over 5 years. Measurement models were developed to derive four broad parenting constructs (Involvement, Control, Rejection, and Stress) and three child adjustment constructs (Internalizing problems, Externalizing problems, and Social competence). After measurement invariance of these constructs was confirmed across relevant groups and over time, both measurement models were integrated in a single crossed-lagged regression analysis of latent constructs. Multiple reciprocal influence were observed between parenting and perceived child adjustment over time: Externalizing and internalizing problems in children were predicted by baseline maternal parenting behaviors, while child social competence was found to reduce parental stress and increase parental involvement and appropriate monitoring. These findings on the motherhood experience are discussed in light of recent research efforts to understand mother-child bi-directional influences, and their potential for practical applications. PMID:25089759

  4. Non-parametric estimation of the case fatality ratio with competing risks data: an application to Severe Acute Respiratory Syndrome (SARS).

    PubMed

    Jewell, Nicholas P; Lei, Xiudong; Ghani, Azra C; Donnelly, Christl A; Leung, Gabriel M; Ho, Lai-Ming; Cowling, Benjamin J; Hedley, Anthony J

    2007-04-30

    For diseases with some level of associated mortality, the case fatality ratio measures the proportion of diseased individuals who die from the disease. In principle, it is straightforward to estimate this quantity from individual follow-up data that provides times from onset to death or recovery. In particular, in a competing risks context, the case fatality ratio is defined by the limiting value of the sub-distribution function, F(1)(t) = Pr(T infinity, where T denotes the time from onset to death (J = 1) or recovery (J = 2). When censoring is present, however, estimation of F(1)(infinity) is complicated by the possibility of little information regarding the right tail of F(1), requiring use of estimators of F(1)(t(*)) or F(1)(t(*))/(F(1)(t(*))+F(2)(t(*))) where t(*) is large, with F(2)(t) = Pr(T

  5. Children's Intellectual and Emotional-Behavioral Adjustment at 4 Years as a Function of Cocaine Exposure, Maternal Characteristics, and Environmental Risk.

    ERIC Educational Resources Information Center

    Bennett, David S.; Bendersky, Margaret; Lewis, Michael

    2002-01-01

    Examined 4-year-olds for effects on IQ of prenatal cocaine exposure, exposure to other substances, risk factors, and neonatal medical problems. Found that maternal verbal IQ and low environmental risk predicted child IQ. Cocaine exposure negatively predicted children's overall IQ and verbal reasoning scores for boys only. Maternal harsh…

  6. Consumption of vitamin B(6) reduces fecal ratio of lithocholic acid to deoxycholic acid, a risk factor for colon cancer, in rats fed a high-fat diet.

    PubMed

    Okazaki, Yukako; Utama, Zaki; Suidasari, Sofya; Zhang, Peipei; Yanaka, Noriyuki; Tomotake, Hiroyuki; Sakaguchi, Ei; Kato, Norihisa

    2012-01-01

    To examine the effect of supplemental dietary vitamin B(6) on the colonic luminal environment, growing male rats were fed a high-fat diet containing 1, 7, or 35 mg pyridoxine HCl/kg diet for 6 wk. Food intake and growth were unaffected by the dietary treatment. Supplemental dietary vitamin B(6) significantly reduced the production of a fecal secondary bile acid, lithocholic acid (the most toxic secondary bile acid and a risk factor for colon cancer), and markedly reduced the ratio of lithocholic acid to deoxycholic acid (a less toxic secondary bile acid) in feces (p<0.05). Increasing dietary vitamin B(6) increased fecal mucin levels (a marker of intestinal barrier function) in a dose-dependent manner (p<0.05) but did not affect fecal immunoglobulin A levels (an index of intestinal immune function). Cecal levels of organic acids were not significantly affected by supplemental dietary vitamin B(6). These results suggest the possibility that dietary vitamin B(6) affects the colonic luminal environment by altering the production of secondary bile acids and mucins.

  7. Evaluating the Use of the Case Mix Index for Risk Adjustment of Healthcare-Associated Infection Data: An Illustration using Clostridium difficile Infection Data from the National Healthcare Safety Network.

    PubMed

    Thompson, Nicola D; Edwards, Jonathan R; Dudeck, Margaret A; Fridkin, Scott K; Magill, Shelley S

    2016-01-01

    BACKGROUND Case mix index (CMI) has been used as a facility-level indicator of patient disease severity. We sought to evaluate the potential for CMI to be used for risk adjustment of National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) data. METHODS NHSN facility-wide laboratory-identified Clostridium difficile infection event data from 2012 were merged with the fiscal year 2012 Inpatient Prospective Payment System (IPPS) Impact file by CMS certification number (CCN) to obtain a CMI value for hospitals reporting to NHSN. Negative binomial regression was used to evaluate whether CMI was significantly associated with healthcare facility-onset (HO) CDI in univariate and multivariate analysis. RESULTS Among 1,468 acute care hospitals reporting CDI data to NHSN in 2012, 1,429 matched by CCN to a CMI value in the Impact file. CMI (median, 1.49; interquartile range, 1.36-1.66) was a significant predictor of HO CDI in univariate analysis (P<.0001). After controlling for community onset CDI prevalence rate, medical school affiliation, hospital size, and CDI test type use, CMI remained highly significant (P<.0001), with an increase of 0.1 point in CMI associated with a 3.4% increase in the HO CDI incidence rate. CONCLUSIONS CMI was a significant predictor of NHSN HO CDI incidence. Additional work to explore the feasibility of using CMI for risk adjustment of NHSN data is necessary. Infect. Control Hosp. Epidemiol. 2015;37(1):19-25.

  8. 12 CFR 390.467 - Leverage ratio.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 5 2014-01-01 2014-01-01 false Leverage ratio. 390.467 Section 390.467 Banks... REGULATIONS TRANSFERRED FROM THE OFFICE OF THRIFT SUPERVISION Capital § 390.467 Leverage ratio. (a) The... defined in this subpart, shall consist of a ratio of core capital to adjusted total assets of 3...

  9. 12 CFR 390.467 - Leverage ratio.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 5 2012-01-01 2012-01-01 false Leverage ratio. 390.467 Section 390.467 Banks... REGULATIONS TRANSFERRED FROM THE OFFICE OF THRIFT SUPERVISION Capital § 390.467 Leverage ratio. (a) The... defined in this subpart, shall consist of a ratio of core capital to adjusted total assets of 3...

  10. 12 CFR 390.467 - Leverage ratio.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 5 2013-01-01 2013-01-01 false Leverage ratio. 390.467 Section 390.467 Banks... REGULATIONS TRANSFERRED FROM THE OFFICE OF THRIFT SUPERVISION Capital § 390.467 Leverage ratio. (a) The... defined in this subpart, shall consist of a ratio of core capital to adjusted total assets of 3...

  11. Effect of Adding McKenzie Syndrome, Centralization, Directional Preference, and Psychosocial Classification Variables to a Risk-Adjusted Model Predicting Functional Status Outcomes for Patients With Lumbar Impairments.

    PubMed

    Werneke, Mark W; Edmond, Susan; Deutscher, Daniel; Ward, Jason; Grigsby, David; Young, Michelle; McGill, Troy; McClenahan, Brian; Weinberg, Jon; Davidow, Amy L

    2016-09-01

    Study Design Retrospective cohort. Background Patient-classification subgroupings may be important prognostic factors explaining outcomes. Objectives To determine effects of adding classification variables (McKenzie syndrome and pain patterns, including centralization and directional preference; Symptom Checklist Back Pain Prediction Model [SCL BPPM]; and the Fear-Avoidance Beliefs Questionnaire subscales of work and physical activity) to a baseline risk-adjusted model predicting functional status (FS) outcomes. Methods Consecutive patients completed a battery of questionnaires that gathered information on 11 risk-adjustment variables. Physical therapists trained in Mechanical Diagnosis and Therapy methods classified each patient by McKenzie syndromes and pain pattern. Functional status was assessed at discharge by patient-reported outcomes. Only patients with complete data were included. Risk of selection bias was assessed. Prediction of discharge FS was assessed using linear stepwise regression models, allowing 13 variables to enter the model. Significant variables were retained in subsequent models. Model power (R(2)) and beta coefficients for model variables were estimated. Results Two thousand sixty-six patients with lumbar impairments were evaluated. Of those, 994 (48%), 10 (<1%), and 601 (29%) were excluded due to incomplete psychosocial data, McKenzie classification data, and missing FS at discharge, respectively. The final sample for analyses was 723 (35%). Overall R(2) for the baseline prediction FS model was 0.40. Adding classification variables to the baseline model did not result in significant increases in R(2). McKenzie syndrome or pain pattern explained 2.8% and 3.0% of the variance, respectively. When pain pattern and SCL BPPM were added simultaneously, overall model R(2) increased to 0.44. Although none of these increases in R(2) were significant, some classification variables were stronger predictors compared with some other variables included in

  12. A Low Peripheral Blood CD4/CD8 Ratio Is Associated with Pulmonary Emphysema in HIV

    PubMed Central

    Attia, Engi F.; Akgün, Kathleen M.; Soo Hoo, Guy W.; Freiberg, Matthew S.; Butt, Adeel A.; Wongtrakool, Cherry; Goetz, Matthew Bidwell; Brown, Sheldon T.; Graber, Christopher J.; Huang, Laurence; Crothers, Kristina

    2017-01-01

    Objectives The prevalence of emphysema is higher among HIV-infected (HIV+) individuals compared to HIV-uninfected persons. While greater tobacco use contributes, HIV-related effects on immunity likely confer additional risk. Low peripheral blood CD4+ to CD8+ T-lymphocyte (CD4/CD8) ratio may reflect chronic inflammation in HIV and may be a marker of chronic lung disease in this population. Therefore, we sought to determine whether the CD4/CD8 ratio was associated with chronic obstructive pulmonary disease (COPD), particularly the emphysema subtype, in a cohort of HIV+ subjects. Methods We performed a cross-sectional analysis of 190 HIV+ subjects enrolled in the Examinations of HIV Associated Lung Emphysema (EXHALE) study. Subjects underwent baseline laboratory assessments, pulmonary function testing and chest computed tomography (CT) analyzed for emphysema severity and distribution. We determined the association between CD4/CD8 ratio and emphysema, and the association between CD4/CD8 ratio and pulmonary function markers of COPD. Results Mild or greater emphysema (>10% lung involvement) was present in 31% of subjects. Low CD4/CD8 ratio was associated with >10% emphysema in multivariable models, adjusting for risk factors including smoking, current and nadir CD4 count and HIV RNA level. Those with CD4/CD8 ratio <0.4 had 6.3 (1.1–39) times the odds of >10% emphysema compared to those with a ratio >1.0 in fully adjusted models. A low CD4/CD8 ratio was also associated with reduced diffusion capacity (DLCO). Conclusions A low CD4/CD8 ratio was associated with emphysema and low DLCO in HIV+ subjects, independent of other risk factors and clinical markers of HIV. The CD4/CD8 ratio may be a useful, clinically available, marker for risk of emphysema in HIV+ subjects in the antiretroviral therapy (ART) era. PMID:28122034

  13. Cardiometabolic risk assessments by body mass index z-score or waist-to-height ratio in a multiethnic sample of sixth-graders

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Convention defines pediatric adiposity by the body mass index z-score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabol...

  14. Risk

    NASA Technical Reports Server (NTRS)

    Barshi, Immanuel

    2016-01-01

    Speaking up, i.e. expressing ones concerns, is a critical piece of effective communication. Yet, we see many situations in which crew members have concerns and still remain silent. Why would that be the case? And how can we assess the risks of speaking up vs. the risks of keeping silent? And once we do make up our minds to speak up, how should we go about it? Our workshop aims to answer these questions, and to provide us all with practical tools for effective risk assessment and effective speaking-up strategies..

  15. 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.

  16. 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.

  17. 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.

  18. Energetics of geostrophic adjustment in rotating flow

    NASA Astrophysics Data System (ADS)

    Fang, J.; Wu, R. S.

    2002-09-01

    Energetics of geostrophic adjustment in rotating how is examined in detail with a linear shallow water model. The Initial Unbalanced flow considered first falls under two classes. The first is similar to that adopted by Gill and is here referred to as it mass imbalance model, for the flow is initially motionless but with a sea surface displacement. The other is the same as that considered by Rossby and is referred to as I momentum imbalance model since there is only a velocity perturbation in the initial field. The significant feature of the energetics of geostrophic adjustment for the above two extreme models is that althongh the energy conversion ratio has a large case-to-case variability for different initial conditions, Its value is bounded below by 0 and above by 1 / 2. Based on the discussion of the above extreme models, the energetics of adjustment for an arbitrary initial condition is investigated. It is found that the characteristics of the energetics of geostrophic adjustment mentioned above are also applicable to adjustment of the general unbalanced flow under the condition that the energy conversion ratio is redefined as the conversion ratio between the change of kinetic energy and potential energy of the deviational fields.

  19. Quantitative trait loci for CD4:CD8 lymphocyte ratio are associated with risk of type 1 diabetes and HIV-1 immune control.

    PubMed

    Ferreira, Manuel A R; Mangino, Massimo; Brumme, Chanson J; Zhao, Zhen Zhen; Medland, Sarah E; Wright, Margaret J; Nyholt, Dale R; Gordon, Scott; Campbell, Megan; McEvoy, Brian P; Henders, Anjali; Evans, David M; Lanchbury, Jerry S; Pereyra, Florencia; Walker, Bruce D; Haas, David W; Soranzo, Nicole; Spector, Tim D; de Bakker, Paul I W; Frazer, Ian H; Montgomery, Grant W; Martin, Nicholas G

    2010-01-01

    Abnormal expansion or depletion of particular lymphocyte subsets is associated with clinical manifestations such as HIV progression to AIDS and autoimmune disease. We sought to identify genetic predictors of lymphocyte levels and reasoned that these may play a role in immune-related diseases. We tested 2.3 million variants for association with five lymphocyte subsets, measured in 2538 individuals from the general population, including CD4+ T cells, CD8+ T cells, CD56+ natural killer (NK) cells, and the derived measure CD4:CD8 ratio. We identified two regions of strong association. The first was located in the major histocompatibility complex (MHC), with multiple SNPs strongly associated with CD4:CD8 ratio (rs2524054, p = 2.1 x 10(-28)). The second region was centered within a cluster of genes from the Schlafen family and was associated with NK cell levels (rs1838149, p = 6.1 x 10(-14)). The MHC association with CD4:CD8 replicated convincingly (p = 1.4 x 10(-9)) in an independent panel of 988 individuals. Conditional analyses indicate that there are two major independent quantitative trait loci (QTL) in the MHC region that regulate CD4:CD8 ratio: one is located in the class I cluster and influences CD8 levels, whereas the second is located in the class II cluster and regulates CD4 levels. Jointly, both QTL explained 8% of the variance in CD4:CD8 ratio. The class I variants are also strongly associated with durable host control of HIV, and class II variants are associated with type-1 diabetes, suggesting that genetic variation at the MHC may predispose one to immune-related diseases partly through disregulation of T cell homeostasis.

  20. 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.

  1. Negative Control Outcomes and the Analysis of Standardized Mortality Ratios.

    PubMed

    Richardson, David B; Keil, Alexander P; Tchetgen Tchetgen, Eric; Cooper, Glinda

    2015-09-01

    In occupational cohort mortality studies, epidemiologists often compare the observed number of deaths in the cohort to the expected number obtained by multiplying person-time accrued in the study cohort by the mortality rate in an external reference population. Interpretation of the result may be difficult due to noncomparability of the occupational cohort and reference population with respect to unmeasured risk factors for the outcome of interest. We describe an approach to estimate an adjusted standardized mortality ratio (aSMR) to control for such bias. The approach draws on methods developed for the use of negative control outcomes. Conditions necessary for unbiased estimation are described, as well as looser conditions necessary for bias reduction. The approach is illustrated using data on bladder cancer mortality among male Oak Ridge National Laboratory workers. The SMR for bladder cancer was elevated among hourly-paid males (SMR = 1.9; 95% confidence interval [CI] = 1.3, 2.7) but not among monthly-paid males (SMR = 1.0; 95% CI = 0.67, 1.3). After indirect adjustment using the proposed approach, the mortality ratios were similar in magnitude among hourly- and monthly-paid men (aSMR = 2.2; 95% CI = 1.5, 3.2; and, aSMR = 2.0; 95% CI = 1.4, 2.8, respectively). The proposed adjusted SMR offers a complement to typical SMR analyses.

  2. Effects of Maternal Depression on Youth Adjustment.

    ERIC Educational Resources Information Center

    Alexander, Jennifer

    Depressive disorders are chronic illnesses affecting women and their families for extended periods of time. This paper summarizes research related to the effects of maternal depression on children's short and long term adjustment. Children of depressed mothers are at risk for internalizing and externalizing disorders. Genetics account for a small…

  3. Plasma IL-6/IL-10 Ratio and IL-8, LDH, and HBDH Level Predict the Severity and the Risk of Death in AIDS Patients with Pneumocystis Pneumonia

    PubMed Central

    Sun, Jia; Su, Junwei; Xie, Yirui; Yin, Michael T.; Huang, Ying; Xu, Lijun; Zhou, Qihui

    2016-01-01

    Objective. To identify blood biomarkers to predict severity and mortality in AIDS PCP patients. Methods. Biomarkers including clinical parameters and plasma inflammatory cytokines were assessed in 32 HIV-infected patients with Pneumocystis pneumonia (PCP) at time of admission. Predictive value of the biomarkers for clinical severity and in-hospital mortality was evaluated by corresponding ROC curve. Results. Levels of CRP, WBC, LDH, HBDH, and Ferritin were significantly higher in the severe and nonsurvivor AIDS PCP patients. These important biochemical indicators have inverse correlation with oxygenation index, especially levels of LDH (P = 0.008, R2 = 0.258), HBDH (P = 0.001, R2 = 0.335), and Ferritin (P = 0.005, R2 = 0.237). Plasma IL-8 and IL-6 levels were significantly higher in patients with PaO2/FiO2 ≤ 200 mmHg and nonsurvivors than in those with PaO2/FiO2 > 200 mmHg and survivors. Severe and nonsurvival groups showed higher ratio of mean IL-6/IL-10 level (1.78 ± 1.56, P < 0.001; 1.11 ± 0.72, P = 0.043), larger AUC (95% CI 0.781–1.000, P < 0.001; 95% CI 0.592–0.917, P = 0.043), and more significantly inverse correlation with the oxygenation index. Conclusion. Plasma IL-8, LDH, and HBDH levels and IL-6/IL-10 ratio could be helpful for early evaluation of the severity and predicting fatal outcomes in AIDS PCP patients. PMID:27579328

  4. Plasma IL-6/IL-10 Ratio and IL-8, LDH, and HBDH Level Predict the Severity and the Risk of Death in AIDS Patients with Pneumocystis Pneumonia.

    PubMed

    Sun, Jia; Su, Junwei; Xie, Yirui; Yin, Michael T; Huang, Ying; Xu, Lijun; Zhou, Qihui; Zhu, Biao

    2016-01-01

    Objective. To identify blood biomarkers to predict severity and mortality in AIDS PCP patients. Methods. Biomarkers including clinical parameters and plasma inflammatory cytokines were assessed in 32 HIV-infected patients with Pneumocystis pneumonia (PCP) at time of admission. Predictive value of the biomarkers for clinical severity and in-hospital mortality was evaluated by corresponding ROC curve. Results. Levels of CRP, WBC, LDH, HBDH, and Ferritin were significantly higher in the severe and nonsurvivor AIDS PCP patients. These important biochemical indicators have inverse correlation with oxygenation index, especially levels of LDH (P = 0.008, R (2) = 0.258), HBDH (P = 0.001, R (2) = 0.335), and Ferritin (P = 0.005, R (2) = 0.237). Plasma IL-8 and IL-6 levels were significantly higher in patients with PaO2/FiO2 ≤ 200 mmHg and nonsurvivors than in those with PaO2/FiO2 > 200 mmHg and survivors. Severe and nonsurvival groups showed higher ratio of mean IL-6/IL-10 level (1.78 ± 1.56, P < 0.001; 1.11 ± 0.72, P = 0.043), larger AUC (95% CI 0.781-1.000, P < 0.001; 95% CI 0.592-0.917, P = 0.043), and more significantly inverse correlation with the oxygenation index. Conclusion. Plasma IL-8, LDH, and HBDH levels and IL-6/IL-10 ratio could be helpful for early evaluation of the severity and predicting fatal outcomes in AIDS PCP patients.

  5. 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…

  6. 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.

  7. 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.

  8. Food Insecurity and Self-Reported Hypertension Among Hispanic, Black, and White Adults in 12 States, Behavioral Risk Factor Surveillance System, 2009

    PubMed Central

    Njai, Rashid S.; Siegel, Paul Z.

    2014-01-01

    Food insecurity is positively linked to risk of hypertension; however, it is not known whether this relationship persists after adjustment for socioeconomic position (SEP). We examined the association between food insecurity and self-reported hypertension among adults aged 35 or older (N = 58,677) in 12 states that asked the food insecurity question in their 2009 Behavioral Risk Factor Surveillance System questionnaire. After adjusting for SEP, hypertension was more common among adults reporting food insecurity (adjusted prevalence ratio, 1.27; 95% confidence interval, 1.19–1.36). Our study found a positive relationship between food insecurity and hypertension after adjusting for SEP and other characteristics. PMID:25232748

  9. Food insecurity and self-reported hypertension among Hispanic, black, and white adults in 12 states, Behavioral Risk Factor Surveillance System, 2009.

    PubMed

    Irving, Shalon M; Njai, Rashid S; Siegel, Paul Z

    2014-09-18

    Food insecurity is positively linked to risk of hypertension; however, it is not known whether this relationship persists after adjustment for socioeconomic position (SEP). We examined the association between food insecurity and self-reported hypertension among adults aged 35 or older (N = 58,677) in 12 states that asked the food insecurity question in their 2009 Behavioral Risk Factor Surveillance System questionnaire. After adjusting for SEP, hypertension was more common among adults reporting food insecurity (adjusted prevalence ratio, 1.27; 95% confidence interval, 1.19-1.36). Our study found a positive relationship between food insecurity and hypertension after adjusting for SEP and other characteristics.

  10. 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.

  11. 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.

  12. Prevalence odds ratio versus prevalence ratio: choice comes with consequences.

    PubMed

    Tamhane, Ashutosh R; Westfall, Andrew O; Burkholder, Greer A; Cutter, Gary R

    2016-12-30

    Odds ratio, risk ratio, and prevalence ratio are some of the measures of association which are often reported in research studies quantifying the relationship between an independent variable and the outcome of interest. There has been much debate on the issue of which measure is appropriate to report depending on the study design. However, the literature on selecting a particular category of the outcome to be modeled and/or change in reference group for categorical independent variables and the effect on statistical significance, although known, is scantly discussed nor published with examples. In this article, we provide an example of a cross-sectional study wherein prevalence ratio was chosen over (Prevalence) odds ratio and demonstrate the analytic implications of the choice of category to be modeled and choice of reference level for independent variables. Copyright © 2016 John Wiley & Sons, Ltd.

  13. Breast cancer risk assessment using genetic variants and risk factors in a Singapore Chinese population

    PubMed Central

    2014-01-01

    Introduction Genetic variants for breast cancer risk identified in genome-wide association studies (GWAS) in Western populations require further testing in Asian populations. A risk assessment model incorporating both validated genetic variants and established risk factors may improve its performance in risk prediction of Asian women. Methods A nested case-control study of female breast cancer (411 cases and 1,212 controls) within the Singapore Chinese Health Study was conducted to investigate the effects of 51 genetic variants identified in previous GWAS on breast cancer risk. The independent effect of these genetic variants was assessed by creating a summed genetic risk score (GRS) after adjustment for body mass index and the Gail model risk factors for breast cancer. Results The GRS was an independent predictor of breast cancer risk in Chinese women. The multivariate-adjusted odds ratios (95% confidence intervals) of breast cancer for the second, third, and fourth quartiles of the GRS were 1.26 (0.90 to 1.76), 1.47 (1.06 to 2.04) and 1.75 (1.27 to 2.41) respectively (P for trend <0.001). In addition to established risk factors, the GRS improved the classification of 6.2% of women for their absolute risk of breast cancer in the next five years. Conclusions Genetic variants on top of conventional risk factors can improve the risk prediction of breast cancer in Chinese women. PMID:24941967

  14. Effects of Iron Supplementation With and Without Docosahexaenoic Acid on the Cardiovascular Disease Risk Based on Paraoxonase-1, hs-CRP, and ApoB/ApoA-I Ratio in Women with Iron Deficiency Anemia.

    PubMed

    Shidfar, Farzad; Amani, Samira; Vafa, Mohammadreza; Shekarriz, Ramin; Hosseini, Sharieh; Shidfar, Shahrzad; Eshraghian, Mohammadreza; Mousavi, Seyedeh Neda

    2016-01-01

    Numerous studies have demonstrated that tissue deposition of iron following prolonged high dose of oral supplementation for treatment of iron deficiency anemia (IDA) leads to body iron overload and oxidative stress, which starts the process of atherosclerosis. This study aimed to determine the effect of iron supplementation in combination with docosahexaenoic acid (DHA) on the cardiovascular disease risk based on paraoxonase-1 (PON-1), high-sensitivity C-reactive protein (hs-CRP), and ApoB/ApoA-I ratio in women with IDA. In this randomized controlled trial, 76 women with IDA, aged 15-45 years, were included. The patients were randomly assigned to receive 500 mg of DHA supplement or placebo with an iron tablet, once daily for 12 weeks. The participants were assessed by measurement of the serum iron, ferritin, PON-1, hs-CRP levels, and the ApoB/ApoA-I ratio at the beginning and end of study. Serum hs-CRP decreased in the DHA-supplemented group (p = 0.036), and ApoA-I decreased in the placebo group (p = 0.013). No significant difference was detected for the serum PON-1 concentration and the ApoB/ApoA-I ratio in two groups. Iron supplementation combined with DHA may have favorable effects on serum hs-CRP in women with IDA.

  15. Maternal Genitourinary Infections and the Risk of Gastroschisis

    PubMed Central

    Yazdy, Mahsa M.; Mitchell, Allen A.; Werler, Martha M.

    2014-01-01

    Genitourinary infections (GUIs) have been associated with increased risk of gastroschisis in 2 studies. Using data collected in the Slone Epidemiology Center Birth Defects Study, we examined the association between GUI and gastroschisis. From 1998 to 2010, mothers of 249 gastroschisis cases and 7,104 controls were interviewed within 6 months of delivery about pregnancy events, including vaginal infections, genital herpes, urinary tract infections (UTIs), and other sexually transmitted diseases (STDs). Women were considered exposed if they reported at least 1 instance of a GUI in the first trimester. Logistic regression models were used to calculate odds ratios and 95% confidence intervals. Women who reported having any GUI had an adjusted odds ratio of 1.8 (95% confidence interval (CI): 1.3, 2.4). The highest risk was seen among women who reported a UTI only (adjusted odds ratio = 2.3, 95% CI: 1.5, 3.5), while the odds ratio for an STD only was slightly elevated (adjusted odds ratio = 1.2, 95% CI: 1.0, 1.5). Among women under 25 years of age, the odds ratio for UTI only was 2.6 (95% CI: 1.7, 4.0), and among older women it was 1.8 (95% CI: 0.6, 5.9). When we considered the joint association of UTIs and young maternal age, a synergistic effect was observed. The results of this study add further evidence that UTIs may increase the risk of gastroschisis. PMID:25073472

  16. High Calcium-Magnesium Ratio in Hair Is Associated with Coronary Artery Calcification in Middle-Aged and Elderly Individuals.

    PubMed

    Park, Byoungjin; Kim, Mi-Hyun; Cha, Choong Keun; Lee, Yong-Jae; Kim, Kyong-Chol

    2017-02-06

    The interaction between calcium and magnesium as a risk modifier for cardiovascular disease (CVD) has been largely overlooked in previous studies, for the strict regulatory system in blood has been thought to keep such homeostatic interactions under tight control. This study aimed to investigate the association between calcium-magnesium ratio in hair and subclinical coronary artery calcification. Using multiple linear regression analysis, we examined the associations between calcium-magnesium ratio in hair and the coronary calcium score (CCS) in 216 Koreans aged 40 years and above (122 men and 94 women). We found that the calcium-to-magnesium ratio in hair was independently and positively associated with CCS after adjusting for age and sex (regression coefficient 6.051 ± 2.329, P = 0.010). When we assessed the association between the calcium-magnesium ratio and CCS after adjusting for potential cardiovascular risk factors and vascular function modifying drugs, we found that the strength of association with CCS was comparable to before (regression coefficient 5.434 ± 2.523, P = 0.032). Our findings suggest that among middle-aged and elderly Koreans without clinical CVD, the association between coronary artery calcification and hair calcium-magnesium ratio is stronger in those with a higher calcium-magnesium ratio in hair than in those with a lower ratio.

  17. 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.

  18. 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.

  19. 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.

  20. Remarriage after divorce and depression risk.

    PubMed

    Hiyoshi, A; Fall, K; Netuveli, G; Montgomery, S

    2015-09-01

    As marriage is associated with lower depression rates compared with being single in men, we aimed to examine if remarriage compared with remaining divorced is also associated with a reduced depression risk. Swedish register data were used to define a cohort of men who were born between 1952 and 1956 and underwent a compulsory military conscription assessment in adolescence. This study population comprised men who were divorced in 1985 (n = 72,246). The risk of pharmaceutically treated depression from 2005 to 2009 was compared for those who remarried or remained divorced between 1986 and 2004. Cox proportional hazards analysis was used to estimate hazard ratios for the risk of depression identified by pharmaceutical treatment, with adjustment for a range of potential confounding factors including childhood and adulthood socioeconomic circumstances, cognitive, physical, psychological and medical characteristics at the conscription assessment. The results showed that, even though divorced men who remarried had markers of lower depression risk in earlier life such as higher cognitive and physical function, higher stress resilience and socioeconomic advantages than men who remained divorced, remarriage was associated with a statistically significant elevated risk of depression with an adjusted hazard ratio (and 95% confidence interval) of 1.27(1.03 1.55), compared with men who remained divorced. Remarriage following divorce is not associated with a reduced risk of depression identified by pharmaceutical treatment, compared with remaining divorced. Interpersonal or financial difficulties resulting from remarriage may outweigh the benefits of marriage in terms of depression risk.

  1. Rectus muscle plication using an adjustable technique

    PubMed Central

    Velez, Federico G.; Demer, Joseph L.; Pihlblad, Matthew S.; Pineles, Stacy L.

    2013-01-01

    Background Rectus muscle plication is an alternative muscle-strengthening procedure to rectus muscle resection. Possible advantages of rectus muscle plication include a lower risk of “lost” muscles and anterior segment ischemia. Methods This was a retrospective case series describing a surgical procedure for rectus muscle plication using an adjustable suture technique that can be employed on any of the four rectus muscles. Results A total of 5 adult patients underwent adjustable suture plication procedures. Of these, 2 patients required suture adjustment postoperatively. At the final follow-up visit, all of the patients maintained satisfactory ocular alignment within 6Δ of orthotropia for horizontal deviations and 2Δ of orthotropia for vertical deviations. Diplopia was eliminated in all cases with preoperative diplopia. There were no postoperative complications or unexpected shifts in ocular alignment. Conclusions Rectus muscle plication using this adjustable suture technique may serve as an alternative to rectus muscle resection and may be particularly useful in patients who are at risk for anterior segment ischemia or those in whom a shorter anesthesia time is recommended. PMID:24160967

  2. High Adult Sex Ratios and Risky Sexual Behaviors: A Systematic Review

    PubMed Central

    Bien, Cedric H.; Cai, Yong; Emch, Michael E.; Parish, William; Tucker, Joseph D.

    2013-01-01

    Background Thirty-four countries worldwide have abnormally high sex ratios (>102 men per 100 women), resulting in over 100 million missing women. Widespread sex selective abortion, neglect of young girls leading to premature mortality, and gendered migration have contributed to these persistent and increasing distortions. Abnormally high adult sex ratios in communities may drive sexually transmitted disease (STD) spread where women are missing and men cannot find stable partners. We systematically reviewed evidence on the association between high community sex ratios and individual sexual behaviors. Methods and Findings Seven databases (PubMed, Web of Science, Embase, Scopus, The Cochrane Database of Systematic Reviews, Sociological Abstracts, and PopLINE) were searched without restrictions on time or location. We followed PRISMA guidelines and evaluated quality according to STROBE criteria. 1093 citations were identified and six studies describing 57,054 individuals were included for review. All six studies showed an association between high community sex ratios and individual sexual risk behaviors. In high sex ratio communities, women were more likely to have multiple sex partners and men were more likely to delay first sexual intercourse and purchase sex. Only two studies included STD outcomes. Conclusions High community sex ratios were associated with increased individual sexual risk behavior among both men and women. However, none of the studies examined unprotected sex or appropriately adjusted for gendered migration. Further studies are needed to understand the effect of community sex ratios on sexual health and to inform comprehensive STD control interventions. PMID:23967223

  3. Clinical Risk Factors for Portopulmonary Hypertension

    PubMed Central

    Kawut, Steven M.; Krowka, Michael J.; Trotter, James F.; Roberts, Kari E.; Benza, Raymond L.; Badesch, David B.; Taichman, Darren B.; Horn, Evelyn M.; Zacks, Steven; Kaplowitz, Neil; Brown, Robert S.; Fallon, Michael B.

    2010-01-01

    Portopulmonary hypertension affects up to 6% of patients with advanced liver disease, but the predictors and biologic mechanism for the development of this complication are unknown. We sought to determine the clinical risk factors for portopulmonary hypertension in patients with advanced liver disease. We performed a multicenter case-control study nested within a prospective cohort of patients with portal hypertension recruited from tertiary care centers. Cases had a mean pulmonary artery pressure >25 mm Hg, pulmonary vascular resistance >240 dynes · second · cm−5, and pulmonary capillary wedge pressure ≤ 15 mm Hg. Controls had a right ventricular systolic pressure < 40 mm Hg (if estimable) and normal right-sided cardiac morphology by transthoracic echocardiography. The study sample included 34 cases and 141 controls. Female sex was associated with a higher risk of portopulmonary hypertension than male sex (adjusted odds ratio =2.90, 95% confidence interval 1.20-7.01, P = 0.018). Autoimmune hepatitis was associated with an increased risk (adjusted odds ratio = 4.02, 95% confidence interval 1.14-14.23, P = 0.031), and hepatitis C infection was associated with a decreased risk (adjusted odds ratio =0.24, 95% confidence interval 0.09-0.65, P =0.005) of portopulmonary hypertension. The severity of liver disease was not related to the risk of portopulmonary hypertension. Conclusion Female sex and autoimmune hepatitis were associated with an increased risk of portopulmonary hypertension, whereas hepatitis C infection was associated with a decreased risk in patients with advanced liver disease. Hormonal and immunologic factors may therefore be integral to the development of portopulmonary hypertension. PMID:18537192

  4. Childhood peer relationship problems and psychosocial adjustment in late adolescence.

    PubMed

    Woodward, L J; Fergusson, D M

    1999-02-01

    Using prospective longitudinal data from the Christchurch Health and Development Study, this paper examined the relationship between teacher reported peer relationship problems at age 9 and psychosocial adjustment in late adolescence. Results showed that, by age 18, children with high rates of early peer relationship problems were at increased risk of externalizing behavior problems such as criminal offending and substance abuse, but were not at increased risk of anxiety disorder or major depression. Subsequent analyses revealed that these associations were largely explained by the effects of child and family factors associated with both early peer relationship problems and later adjustment. The most influential variable in explaining associations between peer relationship problems and later adjustment was the extent of children's early conduct problems. These results suggest that reported associations between early peer problems and later adjustment are noncausal, and appear to reflect underlying continuities in behavioral adjustment.

  5. The intake of a hazelnut skin extract improves the plasma lipid profile and reduces the lithocholic/deoxycholic bile acid faecal ratio, a risk factor for colon cancer, in hamsters fed a high-fat diet.

    PubMed

    Caimari, Antoni; Puiggròs, Francesc; Suárez, Manuel; Crescenti, Anna; Laos, Sirle; Ruiz, Juan Antonio; Alonso, Virginia; Moragas, Josep; Del Bas, Josep Maria; Arola, Lluís

    2015-01-15

    The effects on lipid and glucose metabolism of a hazelnut skin extract (FIBEROX™) administrated during 8 weeks (HFD-FBX8w group) or during the last 4 weeks of the study (HFD-FBX4w group) to Golden Syrian hamsters fed a high-fat diet (HFD) for 8 weeks were investigated. FIBEROX™ consumption reversed the increase in total and LDL plasma cholesterol induced by the HFD feeding in both HFD-FBX groups and decreased the circulating levels of free fatty acids and triglycerides in the HFD-FBX4w animals. The higher excretion of bile acids found in the faeces of both groups of hamsters fed the FIBEROX™ suggests that this mechanism is involved in the cholesterol-lowering effects of the extract. Furthermore, FIBEROX™ intake sharply decreased the lithocholic/deoxycholic bile acid faecal ratio, a risk factor for colon cancer, in both HFD-FBX groups. In conclusion, the consumption of FIBEROX™ improves different risk factors associated with cardiovascular disease and colon cancer.

  6. The Effect of Family Communication Patterns on Adopted Adolescent Adjustment

    PubMed Central

    Rueter, Martha A.

    2008-01-01

    Adoption and family communication both affect adolescent adjustment. We proposed that adoption status and family communication interact such that adopted adolescents in families with certain communication patterns are at greater risk for adjustment problems. We tested this hypothesis using a community-based sample of 384 adoptive and 208 nonadoptive families. Adolescents in these families were, on average, 16 years of age. The results supported our hypothesis. Adopted adolescents were at significantly greater risk for adjustment problems compared to nonadopted adolescents in families that emphasized conformity orientation without conversation orientation and in families that emphasized neither conformity nor conversation orientation. Adolescents in families emphasizing conversation orientation were at lower risk for adjustment problems, regardless of adoption status. PMID:19649145

  7. 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.

  8. 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.

  9. Subjective Invulnerability, Optimism Bias and Adjustment in Emerging Adulthood

    ERIC Educational Resources Information Center

    Lapsley, Daniel K.; Hill, Patrick L.

    2010-01-01

    The relationship between subjective invulnerability and optimism bias in risk appraisal, and their comparative association with indices of risk activity, substance use and college adjustment problems was assessed in a sample of 350 (M [subscript age] = 20.17; 73% female; 93% White/European American) emerging adults. Subjective invulnerability was…

  10. Ratio of C-Reactive Protein to Albumin Predicts Muscle Mass in Adult Patients Undergoing Hemodialysis

    PubMed Central

    Chen, Yu-Tong; Wu, Pei-Yu; Chen, Hsi-Hsien; Chen, Tso-Hsiao; Hsu, Yung-Ho

    2016-01-01

    Recent studies have indicated that the ratio of C-reactive protein to albumin (CRP–Alb ratio) is associated with clinical outcomes in patients with disease. We examined the predictive value of this ratio in patients undergoing hemodialysis (HD). In this cross-sectional study, 91 eligible adult HD patients were analyzed, and the correlation between the CRP–Alb ratio and skeletal muscle mass normalized for body weight (SMM/wt; estimated using a bioelectrical impedance analyzer) was investigated. The mean age of the study participants was 54.9 ± 6.6 years (ranging from 27 to 64 years); 43 (47.2%) were men. The mean values for the SMM/wt were 39.1% ± 5.4%. The CRP–Alb ratio was found to be negatively correlated with SMM/wt (r = −0.33, P = 0.002) and creatinine (r = −0.20, P = 0.056). All the univariate significant and nonsignificant relevant covariates were selected for multivariable stepwise regression analysis. We determined that the homeostasis model assessment-estimated insulin resistance and CRP–Alb ratio were independent risk determinants for SMM/wt (βHOMA-IR = −0.18 and βCRP–Alb ratio = −3.84, adjusted R2 = 0.32). This study indicated that the CRP–Alb ratio may help clinicians in predicting muscle mass in adult patients undergoing HD. PMID:27768746

  11. Child adjustment in high conflict families.

    PubMed

    Smith, J; Berthelsen, D; O'Connor, I

    1997-03-01

    Children exposed to spousal violence are at risk for social-emotional problems. This research investigated a number of family and child factors which might influence the effects of witnessing spousal violence on young children. Fifty-four mothers who had at least one child in the age range of 3 to 6 years participated in the study. These women had left a violent relationship 12 to 24 months prior to their participation in the study and were not in a new relationship. Information was collected through a structured interview which included the administration of a standardized family violence measure (conflict tactics scale) and child adjustment profile (child behaviour checklist). Forty-two per cent of the children exhibited a level of behavioural problems which would warrant clinical intervention. The amount of violence that the children witnessed, the children's responses when the violence occurred and whether the child copied the violent partner's behaviour, were associated with the children's behavioural adjustment scores. Maternal parenting style was not found to have a significant effect on behavioural adjustment. The study provided important quantitative and qualitative data on the nature of parent-child relationships and children's adjustment in families where there is spousal violence.

  12. 12 CFR 3.6 - Minimum capital ratios.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Minimum capital ratios. 3.6 Section 3.6 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY MINIMUM CAPITAL RATIOS; ISSUANCE OF DIRECTIVES Minimum Capital Ratios § 3.6 Minimum capital ratios. (a) Risk-based capital ratio....

  13. Disposition and adjustment to chronic pain.

    PubMed

    Ramírez-Maestre, Carmen; Esteve, Rosa

    2013-03-01

    Several empirical studies have shown that personal characteristics act as differential variables, which determine how pain is experienced and how the chronic pain patient adjusts to pain. The main aim of the present research is to review the relationships between some dispositional characteristics and pain adjustment. Taking into account the empirical literature, 6 personality traits that are relevant to the pain experience have been selected: neuroticism, anxiety sensitivity, and experiential avoidance as risk factors that increase the probability of patients experiencing a disability; and extraversion, optimism, and resilience as personal resources that increase their capacity to manage pain effectively. The results suggest that it would be useful to include an assessment of normal personality structure during the multi-dimensional evaluation of a person with chronic pain. Understanding these individual personality characteristics will aid in designing pain intervention programs and help predict possible treatment outcomes.

  14. High Neutrophil-to-Lymphocyte Ratio Predicts Cardiovascular Mortality in Chronic Hemodialysis Patients

    PubMed Central

    Xiong, Ruifang

    2017-01-01

    The neutrophil-to-lymphocyte ratio (NLR) is a novel simple biomarker of inflammation. It has emerged as a predictor of poor prognosis in cancer and cardiovascular disease in general population. But little was known of its prognostic value in chronic hemodialysis (HD) patients. Here we investigated the association between NLR and cardiovascular risk markers, including increased pulse pressure (PP), left ventricular mass index (LVMI) and intima-media thickness (IMT), and mortality in HD patients. Two hundred and sixty-eight HD patients were enrolled in this study and were followed for 36 months. The primary end point was all-cause mortality and cardiovascular mortality. Multivariable Cox regression was used to calculate the adjusted hazard ratios for NLR on all-cause and cardiovascular survival. We pinpointed that higher NLR in HD patients was a predictor of increased PP, LVMI, and IMT; HD patients with higher NLR had a lower survival at the end of the study; furthermore, high NLR was an independent predictor of all-cause and cardiovascular mortality when adjusted for other risk factors. In conclusion, higher NLR in HD patients was associated with cardiovascular risk factors and mortality. PMID:28316378

  15. 42 CFR 422.308 - Adjustments to capitation rates, benchmarks, bids, and payments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Adjustments to capitation rates, benchmarks, bids... Payments to Medicare Advantage Organizations § 422.308 Adjustments to capitation rates, benchmarks, bids...) Data collection. To adjust for health status, CMS applies a risk factor based on data obtained...

  16. 42 CFR 422.308 - Adjustments to capitation rates, benchmarks, bids, and payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Adjustments to capitation rates, benchmarks, bids... Medicare Advantage Organizations § 422.308 Adjustments to capitation rates, benchmarks, bids, and payments... the determination of actuarial equivalence. (2) Risk adjustment: Health status—(i) Data collection....

  17. Classroom Victimization: Consequences for Social and Academic Adjustment in Elementary School

    ERIC Educational Resources Information Center

    Reuland, Meg M.; Mikami, Amori Yee

    2014-01-01

    Peer victimization is a well-established risk factor for children's adjustment, but it has rarely been studied as a feature of classroom climate. This study examines the consequences of classroom victimization for children's social and academic adjustment. Classroom victimization, social functioning, and academic adjustment were assessed…

  18. 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…

  19. 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.

  20. 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.

  1. Variable mixture ratio performance through nitrogen augmentation

    NASA Technical Reports Server (NTRS)

    Beichel, R.; Obrien, C. J.; Bair, E. K.

    1988-01-01

    High/variable mixture ratio O2/H2 candidate engine cycles are examined for earth-to-orbit vehicle application. Engine performance and power balance information are presented for the candidate cycles relative to chamber pressure, bulk density, and mixture ratio. Included in the cycle screening are concepts where a third fluid (liquid nitrogen) is used to achieve a variable mixture ratio over the trajectory from liftoff to earth orbit. The third fluid cycles offer a very low risk, fully reusable, low operation cost alternative to high/variable mixture ratio bipropellant cycles. Variable mixture ratio engines with extendible nozzle are slightly lower performing than a single mixture ratio engine (MR = 7:1) with extendible nozzle. Dual expander engines (MR = 7:1) have slightly better performance than the single mixture ratio engine. Dual fuel dual expander engines offer a 16 percent improvement over the single mixture ratio engine.

  2. The Golden Ratio

    ERIC Educational Resources Information Center

    Hyde, Hartley

    2004-01-01

    The Golden Ratio is sometimes called the "Golden Section" or the "Divine Proportion", in which three points: A, B, and C, divide a line in this proportion if AC/AB = AB/BC. "Donald in Mathmagicland" includes a section about the Golden Ratio and the ratios within a five-pointed star or pentagram. This article presents two computing exercises that…

  3. Application of Variable Life Adjusted Displays (VLAD) on Victorian Admitted Episodes Dataset (VAED)

    PubMed Central

    2012-01-01

    Background The need to improve patient safety has been identified as a major priority for health reform in developed countries, including Australia. We investigated the implementation and appropriateness of Variable Life Adjusted Displays as a quality control procedure to monitor “in-control” versus “out-of-control” processes in Victorian public hospitals. Methods Victorian Admitted Episode Data from Department of Human Services, Victoria for 2004–7 were used. The VLAD is a plot of a cumulative sum of the difference in expected outcome (range 0–1) and observed outcome (0 or 1) for sequential separations. Three outcomes were assessed: in-hospital mortality for acute myocardial infarction, stroke and heart failure. Logistic regression was used to obtain a realistic measure of expected mortality over the period 2004–5, adjusting for covariates and comorbidities, to estimate expected mortality risk for the separations between 2005–7. VLAD were plotted for the years 2005–7, by the 11 hospitals with the highest frequency of separations. Signalling limits for 30%, 50% and 75% risk decrease and risk increase were determined and plotted for each VLAD utilizing risk-adjusted cumulative sum techniques. This is a likelihood-ratio test statistic for signalling. If the VLAD signalled by intersecting with a limit, the limit was reset. Results The three logit models displayed reasonable fit to the observed data. There were n = 2999 separations in the AMI model, n = 3598 in the HF model and n = 1922 in the stroke model. The number of separations plotted by VLAD ranged from n = 126 to n = 648. No signals were observed in 64%, 55% and 18% of VLAD for AMI, HF and stroke respectively. For AMI and HF 9% of hospitals signalled at least once for each of 30%, 50% and 75% risk increase, whereas this was 45% for stroke. Hospitals signalling at least once for risk decrease ranged from 18% to 36% across the levels of risk and outcomes. No VLAD signalled

  4. Capitation pricing: Adjusting for prior utilization and physician discretion

    PubMed Central

    Anderson, Gerard F.; Cantor, Joel C.; Steinberg, Earl P.; Holloway, James

    1986-01-01

    As the number of Medicare beneficiaries receiving care under at-risk capitation arrangements increases, the method for setting payment rates will come under increasing scrutiny. A number of modifications to the current adjusted average per capita cost (AAPCC) methodology have been proposed, including an adjustment for prior utilization. In this article, we propose use of a utilization adjustment that includes only hospitalizations involving low or moderate physician discretion in the decision to hospitalize. This modification avoids discrimination against capitated systems that prevent certain discretionary admissions. The model also explains more of the variance in per capita expenditures than does the current AAPCC. PMID:10312010

  5. Understanding DALYs (disability-adjusted life years).

    PubMed

    Murray, C J; Acharya, A K

    1997-12-01

    The measurement unit disability-adjusted life years (DALYs), used in recent years to quantify the burden of diseases, injuries and risk factors on human populations, is grounded on cogent economic and ethical principles and can guide policies toward delivering more cost-effective and equitable health care. DALYs follow from a fairness principle that treats 'like as like' within an information set comprising the health conditions of individuals, differentiated solely by age and sex. The particular health state weights used to account for non-fatal health outcomes are derived through the application of various forms of the person trade-off.

  6. Specific cut-off points for waist circumference and waist-to-height ratio as predictors of cardiometabolic risk in Black subjects: a cross-sectional study in Benin and Haiti

    PubMed Central

    EL Mabchour, Asma; Delisle, Hélène; Vilgrain, Colette; Larco, Philippe; Sodjinou, Roger; Batal, Malek

    2015-01-01

    Purpose Waist circumference (WC) and waist-to-height ratio (WHtR) are widely used as indicators of abdominal adiposity and the cut-off values have been validated primarily in Caucasians. In this study we identified the WC and WHtR cut-off points that best predicted cardiometabolic risk (CMR) in groups of African (Benin) and African ancestry (Haiti) Black subjects. Methods This cross-sectional study included 452 apparently healthy subjects from Cotonou (Benin) and Port-au-Prince (Haiti), 217 women and 235 men from 25 to 60 years. CMR biomarkers were the metabolic syndrome components. Additional CMR biomarkers were a high atherogenicity index (total serum cholesterol/high density lipoprotein cholesterol ≥4 in women and ≥5 in men); insulin resistance set at the 75th percentile of the calculated Homeostasis Model Assessment index (HOMA-IR); and inflammation defined as high-sensitivity C-reactive protein (hsCRP) concentrations between 3 and 10 mg/L. WC and WHtR were tested as predictors of two out of the three most prevalent CMR biomarkers. Receiver operating characteristic (ROC) curves, Youden’s index, and likelihood ratios were used to assess the performance of specific WC and WHtR cut-offs. Results High atherogenicity index (59.5%), high blood pressure (23.2%), and insulin resistance (25% by definition) were the most prevalent CMR biomarkers in the study groups. WC and WHtR were equally valid as predictors of CMR. Optimal WC cut-offs were 80 cm and 94 cm in men and women, respectively, which is exactly the reverse of the generic cut-offs. The standard 0.50 cut-off of WHtR appeared valid for men, but it had to be increased to 0.59 in women. Conclusion CMR was widespread in these population groups. The present study suggests that in order to identify Africans with high CMR, WC thresholds will have to be increased in women and lowered in men. Data on larger samples are needed. PMID:26604808

  7. Joint effects between five identified risk variants, allergy, and autoimmune conditions on glioma risk.

    PubMed

    Safaeian, Mahboobeh; Rajaraman, Preetha; Hartge, Patricia; Yeager, Meredith; Linet, Martha; Butler, Mary Ann; Ruder, Avima M; Purdue, Mark P; Hsing, Ann; Beane-Freeman, Laura; Hoppin, Jane A; Albanes, Demetrius; Weinstein, Stephanie J; Inskip, Peter D; Brenner, Alina; Rothman, Nathaniel; Chatterjee, Nilanjan; Gillanders, Elizabeth M; Chanock, Stephen J; Wang, Sophia S

    2013-10-01

    Common variants in two of the five genetic regions recently identified from genome-wide association studies (GWAS) of risk of glioma were reported to interact with a history of allergic symptoms. In a pooled analysis of five epidemiologic studies, we evaluated the association between the five GWAS implicated gene variants and allergies and autoimmune conditions (AIC) on glioma risk (851 adult glioma cases and 3,977 controls). We further evaluated the joint effects between allergies and AIC and these gene variants on glioma risk. Risk estimates were calculated as odds ratios (OR) and 95 % confidence intervals (95 % CI), adjusted for age, gender, and study. Joint effects were evaluated by conducting stratified analyses whereby the risk associations (OR and 95 % CI) with the allergy or autoimmune conditions for glioma were evaluated by the presence or absence of the 'at-risk' variant, and estimated p interaction by fitting models with the main effects of allergy or autoimmune conditions and genotype and an interaction (product) term between them. Four of the five SNPs previously reported by others were statistically significantly associated with increased risk of glioma in our study (rs2736100, rs4295627, rs4977756, and rs6010620); rs498872 was not associated with glioma in our study. Reporting any allergies or AIC was associated with reduced risks of glioma (allergy: adjusted OR = 0.71, 95 % CI 0.55-0.91; AIC: adjusted OR = 0.65, 95 % CI 0.47-0.90). We did not observe differential association between allergic or autoimmune conditions and glioma by genotype, and there were no statistically significant p interactions. Stratified analysis by glioma grade (low and high grade) did not suggest risk differences by disease grade. Our results do not provide evidence that allergies or AIC modulate the association between the four GWAS-identified SNPs examined and risk of glioma.

  8. Route Infrastructure and the Risk of Injuries to Bicyclists: A Case-Crossover Study

    PubMed Central

    Harris, M. Anne; Reynolds, Conor C. O.; Winters, Meghan; Babul, Shelina; Chipman, Mary; Cusimano, Michael D.; Brubacher, Jeff R.; Hunte, Garth; Friedman, Steven M.; Monro, Melody; Shen, Hui; Vernich, Lee; Cripton, Peter A.

    2012-01-01

    Objectives. We compared cycling injury risks of 14 route types and other route infrastructure features. Methods. We recruited 690 city residents injured while cycling in Toronto or Vancouver, Canada. A case-crossover design compared route infrastructure at each injury site to that of a randomly selected control site from the same trip. Results. Of 14 route types, cycle tracks had the lowest risk (adjusted odds ratio [OR] = 0.11; 95% confidence interval [CI] = 0.02, 0.54), about one ninth the risk of the reference: major streets with parked cars and no bike infrastructure. Risks on major streets were lower without parked cars (adjusted OR = 0.63; 95% CI = 0.41, 0.96) and with bike lanes (adjusted OR = 0.54; 95% CI = 0.29, 1.01). Local streets also had lower risks (adjusted OR = 0.51; 95% CI = 0.31, 0.84). Other infrastructure characteristics were associated with increased risks: streetcar or train tracks (adjusted OR = 3.0; 95% CI = 1.8, 5.1), downhill grades (adjusted OR = 2.3; 95% CI = 1.7, 3.1), and construction (adjusted OR = 1.9; 95% CI = 1.3, 2.9). Conclusions. The lower risks on quiet streets and with bike-specific infrastructure along busy streets support the route-design approach used in many northern European countries. Transportation infrastructure with lower bicycling injury risks merits public health support to reduce injuries and promote cycling. PMID:23078480

  9. Serum total cholesterol: HDL cholesterol ratios in US white and black adults by selected demographic and socioeconomic variables (HANES II).

    PubMed Central

    Linn, S; Fulwood, R; Carroll, M; Brook, J G; Johnson, C; Kalsbeek, W D; Rifkind, B M

    1991-01-01

    BACKGROUND: Framingham Study findings suggest that total cholesterol (TC):High density lipoprotein cholesterol (HDL-C) ratio is a useful summary of the joint contribution of TC and HDL-C to coronary heart disease (CHD) risk. Information on the distribution of TC:HDL-C in the US population is limited to selected populations and the relationship of the ratio distribution and its correlates has received little attention. METHOD: TC/HDL-C ratios were examined in a representative sample of the United States adult population ages 20 to 74 years, between February 1976 and February 1980 during NHANES II, using stratification and multivariate regression analyses. RESULTS: Age-adjusted mean ratios were higher in men compared with women and were higher in Whites compared with Blacks. White men had the highest TC/HDL-C mean ratios. These relationships remained after stratification by age, education, body mass index, alcohol use, cigarette smoking, and physical activity. Using multivariate analyses, the ratios were positively related to BMI, age, and smoking; and negatively related to female sex, alcohol use, being Black, and physical activity. CONCLUSIONS: Using a ratio reference point of greater than or equal to 4.5 from the Framingham study, at least an estimated 44 million persons ages 25 to 74 years in the US were found to be at higher risk of developing coronary heart disease. PMID:1853996

  10. 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

  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. Timing of DVT prophylaxis and risk of postoperative knee prosthesis infection.

    PubMed

    Asensio, Angel; Antolín, Francisco J; Sanchez-García, Joseph M; Hidalgo, Olga; Hernández-Navarrete, Maria Jesús; Bishopberger, Cornelia; Miguel, Lucía García-San; Gay-Pobes, Andrés; Cabrera-Quintero, Alberto; Asensio, Paula; Sanz-Sebastián, Cristina; Gonzalez-Torga, Antonio; Ortiz-Espada, Alejandro; Pérez-Serrano, Luis; Ramos, Antonio

    2010-11-02

    This multicenter prospective study was performed to determine risk factors for knee prosthesis infection and the effect of timing doses of prophylactic low-molecular-weight heparins (LMWH) related to time of surgery on the risk of knee prosthesis infection. A total of 5496 consecutive patients who underwent total knee arthroplasty from 2005 to 2006 in 13 orthopedic centers were prospectively followed up for 6 months, and the incidence of knee prosthesis infection was recorded. A case control study was nested in the cohort. Case patients were matched to uninfected (control) patients, and the timing of perioperative LMWH was recorded as the main risk factor. Fifty patients developed postoperative knee prosthesis infection during the follow-up period, yielding an incidence of prosthesis infection of 0.91% (95% CI, 0.68%-1.20%). Forty-four patients were matched to 106 controls. Case patients received the first LMWH dose ±12 hours from the start of surgery more frequently than their control counterparts (odds ratio, 1.5; 95% CI, 0.73-3.0). After adjusting by main risk factors, no statistical association was found between close perioperative timing of LMWH and risk of prosthesis infection. Diabetes mellitus (adjusted odds ratio, 3.2; 95% CI, 1.2-8.8) and wound hematoma (adjusted odds ratio, 4.2; 95% CI, 1.1-16.5) were found to be independent risk factors for prosthesis infection.

  13. Triglyceride to HDL-C Ratio is Associated with Insulin Resistance in Overweight and Obese Children.

    PubMed

    Iwani, Nur Ahmad Kamil Zati; Jalaludin, Muhammad Yazid; Zin, Ruziana Mona Wan Mohd; Fuziah, Md Zain; Hong, Janet Yeow Hua; Abqariyah, Yahya; Mokhtar, Abdul Halim; Wan Nazaimoon, Wan Mohamud

    2017-01-06

    The purpose of this study was to investigate the usefulness of triglyceride to hdl-c ratio (TG:HDL-C) as an insulin resistance (IR) marker for overweight and obese children. A total of 271 blood samples of obese and overweight children aged 9-16 years were analysed for fasting glucose, lipids and insulin. Children were divided into IR and non-insulin resistance, using homeostasis model assessment (HOMA). The children were then stratified by tertiles of TG: HDL-C ratio. The strength between TG:HDL-C ratio and other parameters of IR were quantified using Pearson correlation coefficient (r). Odds ratio was estimated using multiple logistic regression adjusted for age, gender, pubertal stages and IR potential risk factors. Children with IR had significantly higher TG:HDL-C ratio (2.48) (p = 0.01). TG:HDL-C ratio was significantly correlated with HOMA-IR (r = 0.104, p < 0.005) and waist circumference (r = 0.134, p < 0.001). Increasing tertiles of TG:HDL-C ratio showed significant increase in mean insulin level (p = 0.03), HOMA-IR (p = 0.04) and significantly higher number of children with acanthosis nigricans and metabolic syndrome. The odds of having IR was about 2.5 times higher (OR = 2.47; 95% CI 1.23, 4.95; p = 0.01) for those in the highest tertiles of TG:HDL-C ratio. Hence, TG:HDL-C may be a useful tool to identify high risk individuals.

  14. Triglyceride to HDL-C Ratio is Associated with Insulin Resistance in Overweight and Obese Children

    PubMed Central

    Iwani, Nur Ahmad Kamil Zati; Jalaludin, Muhammad Yazid; Zin, Ruziana Mona Wan Mohd; Fuziah, Md Zain; Hong, Janet Yeow Hua; Abqariyah, Yahya; Mokhtar, Abdul Halim; Wan Nazaimoon, Wan Mohamud

    2017-01-01

    The purpose of this study was to investigate the usefulness of triglyceride to hdl-c ratio (TG:HDL-C) as an insulin resistance (IR) marker for overweight and obese children. A total of 271 blood samples of obese and overweight children aged 9–16 years were analysed for fasting glucose, lipids and insulin. Children were divided into IR and non-insulin resistance, using homeostasis model assessment (HOMA). The children were then stratified by tertiles of TG: HDL-C ratio. The strength between TG:HDL-C ratio and other parameters of IR were quantified using Pearson correlation coefficient (r). Odds ratio was estimated using multiple logistic regression adjusted for age, gender, pubertal stages and IR potential risk factors. Children with IR had significantly higher TG:HDL-C ratio (2.48) (p = 0.01). TG:HDL-C ratio was significantly correlated with HOMA-IR (r = 0.104, p < 0.005) and waist circumference (r = 0.134, p < 0.001). Increasing tertiles of TG:HDL-C ratio showed significant increase in mean insulin level (p = 0.03), HOMA-IR (p = 0.04) and significantly higher number of children with acanthosis nigricans and metabolic syndrome. The odds of having IR was about 2.5 times higher (OR = 2.47; 95% CI 1.23, 4.95; p = 0.01) for those in the highest tertiles of TG:HDL-C ratio. Hence, TG:HDL-C may be a useful tool to identify high risk individuals. PMID:28059134

  15. Risk of cardiovascular disease among patients with sarcoidosis: a population-based retrospective cohort study, 1976-2013.

    PubMed

    Ungprasert, Patompong; Crowson, Cynthia S; Matteson, Eric L

    2017-02-01

    A higher incidence of cardiovascular disease (CVD) has been observed in several chronic inflammatory diseases. However, data on sarcoidosis are limited.In this study, 345 patients with incident sarcoidosis in Olmsted County (Minnesota, USA) during 1976-2013 were identified based on comprehensive medical record review. 345 sex- and age-matched comparators were also identified from the same underlying population. Medical records were individually reviewed for CVD, including coronary artery disease, congestive heart failure, atrial fibrillation, cerebrovascular accident, transient ischaemic attack, peripheral arterial disease and abdominal aortic aneurysm. Cox proportional hazards models with adjustment for age, sex, calendar year and cardiovascular risk factors were used to compare the rate of development of CVD between cases and comparators.The prevalence of CVD before the index date was not significantly different between the two groups. Adjusting for age, sex and calendar year, the risk of incident CVD after the index date was significantly elevated among patients with sarcoidosis with an adjusted hazard ratio of 1.57 (95% CI 1.15-2.16). Adjustment for cardiovascular risk factors yielded an adjusted hazard ratio of 1.65 (95% CI 1.08-2.53). Significantly increased risk was also observed for several types of CVD, including coronary artery disease, congestive heart failure, atrial fibrillation and cerebrovascular accident.Increased incidence of CVD among patients with sarcoidosis was demonstrated in this population-based cohort, even after controlling for baseline traditional atherosclerotic risk factors.

  16. Combining biomarkers for classification with covariate adjustment.

    PubMed

    Kim, Soyoung; Huang, Ying

    2017-03-09

    Combining multiple markers can improve classification accuracy compared with using a single marker. In practice, covariates associated with markers or disease outcome can affect the performance of a biomarker or biomarker combination in the population. The covariate-adjusted receiver operating characteristic (ROC) curve has been proposed as a tool to tease out the covariate effect in the evaluation of a single marker; this curve characterizes the classification accuracy solely because of the marker of interest. However, research on the effect of covariates on the performance of marker combinations and on how to adjust for the covariate effect when combining markers is still lacking. In this article, we examine the effect of covariates on classification performance of linear marker combinations and propose to adjust for covariates in combining markers by maximizing the nonparametric estimate of the area under the covariate-adjusted ROC curve. The proposed method provides a way to estimate the best linear biomarker combination that is robust to risk model assumptions underlying alternative regression-model-based methods. The proposed estimator is shown to be consistent and asymptotically normally distributed. We conduct simulations to evaluate the performance of our estimator in cohort and case/control designs and compare several different weighting strategies during estimation with respect to efficiency. Our estimator is also compared with alternative regression-model-based estimators or estimators that maximize the empirical area under the ROC curve, with respect to bias and efficiency. We apply the proposed method to a biomarker study from an human immunodeficiency virus vaccine trial. Copyright © 2017 John Wiley & Sons, Ltd.

  17. Long-term follow-up of tandem high-dose therapy with autologous stem cell support for adults with high-risk age-adjusted international prognostic index aggressive non-Hodgkin Lymphomas: a GOELAMS pilot study.

    PubMed

    Monjanel, Hélène; Deconinck, Eric; Perrodeau, Elodie; Gastinne, Thomas; Delwail, Vincent; Moreau, Anne; François, Sylvie; Berthou, Christian; Gyan, Emmanuel; Milpied, Noël

    2011-06-01

    Single high-dose therapy (HDT) followed by autologous peripheral blood stem cell (PBSC) support improves complete response and overall survival (OS) in untreated aggressive non-Hodgkin's lymphoma (NHL). However, patients with a high age-adjusted international prognostic index (aa-IPI equal to 3) still have poor clinical outcome despite high dose intensity regimen. To improve complete response in this subgroup, the French Groupe Ouest-Est des Leucémies et Autres Maladies du Sang (GOELAMS) conducted a pilot phase II trial (073) evaluating tandem HDT with PBSC support in a series of 45 patients with aa-IPI equal to 3 untreated aggressive non-Hodgkin's lymphoma. After induction with an anthracyclin-containing regimen, responders underwent tandem HDT conditioned by high-dose mitoxantrone plus cytarabine for the first HDT and total-body irradiation (TBI), carmustine, etoposide, and cyclophosphamide for the second HDT. Thirty-one patients out of 41 evaluable patients completed the program. There were 4 toxic deaths. The complete response rate was 49%. With a median follow-up of 114 months for surviving patients, the OS was 51%, and 19 out of the 22 patients (86%) who reached a complete response are alive and relapse-free. Recent prospective evaluation of quality of life and comorbidities of surviving patients does not reveal long-term toxicities of the procedure. In the era of monoclonal antibodies and response-adapted therapy, the role of tandem HDT still need to be determined.

  18. Quality of life and quality-adjusted survival (Q-TWiST) in patients receiving dose-intensive or standard dose chemotherapy for high-risk primary breast cancer.

    PubMed

    Bernhard, J; Zahrieh, D; Zhang, J J; Martinelli, G; Basser, R; Hürny, C; Forbes, J F; Aebi, S; Yeo, W; Thürlimann, B; Green, M D; Colleoni, M; Gelber, R D; Castiglione-Gertsch, M; Price, K N; Goldhirsch, A; Coates, A S

    2008-01-15

    Quality of life (QL) is an important consideration when comparing adjuvant therapies for early breast cancer, especially if they differ substantially in toxicity. We evaluated QL and Q-TWiST among patients randomised to adjuvant dose-intensive epirubicin and cyclophosphamide administered with filgrastim and progenitor cell support (DI-EC) or standard-dose anthracycline-based chemotherapy (SD-CT). We estimated the duration of chemotherapy toxicity (TOX), time without disease symptoms and toxicity (TWiST), and time following relapse (REL). Patients scored QL indicators. Mean durations for the three transition times were weighted with patient reported utilities to obtain mean Q-TWiST. Patients receiving DI-EC reported worse QL during TOX, especially treatment burden (month 3: P<0.01), but a faster recovery 3 months following chemotherapy than patients receiving SD-CT, for example, less coping effort (P<0.01). Average Q-TWiST was 1.8 months longer for patients receiving DI-EC (95% CI, -2.5 to 6.1). Q-TWiST favoured DI-EC for most values of utilities attached to TOX and REL. Despite greater initial toxicity, quality-adjusted survival was similar or better with dose-intensive treatment as compared to standard treatment. Thus, QL considerations should not be prohibitive if future intensive therapies show superior efficacy.

  19. Nuclear Cataract Shows Significant Familial Aggregation in an Older Population after Adjustment for Possible Shared Environmental Factors

    PubMed Central

    Congdon, Nathan; Broman, Karl W.; Lai, Hong; Munoz, Beatriz; Bowie, Heidi; Gilber, Donna; Wojciechowski, Robert; Alston, Christine; West, Sheila K.

    2011-01-01

    Purpose To quantify the association between siblings in age-related nuclear cataract, after adjusting for known environmental and personal risk factors. Methods All participants (probands) in the Salisbury Eye Evaluation (SEE) project and their locally resident siblings underwent digital slit lamp photography and were administered a questionnaire to assess risk factors for cataract including: age, gender, lifetime sun exposure, smoking and diabetes history, and use of alcohol and medications such as estrogens and steroids. In addition, blood pressure, body mass index, and serum antioxidants were measured in all participants. Lens photographs were graded by trained observers masked to the subjects' identity, using the Wilmer Cataract Grading System. The odds ratio for siblings for affectedness with nuclear cataract and the sibling correlation of nuclear cataract grade, after adjusting for covariates, were estimated with generalized estimating equations. Results Among 307 probands (mean age, 77.6 ± 4.5 years) and 434 full siblings (mean age, 72.4 ± 7.4 years), the average sibship size was 2.7 per family. After adjustment for covariates, the probability of development of nuclear cataract was significantly increased (odds ratio [OR] = 2.07, 95% confidence interval [CI], 1.30–3.30) among individuals with a sibling with nuclear cataract (nuclear grade ≥ 3.0). The final fitted model indicated a magnitude of heritability for nuclear cataract of 35.6% (95% CI: 21.0%–50.3%) after adjustment for the covariates. Conclusions Findings in this study are consistent with a genetic effect for age-related nuclear cataract, a common and clinically significant form of lens opacity. PMID:15223793

  20. Risk Factors for premature birth in a hospital 1

    PubMed Central

    Ahumada-Barrios, Margarita E.; Alvarado, German F.

    2016-01-01

    Abstract Objective: to determine the risk factors for premature birth. Methods: retrospective case-control study of 600 pregnant women assisted in a hospital, with 298 pregnant women in the case group (who gave birth prematurely <37 weeks) and 302 pregnant women who gave birth to a full-term newborn in the control group. Stata software version 12.2 was used. The Chi-square test was used in bivariate analysis and logistic regression was used in multivariate analysis, from which Odds Ratios (OR) and Confidence Intervals (CI) of 95% were derived. Results: risk factors associated with premature birth were current twin pregnancy (adjusted OR= 2.4; p= 0.02), inadequate prenatal care (< 6 controls) (adjusted OR= 3.2; p <0.001), absent prenatal care (adjusted OR= 3.0; p <0.001), history of premature birth (adjusted OR= 3.7; p <0.001) and preeclampsia (adjusted OR= 1.9; p= 0.005). Conclusion: history of premature birth, preeclampsia, not receiving prenatal care and receiving inadequate prenatal care were risk factors for premature birth. PMID:27463110

  1. Offer/Acceptance Ratio.

    ERIC Educational Resources Information Center

    Collins, Mimi

    1997-01-01

    Explores how human resource professionals, with above average offer/acceptance ratios, streamline their recruitment efforts. Profiles company strategies with internships, internal promotion, cooperative education programs, and how to get candidates to accept offers. Also discusses how to use the offer/acceptance ratio as a measure of program…

  2. 12 CFR 3.6 - Minimum capital ratios.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Minimum capital ratios. 3.6 Section 3.6 Banks... maintain Tier 1 capital in an amount equal to at least 3.0 percent of adjusted total assets. (c) Additional... banks meeting the conditions set forth in this paragraph (c), the minimum Tier 1 leverage ratio is...

  3. 12 CFR 3.6 - Minimum capital ratios.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Minimum capital ratios. 3.6 Section 3.6 Banks... maintain Tier 1 capital in an amount equal to at least 3.0 percent of adjusted total assets. (c) Additional... banks meeting the conditions set forth in this paragraph (c), the minimum Tier 1 leverage ratio is...

  4. Workplace bullying and the risk of cardiovascular disease and depression

    PubMed Central

    Kivimaki, M; Virtanen, M; Vartia, M; Elovainio, M; Vahtera, J; Keltikangas-Jarvi..., L

    2003-01-01

    Aims: To examine exposure to workplace bullying as a risk factor for cardiovascular disease and depression in employees. Methods: Logistic regression models were related to prospective data from two surveys in a cohort of 5432 hospital employees (601 men and 4831 women), aged 18–63 years. Outcomes were new reports of doctor diagnosed cardiovascular disease and depression during the two year follow up among those who were free from these diseases at baseline. Results: The prevalence of bullying was 5% in the first survey and 6% in the second survey. Two per cent reported bullying experiences in both surveys, an indication of prolonged bullying. After adjustment for sex, age, and income, the odds ratio of incident cardiovascular disease for victims of prolonged bullying compared to non-bullied employees was 2.3 (95% CI 1.2 to 4.6). A further adjustment for overweight at baseline attenuated the odds ratio to 1.6 (95% CI 0.8 to 3.5). The association between prolonged bullying and incident depression was significant, even after these adjustments (odds ratio 4.2, 95% CI 2.0 to 8.6). Conclusions: A strong association between workplace bullying and subsequent depression suggests that bullying is an aetiological factor for mental health problems. The victims of bullying also seem to be at greater risk of cardiovascular disease, but this risk may partly be attributable to overweight. PMID:14504368

  5. 10 CFR 436.22 - Adjusted internal rate of return.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... adjusted internal rate of return is the overall rate of return on an energy or water conservation measure... attributable to the proposed energy or water conservation measure. The denominator of the ratio is the present... proposed energy or water conservation measure....

  6. 10 CFR 436.22 - Adjusted internal rate of return.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... adjusted internal rate of return is the overall rate of return on an energy or water conservation measure... attributable to the proposed energy or water conservation measure. The denominator of the ratio is the present... proposed energy or water conservation measure....

  7. Geometrical optical performance evaluation of some seasonally adjusted solar concentrators

    SciTech Connect

    Mazumder, R.K.; Kandpal, T.C.; Mullick, S.C.

    1986-12-01

    The concentration characteristics of mirror profiles composed of small plane mirror elements have been studied for seasonally adjusted solar concentrators with different absorbers: flat horizontal, flat vertical, triangular cross section, and tubular. The distributions of local concentration ratio over these absorbers have been investigated using a ray tracing procedure.

  8. The relationship between life adjustment and parental bonding in military personnel with adjustment disorder in Taiwan.

    PubMed

    For-Wey, Lung; Fei-Yin, Lee; Bih-Ching, Shu

    2002-08-01

    The aim of the present study was to examine the characteristics of military personnel with adjustment disorder to give them more appropriate treatment. The participants were 36 military personnel who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria of adjustment disorder as diagnosed by a psychiatrist at a teaching hospital in southern Taiwan. Another 24 persons were recruited as an age-matched control group. Each individual completed the clinical interview and the Wechsler Adult Intelligence Scale-Revised and then completed the questionnaires which included demographic information, the Parental Bonding Instrument, the Eysenck Personality Questionnaire, and the Chinese Health Questionnaire. We found statistically significant differences between the case and control groups in personality and parental bonding attitudes. Soldiers with higher neuroticism, lower extraversion, and maternal overprotection had an increased risk of suffering from adjustment disorder. The inclusion of family function and the military environment and such other factors as cultural variables is recommended for future study. The statistical approach of structural equation modeling also should be considered in future studies to determine competing risk factors and mediating effects.

  9. 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.

  10. 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.

  11. 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…

  12. Piezo-driven adjustment of a cryogenic detector

    NASA Astrophysics Data System (ADS)

    Pragt, Johan H.; van den Brink, Raymond; Kroes, Gabby; Tromp, Niels; Ochs, Jean-Baptiste

    2008-07-01

    This paper presents the specifications, design, construction and evaluation of a piezo-driven tip/tilt/focus mechanism which can align a detector or any other optical component in a cryogenic environment. Even with a no-adjustment design philosophy, usually one or two components have to be adjusted in order to compensate for the total of optical and mechanical tolerances in an optical cryogenic instrument. Normally these adjustments are made by means of shims or stiff screw mechanisms and are applied at room temperature. In order to adjust the particular component(s), mostly by just a few microns, the high-risk and time-consuming operation of opening a cryostat is required. For a large cryostat the typical cycle of cooling, testing, warm-up, opening, adjustment, closing and cooling again, takes roughly two weeks. Often the cycle needs to be repeated a few times before the required position is obtained. ASTRON developed a piezo driven tip/tilt/focus mechanism which can adjust a detector or any other optical component in both the ambient and cryogenic (<100 K, vacuum) environment. Only during adjustment the system is active, for the rest of time it is a passive robust system with a high stability. The main specifications are a stroke of +/- 0,6 mm and tip/tilt of +/-1,2 mrad.

  13. Lung Cancer Risk Among Hairdressers: A Pooled Analysis of Case-Control Studies Conducted Between 1985 and 2010

    PubMed Central

    Olsson, Ann C.; Xu, Yiwen; Schüz, Joachim; Vlaanderen, Jelle; Kromhout, Hans; Vermeulen, Roel; Peters, Susan; Stücker, Isabelle; Guida, Florence; Brüske, Irene; Wichmann, Heinz-Erich; Consonni, Dario; Landi, Maria Teresa; Caporaso, Neil; Tse, Lap Ah; Yu, Ignatius Tak-sun; Siemiatycki, Jack; Richardson, Lesley; Mirabelli, Dario; Richiardi, Lorenzo; Simonato, Lorenzo; Gustavsson, Per; Plato, Nils; Jöckel, Karl-Heinz; Ahrens, Wolfgang; Pohlabeln, Hermann; Tardón, Adonina; Zaridze, David; Marcus, Michael W.; ‘t Mannetje, Andrea; Pearce, Neil; McLaughlin, John; Demers, Paul; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Rudnai, Peter; Fabianova, Eleonora; Dumitru, Rodica Stanescu; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Boffetta, Paolo; Fortes, Cristina; Bueno-de-Mesquita, Bas; Kendzia, Benjamin; Behrens, Thomas; Pesch, Beate; Brüning, Thomas; Straif, Kurt

    2013-01-01

    Increased lung cancer risks among hairdressers were observed in large registry-based cohort studies from Scandinavia, but these studies could not adjust for smoking. Our objective was to evaluate the lung cancer risk among hairdressers while adjusting for smoking and other confounders in a pooled database of 16 case-control studies conducted in Europe, Canada, China, and New Zealand between 1985 and 2010 (the Pooled Analysis of Case-Control Studies on the Joint Effects of Occupational Carcinogens in the Development of Lung Cancer). Lifetime occupational and smoking information was collected through interviews with 19,369 cases of lung cancer and 23,674 matched population or hospital controls. Overall, 170 cases and 167 controls had ever worked as hairdresser or barber. The odds ratios for lung cancer in women were 1.65 (95% confidence interval (CI): 1.16, 2.35) without adjustment for smoking and 1.12 (95% CI: 0.75, 1.68) with adjustment for smoking; however, women employed before 1954 also experienced an increased lung cancer risk after adjustment for smoking (odds ratio = 2.66, 95% CI: 1.09, 6.47). The odds ratios in male hairdressers/barbers were generally not elevated, except for an increased odds ratio for adenocarcinoma in long-term barbers (odds ratio = 2.20, 95% CI: 1.02, 4.77). Our results suggest that the increased lung cancer risks among hairdressers are due to their smoking behavior; single elevated risk estimates should be interpreted with caution and need replication in other studies. PMID:24068200

  14. Lung cancer risk among hairdressers: a pooled analysis of case-control studies conducted between 1985 and 2010.

    PubMed

    Olsson, Ann C; Xu, Yiwen; Schüz, Joachim; Vlaanderen, Jelle; Kromhout, Hans; Vermeulen, Roel; Peters, Susan; Stücker, Isabelle; Guida, Florence; Brüske, Irene; Wichmann, Heinz-Erich; Consonni, Dario; Landi, Maria Teresa; Caporaso, Neil; Tse, Lap Ah; Yu, Ignatius Tak-sun; Siemiatycki, Jack; Richardson, Lesley; Mirabelli, Dario; Richiardi, Lorenzo; Simonato, Lorenzo; Gustavsson, Per; Plato, Nils; Jöckel, Karl-Heinz; Ahrens, Wolfgang; Pohlabeln, Hermann; Tardón, Adonina; Zaridze, David; Marcus, Michael W; 't Mannetje, Andrea; Pearce, Neil; McLaughlin, John; Demers, Paul; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Rudnai, Peter; Fabianova, Eleonora; Dumitru, Rodica Stanescu; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Boffetta, Paolo; Fortes, Cristina; Bueno-de-Mesquita, Bas; Kendzia, Benjamin; Behrens, Thomas; Pesch, Beate; Brüning, Thomas; Straif, Kurt

    2013-11-01

    Increased lung cancer risks among hairdressers were observed in large registry-based cohort studies from Scandinavia, but these studies could not adjust for smoking. Our objective was to evaluate the lung cancer risk among hairdressers while adjusting for smoking and other confounders in a pooled database of 16 case-control studies conducted in Europe, Canada, China, and New Zealand between 1985 and 2010 (the Pooled Analysis of Case-Control Studies on the Joint Effects of Occupational Carcinogens in the Development of Lung Cancer). Lifetime occupational and smoking information was collected through interviews with 19,369 cases of lung cancer and 23,674 matched population or hospital controls. Overall, 170 cases and 167 controls had ever worked as hairdresser or barber. The odds ratios for lung cancer in women were 1.65 (95% confidence interval (CI): 1.16, 2.35) without adjustment for smoking and 1.12 (95% CI: 0.75, 1.68) with adjustment for smoking; however, women employed before 1954 also experienced an increased lung cancer risk after adjustment for smoking (odds ratio = 2.66, 95% CI: 1.09, 6.47). The odds ratios in male hairdressers/barbers were generally not elevated, except for an increased odds ratio for adenocarcinoma in long-term barbers (odds ratio = 2.20, 95% CI: 1.02, 4.77). Our results suggest that the increased lung cancer risks among hairdressers are due to their smoking behavior; single elevated risk estimates should be interpreted with caution and need replication in other studies.

  15. Promotive Factors and Psychosocial Adjustment among Urban Youth

    ERIC Educational Resources Information Center

    O'Neal, LaToya J.; Cotten, Shelia R.

    2016-01-01

    Background: Urban youth are often exposed to compounded risk factors which make them more vulnerable to negative outcomes. Research examining promotive factors which may reduce vulnerabilities to poor psychosocial adjustment among this population is limited. Objective: The current study addresses this limitation by examining the impact of…

  16. Interpersonal Competence Configurations, Behavior Problems, and Social Adjustment in Preadolescence

    ERIC Educational Resources Information Center

    Farmer, Thomas W.; Estell, David B.; Hall, Cristin M.; Pearl, Ruth; Van Acker, Richard; Rodkin, Philip C.

    2008-01-01

    This study examines interpersonal competence configurations in relation to students' concurrent behavior problems and social risks for later adjustment difficulties. Participants are 648 (345 girls, 303 boys) fourth-grade students (65% White, 6.9% African American, 19.5% Hispanic, 4.6% Asian, and 4.0% Other) from the suburbs of a major Midwestern…

  17. Parental Care Aids, but Parental Overprotection Hinders, College Adjustment

    ERIC Educational Resources Information Center

    Klein, Matthew B.; Pierce, John D., Jr.

    2010-01-01

    Previous work has shown that students who have troublesome relationships with their parents show higher risk factors for poorer college adjustment. In the present study, we focused on the balance between two key aspects of parenting style, parental care and overprotection, as they affect the transition to college life. Eighty-three undergraduate…

  18. High Aspect Ratio Wrinkles

    NASA Astrophysics Data System (ADS)

    Chen, Yu-Cheng; Crosby, Alfred

    2015-03-01

    Buckling-induced surface undulations are widely found in living creatures, for instance, gut villi and the surface of flower petal cells. These undulations provide unique functionalities with their extremely high aspect ratios. For the synthetic systems, sinusoidal wrinkles that are induced by buckling a thin film attached on a soft substrate have been proposed to many applications. However, the impact of the synthetic wrinkles have been restricted by limited aspect ratios, ranging from 0 to 0.35. Within this range, wrinkle aspect ratio is known to increase with increasing compressive strain until a critical strain is reached, at which point wrinkles transition to localizations, such as folds or period doublings. Inspired by the living creatures, we propose that wrinkles can be stabilized in high aspect ratio by manipulating the strain energy in the substrate. We experimentally demonstrate this idea by forming a secondary crosslinking network in the wrinkled surface and successfully achieve aspect ratio as large as 0.8. This work not only provides insights for the mechanism of high aspect ratio structures seen in living creatures, but also demonstrates significant promise for future wrinkle-based applications.

  19. 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...

  20. Reproductive factors associated with breast cancer risk in northern Iran.

    PubMed

    Hajian-Tilaki, K O; Kaveh-Ahangar, T

    2011-06-01

    Breast cancer is a common malignancy for women in most parts of the world and the incidence in Iranian women is growing. The patients are relatively younger than their western counterparts. The aim of study was to investigate the roles of reproductive factors for breast cancer in Babol. In a case-control study in Babol, we recruited a total of 100 new patients with histologically confirmed breast cancer and 200 age-matched controls selected from outpatient clinics. Demographic and reproductive factors were ascertained by in-person interview using a constructed questionnaire. Several potential confounding factors were adjusted using multiple logistic model. The adjusted odds ratio showed that having higher age at first pregnancy and abortion were associated with increased breast cancer risk (the adjusted OR = 4.1, 95% CI: 1.3-13.2 and 2.93, 95% CI: 1.64-5.24, respectively). By increasing parity, the risk had reduced significantly; among women with parity ≥ 5, the adjusted OR was 0.09 (95% CI 0.01-0.7) compared with nulliparous women, and also for each additional parity, the risk reduced by 50% (OR = 0.50, 95% CI: 0.34-0.71). The duration of breast feeding was inversely associated with breast cancer risk, while after additional adjustment for parity, no longer the protective effect of breast feeding was observed. Nulliparity, late age at first birth and abortion were the most important reproductive factors associated with breast cancer risk; therefore, it is recommended to women with these risk factors to perform breast cancer screening tests earlier.

  1. Age-adjusted charlson comorbidity index score as predictor of prolonged postoperative ileus in patients with colorectal cancer who underwent surgical resection.

    PubMed

    Tian, Yaohua; Xu, Beibei; Yu, Guopei; Li, Yan; Liu, Hui

    2017-02-11

    Comorbidities had considerable effects on the development of postoperative ileus (POI). The primary aim of the present study was to determine the influence of the age-adjusted Charlson comorbidity index (ACCI) score on the risk of prolonged POI in patients with colorectal cancer who underwent surgical resection. Using the electronic Hospitalization Summary Reports, we identified 11,397 patients with colorectal cancer who underwent surgical resection from 2013 through 2015. Logistic regression models were applied to evaluate the effect of the ACCI score on the risk of prolonged POI. The ACCI score had a positive graded association with the risk of prolonged POI in both colon and rectal cancer (P for trend < 0.05). Among patients with rectal cancer, after adjusting for potential confounders, those with an ACCI score of 4-5 had a 108% higher risk of prolonged POI than those with an ACCI score of 0-1 (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.09-3.98), and those with an ACCI score of ≥ 6 had a 130% higher risk (OR, 2.30; 95% CI, 1.08-4.89). Among patients with colon cancer, those with an ACCI score of ≥ 6 had a 47% greater risk of prolonged POI than those with an ACCI score of 0-1 (OR, 1.47; 95% CI, 1.07-2.02). These findings suggested that a higher ACCI score was an independent predictor of the development of prolonged POI.

  2. The association of waist hip ratio and angiographically determined coronary artery disease.

    PubMed

    Hartz, A; Grubb, B; Wild, R; Van Nort, J J; Kuhn, E; Freedman, D; Rimm, A

    1990-08-01

    Body fat distribution as measured by the ratio of waist circumference to hip circumference (WHR) is now accepted as an important risk factor for a number of diseases. This study evaluated the association of WHR and coronary artery disease (CAD). Measurements included the subjects' height, weight, waist girth, hip girth, significant CAD on coronary angiography, and cholesterol levels. A history of myocardial infarction, angina, diabetes or hypertension was obtained from subject interviews. The subjects were analyzed in two age groups: younger than age 60 (88 men and 39 women) and age 60 or older (85 men and 63 women). For older women the relative odds of CAD comparing women at the 75th percentile of WHR to women at the 25th percentile was 3.67 (P = 0.003), with a 95 percent confidence interval of 1.57-8.57. The relative odds was reduced to 2.80 after adjusting for all other risk factors. WHR was significantly associated with angiographic evidence of CAD in all women combined after adjusting for age (P = 0.0004), but it was not significantly associated with CAD in younger women or in men. The results suggest that in older women the risk of CAD increases with a greater percentage of body fat in the abdomen.

  3. Compression ratio effect on methane HCCI combustion

    SciTech Connect

    Aceves, S. M.; Pitz, W.; Smith, J. R.; Westbrook, C.

    1998-09-29

    We have used the HCT (Hydrodynamics, Chemistry and Transport) chemical kinetics code to simulate HCCI (homogeneous charge compression ignition) combustion of methane-air mixtures. HCT is applied to explore the ignition timing, bum duration, NOx production, gross indicated efficiency and gross IMEP of a supercharged engine (3 atm. Intake pressure) with 14:1, 16:l and 18:1 compression ratios at 1200 rpm. HCT has been modified to incorporate the effect of heat transfer and to calculate the temperature that results from mixing the recycled exhaust with the fresh mixture. This study uses a single control volume reaction zone that varies as a function of crank angle. The ignition process is controlled by adjusting the intake equivalence ratio and the residual gas trapping (RGT). RGT is internal exhaust gas recirculation which recycles both thermal energy and combustion product species. Adjustment of equivalence ratio and RGT is accomplished by varying the timing of the exhaust valve closure in either 2-stroke or 4-stroke engines. Inlet manifold temperature is held constant at 300 K. Results show that, for each compression ratio, there is a range of operational conditions that show promise of achieving the control necessary to vary power output while keeping indicated efficiency above 50% and NOx levels below 100 ppm. HCT results are also compared with a set of recent experimental data for natural gas.

  4. Envera Variable Compression Ratio Engine

    SciTech Connect

    Charles Mendler

    2011-03-15

    the compression ratio can be raised (to as much as 18:1) providing high engine efficiency. It is important to recognize that for a well designed VCR engine cylinder pressure does not need to be higher than found in current production turbocharged engines. As such, there is no need for a stronger crankcase, bearings and other load bearing parts within the VCR engine. The Envera VCR mechanism uses an eccentric carrier approach to adjust engine compression ratio. The crankshaft main bearings are mounted in this eccentric carrier or 'crankshaft cradle' and pivoting the eccentric carrier 30 degrees adjusts compression ratio from 9:1 to 18:1. The eccentric carrier is made up of a casting that provides rigid support for the main bearings, and removable upper bearing caps. Oil feed to the main bearings transits through the bearing cap fastener sockets. The eccentric carrier design was chosen for its low cost and rigid support of the main bearings. A control shaft and connecting links are used to pivot the eccentric carrier. The control shaft mechanism features compression ratio lock-up at minimum and maximum compression ratio settings. The control shaft method of pivoting the eccentric carrier was selected due to its lock-up capability. The control shaft can be rotated by a hydraulic actuator or an electric motor. The engine shown in Figures 3 and 4 has a hydraulic actuator that was developed under the current program. In-line 4-cylinder engines are significantly less expensive than V engines because an entire cylinder head can be eliminated. The cost savings from eliminating cylinders and an entire cylinder head will notably offset the added cost of the VCR and supercharging. Replacing V6 and V8 engines with in-line VCR 4-cylinder engines will provide high fuel economy at low cost. Numerous enabling technologies exist which have the potential to increase engine efficiency. The greatest efficiency gains are realized when the right combination of advanced and new technologies

  5. 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.

  6. 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…

  7. 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…

  8. 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'…

  9. Effects of an angry temperament on coronary heart disease risk : The Atherosclerosis Risk in Communities Study.

    PubMed

    Williams, J E; Nieto, F J; Sanford, C P; Tyroler, H A

    2001-08-01

    The objective of the study was to determine which component of an anger-prone personality more strongly predicts coronary heart disease (CHD) risk. Proneness to anger, as assessed by the Spielberger Trait Anger Scale, is composed of two distinct subcomponents-anger-temperament and anger-reaction. Participants were 12,990 middle-aged Black men and women and White men and women from the Atherosclerosis Risk in Communities Study who were followed for the occurrence of acute myocardial infarction (MI)/fatal CHD, silent MI, or cardiac revascularization procedures (average = 53 months; maximum = 72 months) through December 31, 1995. Among normotensive persons, a strong, angry temperament (tendency toward quick, minimally provoked, or unprovoked anger) was associated with combined CHD (acute MI/fatal CHD, silent MI, or cardiac revascularization procedures) (multivariate-adjusted hazard ratio = 2.10, 95% confidence interval: 1.34, 3.29) and with 'hard" events (acute MI/fatal CHD) (multivariate adjusted hazard ratio = 2.28, 95% confidence interval: 1.29, 4.02). CHD event-free survival among normotensives who had a strong, angry temperament was not significantly different from that of hypertensives at either level of anger. These data suggest that a strong, angry temperament rather than anger in reaction to criticism, frustration, or unfair treatment places normotensive, middle-aged persons at increased risk for cardiac events and may confer a CHD risk similar to that of hypertension.

  10. Pregnancy-induced hypertension and diabetes and the risk of cardiovascular disease, stroke, and diabetes hospitalization in the year following delivery.

    PubMed

    Savitz, David A; Danilack, Valery A; Elston, Beth; Lipkind, Heather S

    2014-07-01

    Although pregnancy events predict the long-term risk of chronic disease, little is known about their short-term impact because of the rarity of clinical events. We examined hospital discharge diagnoses linked to birth certificate data in the year following delivery for 849,639 births during 1995-2004 in New York City, New York. Adjusted odds ratios characterized the relationship between pregnancy complications and subsequent hospitalization for cardiovascular disease, stroke, and diabetes. Gestational hypertension was related to heart failure (adjusted odds ratio = 2.6, 95% confidence interval: 1.5, 4.5). Preeclampsia was related to all of the outcomes considered except type 1 diabetes, with adjusted odds ratios ranging from 2.0 to 4.1. Gestational diabetes was strongly related to the risk of subsequent diabetes (for type 1 diabetes, adjusted odds ratio = 40.4, 95% confidence interval: 23.8, 68.5; for type 2 diabetes, adjusted odds ratio = 22.6, 95% confidence interval: 16.9, 30.4) but to no other outcomes. The relationship of pregnancy complications to future chronic disease is apparent as early as the year following delivery. Moreover, elucidating short-term clinical outcomes offers the potential for etiological insights into the relationship between pregnancy events and chronic disease over the life course.

  11. Early pregnancy levels of pregnancy-associated plasma protein a and the risk of intrauterine growth restriction, premature birth, preeclampsia, and stillbirth.

    PubMed

    Smith, Gordon C S; Stenhouse, Emily J; Crossley, Jennifer A; Aitken, David A; Cameron, Alan D; Connor, J Michael

    2002-04-01

    The risk of adverse perinatal outcome among 8839 women recruited to a multicenter, prospective cohort study was related to maternal circulating concentrations of trophoblast-derived proteins at 8-14 wk gestation. Women with a pregnancy-associated plasma protein A (PAPP-A) in the lowest fifth percentile at 8-14 wk gestation had an increased risk of intrauterine growth restriction [adjusted odds ratio, 2.9; 95% confidence interval (CI), 2.0-4.1], extremely premature delivery (adjusted odds ratio, 2.9; 95% CI, 1.6-5.5), moderately premature delivery (adjusted odds ratio, 2.4; 95% CI, 1.7-3.5), preeclampsia (adjusted odds ratio, 2.3; 95% CI, 1.6-3.3), and stillbirth (adjusted odds ratio, 3.6; 95% CI, 1.2-11.0). The strengths of the associations were similar when the test was performed before 13 wk gestation or between 13 and 14 wk gestation. In contrast, levels of free beta-human CG, another circulating protein synthesized by the syncytiotrophoblast, were not predictive of later outcome in multivariate analysis. PAPP-A has been identified as a protease specific for IGF binding proteins. We conclude that control of the IGF system in the first and early second trimester trophoblast may have a key role in determining subsequent pregnancy outcome.

  12. A gigawatt level repetitive rate adjustable magnetic pulse compressor

    NASA Astrophysics Data System (ADS)

    Li, Song; Gao, Jing-Ming; Yang, Han-Wu; Qian, Bao-Liang; Li, Ze-Xin

    2015-08-01

    In this paper, a gigawatt level repetitive rate adjustable magnetic pulse compressor is investigated both numerically and experimentally. The device has advantages of high power level, high repetitive rate achievability, and long lifetime reliability. Importantly, dominate parameters including the saturation time, the peak voltage, and even the compression ratio can be potentially adjusted continuously and reliably, which significantly expands the applicable area of the device and generators based on it. Specifically, a two-stage adjustable magnetic pulse compressor, utilized for charging the pulse forming network of a high power pulse generator, is designed with different compression ratios of 25 and 18 through an optimized design process. Equivalent circuit analysis shows that the modification of compression ratio can be achieved by just changing the turn number of the winding. At the same time, increasing inductance of the grounded inductor will decrease the peak voltage and delay the charging process. Based on these analyses, an adjustable compressor was built and studied experimentally in both the single shot mode and repetitive rate mode. Pulses with peak voltage of 60 kV and energy per pulse of 360 J were obtained in the experiment. The rise times of the pulses were compressed from 25 μs to 1 μs and from 18 μs to 1 μs, respectively, at repetitive rate of 20 Hz with good repeatability. Experimental results show reasonable agreement with analyses.

  13. Ratio imaging instrumentation.

    PubMed

    Dunn, Kenneth; Maxfield, Frederick R

    2003-01-01

    Using ratio imaging to obtain quantitative information from microscope images is a powerful tool that has been used successfully in numerous studies. Although ratio imaging reduces the effects of many parameters that can interfere with accurate measurements, it is not a panacea. In designing a ratio imaging experiment, all of the potential problems discussed in this chapter must be considered. Undoubtedly, other problems that were not discussed can also interfere with accurate and meaningful measurements. Many of the problems discussed here were observed in the authors' laboratories. In our experience there are no standard routines or methods that can foresee every problem before it has been encountered. Good experimental design can minimize problems, but the investigator must continue to be alert. Progress in instrumentation continues to overcome some of the difficulties encountered in ratio imaging. CCD cameras with 12- to 14-bit pixel depth are being used more frequently, and several confocal microscope manufacturers are now also using 12-bit digitization. The dramatic increase in the use of confocal microscopes over the past decade is now causing microscope manufacturers to more critically evaluate the effect of axial chromatic aberration in objectives, and recent designs to minimize this problem are being implemented. Other developments such as the use of AOTFs to attenuate laser lines extend the applicability of ratio imaging. Ratio imaging is clearly applicable to a wide range of cell biological problems beyond its widespread use for measuring ion concentrations. Imaginative but careful use of this technique should continue to provide novel insights into the properties of cells.

  14. Effect of selective serotonin reuptake inhibitors on bleeding risk in patients with atrial fibrillation taking warfarin.

    PubMed

    Quinn, Gene R; Singer, Daniel E; Chang, Yuchiao; Go, Alan S; Borowsky, Leila H; Udaltsova, Natalia; Fang, Margaret C

    2014-08-15

    Selective serotonin reuptake inhibitor (SSRI) medications have been linked to increased bleeding risk; however, the actual association among warfarin, SSRI exposure, and bleeding risk has not been well-established. We studied the AnTicoagulation and Risk factors In Atrial fibrillation cohort of 13,559 adults with atrial fibrillation, restricted to the 9,186 patients contributing follow-up time while taking warfarin. Exposure to SSRIs and tricyclic antidepressants (TCAs) was assessed from pharmacy database dispensing data. The main outcome was hospitalization for major hemorrhage. Results were adjusted for bleeding risk and time in international normalized ratio range >3. We identified 461 major hemorrhages during 32,888 person-years of follow-up, 45 events during SSRI use, 12 during TCA-only use, and 404 without either medication. Hemorrhage rates were higher during periods of SSRI exposure compared with periods on no antidepressants (2.32 per 100 person-years vs 1.35 per 100 person-years, p <0.001) and did not differ between TCA exposure and no antidepressants (1.30 per 100 person-years on TCAs, p = 0.94). After adjustment for underlying bleeding risk and time in international normalized ratio range >3, SSRI exposure was associated with an increased rate of hemorrhage compared with no antidepressants (adjusted relative risk 1.41, 95% confidence interval 1.04 to 1.92, p = 0.03), whereas TCA exposure was not (adjusted relative risk 0.82, 95% confidence interval 0.46 to 1.46, p = 0.50). In conclusion, SSRI exposure was associated with higher major hemorrhage risk in patients taking warfarin, and this risk should be considered when selecting antidepressant treatments in those patients.

  15. Obesity and Risk of Thyroid Cancer: Evidence from a Meta-Analysis of 21 Observational Studies

    PubMed Central

    Ma, Jie; Huang, Min; Wang, Li; Ye, Wei; Tong, Yan; Wang, Hanmin

    2015-01-01

    Background Several studies have evaluated the association between obesity and thyroid cancer risk. However, the results remain uncertain. In this study, we conducted a meta-analysis to assess the association between obesity and thyroid cancer risk. Material/Methods Published literature from PubMed, EMBASE, Springer Link, Ovid, Chinese Wanfang Data Knowledge Service Platform, Chinese National Knowledge Infrastructure (CNKI), and Chinese Biology Medicine (CBM) were retrieved before 10 August 2014. We included all studies that reported adjusted risk ratios (RRs), hazard ratios (HRs) or odds ratios (ORs), and 95% confidence intervals (CIs) of thyroid cancer risk. Results Thirty-two studies (n=12 620 676) were included in this meta-analysis. Obesity was associated with a significantly increased risk of thyroid cancer (adjusted RR=1.33; 95% CI, 1.24–1.42; I2=25%). In the subgroup analysis by study type, increased risk of thyroid cancer was found in cohort studies and case-control studies. In subgroup analysis by sex, both obese men and women were at significantly greater risk of thyroid cancer than non-obese subjects. When stratified by ethnicity, significantly elevated risk was observed in Caucasians and in Asians. In the age subgroup analysis, both young and old populations showed increased thyroid cancer risk. Subgroup analysis on smoking status showed that increased thyroid cancer risks were found in smokers and in non-smokers. In the histology subgroup analyses, increased risks of papillary thyroid cancer, follicular thyroid cancer, and anaplastic thyroid cancer were observed. However, obesity was associated with decreased risk of medullary thyroid cancer. Conclusions Our results indicate that obesity is associated with an increased thyroid cancer risk, except medullary thyroid cancer. PMID:25612155

  16. 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...

  17. 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)...

  18. 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)...

  19. 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…

  20. Mexican-origin parents' work conditions and adolescents' adjustment.

    PubMed

    Wheeler, Lorey A; Updegraff, Kimberly A; Crouter, Ann

    2015-06-01

    Mexican-origin parents' work experiences are a distal extrafamilial context for adolescents' adjustment. This 2-wave multiinformant study examined the prospective mechanisms linking parents' work conditions (i.e., self-direction, work pressure, workplace discrimination) to adolescents' adjustment (i.e., educational expectations, depressive symptoms, risky behavior) across the transition to high school drawing on work socialization and spillover models. We examined the indirect effects of parental work conditions on adolescent adjustment through parents' psychological functioning (i.e., depressive symptoms, role overload) and aspects of the parent-adolescent relationship (i.e., parental solicitation, parent-adolescent conflict), as well as moderation by adolescent gender. Participants were 246 predominantly immigrant, Mexican-origin, 2-parent families who participated in home interviews when adolescents were approximately 13 and 15 years of age. Results supported the positive impact of fathers' occupational self-direction on all 3 aspects of adolescents' adjustment through decreased father-adolescent conflict, after controlling for family socioeconomic status and earner status, and underemployment. Parental work pressure and discrimination were indirectly linked to adolescents' adjustment, with different mechanisms emerging for mothers and fathers. Adolescents' gender moderated the associations between fathers' self-direction and girls' depressive symptoms, and fathers' experiences of discrimination and boys' risk behavior. Results suggest that Mexican-origin mothers' and fathers' perceptions of work conditions have important implications for multiple domains of adolescents' adjustment across the transition to high school.

  1. Mexican-Origin Parents’ Work Conditions and Adolescents’ Adjustment

    PubMed Central

    Wheeler, Lorey A.; Updegraff, Kimberly A.; Crouter, Ann

    2015-01-01

    Mexican-origin parents’ work experiences are a distal extra-familial context for adolescents’ adjustment. This two-wave multi-informant study examined the prospective mechanisms linking parents’ work conditions (i.e., self-direction, work pressure, workplace discrimination) to adolescents’ adjustment (i.e., educational expectations, depressive symptoms, risky behavior) across the transition to high school drawing on work socialization and spillover models. We examined the indirect effects of parental work conditions on adolescent adjustment through parents’ psychological functioning (i.e., depressive symptoms, role overload) and aspects of the parent-adolescent relationship (i.e., parental solicitation, parent-adolescent conflict), as well as moderation by adolescent gender. Participants were 246 predominantly immigrant, Mexican-origin, two-parent families who participated in home interviews when adolescents were approximately 13 and 15 years of age. Results supported the positive impact of fathers’ occupational self-direction on all three aspects of adolescents’ adjustment through decreased father-adolescent conflict, after controlling for family socioeconomic status and earner status, and underemployment. Parental work pressure and discrimination were indirectly linked to adolescents’ adjustment, with different mechanisms emerging for mothers and fathers. Adolescents’ gender moderated the associations between fathers’ self-direction and girls’ depressive symptoms, and fathers’ experiences of discrimination and boys’ risk behavior. Results suggest that Mexican-origin mothers’ and fathers’ perceptions of work conditions have important implications for multiple domains of adolescents’ adjustment across the transition to high school. PMID:25938710

  2. Digit ratio in birds.

    PubMed

    Lombardo, Michael P; Thorpe, Patrick A; Brown, Barbara M; Sian, Katie

    2008-12-01

    The Homeobox (Hox) genes direct the development of tetrapod digits. The expression of Hox genes may be influenced by endogenous sex steroids during development. Manning (Digit ratio. New Brunswick, NJ: Rutgers University Press, 2002) predicted that the ratio between the lengths of digits 2 (2D) and 4 (4D) should be sexually dimorphic because prenatal exposure to estrogens and androgens positively influence the lengths of 2D and 4D, respectively. We measured digits and other morphological traits of birds from three orders (Passeriformes, house sparrow, Passer domesticus; tree swallow, Tachycineta bicolor; Pscittaciformes, budgerigar, Melopsittacus undulates; Galliformes, chicken, Gallus domesticus) to test this prediction. None were sexually dimorphic for 2D:4D and there were no associations between 2D:4D and other sexually dimorphic traits. When we pooled data from all four species after we averaged right and left side digits from each individual and z-transformed the resulting digit ratios, we found that males had significantly larger 2D:4D than did females. Tetrapods appear to be sexually dimorphic for 2D:4D with 2D:4D larger in males as in some birds and reptiles and 2D:4D smaller in males as in some mammals. The differences between the reptile and mammal lineages in the directionality of 2D:4D may be related to the differences between them in chromosomal sex determination. We suggest that (a) natural selection for a perching foot in the first birds may have overridden the effects of hormones on the development of digit ratio in this group of vertebrates and (b) caution be used in making inferences about prenatal exposure to hormones and digit ratio in birds.

  3. 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.

  4. Devising an adjustable splitter for dual-column gas chromatography.

    PubMed

    Wang, Chieh-Heng; Chang, Chih-Chung; Wang, Jia-Lin

    2007-09-07

    A flow controlled adjustable splitter was configured from a Deans switch and employed in an automated dual column gas chromatographic (GC) system for analyzing mono-aromatic compounds. Volatile organic compounds (VOCs), thermally desorbed from the sorbent trap, were split by the adjustable splitter onto two columns of different phases for separation and then detection by flame ionization detection (FID). Unlike regular splitters in which the split ratio is passively determined by the diameter and/or length of the connecting columns or tubing, the split ratio in our adjustable splitter is controlled by the auxiliary flow in the Deans switch. The auxiliary flow serves as a gas plug on either side of the column for decreasing the sample flow in one transfer line, but increasing the flow in the other. By adjusting the auxiliary flow and therefore the size of the gas plug, the split ratio can be easily varied and favorable to the side of no auxiliary gas. As an illustration, two columns, DB-1 and Cyclodex-B, were employed in this study for separating benzene, toluene, ethylbenzene, xylenes, denoted as BTEX, in particular the structural isomers of o-, m-, p-xylenes. This configuration demonstrates that BTEX cannot be fully separated with either column, but can be deconvoluted by simple algebra if dual columns are used with a splitter. The applicability of the proposed concept was tested by analyzing a gas standard containing BTEX at different split ratios and with various sample sizes, all leading to a constant ratio of m-xylene versus p-xylene.

  5. Tea, Coffee, and Milk Consumption and Colorectal Cancer Risk

    PubMed Central

    Green, Chadwick John; de Dauwe, Palina; Boyle, Terry; Tabatabaei, Seyed Mehdi; Fritschi, Lin; Heyworth, Jane Shirley

    2014-01-01

    Background Data regarding the effects of tea, coffee, and milk on the risk of colorectal cancer are inconsistent. We investigated associations of tea, coffee, and milk consumption with colorectal cancer risk and attempted to determine if these exposures were differentially associated with the risks of proximal colon, distal colon, and rectal cancers. Methods Data from 854 incident cases and 948 controls were analyzed in a case-control study of colorectal cancer in Western Australia during 2005–07. Multivariable logistic regression was used to analyze the associations of black tea (with and without milk), green tea, herbal tea, hot coffee, iced coffee, and milk with colorectal cancer. Results Consumption of 1 or more cups of herbal tea per week was associated with a significantly decreased risk of distal colon cancer (adjusted odds ratio, 0.37; 95% CI, 0.16–0.82; PTrend = 0.044), and consumption of 1 or more cups of iced coffee per week was associated with increased risk of rectal cancer (adjusted odds ratio, 1.52; 95% CI, 0.91–2.54; PTrend = 0.004). Neither herbal tea nor iced coffee was associated with the risk of proximal colon cancer. Hot coffee was associated with a possible increased risk of distal colon cancer. Black tea (with or without milk), green tea, decaffeinated coffee, and milk were not significantly associated with colorectal cancer risk. Conclusions Consumption of herbal tea was associated with reduced risk of distal colon cancer, and consumption of iced coffee was associated with increased rectal cancer risk. PMID:24531002

  6. Petroleum staff reluctance and adjustment to innovative changes

    NASA Astrophysics Data System (ADS)

    Makasheva, Yu S.; Makasheva, N. P.; Remnyakov, V. V.; Burykhin, B. S.; Shenderova, I. V.

    2015-11-01

    The modern economy is developing in the direction of innovations implementation. Innovations are becoming the basic prerequisite for the competitiveness of the enterprises. The Russian oil and gas sector innovation issue is very crucial. Low innovation activity of companies could result in a serious threat due to the strong global competition, increased uncertainty and risks. The need for innovative changes often meets reluctance. The reasons of it vary and require serious research. Managers should give special attention to the development of adjustment ability of the staff, to introduce modern methods for improving the adjustment potential of the enterprise staff.

  7. Risk factors associated with kanamycin-resistant tuberculosis in a Beijing tuberculosis referral hospital.

    PubMed

    Yu, Hao Tian; Wang, Qi; Yang, Nan; Li, Hong Min; Liang, Jian Qin; Liu, Cui Hua

    2012-07-01

    The rapidly increasing number of multidrug-resistant tuberculosis (MDR-TB) cases worldwide underlines the necessity for the rational use of key second-line drugs such as kanamycin. In this study, we determined the prevalence of, and risk factors associated with, kanamycin-resistant tuberculosis (TB) in 309 Hospital, Beijing, China, with the aim of providing information for better case management in order to minimize further development of extensively drug-resistant TB (XDR-TB). Drug susceptibility testing results and clinical data were retrospectively analysed for hospitalized TB patients for whom such data were available in 309 Hospital for the period 1997-2009. Univariate and multivariate analyses were used to determine the risk factors associated with kanamycin-resistant TB. During 1997-2009, 553 (14.4 %) of 3843 tested Mycobacterium tuberculosis isolates from hospitalized TB patients were kanamycin-resistant. The increasing trend of resistance to kanamycin was reversed since 2000. The independent risk factors associated with kanamycin-resistant TB included living in urban areas [adjusted odds ratio (OR) = 1.89], being retreated for repeat cases (adjusted OR = 1.60), being smear-positive for acid-fast bacilli at admission to the hospital (adjusted OR = 1.39), having ofloxacin-resistant (adjusted OR = 1.61) or para-aminosalicylic acid-resistant TB (adjusted OR = 1.47), having MDR-TB (adjusted OR = 5.10), having MDR-TB plus ofloxacin resistance (adjusted OR = 4.27) and having poly-resistant TB (adjusted OR = 3.94). The remaining rate of kanamycin resistance is still high despite the reversal of the increasing trend during the past decade. Surveillance of kanamycin resistance, especially among high-risk populations, should be continued to closely monitor trends so that appropriate action can be taken.

  8. Dose-adjusted Chemotherapy for Untreated c-MYC-positive Lymphoma

    Cancer.gov

    In this trial, adult patients with newly diagnosed Burkitt lymphoma or c-MYC-positive DLBCL will be separated into low-risk and high-risk groups; those in the low-risk group will be treated with at least three cycles of dose-adjusted EPOCH-R

  9. Regular analgesic use and risk of multiple myeloma.

    PubMed

    Moysich, Kirsten B; Bonner, Mathew R; Beehler, Gregory P; Marshall, James R; Menezes, Ravi J; Baker, Julie A; Weiss, Joli R; Chanan-Khan, Asher

    2007-04-01

    Analgesic use has been implicated in the chemoprevention of a number of solid tumors, but to date no previous research has focused on the role of analgesics in the etiology of multiple myeloma (MM). We conducted a hospital-based case-control study of 117 patients with primary, incident MM and 483 age and residence matched controls without benign or malignant neoplasms. All participants received medical services at Roswell Park Cancer Institute in Buffalo, NY, and completed a comprehensive epidemiological questionnaire. Participants who reported analgesic use at least once a week for at least 6 months were classified as regular users; individuals who did not use analgesics regularly served as the reference group throughout the analyses. We used unconditional logistic regression analyses to compute crude and adjusted odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Compared to non-users, regular aspirin users were not at reduced risk of MM (adjusted OR=0.99; 95% CI 0.65-1.49), nor were participants with the highest frequency or duration of aspirin use. A significant risk elevation was found for participants who were regular acetaminophen users (adjusted OR=2.95; 95% CI 1.72-5.08). Further, marked increases in risk of MM were noted with both greater frequency (>7 tablets weekly; adjusted OR=4.36; 95% CI 1.70-11.2) and greater duration (>10 years; adjusted OR=3.26; 95% CI 1.52-7.02) of acetaminophen use. We observed no evidence of a chemoprotective effect of aspirin on MM risk, but observed significant risk elevations with various measures of acetaminophen use. Our results warrant further investigation in population-based case-control and cohort studies and should be interpreted with caution in light of the limited sample size and biases inherent in hospital-based studies.

  10. Association of dietary fat and carbohydrate consumption and predicted ten-year risk for developing coronary heart disease in a general Japanese population.

    PubMed

    Minoura, Akira; Wang, Da-Hong; Sato, Yoshie; Zou, Yu; Sakano, Noriko; Kubo, Masayuki; Takemoto, Kei; Masatomi, Chie; Ogino, Keiki

    2014-01-01

    We examined the relationships between dietary carbohydrate, protein, fat, and the ratio of n6/n3 fatty acid intakes with the predicted 10-year coronary heart disease (CHD) risk in a general Japanese population. We used the Framingham risk score to determine the 10-year CHD risk of the subjects, who were employees of 6 companies in a single prefecture in Japan. After excluding the subjects who reported any history of angina pectoris, myocardial infarction, diabetes, or cancer, and those with missing data resulting in the inability of estimation of 10-year CHD risk and food intakes, the final data analysis was carried out for 809 subjects. The logistic regression models revealed a significantly increased odds ratio of 10-year CHD risk in the subjects with the highest tertile of carbohydrate intake (% energy) (odds ratio 3.64, 95% CI, 2.07-6.40); after adjustment for other variables, the odds ratio for the 10-year CHD risk was also higher in the subjects with the highest tertile of carbohydrate intake (odds ratio 1.72, 95% CI, 0.70-4.25). We also found that fat intake and the ratio of n6/n3 fatty acids were inversely associated with the predicted 10-year CHD risk (p for trend<0.01). The present findings added evidence of a positive association of dietary carbohydrate and inverse associations of total fat and n6/n3 fatty acid ratio with the predicted 10-year CHD risk in a general Japanese population.

  11. Risk scoring for percutaneous coronary intervention: let's do it!

    PubMed Central

    Siotia, A

    2006-01-01

    The recent publication of a robust percutaneous coronary intervention (PCI) risk scoring system should stimulate every interventional cardiologist to incorporate risk adjustment into their everyday practice PMID:16621880

  12. Is antipsychotic polypharmacy associated with metabolic syndrome even after adjustment for lifestyle effects?: a cross-sectional study

    PubMed Central

    2011-01-01

    Background Although the validity and safety of antipsychotic polypharmacy remains unclear, it is commonplace in the treatment of schizophrenia. This study aimed to investigate the degree that antipsychotic polypharmacy contributed to metabolic syndrome in outpatients with schizophrenia, after adjustment for the effects of lifestyle. Methods A cross-sectional survey was carried out between April 2007 and October 2007 at Yamanashi Prefectural KITA hospital in Japan. 334 patients consented to this cross-sectional study. We measured the components consisting metabolic syndrome, and interviewed the participants about their lifestyle. We classified metabolic syndrome into four groups according to the severity of metabolic disturbance: the metabolic syndrome; the pre-metabolic syndrome; the visceral fat obesity; and the normal group. We used multinomial logistic regression models to assess the association of metabolic syndrome with antipsychotic polypharmacy, adjusting for lifestyle. Results Seventy-four (22.2%) patients were in the metabolic syndrome group, 61 (18.3%) patients were in the pre-metabolic syndrome group, and 41 (12.3%) patients were in visceral fat obesity group. Antipsychotic polypharmacy was present in 167 (50.0%) patients. In multinomial logistic regression analyses, antipsychotic polypharmacy was significantly associated with the pre-metabolic syndrome group (adjusted odds ratio [AOR], 2.348; 95% confidence interval [CI], 1.181-4.668), but not with the metabolic syndrome group (AOR, 1.269; 95%CI, 0.679-2.371). Conclusions These results suggest that antipsychotic polypharmacy, compared with monotherapy, may be independently associated with an increased risk of having pre-metabolic syndrome, even after adjusting for patients' lifestyle characteristics. As metabolic syndrome is associated with an increased risk of cardiovascular mortality, further studies are needed to clarify the validity and safety of antipsychotic polypharmacy. PMID:21791046

  13. 12 CFR 3.6 - Minimum capital ratios.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Minimum capital ratios. 3.6 Section 3.6 Banks... national banks must have and maintain the minimum risk-based capital ratio as set forth in appendix A (and, for certain banks, in appendix B). (b) Total assets leverage ratio. All national banks must have...

  14. Risk of fetal death after pandemic influenza infection or vaccination during pregnancy

    PubMed Central

    Håberg, Siri E; Trogstad, Lill; Gunnes, Nina; Wilcox, Allen J.; Gjessing, Håkon K.; Samuelsen, Sven Ove; Skrondal, Anders; Cappelen, Inger; Engeland, Anders; Aavitsland, Preben; Madsen, Steinar; Buajordet, Ingebjørg; Furu, Kari; Nafstad, Per; Vollset, Stein Emil; Berit, Feiring; Nøkleby, Hanne; Magnus, Per; Stoltenberg, Camilla

    2013-01-01

    Background During the 2009 influenza pandemic, pregnant women were at particular risk of serious influenza illness. This concern was further complicated by questions about vaccine safety in pregnant women raised by anecdotal reports of fetal deaths following vaccination. Methods We explored the safety of influenza vaccination of pregnant women by linking Norwegian national registries and medical consultation data to determine influenza diagnosis, vaccination status, birth outcomes, and background information for pregnant women before, during, and after the pandemic. We used Cox regression models to estimate hazard ratios of fetal death, with gestational day as the time metric and vaccination and pandemic exposure as time-dependent exposure variables. Results There were 117,347 eligible pregnancies in Norway in 2009–2010. Fetal mortality was 4.9/1000. 54% of pregnant women in their second or third trimester during the pandemic were vaccinated. Vaccination in pregnancy substantially reduced the risk of influenza diagnosis (adjusted hazard ratio, 0.30; 95% confidence interval [CI], 0.25 to 0.34). A clinical diagnosis of influenza in the mother increased the risk of fetal death (adjusted hazard ratio, 1.91; 95% CI, 1.07 to 3.41). Among pregnant women, the risk of fetal death was lower with vaccination, although this reduction was not statistically significant (adjusted hazard ratio, 0.88; 95% CI, 0.66 to 1.17). Conclusions Pandemic influenza in pregnancy was associated with increased risk of fetal death. Vaccination during pregnancy reduced the risk of influenza diagnosis. Vaccination itself did not increase fetal mortality, and may have reduced the risk of influenza-related fetal death during the pandemic. PMID:23323868

  15. International normalized ratio self-testing and self-management: improving patient outcomes

    PubMed Central

    Pozzi, Matteo; Mitchell, Julia; Henaine, Anna Maria; Hanna, Najib; Safi, Ola; Henaine, Roland

    2016-01-01

    Long term oral anti-coagulation with vitamin K antagonists is a risk factor of hemorrhagic or thromebomlic complications. Periodic laboratory testing of international normalized ratio (INR) and a subsequent dose adjustment are therefore mandatory. The use of home testing devices to measure INR has been suggested as a potential way to improve the comfort and compliance of the patients and their families, the frequency of monitoring and, finally, the management and safety of long-term oral anticoagulation. In pediatric patients, increased doses to obtain and maintain the therapeutic target INR, more frequent adjustments and INR testing, multiple medication, inconstant nutritional intake, difficult venepunctures, and the need to go to the laboratory for testing (interruption of school and parents’ work attendance) highlight those difficulties. After reviewing the most relevant published studies of self-testing and self-management of INR for adult patients and children on oral anticoagulation, it seems that these are valuable and effective strategies of INR control. Despite an unclear relationship between INR control and clinical effects, these self-strategies provide a better control of the anticoagulant effect, improve patients and their family quality of life, and are an appealing solution in term of cost-effectiveness. Structured education and knowledge evaluation by trained health care professionals is required for children, to be able to adjust their dose treatment safely and accurately. However, further data are necessary in order to best define those patients who might better benefit from this multidisciplinary approach. PMID:27785043

  16. Multi-ratio transmission

    SciTech Connect

    Polak, J.C.

    1987-07-14

    A preselected multi-ratio power transmission is described comprising: input means for transmitting drive forces; output means; first, second and third friction clutch means each selectively engageable with the input means for accepting drive forces. First input gear means drivingly connects with the first friction clutch means; second input gear means drivingly connects with the second friction clutch means; third input gear means drivingly connects with the third clutch means; first output gear means drivingly connects with the first input gear means; second output gear means drivingly connects with the first and second input gear means; third output means drivingly connects between the third input gear means and the output means; and one double-acting synchronizer clutch for selectively engaging the first output gear means with the output means and alternately the second output gear means with the output means. The first friction clutch means and the one double-acting synchronizer clutch cooperates during engagement to establish two forward drive ratios between the input and output means. The second friction clutch means and the one double-acting synchronizer clutch cooperates during engagement to establish two other forward drive ratios between the input and output means. The third friction clutch means is engageable to provide another forward drive ratio between the input means and the output means; and the one double-acting synchronizer clutch is relieved of transmitting drive forces during the engagement of the third friction clutch means and being manipulable for alternate connection with either the first output gear or the second output gear while the third friction clutch means is engaged.

  17. Venous thrombosis risk associated with plasma hypofibrinolysis is explained by elevated plasma levels of TAFI and PAI-1.

    PubMed

    Meltzer, Mirjam E; Lisman, Ton; de Groot, Philip G; Meijers, Joost C M; le Cessie, Saskia; Doggen, Carine J M; Rosendaal, Frits R

    2010-07-08

    Elevated plasma clot lysis time (CLT) increases risk of venous and arterial thrombosis. It is unclear which fibrinolytic factors contribute to thrombosis risk. In 743 healthy control subjects we investigated determinants of CLT. By comparison with 770 thrombosis patients, we assessed plasma levels of fibrinolytic proteins as risk factors for a first thrombosis. Plasminogen activator inhibitor-1 (PAI-1) levels were the main determinants of CLT, followed by plasminogen, thrombin-activatable fibrinolysis inhibitor (TAFI), prothrombin, and alpha2-antiplasmin. Fibrinogen, factor VII, X, and XI contributed minimally. These proteins explained 77% of variation in CLT. Levels of the fibrinolytic factors were associated with thrombosis risk (odds ratios, highest quartile vs lowest, adjusted for age, sex, and body mass index: 1.6 for plasminogen, 1.2 for alpha2-antiplasmin, 1.6 for TAFI, 1.6 for PAI-1, and 1.8 for tissue plasminogen activator [t-PA]). Adjusting for acute-phase proteins attenuated the risk associated with elevated plasminogen levels. The risk associated with increased t-PA nearly disappeared after adjusting for acute-phase proteins and endothelial activation. TAFI and PAI-1 remained associated with thrombosis after extensive adjustment. In conclusion, CLT reflects levels of all fibrinolytic factors except t-PA. Plasminogen, TAFI, PAI-1, and t-PA are associated with venous thrombosis. However, plasminogen and t-PA levels may reflect underlying risk factors.

  18. Hunger and Behavioral Risk Factors for Noncommunicable Diseases in School-Going Adolescents in Bolivia, 2012

    PubMed Central

    2016-01-01

    Hunger may play a role in noncommunicable disease (NCD) risk. This study used the 2012 Global School-based Student Health Survey from Bolivia to determine the association between hunger and risk factors for NCDs among adolescents. Hunger was associated with increased odds of nondaily fruit and vegetable consumption (adjusted odds ratio [AOR] = 1.21; P < .001), inadequate physical activity (AOR = 1.21; P = .001), and current tobacco use (hunger sometimes [AOR = 1.83; P < .001] or most of the time/always [AOR = 2.12; P < .001]). Interventions to reduce the burden of NCDs in Bolivia should address hunger, in addition to traditional behavioral risk factors. PMID:27103264

  19. Attributable Risk Estimate of Severe Psoriasis on Major Cardiovascular Events

    PubMed Central

    Mehta, Nehal N.; Yu, YiDing; Pinnelas, Rebecca; Krishnamoorthy, Parasuram; Shin, Daniel B.; Troxel, Andrea B.; Gelfand, Joel M.

    2011-01-01

    Background Recent studies suggest that psoriasis, particularly if severe, may be a risk factor for major adverse cardiac events such as myocardial infarction, stroke, and mortality from cardiovascular disease. We compared the risk of major adverse cardiac events between patients with psoriasis and the general population and estimated the attributable risk of severe psoriasis. Methods We performed a cohort study in the General Practice Research Database. Severe psoriasis was defined as receiving a psoriasis diagnosis and systemic therapy (N=3,603). Up to 4 patients without psoriasis were selected from the same practices and start dates for each patient with psoriasis (N=14,330). Results Severe psoriasis was a risk factor for major adverse cardiac events (hazard ratio 1.53; 95% confidence interval 1.26, 1.85) after adjusting for age, gender, diabetes, hypertension, tobacco use and hyperlipidemia. After fully adjusted analysis, severe psoriasis conferred an additional 6.2% absolute risk of 10-year major adverse cardiac events. Conclusions Severe psoriasis confers an additional 6.2% absolute risk of 10-year rate of major adverse cardiac events compared to the general population. This potentially has important therapeutic implications for cardiovascular risk stratification and prevention in patients with severe psoriasis. Future prospective studies are needed to validate these findings. PMID:21787906

  20. Matrix metalloproteinase 1, 3 and 12 polymorphisms and esophageal adenocarcinoma risk and prognosis.

    PubMed

    Bradbury, Penelope A; Zhai, Rihong; Hopkins, Jessica; Kulke, Matthew H; Heist, Rebecca S; Singh, Simron; Zhou, Wei; Ma, Clement; Xu, Wei; Asomaning, Kofi; Ter-Minassian, Monica; Wang, Zhaoxi; Su, Li; Christiani, David C; Liu, Geoffrey

    2009-05-01

    The matrix metalloproteinase (MMP) family degrade extracellular matrix and mediate pathways including apoptosis, angiogenesis and immunity. We studied the association between four MMP polymorphisms within three MMP genes and esophageal adenocarcinoma (EA) risk and prognosis. A total of 313 EA cases and 455 age and gender frequency-matched controls were genotyped for MMP1 1G/2G, MMP3 6A/5A, MMP12 -82A/G and MMP12 1082A/G. The association between individual MMP polymorphisms and EA risk was evaluated using regression models and adjusted for age, gender, adult body mass index and smoking status. Haplotype analysis was performed to investigate the combined effect of all four linked MMP polymorphisms and EA risk. The MMP1 and MMP3 polymorphisms were associated with increased EA risk: MMP1 1G/2G and 2G/2G had adjusted odds ratios of 1.46 [95% confidence interval 1.0-2.1; P = 0.04] and adjusted odds ratio 1.83 (1.2-2.8; P = 0.005), respectively, whereas MMP3 6A/5A had adjusted odds ratio 1.40 (95% confidence interval 1.0-2.1; P = 0.09) and MMP3 5A/5A had 1.61 (95% confidence interval 1.0-2.5; P = 0.03). Two MMP haplotypes [MMP1-MMP3-MMP12 (-82) 2G-5A-A (adjusted odds ratio 1.36, 95% confidence interval 1.0-1.8; P = 0.03) and 2G-5A-G (adjusted odds ratio 1.70, 95% confidence interval 1.1-2.6; P = 0.01)] were also associated with increased EA risk. The relationship between BE cases with the same set of controls was similar. No association was identified between the MMP polymorphisms and overall survival or progression free survival of patients with EA. MMP1, MMP3 and possibly MMP12 -82A/G polymorphisms and their haplotypes are associated with increased EA risk.

  1. Sierra Leone's Former Child Soldiers: A Follow-Up Study of Psychosocial Adjustment and Community Reintegration

    ERIC Educational Resources Information Center

    Betancourt, Theresa Stichick; Borisova, Ivelina Ivanova; Williams, Timothy Philip; Brennan, Robert T.; Whitfield, Theodore H.; de la Soudiere, Marie; Williamson, John; Gilman, Stephen E.

    2010-01-01

    This is the first prospective study to investigate psychosocial adjustment in male and female former child soldiers (ages 10-18; n = 156, 12% female). The study began in Sierra Leone in 2002 and was designed to examine both risk and protective factors in psychosocial adjustment. Over the 2-year period of follow-up, youth who had wounded or killed…

  2. 46 CFR 309.6 - Adjustments for condition, equipment, and other considerations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Adjustments for condition, equipment, and other considerations. 309.6 Section 309.6 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS VALUES FOR WAR RISK INSURANCE § 309.6 Adjustments for condition, equipment, and...

  3. 46 CFR 309.6 - Adjustments for condition, equipment, and other considerations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Adjustments for condition, equipment, and other... OPERATIONS VALUES FOR WAR RISK INSURANCE § 309.6 Adjustments for condition, equipment, and other... stated valuation. (b) Special equipment. If the depreciated reproduction cost less construction...

  4. Exploring Post-Program Psychological Adjustment for Adult Staff Facilitating a Wilderness Adventure Program

    ERIC Educational Resources Information Center

    Lawrence-Wood, Ellie; Raymond, Ivan

    2011-01-01

    This paper outlines a pilot study of the post-program psychological adjustment outcomes of adult staff facilitating an Australian-based wilderness adventure program for youth at risk. The descriptive and correlational survey study (N = 62) examined the psychological adjustment processes staff underwent following program completion, and the factors…

  5. Factors Influencing Adjustment in Siblings of Children with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Meyer, Katherine A.; Ingersoll, Brooke; Hambrick, David Z.

    2011-01-01

    Siblings of children with autism spectrum disorders (ASD) may be at an increased risk of adjustment problems. To examine possible predictors of adjustment difficulties in siblings, 70 mothers with at least one child with ASD and one typical child completed surveys of symptom severity in the child with ASD, impact of the child with ASD on the…

  6. Parents' Promotion of Psychological Autonomy, Psychological Control, and Mexican-American Adolescents' Adjustment

    ERIC Educational Resources Information Center

    Sher-Censor, Efrat; Parke, Ross D.; Coltrane, Scott

    2011-01-01

    Mexican-American adolescents are at an elevated risk for adjustment difficulties. In an effort to identify parenting practices that can affect the adjustment of Mexican-American youth, the current study examined parents' promotion of psychological autonomy and parents' psychological control as perceived by Mexican-American early adolescents, and…

  7. Case-mix adjusted hospital mortality is a poor proxy for preventable mortality: a modelling study

    PubMed Central

    Girling, Alan J; Hofer, Timothy P; Wu, Jianhua; Chilton, Peter J; Nicholl, Jonathan P; Mohammed, Mohammed A; Lilford, Richard J

    2012-01-01

    Risk-adjustment schemes are used to monitor hospital performance, on the assumption that excess mortality not explained by case mix is largely attributable to suboptimal care. We have developed a model to estimate the proportion of the variation in standardised mortality ratios (SMRs) that can be accounted for by variation in preventable mortality. The model was populated with values from the literature to estimate a predictive value of the SMR in this context—specifically the proportion of those hospitals with SMRs among the highest 2.5% that fall among the worst 2.5% for preventable mortality. The extent to which SMRs reflect preventable mortality rates is highly sensitive to the proportion of deaths that are preventable. If 6% of hospital deaths are preventable (as suggested by the literature), the predictive value of the SMR can be no greater than 9%. This value could rise to 30%, if 15% of deaths are preventable. The model offers a ‘reality check’ for case mix adjustment schemes designed to isolate the preventable component of any outcome rate. PMID:23069860

  8. Bias-adjusted satellite-based rainfall estimates for predicting floods: Narayani Basin

    USGS Publications Warehouse

    Shrestha, M.S.; Artan, G.A.; Bajracharya, S.R.; Gautam, D.K.; Tokar, S.A.

    2011-01-01

    In Nepal, as the spatial distribution of rain gauges is not sufficient to provide detailed perspective on the highly varied spatial nature of rainfall, satellite-based rainfall estimates provides the opportunity for timely estimation. This paper presents the flood prediction of Narayani Basin at the Devghat hydrometric station (32000km2) using bias-adjusted satellite rainfall estimates and the Geospatial Stream Flow Model (GeoSFM), a spatially distributed, physically based hydrologic model. The GeoSFM with gridded gauge observed rainfall inputs using kriging interpolation from 2003 was used for calibration and 2004 for validation to simulate stream flow with both having a Nash Sutcliff Efficiency of above 0.7. With the National Oceanic and Atmospheric Administration Climate Prediction Centre's rainfall estimates (CPC-RFE2.0), using the same calibrated parameters, for 2003 the model performance deteriorated but improved after recalibration with CPC-RFE2.0 indicating the need to recalibrate the model with satellite-based rainfall estimates. Adjusting the CPC-RFE2.0 by a seasonal, monthly and 7-day moving average ratio, improvement in model performance was achieved. Furthermore, a new gauge-satellite merged rainfall estimates obtained from ingestion of local rain gauge data resulted in significant improvement in flood predictability. The results indicate the applicability of satellite-based rainfall estimates in flood prediction with appropriate bias correction. ?? 2011 The Authors. Journal of Flood Risk Management ?? 2011 The Chartered Institution of Water and Environmental Management.

  9. Glucocorticoid therapy and risk of bladder cancer

    PubMed Central

    Dietrich, K; Schned, A; Fortuny, J; Heaney, J; Marsit, C; Kelsey, K T; Karagas, M R

    2009-01-01

    Background: Use of immunosuppressive drugs post organ transplantation, and prolonged use of glucorticoids for other conditions have been associated with subsequent risk of certain malignancies, that is, skin cancers and lymphoma. There is evidence that the incidence of bladder cancer is also elevated among organ transplant recipients, however, it is unknown whether other groups of patients, that is, those taking oral glucocorticoids, likewise are at an increased risk. Methods: In a population-based case–control study in New Hampshire, USA, we compared the use of glucocorticoids in 786 bladder cancer cases and in 1083 controls. We used unconditional logistic regression analysis to compute adjusted odds ratios (ORs) associated with oral glucocorticoid use. Results: In our analysis, the risk of bladder cancer was related to a history of prolonged oral glucocorticoid use (OR=1.85, 95% CI=1.24–2.76, adjusted for age, gender and smoking). Associations with oral glucocorticoid use were stronger for invasive tumours (OR=2.12, 95% CI=1.17–3.85) and tumours with high (3+) p53 staining intensity (OR=2.35, 95% CI=1.26–4.36). Conclusion: Our results raise the possibility of an increased risk of bladder cancer from systemic use of glucocorticoids, and a potential role of immune surveillance in bladder cancer aetiology. PMID:19773763

  10. Longer Duration of Diabetes Strongly Impacts Fracture Risk Assessment: The Manitoba BMD Cohort

    PubMed Central

    Majumdar, Sumit R.; Lix, Lisa M.; Morin, Suzanne N.; Johansson, Helena; Oden, Anders; McCloskey, Eugene V.; Kanis, John A.

    2016-01-01

    Context: Type 2 diabetes is associated with a higher risk for major osteoporotic fracture (MOF) and hip fracture than predicted by the World Health Organization fracture risk assessment (FRAX) tool. Objective: The objective of the study was to examine the impact of diabetes duration on fracture risk. Methods: Using a clinical dual-energy x-ray absorptiometry registry linked with the Manitoba administrative databases, we identified all women age 40 years or older with 10 or more years of prior health care coverage undergoing hip dual-energy x-ray absorptiometry measurements (1996–2013). Incident MOF and incident hip fractures were each studied over 7 years. Cox proportional hazards models were adjusted for FRAX (FRAX adjusted) and then FRAX plus comorbidity, falls, osteoporosis therapy, or insulin (fully adjusted). FRAX calibration was assessed comparing observed vs predicted probabilities. Results: There were 49 098 women without and 8840 women with diabetes (31.4% >10 y duration; 20.1% 5–10 y; 23.7% <5 y; 24.8% new onset). In FRAX-adjusted analyses, only duration longer than 10 years was associated with a higher risk for MOF (hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.30–1.66), and this was similar in the fully adjusted models (HR 1.34, 95% CI 1.17–1.54). In contrast, a higher risk for hip fracture was seen for all durations in a dose-dependent fashion (eg, FRAX adjusted HR 2.10, 95% CI 1.71–2.59 for duration >10 y vs HR 1.32, 95% CI 1.03–1.69 for new onset). FRAX significantly underestimated the MOF risk (calibration ratio 1.24, 95% CI 1.08–1.39) and hip fracture risk (1.93, 95% CI 1.50–2.35) in those with a diabetes duration longer than 10 years. Conclusion: Diabetes is a FRAX-independent risk factor for MOF only in women with a long duration of diabetes, but diabetes increases hip fracture risk, regardless of duration. Those with diabetes longer than 10 years are at particularly high risk of fracture, and this elevated risk is

  11. Retinal vascular caliber and risk of dementia

    PubMed Central

    de Jong, F.J.; Schrijvers, E.M.C.; Ikram, M.K.; Koudstaal, P.J.; de Jong, P.T.V.M.; Hofman, A.; Vingerling, J.R.

    2011-01-01

    Background: Retinal vessels provide a unique opportunity to study both systemic and cerebrovascular disease. Smaller retinal arteriolar calibers are strongly related to hypertension, whereas larger retinal venular calibers are more related to inflammation, cerebral hypoperfusion, and cerebrovascular disease. Whether retinal vessel calibers are related to dementia remains unclear. Methods: We investigated whether retinal arteriolar and venular calibers are associated with risk of dementia, and its subtypes Alzheimer disease (AD) and vascular dementia, in the prospective population-based Rotterdam Study. Digitized retinal images were available in 5,553 participants aged 55 years or over and dementia-free at baseline (1990–1993). Participants were re-examined in 1993–1994, 1997–1999, and 2002–2004 and were continuously monitored for development of dementia. Results: During a mean follow-up of 11.6 years, 655 participants developed dementia. AD was diagnosed in 519 and vascular dementia in 73 participants. Larger venular calibers were associated with an increased risk of dementia, in particular vascular dementia (age- and sex-adjusted hazard ratio per SD increase: 1.31; 95% confidence interval 1.06–1.64), but not AD. The association remained significant after adjustment for stroke and cardiovascular risk factors. Smaller arteriolar calibers were also associated with an increased risk of vascular dementia, yet only when adjusted for venular calibers. Conclusions: Retinal venular widening is associated with an increased risk of vascular dementia. Our findings are in line with previous observations in stroke and cerebral small-vessel disease and suggest that the association between larger retinal venular calibers and dementia may reflect cerebral hypoperfusion and subsequent ischemia. PMID:21288987

  12. Early-life factors and endometriosis risk

    PubMed Central

    Upson, Kristen; Sathyanarayana, Sheela; Scholes, Delia; Holt, Victoria L.

    2015-01-01

    Objective To study early-life factors in relation to endometriosis risk in adulthood. Design Population-based case-control study. Setting Women’s Risk of Endometriosis (WREN) study was conducted among female enrollees ages 18-49 years of a large, integrated healthcare system in western Washington State. Patients Cases (n=310) were women diagnosed for the first time with endometriosis between years 1996-2001 and controls (n=727) were women without a diagnosis of endometriosis randomly selected from the healthcare system population. Interventions None. Main outcome measures Adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the associations between intrauterine diethylstilbestrol (DES) exposure, maternal smoking, mother’s age at delivery, firstborn status, birth weight, fetal number, prematurity, and regular soy formula feeding during infancy and endometriosis were estimated using unconditional logistic regression, adjusting for frequency matching and confounding variables. Information on early-life factors was ascertained retrospectively by in-person interview, with information on maternal DES use and regular soy formula feeding directly gathered from the participant’s mother or other family member. Results We observed that women who were regularly fed soy formula as infants had over twice the risk of endometriosis compared to unexposed women (aOR 2.4, 95% CI: 1.2-4.9). Our data also suggested increased endometriosis risk with prematurity (aOR 1.7, 95% CI: 0.9-3.1) and maternal use of DES (OR 2.0, 95% CI: 0.8-4.9, adjusting only for frequency matching variables), although these confidence intervals included the null. Conclusion Our results support the hypothesis that disruption of development during fetal and infant periods may increase the risk of endometriosis in adulthood. PMID:26211883

  13. Baseline Caries Risk Assessment as a Predictor of Caries Incidence

    PubMed Central

    Chaffee, Benjamin W.; Cheng, Jing; Featherstone, John D. B.

    2015-01-01

    Few studies have evaluated clinical outcomes following caries risk assessment in large datasets that reflect risk assessments performed during routine practice. OBJECTIVE From clinical records, compare 18-month caries incidence according to baseline caries risk designation. METHODS For this retrospective cohort study, data were collected from electronic records of non-edentulous adult patients who completed an oral examination and caries risk assessment (CRA) at a university instructional clinic from 2007 to 2012 (N=18,004 baseline patients). The primary outcome was the number of new decayed/restored teeth from the initial CRA to the ensuing oral examination, through June 30, 2013 (N=4468 patients with follow-up). We obtained doubly-robust estimates for 18-month caries increment by baseline CRA category (low, moderate, high, extreme), adjusted for patient characteristics (age, sex, payer type, race/ethnicity, number of teeth), provider type, and calendar year. RESULTS Adjusted mean decayed, restored tooth (DFT) increment from baseline to follow-up was greater with each rising category of baseline caries risk, from low (0.94), moderate (1.26), high (1.79), to extreme (3.26). The percentage of patients with any newly affected teeth (DFT increment >0) was similar among low-risk and moderate-risk patients (cumulative incidence ratio, RR: 1.01; 95% confidence interval, CI: 0.83, 1.23), but was increased relative to low-risk patients among high-risk (RR: 1.28; 95% CI: 1.10, 1.52), and extreme-risk patients (RR: 1.52; 95% CI: 1.23, 1.87). CONCLUSIONS These results lend evidence that baseline caries risk predicts future caries in this setting, supporting the use of caries risk assessment to identify candidate patients for more intensive preventive therapy. PMID:25731155

  14. 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

  15. 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.

  16. Protein/energy ratios of current diets in developed and developing countries compared with a safe protein/energy ratio: implications for recommended protein and amino acid intakes.

    PubMed

    Millward, D Joe; Jackson, Alan A

    2004-05-01

    Revised estimates of protein and amino acid requirements are under discussion by the Food and Agriculture Organization (FAO)/World Health Organizaion (WHO), and have been proposed in a recent report on Dietary Reference Intakes (DRIs) from the USA. The nature and magnitude of these requirements are not entirely resolved, and no consideration has been given to the potential influence of metabolic adaptation on dietary requirements. We have examined the implications of these new values, and of the conceptual metabolic framework in which they are used, for defining the nutritional adequacy of protein intakes in developed and developing countries. We have expressed proposed values for protein requirements in relation to energy requirements, predicted for physical activity levels of 1.5, 1.75 and 2.0 times basal metabolic rate, in order to generate reference ratios for protein energy/total energy (reference P/E ratio) as a function of age, body weight, gender and physical activity level. Proposed values for amino acid requirements have been used to adjust the available digestible P/E ratio of foods and diets for protein quality. Focusing on the diets of UK omnivores and vegetarians and on diets in India, the risk of protein deficiency is evaluated from a comparison of P/E ratios of metabolic requirements with protein-quality-adjusted P/E ratios of intakes. A qualitative and conservative estimate of risk of deficiency is made by comparing the adjusted P/E ratio of the intake with a reference P/E ratio calculated for age, body weight, gender and physical activity according to FAO/WHO/United Nations University. A semi-quantitative estimate of risk of deficiency has also been made by the cut point approach, calculated as the proportion of the intake distribution below the mean P/E ratio of the requirement. Values for the quality-adjusted P/E ratio of the diet range from 0.126 for the UK omnivore diet to 0.054 for a rice-based diet of adults in West Bengal, which is lysine

  17. The aspartate aminotransferase-to-alanine aminotransferase ratio predicts all-cause and cardiovascular mortality in patients with type 2 diabetes

    PubMed Central

    Zoppini, Giacomo; Cacciatori, Vittorio; Negri, Carlo; Stoico, Vincenzo; Lippi, Giuseppe; Targher, Giovanni; Bonora, Enzo

    2016-01-01

    Abstract An increased aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) has been widely used as a marker of advanced hepatic fibrosis. Increased AAR was also shown to be significantly associated with the risk of developing cardiovascular (CV) disease. The aim of this study was to assess the relationship between the AAR and mortality risk in a well-characterized cohort of patients with type 2 diabetes. A cohort of 2529 type 2 diabetic outpatients was followed-up for 6 years to collect cause-specific mortality. Cox regression analyses were modeled to estimate the independent association between AAR and the risk of all-cause and CV mortality. Over the 6-year follow-up period, 12.1% of patients died, 47.5% of whom from CV causes. An increased AAR, but not its individual components, was significantly associated with an increased risk of all-cause (adjusted-hazard risk 1.83, confidence interval [CI] 95% 1.14–2.93, P = 0.012) and CV (adjusted-hazard risk 2.60, CI 95% 1.38–4.90, P < 0.003) mortality after adjustment for multiple clinical risk factors and potential confounding variables. The AAR was independently associated with an increased risk of both all-cause and CV mortality in patients with type 2 diabetes. These findings suggest that an increased AAR may reflect more systemic derangements that are not simply limited to liver damage. Further studies are needed to elucidate the pathophysiological implications of an increased AAR. PMID:27787357

  18. Extracellular mass/body cell mass ratio is an independent predictor of survival in peritoneal dialysis patients.

    PubMed

    Avram, Morrell M; Fein, Paul A; Borawski, Cezary; Chattopadhyay, Jyotiprakas; Matza, Betty

    2010-08-01

    Malnutrition is a strong predictor of mortality in peritoneal dialysis (PD) patients. Extracellular mass (ECM) contains all the metabolically inactive, whereas body cell mass (BCM) contains all the metabolically active, tissues of the body. ECM/BCM ratio is a highly sensitive index of malnutrition. The objective of this study was to explore the relationship between ECM/BCM ratio and survival in PD patients. We enrolled 62 patients from November 2000 to July 2008. On enrollment, demographic, clinical, and biochemical data were recorded. Bioimpedance analysis (BIA) was used to determine ECM and BCM in PD patients. Patients were followed up to November 2008. Mean age was 54+/-16 (s.d.) years; female, 55%; African Americans, 65%; diabetic, 24%. Mean ECM/BCM ratio was 1.206+/-0.197 (range: 0.73-1.62). Diabetics had higher ECM/BCM ratio than nondiabetics (1.29 vs 1.18, P=0.04). ECM/BCM ratio correlated directly with age (r=0.38, P=0.002) and inversely with serum albumin (r=-0.43, P=0.001), creatinine (-0.24, P=0.08), blood urea nitrogen (r=-0.26, P=0.06), and total protein (r=-0.31, P=0.026). Using multivariate Cox regression analysis, adjusting for age, race, gender, diabetes, and human immunodeficiency virus status, enrollment ECM/BCM ratio was a significant independent predictor of mortality (relative risk=1.035, P=0.018). For every 10% increase in the ECM/BCM ratio, the relative risk of death was increased by about 35%. In conclusion, BIA-derived enrollment ECM/BCM ratio, a marker of malnutrition, was an independent predictor of long-term survival in PD patients.

  19. MITF E318K's effect on melanoma risk independent of, but modified by, other risk factors.

    PubMed

    Berwick, Marianne; MacArthur, Jamie; Orlow, Irene; Kanetsky, Peter; Begg, Colin B; Luo, Li; Reiner, Anne; Sharma, Ajay; Armstrong, Bruce K; Kricker, Anne; Cust, Anne E; Marrett, Loraine D; Gruber, Stephen B; Anton-Culver, Hoda; Zanetti, Roberto; Rosso, Stefano; Gallagher, Richard P; Dwyer, Terence; Venn, Alison; Busam, Klaus; From, Lynn; White, Kirsten; Thomas, Nancy E

    2014-05-01

    A rare germline variant in the microphthalmia-associated transcription factor (MITF) gene, E318K, has been reported as associated with melanoma. We confirmed its independent association with melanoma [odds ratio (OR) 1.7, 95% confidence interval (CI) = 1.1, 2.7, P = 0.03]; adjusted for age, sex, center, age × sex interaction, pigmentation characteristics, family history of melanoma, and nevus density). In stratified analyses, carriage of MITF E318K was associated with melanoma more strongly in people with dark hair than fair hair (P for interaction, 0.03) and in those with no moles than some or many moles (P for interaction, <0.01). There was no evidence of interaction between MC1R 'red hair variants' and MITF E318K. Moreover, risk of melanoma among carriers with 'low risk' phenotypes was as great or greater than among those with 'at risk' phenotypes with few exceptions.

  20. Wide-range adjustment technique of playback wavelength of MBDCG Lippmann hologram

    NASA Astrophysics Data System (ADS)

    Zhu, Jianhua; Dong, Guangxing; Li, Jiangfeng; Du, Jinglei

    2003-12-01

    In this paper, a new technique is presented for adjusting the playback wavelength of Lippmann holograms recorded in methylene-blue sensitized dichromated gelatin (MBDCG). The main feature of this technique is introducing a water-soluble organic reagent into MBDCG photosensitive layer as preswelling reagent and wavelength adjuster. This method has wide wavelength adjustment range and high signal-to-noise ratio, can be applied to adjust the playback wavelength of reflection hologram quantitatively by changing the concentration of preswelling reagent. Its possible applications include color image display, holographic optical elements, and optical anti-counterfeiting.

  1. Identification of men with the highest risk of early disease recurrence after radical prostatectomy

    PubMed Central

    Sundi, Debasish; Wang, Vinson; Pierorazio, Phillip M.; Han, Misop; Partin, Alan W.; Tran, Phuoc T.; Ross, Ashley E.; Bivalacqua, Trinity J.

    2014-01-01

    Background Men destined to have early biochemical recurrence (BCR) following radical prostatectomy (RP) may be optimal candidates for multimodal treatment. Here we identified pre-operative predictors of early BCR within a surgical cohort who recurred. Methods An institutional prostate cancer (PCa) database containing over 20,000 patients was queried to identify 1471 men who had BCR after RP, and pre-operative predictors of early versus late BCR were assessed. Early BCR was defined as recurrence within one year after RP. Within the recurrence cohort, those with National Comprehensive Cancer Network (NCCN) high-risk features were more likely to experience early BCR. Therefore, in all NCCN high-risk men in the database, we abstracted detailed pathologic biopsy data. Among 753 high-risk men, 41 alternate multivariable criteria were assessed for their ability to predict early BCR in crude and adjusted logistic regression models. Results The criteria that best identified those likely to experience early BCR are primary Gleason pattern 5 on biopsy or ≥4 cores containing pattern 4 (odds ratio 3.17, p <0.001). These criteria included 26.7% of NCCN high-risk men. Additionally, these criteria selected for men within the high-risk classification who were at significantly higher risk of subsequent metastasis (adjusted hazard ratio 3.04, p<0.001) and cancer-specific death (adjusted hazard ratio 3.27, p<0.001). Conclusions In men with PCa who present with high-risk features, pre-operative criteria have the ability to discriminate the subgroup most likely to experience early BCR after RP. Men at risk for early disease recurrence may be the most suitable candidates for multimodal therapy. PMID:24453066

  2. Age adjustment in ecological studies: using a study on arsenic ingestion and bladder cancer as an example

    PubMed Central

    2011-01-01

    Background Despite its limitations, ecological study design is widely applied in epidemiology. In most cases, adjustment for age is necessary, but different methods may lead to different conclusions. To compare three methods of age adjustment, a study on the associations between arsenic in drinking water and incidence of bladder cancer in 243 townships in Taiwan was used as an example. Methods A total of 3068 cases of bladder cancer, including 2276 men and 792 women, were identified during a ten-year study period in the study townships. Three methods were applied to analyze the same data set on the ten-year study period. The first (Direct Method) applied direct standardization to obtain standardized incidence rate and then used it as the dependent variable in the regression analysis. The second (Indirect Method) applied indirect standardization to obtain standardized incidence ratio and then used it as the dependent variable in the regression analysis instead. The third (Variable Method) used proportions of residents in different age groups as a part of the independent variables in the multiple regression models. Results All three methods showed a statistically significant positive association between arsenic exposure above 0.64 mg/L and incidence of bladder cancer in men and women, but different results were observed for the other exposure categories. In addition, the risk estimates obtained by different methods for the same exposure category were all different. Conclusions Using an empirical example, the current study confirmed the argument made by other researchers previously that whereas the three different methods of age adjustment may lead to different conclusions, only the third approach can obtain unbiased estimates of the risks. The third method can also generate estimates of the risk associated with each age group, but the other two are unable to evaluate the effects of age directly. PMID:22014275

  3. Mortality Risk of Hypnotics: Strengths and Limits of Evidence.

    PubMed

    Kripke, Daniel F

    2016-02-01

    Sleeping pills, more formally defined as hypnotics, are sedatives used to induce and maintain sleep. In a review of publications for the past 30 years, descriptive epidemiologic studies were identified that examined the mortality risk of hypnotics and related sedative-anxiolytics. Of the 34 studies estimating risk ratios, odds ratios, or hazard ratios, excess mortality associated with hypnotics was significant (p < 0.05) in 24 studies including all 14 of the largest, contrasted with no studies at all suggesting that hypnotics ever prolong life. The studies had many limitations: possibly tending to overestimate risk, such as possible confounding by indication with other risk factors; confusing hypnotics with drugs having other indications; possible genetic confounders; and too much heterogeneity of studies for meta-analyses. There were balancing limitations possibly tending towards underestimates of risk such as limited power, excessive follow-up intervals with possible follow-up mixing of participants taking hypnotics with controls, missing dosage data for most studies, and over-adjustment of confounders. Epidemiologic association in itself is not adequate proof of causality, but there is proof that hypnotics cause death in overdoses; there is thorough understanding of how hypnotics euthanize animals and execute humans; and there is proof that hypnotics cause potentially lethal morbidities such as depression, infection, poor driving, suppressed respiration, and possibly cancer. Combining these proofs with consistent evidence of association, the great weight of evidence is that hypnotics cause huge risks of decreasing a patient's duration of survival.

  4. Association of BRCA1 Functional Single Nucleotide Polymorphisms with Risk of Differentiated Thyroid Carcinoma

    PubMed Central

    Xu, Li; Doan, Phi C.; Wei, Qingyi; Liu, Yanhong; Li, Guojun

    2012-01-01

    Background Breast cancer 1, early onset (BRCA1) is a vital DNA repair gene, and the single nucleotide polymorphisms (SNPs) of this gene have been studied in diverse cancer types. In this study, we investigated the association between eight common BRCA1 functional SNPs and the risk of differentiated thyroid carcinoma (DTC). Methods This cancer center-based case–control study included 303 DTC cases and 511 controls. A polymerase chain reaction-based restriction fragment length polymorphism assay was performed for genotyping. Unconditional logistical regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) in single-SNP analysis and haplotype analysis. Results A decreased risk of DTC was found for the A1988G heterozygous AG genotype (adjusted OR=0.63, 95% CI: 0.45–0.87, Bonferroni-adjusted p-value=0.036). AATAATA and ATAA haplotypes that carry C33420T variant allele were associated with reduced papillary thyroid cancer risk (adjusted OR=0.52, 95% CI: 0.33–0.84; adjusted OR=0.62, 95% CI: 0.40–0.95, respectively). Also, having a combination of ≥3 favorable genotypes was associated with a DTC risk reduction (adjusted OR=0.69, 95% CI: 0.50–0.95). The A31875G AG/GG genotype was associated with a 69% reduced risk of multifocal primary tumor in DTC patients (adjusted OR=0.31, 95% CI: 0.12–0.81). Conclusion BRCA1 genetic polymorphisms may play a role in DTC risk, while the possible associations warrant confirmation in independent studies. PMID:22136207

  5. Dietary intake in adults at risk for Huntington disease

    PubMed Central

    Marder, K; Zhao, H; Eberly, S; Tanner, C M.; Oakes, D; Shoulson, I

    2009-01-01

    Objective: To examine caloric intake, dietary composition, and body mass index (BMI) in participants in the Prospective Huntington At Risk Observational Study (PHAROS). Methods: Caloric intake and macronutrient composition were measured using the National Cancer Institute Food Frequency Questionnaire (FFQ) in 652 participants at risk for Huntington disease (HD) who did not meet clinical criteria for HD. Logistic regression was used to examine the relationship between macronutrients, BMI, caloric intake, and genetic status (CAG <37 vs CAG ≥37), adjusting for age, gender, and education. Linear regression was used to determine the relationship between caloric intake, BMI, and CAG repeat length. Results: A total of 435 participants with CAG <37 and 217 with CAG ≥37 completed the FFQ. Individuals in the CAG ≥37 group had a twofold odds of being represented in the second, third, or fourth quartile of caloric intake compared to the lowest quartile adjusted for age, gender, education, and BMI. This relationship was attenuated in the highest quartile when additionally adjusted for total motor score. In subjects with CAG ≥37, higher caloric intake, but not BMI, was associated with both higher CAG repeat length (adjusted regression coefficient = 0.26, p = 0.032) and 5-year probability of onset of HD (adjusted regression coefficient = 0.024; p = 0.013). Adjusted analyses showed no differences in macronutrient composition between groups. Conclusions: Increased caloric intake may be necessary to maintain body mass index in clinically unaffected individuals with CAG repeat length ≥37. This may be related to increased energy expenditure due to subtle motor impairment or a hypermetabolic state. GLOSSARY BEE = basal energy expenditure; BMI = body mass index; FFQ = Food Frequency Questionnaire; HD = Huntington disease; OR = odds ratio; PD = Parkinson disease; PHAROS = Prospective Huntington At Risk Observational Study; TEE = total energy expenditure; UHDRS = Unified

  6. Risk of Fetal Death after Treatment with Antipsychotic Medications during Pregnancy

    PubMed Central

    Sørensen, Merete Juul; Kjaersgaard, Maiken Ina Siegismund; Pedersen, Henrik Søndergaard; Vestergaard, Mogens; Christensen, Jacob; Olsen, Jørn; Parner, Erik; Pedersen, Lars Henning; Bech, Bodil Hammer

    2015-01-01

    Background Antipsychotic medications are increasingly used during pregnancy. Nevertheless, fetal risks are still not fully studied. It is currently unclear whether the antipsychotic treatment might induce a higher risk of fetal death. We aimed to determine if use of antipsychotic medication during pregnancy is associated with an increased risk of spontaneous abortion or stillbirth. Methods In a historical cohort study, we identified all clinically recognized pregnancies registered in the nationwide Danish registries from 1997 to 2008 (N = 1,005,319). Exposure was defined as any prescription of antipsychotic medications redeemed by the pregnant women during the exposure window, and recorded in the Danish National Prescription Register. Outcome was defined as any spontaneous abortion or stillbirth recorded in the Danish National Hospital Register and the Danish Medical Birth Register respectively. Results Women exposed to antipsychotic medications during pregnancy had a 34% higher risk of spontaneous abortion (adjusted relative risk = 1.34; 95% confidence interval = 1.22; 1.46) compared to unexposed women, but a similar risk compared to women exposed prior to (but not during) pregnancy (adjusted relative risk = 1.04; 95% confidence interval = 0.93; 1.17). The risk of spontaneous abortion was not increased in exposed pregnancies when compared to unexposed pregnancies in the same women (adjusted hazard ratio = 1.11; 95% CI = 0.94; 1.31). A twofold higher risk of stillbirth was found in women exposed to antipsychotic medications compared with unexposed women (relative risk = 2.27; 95% confidence interval = 1.45; 3.55) and compared with women exposed only prior to pregnancy (relative risk = 2.06; 95% confidence interval = 1.01; 4.19). Conclusions The increased risk of spontaneous abortion found in women treated with antipsychotic medications during pregnancy is most likely due to confounding factors. The risk of stillbirth was twofold higher in pregnancies exposed to

  7. Social Adjustment of At-Risk Technology Education Students

    ERIC Educational Resources Information Center

    Ernst, Jeremy V.; Moye, Johnny J.

    2013-01-01

    Individual technology education students' subgroup dynamic informs progressions of research while apprising technology teacher educators and classroom technology education teachers of intricate differences between students. Recognition of these differences help educators realize that classroom structure, instruction, and activities must be…

  8. 12 CFR 615.5210 - Risk-adjusted assets.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... rating must be one grade below investment grade or better (e.g., BB or better) or its short-term external... grade below investment grade or better (e.g., BB or better) or its short-term external rating must be...-term external rating that is two grades below investment grade or lower (e.g., B or lower) or a...

  9. Child Adjustment to Parental Combat Deployment: Risk and Resilience Models

    DTIC Science & Technology

    2012-03-01

    answer all items. Below is a list of items that describe children and youths . For each item that describes your child now or within the past 6...twitching (describe):~~ 0 1 2 15. Cruel to animals 0 1 2 16. Cruelty, bullying , or meanness to others 0 1 2 47. Nightmares 0 1 2 17. Daydreams or...gets lost in his/her thoughts 0 1 2 48. Not liked by other kids 0 1 2 18. Deliberately harms self or attempts suicide 0 1 2 49. Constipated, doesn’t

  10. Child Adjustment to Parental Combat Deployment: Risk and Resilience Models

    DTIC Science & Technology

    2011-03-01

    print, Be sure to answer all items. Below is a list of items that describe children and youths . For each item that describes your child now or within...movements or twitching (describe):~~ 0 1 2 15. Cruel to animals 0 1 2 16. Cruelty, bullying , or meanness to others 0 1 2 47. Nightmares 0 1 2 17...Daydreams or gets lost in his/her thoughts 0 1 2 48. Not liked by other kids 0 1 2 18. Deliberately harms self or attempts suicide 0 1 2 49

  11. 42 CFR 422.310 - Risk adjustment data.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422... characterize the functional limitations of enrollees of each MA organization. (c) Sources and extent of...

  12. 42 CFR 422.310 - Risk adjustment data.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422... characterize the functional limitations of enrollees of each MA organization. (c) Sources and extent of...

  13. Risk-Adjusted Returns and Stock Market Games.

    ERIC Educational Resources Information Center

    Kagan, Gary; And Others

    1995-01-01

    Maintains that stock market games are designed to provide students with a background for investing in securities, especially stocks. Reviews two games used with secondary students, analyzes statistical data from these experiences, and considers weaknesses in the games. (CFR)

  14. Proactive and reactive sibling aggression and adjustment in adolescence.

    PubMed

    Tucker, Corinna Jenkins; Van Gundy, Karen T; Wiesen-Martin, Desireé; Hiley Sharp, Erin; Rebellon, Cesar J; Stracuzzi, Nena F

    2015-03-01

    Existing research on aggression tends to narrowly focus on peers; less is known about sibling aggression, most likely due to its historical acceptance. Aggression is characterized by its forms (i.e., physical vs. social or relational aggression) and its functions (i.e., the motivations behind the aggressive act and categorized as proactive vs. reactive aggression). We use data from a two-wave study of middle (n = 197; M age = 12.63 years at Wave 1) and older (n = 159; M age = 16.50 years at Wave 1) adolescents to assess the extent to which proactive and reactive functions of sibling aggression make unique or conditional contributions to adolescent adjustment (i.e., depression, delinquency, and substance use). We find that proactive sibling aggression increases risk for problem substance use and delinquent behavior, reactive sibling aggression increases risk for depressed mood and delinquent behavior, and such results are observed even with statistical adjustments for sociodemographic and family variables, stressful life events, and prior adjustment. Few conditional effects of proactive or reactive sibling aggression by sex or grade are observed; yet, for all three outcomes, the harmful effects of reactive sibling aggression are strongest among adolescents who report low levels of proactive sibling aggression. The results speak to the importance of understanding the proactive and reactive functions of sibling aggressive behaviors for adolescent adjustment.

  15. 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.

  16. 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....

  17. 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)

  18. Alcohol and risk of breast cancer in Mexican women

    PubMed Central

    Beasley, Jeannette M.; Coronado, Gloria D.; Livaudais, Jennifer; Angeles-Llerenas, Angélica; Ortega-Olvera, Carolina; Romieu, Isabelle; Lazcano-Ponce, Eduardo; Torres-Mejía, Gabriela

    2010-01-01

    BACKGROUND Little is known about the relationship between alcohol intake and breast cancer risk among Mexican women. This association may be modified by folate and Vitamin B12. METHODS A population-based case control study conducted in Mexico recruited 1000 incident breast cancer cases aged 35–69 and 1074 controls matched on age, region, and health care system. In-person interviews were conducted to assess breast cancer risk factors and recent diet using a food frequency questionnaire. Conditional logistic regression models estimated adjusted odds ratios and 95% confidence intervals. RESULTS Over one-half (57%) of cases and less than one-half of controls (45%) reported any lifetime alcohol consumption. Compared with never drinkers, women reporting ever drinking (Adjusted OR=1.25, 95% CI=0.99–1.58) had a greater odds of breast cancer. There was evidence for interaction in the association between ever consuming any alcohol and breast cancer by folate (p for interaction=0.04) suggesting women with lower folate intake had a higher odds of breast cancer (Adjusted OR=1.99, 95% CI= 1.26–3.16) compared to women with higher folate intake (OR=1.12, 95% CI = 0.69–1.83). CONCLUSIONS Our findings support emerging evidence that any alcohol intake increases risk of breast cancer. Insufficient intake of folate may further elevate risk for developing breast cancer among women who consume alcohol. PMID:20155314

  19. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention

    PubMed Central

    Millán, Jesús; Pintó, Xavier; Muñoz, Anna; Zúñiga, Manuel; Rubiés-Prat, Joan; Pallardo, Luis Felipe; Masana, Luis; Mangas, Alipio; Hernández-Mijares, Antonio; González-Santos, Pedro; Ascaso, Juan F; Pedro-Botet, Juan

    2009-01-01

    Low-density lipoprotein (LDL) cholesterol concentration has been the prime index of cardiovascular disease risk and the main target for therapy. However, several lipoprotein ratios or “atherogenic indices” have been defined in an attempt to optimize the predictive capacity of the lipid profile. In this review, we summarize their pathophysiological aspects, and highlight the rationale for using these lipoprotein ratios as cardiovascular risk factors in clinical practice, specifying their cut-off risk levels and a target for lipid-lowering therapy. Total/high-density lipoprotein (HDL) cholesterol and LDL/HDL cholesterol ratios are risk indicators with greater predictive value than isolated parameters used independently, particularly LDL. Future recommendations regarding the diagnosis and treatment of dyslipidemia, including instruments for calculating cardiovascular risk or action guidelines, should include the lipoprotein ratios with greater predictive power which, in view of the evidence-based results, are none other than those which include HDL cholesterol. PMID:19774217

  20. 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