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Sample records for adult general intensive

  1. A pilot study of sound levels in an Australian adult general intensive care unit.

    PubMed

    Elliott, Rosalind M; McKinley, Sharon M; Eager, David

    2010-01-01

    High technology and activity levels in the intensive care unit (ICU) lead to elevated and disturbing sound levels. As noise has been shown to affect the ability of patients to rest and sleep, continuous sound levels are required during sleep investigations. The aim of this pilot study was to develop a robust protocol to measure continuous sound levels for a larger more substantive future study to improve sleep for the ICU patient. A review of published studies of sound levels in intensive care settings revealed sufficient information to develop a study protocol. The study protocol resulted in 10 usable recordings out of 11 attempts to collect pilot data. The mean recording time was 17.49 +/- 4.5 h. Sound levels exceeded recommendations made by the World Health Organization (WHO) for hospitals. The mean equivalent sound level (LAeq) was 56.22 +/- 1.65 dB and LA90 was 46.8 +/- 2.46 dB. The data reveal the requirement for a noise reduction program within this ICU.

  2. General Information about Adult Primary Liver Cancer

    MedlinePlus

    ... Cancer Prevention Liver Cancer Screening Research Adult Primary Liver Cancer Treatment (PDQ®)–Patient Version General Information About Adult Primary Liver Cancer Go to Health Professional Version Key Points ...

  3. Intensive care of the adult patient with congenital heart disease.

    PubMed

    Allan, Catherine K

    2011-01-01

    Prevalence of congenital heart disease in the adult population has increased out of proportion to that of the pediatric population as survival has improved, and adult congenital heart disease patients make up a growing percentage of pediatric and adult cardiac intensive care unit admissions. These patients often develop complex multiorgan system disease as a result of long-standing altered cardiac physiology, and many require reoperation during adulthood. Practitioners who care for these patients in the cardiac intensive care unit must have a strong working knowledge of the pathophysiology of complex congenital heart disease, and a full team of specialists must be available to assist in the care of these patients. This chapter will review some of the common multiorgan system effects of long-standing congenital heart disease (eg, renal and hepatic dysfunction, coagulation abnormalities, arrhythmias) as well as some of the unique cardiopulmonary physiology of this patient population.

  4. [Hypoxemia after general anesthesia in healthy adults].

    PubMed

    Croston, J; Brown, L

    1990-09-01

    It has been shown that a variable percentage of patients who receive a general anesthetic are significantly hypoxemic when they arrive at the recovery room. Pulse oximetry has proved to be a reliable method to determine arterial oxygen saturation when compared to arterial or mixed venous blood oxygen saturation measurements. The authors determined the incidence and severity of hypoxemia by pulse oximetry in 45 healthy adult patients, (non obese, non smokers) who underwent non thoracic surgery under general anesthesia. Arterial oxygen saturation was measured without premedication before surgery (control), when they arrived at the recovery room, and 5 and 15 minutes later. The axillary temperature was taken at the same times. The results were expressed as the median and standard deviation and were analyzed with Student T Test, and p LO.05 was considered significant. Nine patients (20%) showed unacceptable oxygen saturation when they arrived at the recovery room (88.4 +/- 2.50%, LO.05). All patients showed significant hypothermia (35.3 +/- 0.54 degrees C). The authors conclude that a significant number of healthy adult patients who are given a general anesthetic show severe hypoxemia when they arrive at the recovery room. The severe hypothermia found in these patients can aggravate the hypoxemia. They consider it is mandatory to control the temperature of and to administer oxygen in the recovery room to all patients who receive a general anesthetic.

  5. Adult Hippocampal Neurogenesis, Fear Generalization, and Stress

    PubMed Central

    Besnard, Antoine; Sahay, Amar

    2016-01-01

    The generalization of fear is an adaptive, behavioral, and physiological response to the likelihood of threat in the environment. In contrast, the overgeneralization of fear, a cardinal feature of posttraumatic stress disorder (PTSD), manifests as inappropriate, uncontrollable expression of fear in neutral and safe environments. Overgeneralization of fear stems from impaired discrimination of safe from aversive environments or discernment of unlikely threats from those that are highly probable. In addition, the time-dependent erosion of episodic details of traumatic memories might contribute to their generalization. Understanding the neural mechanisms underlying the overgeneralization of fear will guide development of novel therapeutic strategies to combat PTSD. Here, we conceptualize generalization of fear in terms of resolution of interference between similar memories. We propose a role for a fundamental encoding mechanism, pattern separation, in the dentate gyrus (DG)–CA3 circuit in resolving interference between ambiguous or uncertain threats and in preserving episodic content of remote aversive memories in hippocampal–cortical networks. We invoke cellular-, circuit-, and systems-based mechanisms by which adult-born dentate granule cells (DGCs) modulate pattern separation to influence resolution of interference and maintain precision of remote aversive memories. We discuss evidence for how these mechanisms are affected by stress, a risk factor for PTSD, to increase memory interference and decrease precision. Using this scaffold we ideate strategies to curb overgeneralization of fear in PTSD. PMID:26068726

  6. Intense Exercise Promotes Adult Hippocampal Neurogenesis But Not Spatial Discrimination

    PubMed Central

    So, Ji H.; Huang, Chao; Ge, Minyan; Cai, Guangyao; Zhang, Lanqiu; Lu, Yisheng; Mu, Yangling

    2017-01-01

    Hippocampal neurogenesis persists throughout adult life and plays an important role in learning and memory. Although the influence of physical exercise on neurogenesis has been intensively studied, there is controversy in regard to how the impact of exercise may vary with its regime. Less is known about how distinct exercise paradigms may differentially affect the learning behavior. Here we found that, chronic moderate treadmill running led to an increase of cell proliferation, survival, neuronal differentiation, and migration. In contrast, intense running only promoted neuronal differentiation and migration, which was accompanied with lower expressions of vascular endothelial growth factor, brain-derived neurotrophic factor, insulin-like growth factor 1, and erythropoietin. In addition, the intensely but not mildly exercised animals exhibited a lower mitochondrial activity in the dentate gyrus. Correspondingly, neurogenesis induced by moderate but not intense exercise was sufficient to improve the animal’s ability in spatial pattern separation. Our data indicate that the effect of exercise on spatial learning is intensity-dependent and may involve mechanisms other than a simple increase in the number of new neurons. PMID:28197080

  7. Physical restraints practice in adult intensive care units in Egypt.

    PubMed

    Kandeel, Nahed Attia; Attia, Amal Kadry

    2013-03-01

    Physical restraints are commonly used in intensive care units to reduce the risk of injury and ensure patient safety. However, there is still controversy regarding the practice of physical restraints in such units. The purpose of this study was to investigate the practices of physical restraints among critical care nurses in El-Mansoura City, Egypt. The study involved a convenience sample of 275 critically ill adult patients, and 153 nurses. Data were collected from 11 intensive care units using a "physical restraint observation form" and a "structured questionnaire." The results revealed that physical restraint was commonly used to ensure patient safety. Assessment of physical restraint was mainly restricted to peripheral circulation. The most commonly reported physically restrained site complications included: redness, bruising, swelling, and edema. The results illustrated a lack of documentation on physical restraint and a lack of education of patients and their families about the rationale of physical restraint usage. The study shed light on the need for standard guidelines and policies for physical restraint practices in Egyptian intensive care units.

  8. Generalized Potential of Adult Neural Stem Cells

    NASA Astrophysics Data System (ADS)

    Clarke, Diana L.; Johansson, Clas B.; Wilbertz, Johannes; Veress, Biborka; Nilsson, Erik; Karlström, Helena; Lendahl, Urban; Frisén, Jonas

    2000-06-01

    The differentiation potential of stem cells in tissues of the adult has been thought to be limited to cell lineages present in the organ from which they were derived, but there is evidence that some stem cells may have a broader differentiation repertoire. We show here that neural stem cells from the adult mouse brain can contribute to the formation of chimeric chick and mouse embryos and give rise to cells of all germ layers. This demonstrates that an adult neural stem cell has a very broad developmental capacity and may potentially be used to generate a variety of cell types for transplantation in different diseases.

  9. [Factors associated with nursing workload in adult intensive care units].

    PubMed

    Gonçalves, Leilane Andrade; Padilha, Kátia Grillo

    2007-12-01

    This study was aimed both at analyzing the nursing workload on the first day of admission of patients in Intensive Care Units (ICUs) and the factors associated with it. This is a qualitative, retrospective, cross-section study that was carried out in April of 2002 and October of 2004. The data were taken from a database that gathered information from 5 ICUs from two private hospitals and the sample was comprised of 214 adult patients that remained in the ICU for at least 24 hours. The total Nursing Activities Score (NAS) average was 69.9%, and the median 68.0%. According to the median, it was verified that 109 (50.9%) individuals required heavy nursing attention and the remaining 105 (49.1%) required less attention. The severity of the illness, the patient's age and the kind of treatment were not factors associated with nursing workload in the first 24 hours at the ICU.

  10. General Information about Adult Acute Lymphoblastic Leukemia

    MedlinePlus

    ... recovery) and treatment options. Adult acute lymphoblastic leukemia (ALL) is a type of cancer in which the ... to radiation may increase the risk of developing ALL. Anything that increases your risk of getting a ...

  11. The association between perceived sweetness intensity and dietary intake in young adults.

    PubMed

    Cicerale, Sara; Riddell, Lynnette J; Keast, Russell S J

    2012-01-01

    Individual differences in taste perception may influence dietary habits, nutritional status, and ultimately nutrition-related chronic disease risk. Individual differences in sweetness intensity perception and the relationship between perceived sweetness intensity, food behaviors, and dietary intake was investigated in 85 adults. Subjects (body mass index [BMI]= 21 ± 3, 21 ± 4 y) completed a food and diet questionnaire, food variety survey, 2 24-h food records, and a perceived sweetness intensity measurement using the general labeled magnitude scale (gLMS). There was interindividual variation in perceived sweetness intensity (0 to 34 gLMS units, mean 10 ± 7). One-way analysis of variance (ANOVA) revealed no difference between perceived sweetness intensity and degree of importance placed on not adding sugar to tea or coffee (P = 0.2) and the degree of importance placed on avoiding sugar-sweetened or fizzy drinks (P = 1.0). Independent t-test analysis revealed no significant association between perceived sweetness intensity and the food variety measure for sugar and confectionary intake (P = 0.6) and selected fruit and vegetable intake (P = 0.1 to 0.9). One-way ANOVA also demonstrated no difference between tertiles of sweetness intensity and BMI (P = 0.1), age (P = 0.3), and food variety score (P = 0.5). No correlation was observed with regards to perceived sweetness intensity and mean total energy (kJ) intake (r = 0.05, P = 0.7), percent energy from total fat, saturated fat, protein, carbohydrate, and grams of fiber (r =-0.1 to 0.1, P = 0.2 to 0.8) and also for intake of the micronutrients: folate, magnesium, calcium, iron, and zinc (r = 0.1 to 0.2, P = 0.1 to 0.4). Only modest correlations were observed between sodium (r = 0.3, P < 0.05), vitamin C (r = 0.3, P < 0.05), and potassium (r = 0.2, P < 0.0) intake and perceived sweetness intensity. Overall, perceived sweetness intensity does not appear to play a role in food behaviors relating to sugar consumption and

  12. Update on managing generalized anxiety disorder in older adults.

    PubMed

    Clifford, Kalin M; Duncan, Nakia A; Heinrich, Krista; Shaw, Jennifer

    2015-04-01

    With the recent updates to the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5), there are many questions on how to care for older adults with generalized anxiety disorder (GAD) and other psychiatric conditions. The current article reviews the new changes to the DSM-5 for diagnosis of GAD, discusses new anxiety assessment scales that are validated in older adults, evaluates pharmacological agents that have been studied in older adults for GAD treatment, and provides monitoring recommendations to help those who provide care to older adults experiencing GAD.

  13. Evidence for a General Factor Model of ADHD in Adults

    ERIC Educational Resources Information Center

    Gibbins, Christopher; Toplak, Maggie E.; Flora, David B.; Weiss, Margaret D.; Tannock, Rosemary

    2012-01-01

    Objective: To examine factor structures of "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.) symptoms of ADHD in adults. Method: Two sets of models were tested: (a) models with inattention and hyperactivity/impulsivity as separate but correlated latent constructs and (b) hierarchical general factor models with a general factor for…

  14. Usefulness of a Perceived Exertion Scale for Monitoring Exercise Intensity in Adults with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Stanish, Heidi I.; Aucoin, Michael

    2007-01-01

    In order to gain physical fitness and health, exercise must be performed at a sufficient level of intensity. Exercise intensity can be monitored with rated perceived exertion (RPE) scales to promote safe and effective programming. The usefulness of the Children's OMNI Scale as a subjective measure of intensity for adults with intellectual…

  15. MRI correlates of general intelligence in neurotypical adults.

    PubMed

    Malpas, Charles B; Genc, Sila; Saling, Michael M; Velakoulis, Dennis; Desmond, Patricia M; O'Brien, Terence J

    2016-02-01

    There is growing interest in the neurobiological substrate of general intelligence. Psychometric estimates of general intelligence are reduced in a range of neurological disorders, leading to practical application as sensitive, but non-specific, markers of cerebral disorder. This study examined estimates of general intelligence in neurotypical adults using diffusion tensor imaging and resting-state functional connectivity analysis. General intelligence was related to white matter organisation across multiple brain regions, confirming previous work in older healthy adults. We also found that variation in general intelligence was related to a large functional sub-network involving all cortical lobes of the brain. These findings confirm that individual variance in general intelligence is related to diffusely represented brain networks.

  16. APACHE II scoring system on a general intensive care unit: audit of daily APACHE II scores and 6-month survival of 691 patients admitted to a general intensive care unit between May 1990 and December 1991.

    PubMed Central

    Campbell, N N; Tooley, M A; Willatts, S M

    1994-01-01

    In this paper we present a detailed analysis of the use of the APACHE II (acute physiological and chronic health evaluation) scoring system on all of the patients admitted to the general intensive care unit at the Bristol Royal Infirmary over a 20-month period. The 6-month survival of 691 adult medical and surgical patients following intensive care was recorded and this data was analysed with admission and daily APACHE II scores using a relational database. Our data confirms the relationship between admission APACHE II scores and outcome, with mean scores decreasing as duration of survival increases. We also demonstrate that the best day one scores are approximately 50% less than the admission score, irrespective of outcome, indicating the benefit of intensive care. By contrast, however, the scores on day one have either not improved or have worsened since admission, reflecting the importance of the pre-morbid health status of the patient in determining outcome from intensive care. PMID:8196033

  17. Defining and Treating Older Adults with Acute Myeloid Leukemia Who Are Ineligible for Intensive Therapies

    PubMed Central

    Pettit, Kristen; Odenike, Olatoyosi

    2015-01-01

    Although acute myeloid leukemia (AML) is primarily a disease of older adults (age ≥60 years), the optimal treatment for older adults remains largely undefined. Intensive chemotherapy is rarely beneficial for frail older adults or those with poor-risk disease, but criteria that define fitness and/or appropriateness for intensive chemotherapy remain to be standardized. Evaluation of disease-related and patient-specific factors in the context of clinical decision making has therefore been largely subjective. A uniform approach to identify those patients most likely to benefit from intensive therapies is needed. Here, we review currently available objective measures to define older adults with AML who are ineligible for intensive chemotherapy, and discuss promising investigational approaches. PMID:26697412

  18. Generalization of Adult's Stimulus Control of Children's Behavior

    ERIC Educational Resources Information Center

    Redd, William H.

    1970-01-01

    Generalization of stimulus control in different situations and with novel adults occurred with those children who were trained by contingent reinforcement, but not with those trained by both contingent and noncontingent reinforcement. This research was submitted as part of the author's dissertation. (MH)

  19. Suggesting a General ESP Model for Adult Learners

    ERIC Educational Resources Information Center

    Al-Jumaily, Samir

    2011-01-01

    The study suggests a general model that could guarantee the cooperation between teachers and their students to overcome the difficulties encountered in ESP learning. It tries to join together different perspectives in the research of adult education, specifically in the teaching of English for Specific Purposes. It also provides some sort of trust…

  20. Leaving home: how older adults prepare for intensive volunteering.

    PubMed

    Cheek, Cheryl; Piercy, Kathleen W; Grainger, Sarah

    2015-03-01

    Using the concepts in the Fogg Behavioral Model, 37 volunteers aged 50 and older described their preparation for intensive volunteering with faith-based organizations. Their multistage preparation process included decision points where respondents needed to choose whether to drop out or continue preparation. Ability was a stronger determinant of serving than motivation, particularly in terms of health and finances. This model can facilitate understanding of the barriers to volunteering and aid organizations in tailoring support at crucial points for potential older volunteers in intensive service.

  1. Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis

    PubMed Central

    Segal, Neil A.; Glass, Natalie A.; Teran-Yengle, Patricia; Singh, Bhupinder; Wallace, Robert B.; Yack, H. John

    2014-01-01

    Objective To determine whether individualized gait training is more effective than usual care for reducing mobility disability and pain in individuals with symptomatic knee osteoarthritis (OA). Design Adults age ≥60 with symptomatic knee OA and mobility limitations were randomized to physical therapist-directed gait training on an instrumented treadmill, with biofeedback individualized to optimize knee movements, biweekly for 3 months or usual care (control). Mobility disability was defined by LLFDI Basic Lower Limb Function score (primary); limitations by timed 400m walk, chair-stand, and stair-climb tests at baseline, 3, 6 and 12 months; and symptoms by the Knee Injury/Osteoarthritis Outcome Score. Analyses used longitudinal mixed models. Results There were no significant inter-group differences between the 35 gait-training (74.3% women; age 69.7±8.2 years) and 21 control (57.1% women; age 68.9±6.5 years) participants at baseline. At 3 months, gait-training participants had greater improvement in mobility disability (4.3±1.7; p=0.0162) and symptoms (8.6±4.1; p=0.0420). However, there were neither intergroup differences detected for pain, 400m walk, chair-stand or stair-climb times at 3 months nor for any outcomes at 6 or 12 months. Conclusions Compared with usual care, individualized gait-training resulted in immediate improvements in mobility disability and knee symptoms in adults with symptomatic knee OA, but these effects were not sustained. PMID:25768068

  2. Operator priming and generalization of practice in adults' simple arithmetic.

    PubMed

    Chen, Yalin; Campbell, Jamie I D

    2016-04-01

    There is a renewed debate about whether educated adults solve simple addition problems (e.g., 2 + 3) by direct fact retrieval or by fast, automatic counting-based procedures. Recent research testing adults' simple addition and multiplication showed that a 150-ms preview of the operator (+ or ×) facilitated addition, but not multiplication, suggesting that a general addition procedure was primed by the + sign. In Experiment 1 (n = 36), we applied this operator-priming paradigm to rule-based problems (0 + N = N, 1 × N = N, 0 × N = 0) and 1 + N problems with N ranging from 0 to 9. For the rule-based problems, we found both operator-preview facilitation and generalization of practice (e.g., practicing 0 + 3 sped up unpracticed 0 + 8), the latter being a signature of procedure use; however, we also found operator-preview facilitation for 1 + N in the absence of generalization, which implies the 1 + N problems were solved by fact retrieval but nonetheless were facilitated by an operator preview. Thus, the operator preview effect does not discriminate procedure use from fact retrieval. Experiment 2 (n = 36) investigated whether a population with advanced mathematical training-engineering and computer science students-would show generalization of practice for nonrule-based simple addition problems (e.g., 1 + 4, 4 + 7). The 0 + N problems again presented generalization, whereas no nonzero problem type did; but all nonzero problems sped up when the identical problems were retested, as predicted by item-specific fact retrieval. The results pose a strong challenge to the generality of the proposal that skilled adults' simple addition is based on fast procedural algorithms, and instead support a fact-retrieval model of fast addition performance.

  3. Generalization of conditioned fear along a dimension of increasing fear intensity.

    PubMed

    Dunsmoor, Joseph E; Mitroff, Stephen R; LaBar, Kevin S

    2009-07-01

    The present study investigated the extent to which fear generalization in humans is determined by the amount of fear intensity in nonconditioned stimuli relative to a perceptually similar conditioned stimulus. Stimuli consisted of graded emotionally expressive faces of the same identity morphed between neutral and fearful endpoints. Two experimental groups underwent discriminative fear conditioning between a face stimulus of 55% fear intensity (conditioned stimulus, CS+), reinforced with an electric shock, and a second stimulus that was unreinforced (CS-). In Experiment 1 the CS- was a relatively neutral face stimulus, while in Experiment 2 the CS- was the most fear-intense stimulus. Before and following fear conditioning, skin conductance responses (SCR) were recorded to different morph values along the neutral-to-fear dimension. Both experimental groups showed gradients of generalization following fear conditioning that increased with the fear intensity of the stimulus. In Experiment 1 a peak shift in SCRs extended to the most fear-intense stimulus. In contrast, generalization to the most fear-intense stimulus was reduced in Experiment 2, suggesting that discriminative fear learning procedures can attenuate fear generalization. Together, the findings indicate that fear generalization is broadly tuned and sensitive to the amount of fear intensity in nonconditioned stimuli, but that fear generalization can come under stimulus control. These results reveal a novel form of fear generalization in humans that is not merely based on physical similarity to a conditioned exemplar, and may have implications for understanding generalization processes in anxiety disorders characterized by heightened sensitivity to nonthreatening stimuli.

  4. Patient stress in intensive care: comparison between a coronary care unit and a general postoperative unit

    PubMed Central

    Dias, Douglas de Sá; Resende, Mariane Vanessa; Diniz, Gisele do Carmo Leite Machado

    2015-01-01

    Objective To evaluate and compare stressors identified by patients of a coronary intensive care unit with those perceived by patients of a general postoperative intensive care unit. Methods This cross-sectional and descriptive study was conducted in the coronary intensive care and general postoperative intensive care units of a private hospital. In total, 60 patients participated in the study, 30 in each intensive care unit. The stressor scale was used in the intensive care units to identify the stressors. The mean score of each item of the scale was calculated followed by the total stress score. The differences between groups were considered significant when p < 0.05. Results The mean ages of patients were 55.63 ± 13.58 years in the coronary intensive care unit and 53.60 ± 17.47 years in the general postoperative intensive care unit. For patients in the coronary intensive care unit, the main stressors were “being in pain”, “being unable to fulfill family roles” and “being bored”. For patients in the general postoperative intensive care unit, the main stressors were “being in pain”, “being unable to fulfill family roles” and “not being able to communicate”. The mean total stress scores were 104.20 ± 30.95 in the coronary intensive care unit and 116.66 ± 23.72 (p = 0.085) in the general postoperative intensive care unit. When each stressor was compared separately, significant differences were noted only between three items. “Having nurses constantly doing things around your bed” was more stressful to the patients in the general postoperative intensive care unit than to those in the coronary intensive care unit (p = 0.013). Conversely, “hearing unfamiliar sounds and noises” and “hearing people talk about you” were the most stressful items for the patients in the coronary intensive care unit (p = 0.046 and 0.005, respectively). Conclusion The perception of major stressors and the total stress score were similar between patients

  5. Satisfaction Domains Differ between the Patient and Their Family in Adult Intensive Care Units

    PubMed Central

    Song, Ge; Sim, Pei Zhen; Ting, Kit Cheng; Yoo, Jeffrey Kwang Sui; Wang, Qing Li; Mascuri, Raudhah Binte Haji Mohamad; Ong, Venetia Hui Ling; Phua, Jason; Kowitlawakul, Yanika

    2016-01-01

    Background. Patients' and family's satisfaction data from the Asian intensive care units (ICUs) is lacking. Objective. Domains between patient and family satisfaction and contribution of each domain to the general satisfaction were studied. Method. Over 3 months, adult patients across 4 ICUs staying for more than 48 hours with abbreviated mental test score of 7 or above and able to understand English and immediate family members were surveyed by separate validated satisfaction questionnaires. Results. Two hundred patients and 194 families were included in the final analysis. Significant difference in the satisfaction scores was observed between the ICUs. Patients were most and least satisfied in the communication (4.2 out of 5) and decision-making (2.9 out of 5) domains, respectively. Families were most and least satisfied in the relationship with doctors (3.9 out of 5) and family's involvement domains (3.3 out of 5), respectively. Domains contributing most to the general satisfaction were the illness management domain for patients (β coefficient = 0.44) and characteristics of doctors and nurses domain for family (β coefficient = 0.45). Discussion. In an Asian ICU community, patients and families differ in their expectations and valuations of health care processes. Health care providers have difficult tasks in attending to these different domains. PMID:28044138

  6. Satisfaction Domains Differ between the Patient and Their Family in Adult Intensive Care Units.

    PubMed

    Mukhopadhyay, Amartya; Song, Ge; Sim, Pei Zhen; Ting, Kit Cheng; Yoo, Jeffrey Kwang Sui; Wang, Qing Li; Mascuri, Raudhah Binte Haji Mohamad; Ong, Venetia Hui Ling; Phua, Jason; Kowitlawakul, Yanika

    2016-01-01

    Background. Patients' and family's satisfaction data from the Asian intensive care units (ICUs) is lacking. Objective. Domains between patient and family satisfaction and contribution of each domain to the general satisfaction were studied. Method. Over 3 months, adult patients across 4 ICUs staying for more than 48 hours with abbreviated mental test score of 7 or above and able to understand English and immediate family members were surveyed by separate validated satisfaction questionnaires. Results. Two hundred patients and 194 families were included in the final analysis. Significant difference in the satisfaction scores was observed between the ICUs. Patients were most and least satisfied in the communication (4.2 out of 5) and decision-making (2.9 out of 5) domains, respectively. Families were most and least satisfied in the relationship with doctors (3.9 out of 5) and family's involvement domains (3.3 out of 5), respectively. Domains contributing most to the general satisfaction were the illness management domain for patients (β coefficient = 0.44) and characteristics of doctors and nurses domain for family (β coefficient = 0.45). Discussion. In an Asian ICU community, patients and families differ in their expectations and valuations of health care processes. Health care providers have difficult tasks in attending to these different domains.

  7. Recognition of Facial Expressions and Prosodic Cues with Graded Emotional Intensities in Adults with Asperger Syndrome

    ERIC Educational Resources Information Center

    Doi, Hirokazu; Fujisawa, Takashi X.; Kanai, Chieko; Ohta, Haruhisa; Yokoi, Hideki; Iwanami, Akira; Kato, Nobumasa; Shinohara, Kazuyuki

    2013-01-01

    This study investigated the ability of adults with Asperger syndrome to recognize emotional categories of facial expressions and emotional prosodies with graded emotional intensities. The individuals with Asperger syndrome showed poorer recognition performance for angry and sad expressions from both facial and vocal information. The group…

  8. Use of Technology in an Adult Intensive English Program: Benefits and Challenges

    ERIC Educational Resources Information Center

    Fuchs, Carolin; Akbar, Farah Sultana

    2013-01-01

    This exploratory study presents results of an online survey on student teachers' technology proficiencies and uses of various tools in an adult Intensive English Program (IEP) in the United States. The ultimate goal was to identify areas of improvement for teacher education programs with regard to technology-enhanced language teaching and student…

  9. Intensive video gaming improves encoding speed to visual short-term memory in young male adults.

    PubMed

    Wilms, Inge L; Petersen, Anders; Vangkilde, Signe

    2013-01-01

    The purpose of this study was to measure the effect of action video gaming on central elements of visual attention using Bundesen's (1990) Theory of Visual Attention. To examine the cognitive impact of action video gaming, we tested basic functions of visual attention in 42 young male adults. Participants were divided into three groups depending on the amount of time spent playing action video games: non-players (<2h/month, N=12), casual players (4-8h/month, N=10), and experienced players (>15h/month, N=20). All participants were tested in three tasks which tap central functions of visual attention and short-term memory: a test based on the Theory of Visual Attention (TVA), an enumeration test and finally the Attentional Network Test (ANT). The results show that action video gaming does not seem to impact the capacity of visual short-term memory. However, playing action video games does seem to improve the encoding speed of visual information into visual short-term memory and the improvement does seem to depend on the time devoted to gaming. This suggests that intense action video gaming improves basic attentional functioning and that this improvement generalizes into other activities. The implications of these findings for cognitive rehabilitation training are discussed.

  10. Generalization of conditioned fear along a dimension of increasing fear intensity

    PubMed Central

    Dunsmoor, Joseph E.; Mitroff, Stephen R.; LaBar, Kevin S.

    2009-01-01

    The present study investigated the extent to which fear generalization in humans is determined by the amount of fear intensity in nonconditioned stimuli relative to a perceptually similar conditioned stimulus. Stimuli consisted of graded emotionally expressive faces of the same identity morphed between neutral and fearful endpoints. Two experimental groups underwent discriminative fear conditioning between a face stimulus of 55% fear intensity (conditioned stimulus, CS+), reinforced with an electric shock, and a second stimulus that was unreinforced (CS−). In Experiment 1 the CS− was a relatively neutral face stimulus, while in Experiment 2 the CS− was the most fear-intense stimulus. Before and following fear conditioning, skin conductance responses (SCR) were recorded to different morph values along the neutral-to-fear dimension. Both experimental groups showed gradients of generalization following fear conditioning that increased with the fear intensity of the stimulus. In Experiment 1 a peak shift in SCRs extended to the most fear-intense stimulus. In contrast, generalization to the most fear-intense stimulus was reduced in Experiment 2, suggesting that discriminative fear learning procedures can attenuate fear generalization. Together, the findings indicate that fear generalization is broadly tuned and sensitive to the amount of fear intensity in nonconditioned stimuli, but that fear generalization can come under stimulus control. These results reveal a novel form of fear generalization in humans that is not merely based on physical similarity to a conditioned exemplar, and may have implications for understanding generalization processes in anxiety disorders characterized by heightened sensitivity to nonthreatening stimuli. PMID:19553384

  11. Supraspinal fatigue impedes recovery from a low-intensity sustained contraction in old adults.

    PubMed

    Yoon, Tejin; Schlinder-Delap, Bonnie; Keller, Manda L; Hunter, Sandra K

    2012-03-01

    This study determined the contribution of supraspinal fatigue and contractile properties to the age difference in neuromuscular fatigue during and recovery from a low-intensity sustained contraction. Cortical stimulation was used to evoke measures of voluntary activation and muscle relaxation during and after a contraction sustained at 20% of maximal voluntary contraction (MVC) until task failure with elbow flexor muscles in 14 young adults (20.9 ± 3.6 yr, 7 men) and 14 old adults (71.6 ± 5.4 yr, 7 men). Old adults exhibited a longer time to task failure than the young adults (23.8 ± 9.0 vs. 11.5 ± 3.9 min, respectively, P < 0.001). The time to failure was associated with initial peak rates of relaxation of muscle fibers and pressor response (P < 0.05). Increments in torque (superimposed twitch; SIT) generated by transcranial magnetic stimulation (TMS) during brief MVCs, increased during the fatiguing contraction (P < 0.001) and then decreased during recovery (P = 0.02). The increase in the SIT was greater for the old adults than the young adults during the fatiguing contraction and recovery (P < 0.05). Recovery of MVC torque was less for old than young adults at 10 min post-fatiguing contraction (75.1 ± 8.7 vs. 83.6 ± 7.8% of control MVC, respectively, P = 0.01) and was associated with the recovery of the SIT (r = -0.59, r(2) = 0.35, P < 0.001). Motor evoked potential (MEP) amplitude and the silent period elicited during the fatiguing contraction increased less for old adults than young adults (P < 0.05). The greater fatigue resistance with age during a low-intensity sustained contraction was attributable to mechanisms located within the muscle. Recovery of maximal strength after the low-intensity fatiguing contraction however, was impeded more for old adults than young because of greater supraspinal fatigue. Recovery of strength could be an important variable to consider in exercise prescription of old populations.

  12. Nightmares: Risk Factors Among the Finnish General Adult Population

    PubMed Central

    Sandman, Nils; Valli, Katja; Kronholm, Erkki; Revonsuo, Antti; Laatikainen, Tiina; Paunio, Tiina

    2015-01-01

    Study Objectives: To identify risk factors for experiencing nightmares among the Finnish general adult population. The study aimed to both test whether previously reported correlates of frequent nightmares could be reproduced in a large population sample and to explore previously unreported associations. Design: Two independent cross-sectional population surveys of the National FINRISK Study. Setting: Age- and sex-stratified random samples of the Finnish population in 2007 and 2012. Participants: A total of 13,922 participants (6,515 men and 7,407 women) aged 25–74 y. Interventions: N/A. Measurements and results: Nightmare frequency as well as several items related to socioeconomic status, sleep, mental well-being, life satisfaction, alcohol use, medication, and physical well-being were recorded with a questionnaire. In multinomial logistic regression analysis, a depression-related negative attitude toward the self (odds ratio [OR] 1.32 per 1-point increase), insomnia (OR 6.90), and exhaustion and fatigue (OR 6.86) were the strongest risk factors for experiencing frequent nightmares (P < 0.001 for all). Sex, age, a self-reported impaired ability to work, low life satisfaction, the use of antidepressants or hypnotics, and frequent heavy use of alcohol were also strongly associated with frequent nightmares (P < 0.001 for all). Conclusions: Symptoms of depression and insomnia were the strongest predictors of frequent nightmares in this dataset. Additionally, a wide variety of factors related to psychological and physical well-being were associated with nightmare frequency with modest effect sizes. Hence, nightmare frequency appears to have a strong connection with sleep and mood problems, but is also associated with a variety of measures of psychological and physical well-being. Citation: Sandman N, Valli K, Kronholm E, Revonsuo A, Laatikainen T, Paunio T. Nightmares: risk factors among the finnish general adult population. SLEEP 2015;38(4):507–514. PMID:25325474

  13. Noise exposure during early development impairs the processing of sound intensity in adult rats.

    PubMed

    Bures, Zbynek; Grécová, Jolana; Popelár, Jirí; Syka, Josef

    2010-07-01

    During the early postnatal development of rats, the structural and functional maturation of the central auditory nuclei strongly relies on the natural character of the incoming neural activity. Even a temporary deprivation in the critical period results in a deterioration of neuronal responsiveness in adult animals. We demonstrate that besides the poorer frequency selectivity of neurons in the impaired animals reported previously [Grecova et al. (2009)Eur. J. Neurosci. 29, 1921-1930], the neuronal representation of sound intensity is significantly affected. Rate-intensity functions of inferior colliculus neurons were recorded in anaesthetized adult rats that were exposed to intense noise at postnatal day 14, and compared with those obtained in age-matched controls. Although the response thresholds were similar in the exposed and control rats, the neurons in the exposed animals had a longer first-spike latency, a narrower dynamic range, lower maximum response magnitudes and a steeper slope of the rate-intensity functions. The percentage of monotonic neurons was significantly lower in the exposed animals. The observed anomalies were confined to the mid- and high-frequency regions, whereas no significant changes were found in the low-frequency neurons. The altered parameters of the individual rate-intensity functions led also to differences in the cumulative responses. We conclude that a brief noise exposure during the critical period leads to a frequency-dependent alteration of the sound intensity representation in the inferior colliculus of adult rats. The results suggest that such impairments may appear in individuals with normal hearing thresholds, but with a history of noise exposure very early in childhood.

  14. 38 CFR 52.61 - General requirements for adult day health care program.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... adult day health care program. 52.61 Section 52.61 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.61 General requirements for adult day health care program. Adult day health care must be...

  15. 38 CFR 52.61 - General requirements for adult day health care program.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... adult day health care program. 52.61 Section 52.61 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.61 General requirements for adult day health care program. Adult day health care must be...

  16. 38 CFR 52.61 - General requirements for adult day health care program.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... adult day health care program. 52.61 Section 52.61 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.61 General requirements for adult day health care program. Adult day health care must be...

  17. 38 CFR 52.61 - General requirements for adult day health care program.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... adult day health care program. 52.61 Section 52.61 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.61 General requirements for adult day health care program. Adult day health care must be...

  18. Goal orientation, self-regulation strategies, and job-seeking intensity in unemployed adults.

    PubMed

    Creed, Peter A; King, Vivien; Hood, Michelle; McKenzie, Robert

    2009-05-01

    At Time 1 (T1), the authors surveyed 277 unemployed adults using measures of human capital, goal orientation, self-regulation (emotion control, motivation control, work commitment), and job-seeking intensity. At Time 2 (T2), 4 months later, 155 participants indicated their reemployment outcomes in number of job interviews and number of job offers. Using T1 data, the authors tested the predictors of job-seeking intensity and whether self-regulation mediated between goal orientation and job-seeking intensity. Using T1 and T2 data, they tested for predictors of reemployment outcomes and whether job-seeking intensity mediated the relationship between T1 antecedent variables and the reemployment outcomes. Learning goal orientation and self-regulation predicted job-seeking intensity, and self-regulation mediated between learning goal orientation and job-seeking intensity. Job-seeking intensity did not mediate the relationship among human capital, goal orientation, and self-regulation variables and reemployment outcomes.

  19. Potential for intensive volunteering to promote the health of older adults in fair health.

    PubMed

    Barron, Jeremy S; Tan, Erwin J; Yu, Qilu; Song, Meilin; McGill, Sylvia; Fried, Linda P

    2009-07-01

    Volunteer service opportunities for older adults may soon be expanded. Although volunteering is thought to provide health benefits for healthier older adults, it is not known whether older adults in less than very good health are suitable candidates for high-intensity volunteering and can derive health benefits. This manuscript presents a prospective analysis of 174 older adult volunteers serving in Experience Corps Baltimore, a high-intensity senior volunteer program in Baltimore, Maryland. Volunteers served > or =15 h per week, for a full school year, in elementary schools helping children with reading and other skills between 1999 and 2002. Volunteers were assessed with standardized questionnaires and performance-based testing including grip strength, walking speed, chair stand speed, and stair-climbing speed prior to school volunteering and at the end of the school year. Results were stratified by health status. Among 174 volunteers, 55% initially reported "good" and 12% "fair" or "poor" health status. At baseline, those in fair health reported higher frequencies of disease and disability than volunteers in excellent or very good health. After volunteering, a majority of volunteers in every baseline health status category described increased strength and energy. Those in fair health were significantly more likely to display improved stair-climbing speed than those in good or excellent/very good health (100.0% vs. 53.4% vs. 37.5%, p = 0.05), and many showed clinically significant increases in walking speed of >0.5 m/s. Satisfaction and retention rates were high for all health status groups. Clinicians should consider whether their patients in fair or good health, as well as those in better health, might benefit from high-intensity volunteer programs. Productive activity such as volunteering may be an effective community-based approach to health promotion for older adults.

  20. Low-intensity daily walking activity is associated with hippocampal volume in older adults.

    PubMed

    Varma, Vijay R; Chuang, Yi-Fang; Harris, Gregory C; Tan, Erwin J; Carlson, Michelle C

    2015-05-01

    Hippocampal atrophy is associated with memory impairment and dementia and serves as a key biomarker in the preclinical stages of Alzheimer's disease. Physical activity, one of the most promising behavioral interventions to prevent or delay cognitive decline, has been shown to be associated with hippocampal volume; specifically increased aerobic activity and fitness may have a positive effect on the size of the hippocampus. The majority of older adults, however, are sedentary and have difficulty initiating and maintaining exercise programs. A modestly more active lifestyle may nonetheless be beneficial. This study explored whether greater objectively measured daily walking activity was associated with larger hippocampal volume. We additionally explored whether greater low-intensity walking activity, which may be related to leisure-time physical, functional, and social activities, was associated with larger hippocampal volume independent of exercise and higher-intensity walking activity. Segmentation of hippocampal volumes was performed using Functional Magnetic Resonance Imaging of the Brain's Software Library (FSL), and daily walking activity was assessed using a step activity monitor on 92, nondemented, older adult participants. After controlling for age, education, body mass index, cardiovascular disease risk factors, and the Mini Mental State Exam, we found that a greater amount, duration, and frequency of total daily walking activity were each associated with larger hippocampal volume among older women, but not among men. These relationships were specific to hippocampal volume, compared with the thalamus, used as a control brain region, and remained significant for low-intensity walking activity, independent of moderate- to vigorous-intensity activity and self-reported exercise. This is the first study, to our knowledge, to explore the relationship between objectively measured daily walking activity and hippocampal volume in an older adult population. Findings

  1. Factor structure of the 12-item General Health Questionnaire in the Japanese general adult population.

    PubMed

    Doi, Yuriko; Minowa, Masumi

    2003-08-01

    The 12-item General Health Questionnaire (GHQ-12) has been extensively used in a variety of settings across countries. The main aim of the present study was to assess the factor structure of the GHQ-12 for the Japanese general adult population. Data came from a sample of 1808 Japanese aged 20 years or older who were randomly selected based on the 1995 census (897 men and 911 women). Cronbach's alpha coefficients were 0.83 for men and 0.85 for women. Overall, the corrected item-total correlation coefficients were >0.20 for both genders. The GHQ-12 yielded a two-factor solution of psychological distress (items 2, 5, 6, 9, 10 and 11) and social dysfunction (items 1, 3, 4, 7 and 8), which jointly accounted for 49.1% of the total variance, for women. Item 12 on happiness was not discernable. For men, item 12 was separated from a social dysfunction factor and yielded the third factor with item 3 on social role, and the three factors jointly accounted for 57.6%. The results of the present study suggest that the GHQ-12 can be used as an internally reliable and homogeneous scale that produces mainly the factors of psychological distress and social dysfunction. Item 12 may be structurally different in the case of Japanese adults.

  2. Exercise intensities of gardening tasks within older adult allotment gardeners in Wales.

    PubMed

    Hawkins, Jemma L; Smith, Alexander; Backx, Karianne; Clayton, Deborah A

    2015-04-01

    Previous research has suggested that gardening activity could be an effective form of regular exercise for improving physical and psychological health in later life. However, there is a lack of data regarding the exercise intensities of various gardening tasks across different types of gardening and different populations. The purpose of this study was to examine the exercise intensity of gardening activity for older adult allotment gardeners in Wales, United Kingdom following a similar procedure used in previous studies conducted in the United States and South Korea by Park and colleagues (2008a; 2011). Oxygen consumption (VO2) and energy expenditure for six gardening tasks were measured via indirect calorimetery using the portable Oxycon mobile device. From these measures, estimated metabolic equivalent units (METs) were calculated. Consistent with Park et al. (2008a; 2011) the six gardening tasks were classified as low to moderate-high intensity physical activities based on their metabolic values (1.9-5.7 METs).

  3. Performance-intensity functions for normal-hearing adults and children using CASPA

    PubMed Central

    McCreery, Ryan; Ito, Rindy; Spratford, Merry; Lewis, Dawna; Hoover, Brenda; Stelmachowicz, Patricia G.

    2009-01-01

    Objectives The Computer Aided Speech Perception Assessment (CASPA) is a clinical measure of speech recognition that uses ten-item, isophonemic word lists to derive performance-intensity (PI) functions for adult listeners. Because CASPA was developed for adults, the ability to obtain PI functions in children has not been directly evaluated. The current study sought to evaluate PI functions for adults and four age groups of children with normal hearing to compare speech recognition as a function of age using CASPA. Comparisons between age groups for scoring by words and phonemes correct were made to determine the relative benefits of available scoring methods in CASPA. Design Speech recognition using CASPA was completed with twelve adults and four age groups of children (5-6, 7-8, 9-10, and 11-12 year-olds), each with twelve participants. Results were scored by the percentage of words, phonemes, consonants and vowels correct. All participants had normal hearing and age-appropriate speech production skills. Results Adults had higher mean speech recognition scores than children in the 5-6 year-old and 7-8 year-old age groups when responses were scored by the percentage of words correct. However, only differences between the 5-6 year-olds and adults were statistically significant when responses were scored by the percentage of phonemes correct. Speech recognition scores decreased as a function of signal-to-noise ratio (SNR) for both children and adults. However, the magnitude of degradation at poorer SNRs did not vary between adults and children, suggesting that mean differences could not be explained by interference from noise. Conclusions Obtaining PI functions in noise using CASPA is feasible with children as young as 5 years-old. Statistically significant differences in speech recognition were observed between adults and the two youngest age groups of children when scored by the percentage of words correct. When results were scored by the percentage of phonemes

  4. Generalization of Conditioned Fear along a Dimension of Increasing Fear Intensity

    ERIC Educational Resources Information Center

    Dunsmoor, Joseph E.; Mitroff, Stephen R.; LaBar, Kevin S.

    2009-01-01

    The present study investigated the extent to which fear generalization in humans is determined by the amount of fear intensity in nonconditioned stimuli relative to a perceptually similar conditioned stimulus. Stimuli consisted of graded emotionally expressive faces of the same identity morphed between neutral and fearful endpoints. Two…

  5. Assessing a Writing Intensive General Education Capstone: Research as Faculty Development

    ERIC Educational Resources Information Center

    Parrish, Juli; Hesse, Doug; Bateman, Geoffrey

    2016-01-01

    We explain how collaboratively assessing a writing-intensive general education capstone seminar constituted a high-impact practice for faculty development. Students at the University of Denver complete an Advanced Seminar taught by faculty across the curriculum. Topics and themes vary widely, as do types of assigned writing, making assessment an…

  6. GENERAL STRAIN THEORY, PERSISTENCE, AND DESISTANCE AMONG YOUNG ADULT MALES

    PubMed Central

    Eitle, David

    2010-01-01

    Purpose Despite the surge in scholarly activity investigating the criminal career, relatively less attention has been devoted to the issue of criminal desistance versus persistence (until recently). The present study contributed to our understanding of this process by exploring the suitability of General Strain Theory (GST) for predicting changes in criminal activity across time. Methods Data from a longitudinal study of males in South Florida are examined using robust regression analyses. Results The core GST relationship, that changes in strain should predict changes in criminal activity, was supported, even after controlling for important adult social roles such as marriage, labor force participation, and education. While no support for the proposition that changes in self-esteem and social support moderate the strain-criminal desistance association was evinced, evidence was found that angry disposition, a measure of negative emotionality, moderated the association between change in chronic stressors and change in criminal activity. Conclusions While exploratory in nature, these findings demonstrate the utility of employing GST principles in studies of criminal desistance. PMID:21499526

  7. Recognition of facial expressions and prosodic cues with graded emotional intensities in adults with Asperger syndrome.

    PubMed

    Doi, Hirokazu; Fujisawa, Takashi X; Kanai, Chieko; Ohta, Haruhisa; Yokoi, Hideki; Iwanami, Akira; Kato, Nobumasa; Shinohara, Kazuyuki

    2013-09-01

    This study investigated the ability of adults with Asperger syndrome to recognize emotional categories of facial expressions and emotional prosodies with graded emotional intensities. The individuals with Asperger syndrome showed poorer recognition performance for angry and sad expressions from both facial and vocal information. The group difference in facial expression recognition was prominent for stimuli with low or intermediate emotional intensities. In contrast to this, the individuals with Asperger syndrome exhibited lower recognition accuracy than typically-developed controls mainly for emotional prosody with high emotional intensity. In facial expression recognition, Asperger and control groups showed an inversion effect for all categories. The magnitude of this effect was less in the Asperger group for angry and sad expressions, presumably attributable to reduced recruitment of the configural mode of face processing. The individuals with Asperger syndrome outperformed the control participants in recognizing inverted sad expressions, indicating enhanced processing of local facial information representing sad emotion. These results suggest that the adults with Asperger syndrome rely on modality-specific strategies in emotion recognition from facial expression and prosodic information.

  8. College Student Performance on the General Ability Measure for Adults and the Wechsler Intelligence Scale for Adults-Third Edition.

    ERIC Educational Resources Information Center

    Lassiter, Kerry S.; Bell, Nancy L.; Hutchinson, Melody B.; Matthews, T. Darin

    2001-01-01

    Examines the concurrent validity of the General Ability Measure for Adults (GAMA) and the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III). A comparison of the sample's mean scores indicates similar GAMA and WAIS-III Performance IQ scores. In contrast, the sample's mean GAMA IQ score was significantly lower than the sample's mean Full…

  9. Comparison of the General Ability Measure for Adults and the Kaufman Adolescent and Adult Intelligence Test with College Students.

    ERIC Educational Resources Information Center

    Lassiter, Kerry S.; Matthews, T. Darin; Bell, Nancy L.; Maher, Carrie M.

    2002-01-01

    Ninety-four college students were administered the General Ability Measure for Adults (GAMA) and Kaufman Adolescent and Adult Intelligence Test (KAIT). GAMA IQs were significantly and moderately correlated with KAIT Fluid, Crystallized and Composite IQs, supporting the convergent validity of this instrument. Although significant correlations…

  10. Operator Priming and Generalization of Practice in Adults' Simple Arithmetic

    ERIC Educational Resources Information Center

    Chen, Yalin; Campbell, Jamie I. D.

    2016-01-01

    There is a renewed debate about whether educated adults solve simple addition problems (e.g., 2 + 3) by direct fact retrieval or by fast, automatic counting-based procedures. Recent research testing adults' simple addition and multiplication showed that a 150-ms preview of the operator (+ or ×) facilitated addition, but not multiplication,…

  11. Effect of stimulus intensity level on auditory middle latency response brain maps in human adults.

    PubMed

    Tucker, D A; Dietrich, S; McPherson, D L; Salamat, M T

    2001-05-01

    Auditory middle latency response (AMLR) brain maps were obtained in 11 young adults with normal hearing. AMLR waveforms were elicited with monaural clicks presented at three stimulus intensity levels (50, 70, and 90 dB nHL). Recordings were made for right and left ear stimulus presentations. All recordings were obtained in an eyes open/awake status for each subject. Peak-to-peak amplitudes and absolute latencies of the AMLR Pa and Pb waveforms were measured at the Cz electrode site. Pa and Pb waveforms were present 100 percent of the time in response to the 90 dB nHL presentation. The prevalence of Pa and Pb to the 70 dB nHL presentation varied from 86 to 95 percent. The prevalence of Pa and Pb to the 50 dB nHL stimulus never reached 100 percent, ranging in prevalence from 77 to 68 percent. No significant ear effect was seen for amplitude or latency measures of Pa or Pb. AMLR brain maps of the voltage field distributions of Pa and Pb waveforms showed different topographic features. Scalp topography of the Pa waveform was altered by a reduction in stimulus intensity level. At 90 dB nHL, the Pa brain map showed a large positivity midline over the frontal and central scalp areas. At lower stimulus intensity levels, frontal positivity was reduced, and scalp negativity over occipital regions was increased. Pb scalp topography was also altered by a reduction in stimulus intensity level. Varying the stimulus intensity significantly altered Pa and Pb distributions of amplitude and latency measures. Pa and Pb distributions were skewed regardless of stimulus intensity.

  12. Beyond pleasure and pain: Facial expression ambiguity in adults and children during intense situations.

    PubMed

    Wenzler, Sofia; Levine, Sarah; van Dick, Rolf; Oertel-Knöchel, Viola; Aviezer, Hillel

    2016-09-01

    According to psychological models as well as common intuition, intense positive and negative situations evoke highly distinct emotional expressions. Nevertheless, recent work has shown that when judging isolated faces, the affective valence of winning and losing professional tennis players is hard to differentiate. However, expressions produced by professional athletes during publicly broadcasted sports events may be strategically controlled. To shed light on this matter we examined if ordinary people's spontaneous facial expressions evoked during highly intense situations are diagnostic for the situational valence. In Experiment 1 we compared reactions with highly intense positive situations (surprise soldier reunions) versus highly intense negative situations (terror attacks). In Experiment 2, we turned to children and compared facial reactions with highly positive situations (e.g., a child receiving a surprise trip to Disneyland) versus highly negative situations (e.g., a child discovering her parents ate up all her Halloween candy). The results demonstrate that facial expressions of both adults and children are often not diagnostic for the valence of the situation. These findings demonstrate the ambiguity of extreme facial expressions and highlight the importance of context in everyday emotion perception. (PsycINFO Database Record

  13. The M-Integral for Computing Stress Intensity Factors in Generally Anisotropic Materials

    NASA Technical Reports Server (NTRS)

    Warzynek, P. A.; Carter, B. J.; Banks-Sills, L.

    2005-01-01

    The objective of this project is to develop and demonstrate a capability for computing stress intensity factors in generally anisotropic materials. These objectives have been met. The primary deliverable of this project is this report and the information it contains. In addition, we have delivered the source code for a subroutine that will compute stress intensity factors for anisotropic materials encoded in both the C and Python programming languages and made available a version of the FRANC3D program that incorporates this subroutine. Single crystal super alloys are commonly used for components in the hot sections of contemporary jet and rocket engines. Because these components have a uniform atomic lattice orientation throughout, they exhibit anisotropic material behavior. This means that stress intensity solutions developed for isotropic materials are not appropriate for the analysis of crack growth in these materials. Until now, a general numerical technique did not exist for computing stress intensity factors of cracks in anisotropic materials and cubic materials in particular. Such a capability was developed during the project and is described and demonstrated herein.

  14. Intensive Treatment and Severe Hypoglycemia Among Adults With Type 2 Diabetes

    PubMed Central

    McCoy, Rozalina G.; Lipska, Kasia J.; Yao, Xiaoxi; Ross, Joseph S.; Montori, Victor M.; Shah, Nilay D.

    2017-01-01

    Importance Intensive glucose-lowering treatment among patients with non–insulin-requiring type 2 diabetes may increase the risk of hypoglycemia. Objectives To estimate the prevalence of intensive treatment and the association between intensive treatment, clinical complexity, and incidence of severe hypoglycemia among adults with type 2 diabetes who are not using insulin. Design, Setting, and Participants Retrospective analysis of administrative, pharmacy, and laboratory data from the OptumLabs Data Warehouse from January 1, 2001, through December 31, 2013. The study included nonpregnant adults 18 years or older with type 2 diabetes who achieved and maintained a hemoglobin A1c (HbA1c) level less than 7.0% without use of insulin and had no episodes of severe hypoglycemia or hyperglycemia in the prior 12 months. Main Outcomes and Measures Risk-adjusted probability of intensive treatment and incident severe hypoglycemia, stratified by patient clinical complexity. Intensive treatment was defined as use of more glucose-lowering medications than recommended by practice guidelines at specific index HbA1c levels. Severe hypoglycemia was ascertained by ambulatory, emergency department, and hospital claims for hypoglycemia during the 2 years after the index HbA1c test. Patients were categorized as having high vs low clinical complexity if they were 75 years or older, had dementia or end-stage renal disease, or had 3 or more serious chronic conditions. Results Of 31 542 eligible patients (median age, 58 years; interquartile range, 51–65 years; 15 483 women [49.1%]; 18 188 white [57.7%]), 3910 (12.4%) had clinical complexity. The risk-adjusted probability of intensive treatment was 25.7% (95% CI, 25.1%–26.2%) in patients with low clinical complexity and 20.8% (95% CI, 19.4%–22.2%) in patients with high clinical complexity. In patients with low clinical complexity, the risk-adjusted probability of severe hypoglycemia during the subsequent 2 years was 1.02% (95% CI, 0

  15. 20 CFR 416.920 - Evaluation of disability of adults, in general.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Evaluation of disability of adults, in general. 416.920 Section 416.920 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY... § 416.920 Evaluation of disability of adults, in general. (a) General—(1) Purpose of this section....

  16. 20 CFR 416.920 - Evaluation of disability of adults, in general.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Evaluation of disability of adults, in general. 416.920 Section 416.920 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY... § 416.920 Evaluation of disability of adults, in general. (a) General—(1) Purpose of this section....

  17. 20 CFR 416.920 - Evaluation of disability of adults, in general.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Evaluation of disability of adults, in general. 416.920 Section 416.920 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY... § 416.920 Evaluation of disability of adults, in general. (a) General—(1) Purpose of this section....

  18. 20 CFR 416.920 - Evaluation of disability of adults, in general.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Evaluation of disability of adults, in general. 416.920 Section 416.920 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY... § 416.920 Evaluation of disability of adults, in general. (a) General—(1) Purpose of this section....

  19. 90 Minutes of Moderate-Intensity Exercise does not Attenuate Postprandial Triglycerides in Older Adults

    PubMed Central

    BODELL, NATHANIEL G.; GILLUM, TREVOR

    2016-01-01

    To determine whether 90 minutes of moderate-intensity exercise, prior to a high fat meal, attenuates postprandial triglycerides (PPT) in older adults. Eight sedentary older adult volunteers (mean ± SD age = 58 ± 8 years, BMI 26.5 ± 4.2); completed two trials consisting of exercise and a no-exercise control. Exercise trials involved 90 minutes of moderate-intensity exercise 60% heart rate reserve (HRR). Following exercise, an overnight fast of 12–16 hours was performed. Participants were given a high fat meal that consisted of 146 grams of CHO, and 92 grams of fat and instructed to rest. Lipid levels were collected at pre-feeding, 1, 2, 3, and 4 hours post feeding. The control trial involved no exercise, performed an overnight fast of 12–16 hours, and was given the high fat meal followed by four hours of rest and data collection. There was no difference in PPT between the control and exercise trials (p < 0.05). Triglycerides (TG) increased in both trials over pre-feeding values (pre-feeding 123.13 ± 65.03 con. 111 ± 53.9 ex., 1hr 161.50 ± 83.77 con. 149 ± 71.03 ex., 2hrs 208.25 ± 120.69 con. 177 ± 97.29 ex., 3hrs 228 ± 146.99 con. 147.25 ± 87.64 ex., 4hrs 211.75 ± 140.15 con. 169.5 ± 68.14 ex). No difference in triglycerides over time was observed among older adults between the exercise and control trials. PMID:27990228

  20. 90 Minutes of Moderate-Intensity Exercise does not Attenuate Postprandial Triglycerides in Older Adults.

    PubMed

    Bodell, Nathaniel G; Gillum, Trevor

    2016-01-01

    To determine whether 90 minutes of moderate-intensity exercise, prior to a high fat meal, attenuates postprandial triglycerides (PPT) in older adults. Eight sedentary older adult volunteers (mean ± SD age = 58 ± 8 years, BMI 26.5 ± 4.2); completed two trials consisting of exercise and a no-exercise control. Exercise trials involved 90 minutes of moderate-intensity exercise 60% heart rate reserve (HRR). Following exercise, an overnight fast of 12-16 hours was performed. Participants were given a high fat meal that consisted of 146 grams of CHO, and 92 grams of fat and instructed to rest. Lipid levels were collected at pre-feeding, 1, 2, 3, and 4 hours post feeding. The control trial involved no exercise, performed an overnight fast of 12-16 hours, and was given the high fat meal followed by four hours of rest and data collection. There was no difference in PPT between the control and exercise trials (p < 0.05). Triglycerides (TG) increased in both trials over pre-feeding values (pre-feeding 123.13 ± 65.03 con. 111 ± 53.9 ex., 1hr 161.50 ± 83.77 con. 149 ± 71.03 ex., 2hrs 208.25 ± 120.69 con. 177 ± 97.29 ex., 3hrs 228 ± 146.99 con. 147.25 ± 87.64 ex., 4hrs 211.75 ± 140.15 con. 169.5 ± 68.14 ex). No difference in triglycerides over time was observed among older adults between the exercise and control trials.

  1. A survey on patient perception of reduced-intensity transplantation in adults with sickle cell disease.

    PubMed

    Chakrabarti, S; Bareford, D

    2007-04-01

    The development of reduced-intensity conditioning (RIC) and the success of BMT for paediatric sickle cell disease (SCD) have raised the possibility of revisiting this prospect in adults as well. In a chronic debilitating disorder managed with supportive therapy, the patients' perception is critical in the advancement of any potential curative therapy. To explore this aspect, we undertook a questionnaire-based survey on 30 adults with SCD. Sixty two per cent of the patients were ready to accept a transplant-related mortality (TRM) >10%; 30% of them a TRM >30%. A risk of graft failure (GF) >10% was acceptable to 64%, with a risk >30% acceptable to 41%. Infertility was acceptable to only 50%. Chronic graft-versus-host disease (GVHD) was unacceptable to the majority (80%). Seventy six per cent% of patients had a full sibling and 60% were willing to participate in a clinical trial of RIC transplantation. This survey suggests that the majority of adults with SCD might be willing to consider a curative option such as RIC transplantation even with a high TRM or GF. The major concerns relate to chronic GVHD and infertility. There is an urgent need to explore RIC transplants in SCD patients within the framework of a clinical trial, considering patient perception regarding cure and complications.

  2. Effects of Exercise Intensity on Postprandial Improvement in Glucose Disposal and Insulin Sensitivity in Prediabetic Adults

    PubMed Central

    Rynders, Corey A.; Weltman, Judy Y.; Jiang, Boyi; Breton, Marc; Patrie, James; Barrett, Eugene J.

    2014-01-01

    Background: A single bout of exercise improves postprandial glycemia and insulin sensitivity in prediabetic patients; however, the impact of exercise intensity is not well understood. The present study compared the effects of acute isocaloric moderate (MIE) and high-intensity (HIE) exercise on glucose disposal and insulin sensitivity in prediabetic adults. Methods: Subjects (n = 18; age 49 ± 14 y; fasting glucose 105 ± 11 mg/dL; 2 h glucose 170 ± 32 mg/dL) completed a peak O2 consumption/lactate threshold (LT) protocol plus three randomly assigned conditions: 1) control, 1 hour of seated rest, 2) MIE (at LT), and 3) HIE (75% of difference between LT and peak O2 consumption). One hour after exercise, subjects received an oral glucose tolerance test (OGTT). Plasma glucose, insulin, and C-peptide concentrations were sampled at 5- to 10-minute intervals at baseline, during exercise, after exercise, and for 3 hours after glucose ingestion. Total, early-phase, and late-phase area under the glucose and insulin response curves were compared between conditions. Indices of insulin sensitivity (SI) were derived from OGTT data using the oral minimal model. Results: Compared with control, SI improved by 51% (P = .02) and 85% (P < .001) on the MIE and HIE days, respectively. No differences in SI were observed between the exercise conditions (P = .62). Improvements in SI corresponded to significant reductions in the glucose, insulin, and C-peptide area under the curve values during the late phase of the OGTT after HIE (P < .05), with only a trend for reductions after MIE. Conclusion: These results suggest that in prediabetic adults, acute exercise has an immediate and intensity-dependent effect on improving postprandial glycemia and insulin sensitivity. PMID:24243632

  3. Infraclavicular axillary vein cannulation using ultrasound in a mechanically ventilated general intensive care population.

    PubMed

    Glen, H; Lang, I; Christie, L

    2015-09-01

    Central venous catheter (CVC) insertion is commonly undertaken in the ICU. The use of ultrasound (US) to facilitate CVC insertion is standard and is supported by guidelines. Because the subclavian vein cannot be insonated where it underlies the clavicle, its use as a CVC site is now less common. The axillary vein, however, can be seen on US just distal to the subclavian vein and placement of a CVC at this site gives a result which is functionally indistinguishable from a subclavian CVC. We evaluated placement of US-guided axillary CVCs in mechanically ventilated intensive care patients. Data were collected for 125 consecutive US-guided axillary CVC procedures in ventilated patients in an adult intensive care setting. All lines were inserted using real-time US guidance with an out-of-plane technique. One hundred and twenty-five procedures occurred in 119 patients. Successful line placement was achieved in 117 out of 125 (94%) procedures. Complications included four procedures that required repeating due to catheter malposition and one arterial puncture. The median number of attempts per procedure was one (IQR 1 to 2). Thirty-nine (31%) patients had a body mass index of 30 or above, 43 (34%) patients had a coagulopathy and 70 (56%) patients had significant ventilator dependence (FiO2 of 0.5 or above, or positive end expiratory pressure 10 cmH20 or above). The technique of US-guided axillary CVC access can be undertaken successfully in ventilated intensive care patients, even in challenging circumstances. Taken together with existing work on the utility and safety of this technique, we suggest that it be adopted more widely in the intensive care population.

  4. Influence of intensive yoga training on physiological changes in 6 adult women: a case report.

    PubMed

    Raju, P S; Prasad, K V; Venkata, R Y; Murthy, K J; Reddy, M V

    1997-01-01

    The short-term effects of 4 weeks of intensive yoga practice on physiological responses in six healthy adult female volunteers were measured using the maximal exercise treadmill test. Yoga practice involved daily morning and evening sessions of 90 minutes each. Pre- and post-yoga exercise performance was compared. Maximal work output (Wmax) for the group increased by 21%, with a significantly reduced level of oxygen consumption per unit work but without a concomitant significant change in heart rate. After intensive yoga training, at 154 Wmin(-1) (corresponding to Wmax of the pre-yoga maximal exercise test) participants could exercise more comfortably, with a significantly lower heart rate (p < 0.05), reduced minute ventilation (p < 0.05), reduced oxygen consumption per unit work (p < 0.05), and a significantly lower respiratory quotient (p < 0.05). The implications for the effect of intensive yoga on cardiorespiratory efficiency are discussed, with the suggestion that yoga has some transparently different quantifiable physiological effects to other exercises.

  5. Sex difference in substrate oxidation during low-intensity isometric exercise in young adults.

    PubMed

    Sarafian, Delphine; Schutz, Yves; Montani, Jean-Pierre; Dulloo, Abdul G; Miles-Chan, Jennifer L

    2016-09-01

    Low-intensity physical activity is increasingly promoted as an alternative to sedentary behavior. However, much research to date has focused on moderate- to vigorous-intensity physical activity, and in particular dynamic work, with the effect of low-intensity isometric exercise (<4 METs) on substrate utilization yet to be explored. Here we investigate the effects of such exercise on respiratory quotient (RQ) and determine the extent of intra- and inter-individual variability in response. Energy expenditure, RQ, and substrate oxidation were measured by ventilated-hood indirect calorimetry at rest and in response to standardized, intermittent, low-level isometric leg-press exercises at 5 loads (+5, +10, +15, +20, +25 kg) in 26 healthy, young adults. Nine participants repeated the experiment on 3 separate days to assess within-subject, between-day variability. There was no significant difference in energy cost and heart rate responses to low-intensity isometric exercise (<2 METs) between men and women. However, a sex difference was apparent in terms of substrate oxidation - with men increasing both fat and carbohydrate oxidation, and women only increasing fat oxidation while maintaining carbohydrate oxidation at baseline, resting levels. This sex difference was repeatable and persisted when substrate oxidation was adjusted for differences in body weight or body composition. Individual variability in RQ was relatively low, with both intra- and inter-individual coefficients of variation in the range of 3%-6% in both sexes. These results suggest that women preferentially increase fat oxidation during low-level isometric exercise. Whether such physical activity could be incorporated into treatment/prevention strategies aimed at optimizing fat oxidation in women warrants further investigation.

  6. Developmental aspects of fear: Comparing the acquisition and generalization of conditioned fear in children and adults.

    PubMed

    Schiele, Miriam A; Reinhard, Julia; Reif, Andreas; Domschke, Katharina; Romanos, Marcel; Deckert, Jürgen; Pauli, Paul

    2016-05-01

    Most research on human fear conditioning and its generalization has focused on adults whereas only little is known about these processes in children. Direct comparisons between child and adult populations are needed to determine developmental risk markers of fear and anxiety. We compared 267 children and 285 adults in a differential fear conditioning paradigm and generalization test. Skin conductance responses (SCR) and ratings of valence and arousal were obtained to indicate fear learning. Both groups displayed robust and similar differential conditioning on subjective and physiological levels. However, children showed heightened fear generalization compared to adults as indexed by higher arousal ratings and SCR to the generalization stimuli. Results indicate overgeneralization of conditioned fear as a developmental correlate of fear learning. The developmental change from a shallow to a steeper generalization gradient is likely related to the maturation of brain structures that modulate efficient discrimination between danger and (ambiguous) safety cues.

  7. Comparison of absolute intensity between EAS with gamma-families and general EAS at Mount Norikura

    NASA Technical Reports Server (NTRS)

    Mitsumune, T.; Nakatsuka, T.; Nishikawa, K.; Saito, T.; Sakata, M.; Shima, M.; Yamamoto, Y.; Dake, S.; Kawamoto, M.; Kusumose, M.

    1985-01-01

    Gamma-families with total energy greater than 10 TeV, found in the EX chamber which was cooperated with the EAS array were combined with EAS triggered by big bursts. The absolute intensity of the size spectrum of these combined EAS was compared with that of general EAS obtained by AS trigger. The EAS with sizes greater than 2x1 million were always accompanied by gamma-families with sigma E sub gamma H 10 TeV, n sub gamma, H 2 and Emin=3 TeV, although the rate of EAS accompaning such gamma-families decreases rapidly as their sizes decrease.

  8. Body Pain Intensity and Interference in Adults (45-53 Years Old): A Cross-Sectional Survey in Chongqing, China.

    PubMed

    Xu, Xianglong; Li, Bing; Liu, Lingli; Zhao, Yong

    2016-09-07

    Culture and national care models matter both in reporting and treatment of pain status. However, most findings on body pain intensity and interference in adults are from Western studies, with little reliable evidence from China. This study aimed to assess body pain intensity and interference and its associations with demographic, socioeconomic characteristics, and health behaviors in adults. A cross-sectional survey was performed to collect data from 1224 adults, who were recruited via multistage stratified random sampling. The SF-36 quality-of-life instrument was used to investigate body pain intensity and interference. Ordinal logistic regression analysis was used in this study. Our results showed that 64.1% of the participants (males: 687; females: 537) reported body pain, and 45.7% of the participants reported body pain interference. Middle-aged respondents who were female, were unmarried/divorced or separated/widowed, had a negative relationship with their family, had poor sleep quality, and were not satisfied with their current living conditions had a higher body pain intensity rating (ordered logistic regression/six-level pain intensity criterion; odds ratios, p < 0.05). Respondents who were unmarried/divorced or separated/widowed, with a low education level, were unemployed, had lower incomes, had a negative relationship with their family, and were not satisfied with their current living conditions had a higher body pain interference rating (ordered logistic regression/five-level pain interference criterion; odds ratios, p < 0.05). In conclusion, an estimated 64.1% of middle-aged adults reported body pain, and 45.7% of middle-aged adults reported body pain interference. These results provide a clue for possible interventions for improving body pain intensity and interference in adults, especially among middle-aged people. These factors should be taken into consideration in the prevention of pain, pain management and treatment planning in order to help

  9. Nursing care time and quality indicators for adult intensive care: correlation analysis.

    PubMed

    Garcia, Paulo Carlos; Fugulin, Fernanda Maria Togeiro

    2012-01-01

    The objective of this quantitative, correlational and descriptive study was to analyze the time the nursing staff spends to assist patients in Adult Intensive Care Units, as well as to verify its correlation with quality care indicators. The average length of time spent on care and the quality care indicators were identified by consulting management instruments the nursing head of the Unit employs. The average hours of nursing care delivered to patients remained stable, but lower than official Brazilian agencies' indications. The correlation between time of nursing care and the incidence of accidental extubation indicator indicated that it decreases with increasing nursing care delivered by nurses. The results of this investigation showed the influence of nursing care time, provided by nurses, in the outcome of care delivery.

  10. High-intensity telemedicine-enhanced acute care for older adults: an innovative healthcare delivery model.

    PubMed

    Shah, Manish N; Gillespie, Suzanne M; Wood, Nancy; Wasserman, Erin B; Nelson, Dallas L; Dozier, Ann; McConnochie, Kenneth M

    2013-11-01

    Accessing timely acute medical care is a challenge for older adults. This article describes an innovative healthcare model that uses high-intensity telemedicine services to provide rapid acute care for older adults without requiring them to leave their senior living community (SLC) residences. This program, based in a primary care geriatrics practice that cares for SLC residents, is designed to offer acute care through telemedicine for complaints that are felt to need attention before the next available outpatient visit but not to require emergency department (ED) resources. This option gives residents access to care in their residence. Measures used to evaluate the program include successful completion of telemedicine visits, satisfaction of residents and caregivers with telemedicine care, and site of care that would have been recommended had telemedicine been unavailable. During the first 2 years of the program's operation, 281 of 301 requested telemedicine visits were completed successfully. Twelve residents were sent to an ED for care after the telemedicine visit. Ninety-four percent of residents reported being satisfied or very satisfied with telemedicine care. Had telemedicine not been available, residents would have been sent to an ED (48.1%) or urgent care center (27.0%) or been scheduled for an outpatient visit (24.4%). The project demonstrated that high-intensity telemedicine services for acute illnesses are feasible and acceptable and can provide definitive care without requiring ED or urgent care use. Continuation of the program will require evaluation demonstrating equal or better resident-level outcomes and the development of sustainable business models.

  11. Low intensity, long term exposure to tobacco smoke inhibits hippocampal neurogenesis in adult mice.

    PubMed

    Csabai, Dávid; Csekő, Kata; Szaiff, Lilla; Varga, Zsófia; Miseta, Attila; Helyes, Zsuzsanna; Czéh, Boldizsár

    2016-04-01

    Previous data have shown that high dose of nicotine administration or tobacco smoke exposure can reduce cell formation and the survival rate of adult-born neurons in the dentate gyrus. Here, we subjected adult mice to low intensity cigarette smoke exposure over long time periods. We did a 2×30min/day smoke exposure with two cigarettes per occasion over 1- or 2-months. Subsequently, we carried out a systematic quantitative histopathological analysis to assess the number of newborn neurons in the dentate gyrus. To investigate cell proliferation, the exogenous marker 5-bromo-2'-deoxyuridine (BrdU) was administered on the last experimental day and animals were sacrificed 2h later. To investigate the effect of tobacco smoke on the population of immature neurons, we quantified the number of doublecortin-positive (DCX+) neurons in the same animals. We found that exposing animals to cigarette smoke for 1- or 2-months had no influence on cell proliferation rate, but significantly reduced the number of DCX-positive immature neurons. Our tobacco smoke exposure regimen caused no substantial changes in respiratory functions, but histopathological analysis of the pulmonary tissue revealed a marked perivascular/peribronchial edema formation after 1-month and signs of chronic pulmonary inflammation after 2-months of cigarette smoke exposure. These data demonstrate that even mild exposure to cigarette smoke, without significantly affecting respiratory functions, can have a negative effect on adult-born neurons in the dentate gyrus, when applied over longer time periods. Our data indicate that besides nicotine other factors, such as inflammatory mediators, may also contribute to this effect.

  12. Outcomes of Older Adults With Sepsis at Admission to an Intensive Care Unit

    PubMed Central

    Rowe, Theresa; Araujo, Katy L. B.; Van Ness, Peter H.; Pisani, Margaret A.; Juthani-Mehta, Manisha

    2016-01-01

    Background. Sepsis is a major cause of morbidity and mortality among older adults. The main goals of this study were to assess the association of sepsis at intensive care unit (ICU) admission with mortality and to identify predictors associated with increased mortality in older adults. Methods. We conducted a prospective cohort study of 309 participants ≥60 years admitted to an ICU. Sepsis was defined as 2 of 4 systemic inflammatory response syndrome criteria plus a documented infection within 2 calendar days before or after admission. The main outcome measure was time to death within 1 year of ICU admission. Sepsis was evaluated as a predictor for mortality in a Cox proportional hazards model. Results. Of 309 participants, 196 (63%) met the definition of sepsis. Among those admitted with and without sepsis, 75 (38%) vs 20 (18%) died within 1 month of ICU admission (P < .001) and 117 (60%) vs 48 (42%) died within 1 year (P < .001). When adjusting for baseline characteristics, sepsis had a significant impact on mortality (hazard ratio [HR] = 1.80; 95% confidence interval [CI], 1.28–2.52; P < .001); however, after adjusting for baseline characteristics and process covariates (antimicrobials and vasopressor use within 48 hours of admission), the impact of sepsis on mortality became nonsignificant (HR = 1.26; 95% CI, .87–1.84; P = .22). Conclusions. The diagnosis of sepsis in older adults upon ICU admission was associated with an increase in mortality compared with those admitted without sepsis. After controlling for early use of antimicrobials and vasopressors for treatment, the association of sepsis with mortality was reduced. PMID:26925430

  13. Graft failure following reduced-intensity cord blood transplantation for adult patients.

    PubMed

    Narimatsu, Hiroto; Kami, Masahiro; Miyakoshi, Shigesaburo; Murashige, Naoko; Yuji, Koichiro; Hamaki, Tamae; Masuoka, Kazuhiro; Kusumi, Eiji; Kishi, Yukiko; Matsumura, Tomoko; Wake, Atsushi; Morinaga, Shinichi; Kanda, Yoshinobu; Taniguchi, Shuichi

    2006-01-01

    We reviewed the medical records of 123 adult reduced-intensity cord blood transplantation (RI-CBT) recipients to investigate the clinical features of graft failure after RI-CBT. Nine (7.3%) had graft failure, and were classified as graft rejection rather than primary graft failure; they showed peripheral cytopenia with complete loss of donor-type haematopoiesis, implying destruction of donor cells by immunological mechanisms rather than poor graft function. Three of them died of bacterial or fungal infection during neutropenia. Two recovered autologous haematopoiesis. The remaining four patients underwent a second RI-CBT and developed severe regimen-related toxicities. One died of pneumonia on day 8, and the other three achieved engraftment. Two of them died of transplant-related mortality, and the other survived without disease progression for 9.0 months after the second RI-CBT. In total, seven of the nine patients with graft failure died. The median survival of those with graft failure was 3.8 months (range, 0.9-15.4). Graft failure is a serious complication of RI-CBT. As host T cells cannot completely be eliminated by reduced-intensity preparative regimens, we need to be aware of the difficulty in differentiating graft rejection from other causes of graft failure following RI-CBT. Further studies are warranted to establish optimal diagnostic and treatment strategies.

  14. Drug incompatibilities in the adult intensive care unit of a university hospital

    PubMed Central

    Marsilio, Naiane Roveda; da Silva, Daiandy; Bueno, Denise

    2016-01-01

    Objectives This study sought to identify the physical and chemical incompatibilities among the drugs administered intravenously to patients admitted to an adult intensive care unit. We also aimed to establish pharmaceutical guidelines for administering incompatible drugs. Methods This cross-sectional, prospective, and quantitative study was conducted from July to September 2015. Drug incompatibilities were identified based on an analysis of the patient prescriptions available in the hospital online management system. A pharmaceutical intervention was performed using the guidelines on the preparation and administration of incompatible drugs. Adherence to those guidelines was subsequently assessed among the nursing staff. Results A total of 100 prescriptions were analyzed; 68 were incompatible with the intravenous drugs prescribed. A total of 271 drug incompatibilities were found, averaging 4.0 ± 3.3 incompatibilities per prescription. The most commonly found drug incompatibilities were between midazolam and hydrocortisone (8.9%), between cefepime and midazolam (5.2%), and between hydrocortisone and vancomycin (5.2%). The drugs most commonly involved in incompatibilities were midazolam, hydrocortisone, and vancomycin. The most common incompatibilities occurred when a drug was administered via continuous infusion and another was administered intermittently (50%). Of the 68 prescriptions that led to pharmaceutical guidelines, 45 (66.2%) were fully adhered to by the nursing staff. Conclusion Patients under intensive care were subjected to a high rate of incompatibilities. Drug incompatibilities can be identified and eliminated by the pharmacist on the multidisciplinary team, thereby reducing undesirable effects among patients. PMID:27410410

  15. Mental health in young adults and adolescents - supporting general physicians to provide holistic care.

    PubMed

    Jurewicz, Izabela

    2015-04-01

    In the era of an ageing population, young adults on medical wards are quite rare, as only 12% of young adults report a long-term illness or disability. However, mental health problems remain prevalent in the younger population. In a recent report, mental health and obesity were listed as the most common problems in young adults. Teams set up specifically for the needs of younger adults, such as early intervention in psychosis services are shown to work better than traditional care and have also proven to be cost effective. On the medical wards, younger patients may elicit strong emotions in staff, who often feel protective and may identify strongly with the young patient's suffering. In order to provide holistic care for young adults, general physicians need to recognise common presentations of mental illness in young adults such as depression, deliberate self-harm, eating disorders and substance misuse. Apart from treating illness, health promotion is particularly important for young adults.

  16. Comorbidity, age and mortality among adults treated intensively for acute myeloid leukemia (AML)

    PubMed Central

    Tawfik, Bernard; Pardee, Timothy; Isom, Scott; Sliesoraitis, Sarunas; Winter, Allison; Lawrence, Julia; Powell, Bayard L.; Klepin, Heidi D.

    2015-01-01

    Introduction Our goal was to characterize comorbidities among adults receiving intensive therapy for AML, and investigate their association with outcomes. Methods We retrospectively analyzed 277 consecutive patients with newly diagnosed AML treated intensively at the Comprehensive Cancer Center of Wake Forest University from 2002–2009. Pretreatment comorbidities were identified by ICD-9 codes and chart review. Comorbidity burden (modified Charlson Comorbidity Index [CCI]) and specific conditions were analyzed individually. Outcomes were overall survival (OS), remission, and 30-day mortality. Covariates included age, gender, cytogenetic characteristics, hemoglobin, white cell count, lactate dehydrogenase, body mass index, and insurance type. Cox proportional hazards models were used to evaluate OS; logistic regression was used for remission and 30-day mortality. Results In this series, 144 patients were ≥60 years old (median age 70 years, median survival 8.7 months) and 133 were <60 years (median age 47 years, median survival 23.1 months). Older patients had a higher comorbidity burden (CCI≥1 58% versus 26%, p<0.001). Prevalent comorbid conditions differed by age (diabetes 19.2% versus 7.5%; cardiovascular disease 12.5% versus 4.5%, for older versus younger patients, respectively). The CCI was not independently associated with OS or 30-day mortality in either age group. Among older patients, diabetes was associated with higher 30-day mortality (33.3% vs. 12.0% in diabetic vs. non diabetic patients, p =0.006). Controlling for age, cytogenetic characteristics and other comorbidities, the presence of diabetes increased the odds of 30-day mortality by 4.9 (CI 1.6–15.2) times. Discussion Diabetes is adversely associated with 30-day survival in older AML patients receiving intensive therapy. PMID:26527394

  17. Prevalence of Chronic Medical Conditions in Adults with Mental Retardation: Comparison with the General Population.

    ERIC Educational Resources Information Center

    Kapell, Deborah; Nightingale, Beryle; Rodriguez, Ana; Lee, Joseph H.; Zigman, Warren B.; Schupf, Nicole

    1998-01-01

    A study interviewed caregivers and reviewed medical records of 278 adults with mental retardation with and without Down syndrome. The adults with mental retardation had age-related disorders comparable to those in the general population, but there was an increased frequency of thyroid disorders, nonischemic heart disorders, and sensory impairment.…

  18. General Education Development (GED®) Credential Attainment, Externalizing Disorders, and Substance Use Disorders in Disconnected Emerging Adults

    ERIC Educational Resources Information Center

    Bergman, Andrea; Kong, Grace; Pope, Alice

    2014-01-01

    There are many benefits for emerging adults, both financial and personal, in obtaining a General Education Development (GED®) credential (Ou, 2008). However, little is known about the correlates of GED® credential attainment in "disconnected" emerging adults attending GED® programs. Our goal was to examine whether externalizing…

  19. [Adult immunisation: General points, hot topics and perspectives].

    PubMed

    Loubet, P; Launay, O

    2017-02-14

    Vaccination in immunocompetent adult mainly concerns booster vaccination against diphtheria, tetanus, polio and pertussis. Some chronic diseases may also require the achievement of pneumococcal and influenza vaccines. In addition, from the age of 65, annual influenza vaccination as well as one dose of a live attenuated shingles vaccine between 64 and 75 years are recommended. Immunocompromised adults, due to the increased risk of serious infections responsible of significant morbidity and mortality, are particularly concerned by vaccination. Main issues in this population are the decreased immunogenicity and efficacy of vaccination and the risk of infection with live attenuated vaccines and. Depending on the type of immunosuppression, the recommended vaccines and vaccination schemes differ. Vaccination of healthy persons caring or residing with immunocompromised patients is an important point in the vaccine strategy. The current perspectives in vaccinology concern the development of vaccines against healthcare associated infections (Clostridium difficile and Staphylococcus aureus in particular), the strategy of vaccination during pregnancy to protect new-borns (respiratory syncytial virus, group B streptococcus) and the development of new adjuvants and new routes of immunization. With the overall decline in immunization coverage and increasing distrust of vaccination, the problem of vaccine hesitancy is also a hot topic. The reasons for doubt in the vaccine usefulness and the solutions to be applied are also crucial issues.

  20. Measuring the effectiveness of an intensive IPV training program offered to Greek general practitioners and residents of general practice

    PubMed Central

    2013-01-01

    Background The need for effective training of primary care physicians in the prevention, detection and handling of intimate partner violence (IPV) has been widely acknowledged, given its frequency in daily practice. The current intervention study aimed to measure changes in the actual IPV knowledge, perceived knowledge, perceived preparedness and detection ability of practicing general practitioners (GPs) and general practice residents, following an intensive IPV training program. Methods A pre/post-test design with a control group was employed to compare changes in baseline measures of IPV at the post intervention stage and at 12 months. A total of 40 participants provided full data; 25 GPs (11 in the intervention and 14 in the control) and 15 residents (intervention only). Three scales of the PREMIS survey were used to draw information on the study outcomes. Results The training program met high acceptance by both groups of participants and high practicality in clinical practice. The GPs in the intervention group performed better than the GPs in the control group on “Perceived preparedness” and “Perceived knowledge” in both the post-intervention (p = .012, r = .50 and p = .001, r = .68) and the 12-month follow-up (p = .024, r = .45 and p = .007, r = .54) as well as better than the residents in “Perceived preparedness” at post-intervention level (p = .037, r = .41). Residents on the other hand, performed better than the GPs in the intervention group on “Actual knowledge” at the 12-month follow-up (p = .012, r = .49). No significant improvements or between group differences were found in terms of the self-reported detection of IPV cases. Conclusion Further studies are needed to decide whether residency training could serve as an early intervention stage for IPV training. PMID:23537186

  1. Application of Jean Piaget's theory of human development for nursing children in an adult intensive therapy unit.

    PubMed

    Green, A

    1991-12-01

    Piaget (1964) believed that interaction with the environment has a large part to play in human development. Matthew (1986) states that in an ideal world critically ill children should be cared for by staff trained in paediatrics, within designated paediatric intensive therapy units. Unfortunately, there are only 28 paediatric intensive therapy units in Great Britain (CMA Medical Data, 1987), consequently each year a third of children requiring intensive care are admitted to adult intensive therapy units (ITU). A knowledge and understanding of developmental psychology can therefore be beneficial to nurses in assessing which stage of development a child has reached, in order to plan the correct level of stimulation, and hence facilitate progress rather than regression in the accomplishment of developmental tasks. The psychological and social processes involved in Jean Piaget's (1896-1980) theory of human development are discussed with regard to nursing children requiring intubation and ventilation in an adult ITU.

  2. Pilot study: can older inactive adults learn how to reach the required intensity of physical activity guideline?

    PubMed Central

    Bouchard, Danielle R; Langlois, Marie-France; Boisvert-Vigneault, Katherine; Farand, Paul; Paulin, Mathieu; Baillargeon, Jean-Patrice

    2013-01-01

    Most individuals do not reach the recommended physical activity level of at least 150 minutes of aerobic exercise (AE) at moderate-to-vigorous intensity per week. For example, only 13% of older Canadian adults reach World Health Organization physical activity guideline (PAG). One of the reasons might be a difficulty identifying the required intensity. Twenty-five inactive older adults received one session about the AE-PAG and how to use a tool or strategy to help them identify AE intensity: heart-rate (HR) monitor (% of maximal HR; N = 9); manual pulse (% of maximal HR; N = 8); or pedometer (walking cadence; N = 8). Participants had 8 weeks to implement their specific tool with the aim of reaching the PAG by walking at home. At pre- and post-intervention, the capacity to identify AE intensity and AE time spent at moderate-to-vigorous intensity were evaluated. Only the two groups using a tool increased total AE time (both P < 0.01), but no group improved the time spent at moderate-to-vigorous intensity. No significant improvement was observed in the ability to correctly identify AE intensity in any of the groups, but a tendency was observed in the pedometer group (P = 0.07). Using walking cadence with a pedometer should be explored as a tool to reach the PAG as it is inexpensive, easy to use, and seemed the best tool to improve both AE time and perception of intensity. PMID:23662053

  3. Pilot study: can older inactive adults learn how to reach the required intensity of physical activity guideline?

    PubMed

    Bouchard, Danielle R; Langlois, Marie-France; Boisvert-Vigneault, Katherine; Farand, Paul; Paulin, Mathieu; Baillargeon, Jean-Patrice

    2013-01-01

    Most individuals do not reach the recommended physical activity level of at least 150 minutes of aerobic exercise (AE) at moderate-to-vigorous intensity per week. For example, only 13% of older Canadian adults reach World Health Organization physical activity guideline (PAG). One of the reasons might be a difficulty identifying the required intensity. Twenty-five inactive older adults received one session about the AE-PAG and how to use a tool or strategy to help them identify AE intensity: heart-rate (HR) monitor (% of maximal HR; N = 9); manual pulse (% of maximal HR; N = 8); or pedometer (walking cadence; N = 8). Participants had 8 weeks to implement their specific tool with the aim of reaching the PAG by walking at home. At pre- and post-intervention, the capacity to identify AE intensity and AE time spent at moderate-to-vigorous intensity were evaluated. Only the two groups using a tool increased total AE time (both P < 0.01), but no group improved the time spent at moderate-to-vigorous intensity. No significant improvement was observed in the ability to correctly identify AE intensity in any of the groups, but a tendency was observed in the pedometer group (P = 0.07). Using walking cadence with a pedometer should be explored as a tool to reach the PAG as it is inexpensive, easy to use, and seemed the best tool to improve both AE time and perception of intensity.

  4. Focal Epileptogenic Lesions in Adult Patients with Epilepsy and Generalized Epileptiform Discharges

    PubMed Central

    Kim, Dong Wook; Lee, Seo-Young; Lee, Sang Kun

    2016-01-01

    Background and Purpose There are reports of successful resective epilepsy surgery for pediatric patients with epilepsy and generalized epileptiform discharges when they had focal epileptogenic lesions identified by MRI. However, there is limited information regarding adult patients with epilepsy who have both generalized epileptiform discharges and focal epileptogenic lesions. Methods To investigate the incidence and characteristics of adult patients who have both generalized epileptiform discharges and potentially epileptogenic lesions, we retrospectively analyzed data of clinical features and results of EEG and MRI of all patients with adult-onset epilepsy in a tertiary referral hospital. Results While 1315 patients were classified as having partial seizures, 207 patients were classified as having generalized seizures. Five of 207 patients (2.4%) with generalized seizures had potentially epileptogenic lesions. All the epileptogenic lesions were congenital or acquired during early life, such as focal cortical dysplasia, dysembryoplastic neuroepithelial tumor, and cerebromalacic change because of perinatal injury. Conclusions The presence of epileptogenic lesions in adult patients with generalized epileptiform discharges may be an incidental finding, but it has been suggested that some adult-onset epilepsy with generalized epileptiform discharges may actually have focal onset, which may have significant clinical implications for the choice of appropriate treatment. PMID:28101478

  5. Diabetic ketoacidosis: Treatment in the intensive care unit or general medical/surgical ward?

    PubMed Central

    Mendez, Yamely; Surani, Salim; Varon, Joseph

    2017-01-01

    Diabetic ketoacidosis (DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This syndrome occurs as a result of insulin deficiency. Patients can be dramatically ill, however, with aggressive treatment, most patients recover rapidly. Despite being a low-risk condition, the development of acidosis, is one of the admission criteria to the intensive care unit (ICU) for these patients, in order to provide close monitoring, and recognize complications that could result from the use of aggressive therapy, such as continuous infusions if insulin. In some institutions, DKA is treated in the emergency department and general medical/surgical wards to avoid ICU overcrowding. PMID:28265341

  6. How to Study the Influence of Intensity of Treatment on Generalized Skill and Knowledge Acquisition in Students with Disabilities

    ERIC Educational Resources Information Center

    Yoder, Paul J.; Woynaroski, Tiffany

    2015-01-01

    Seven empirical studies from this special issue and an overview chapter are reviewed to illustrate several points about studying the possible effects of treatment intensity manipulations on generalized skill or knowledge acquisition in students with disabilities. First, we make a case in favor of studying intensity as separate from complexity and…

  7. Sex differences in the intensity and qualitative dimensions of exertional dyspnea in physically active young adults

    PubMed Central

    Cory, Julia M.; Schaeffer, Michele R.; Wilkie, Sabrina S.; Ramsook, Andrew H.; Puyat, Joseph H.; Arbour, Brandon; Basran, Robbi; Lam, Michael; Les, Christian; MacDonald, Benjamin; Jensen, Dennis

    2015-01-01

    Understanding sex differences in the qualitative dimensions of exertional dyspnea may provide insight into why women are more affected by this symptom than men. This study explored the evolution of the qualitative dimensions of dyspnea in 70 healthy, young, physically active adults (35 M and 35 F). Participants rated the intensity of their breathing discomfort (Borg 0-10 scale) and selected phrases that best described their breathing from a standardized list (work/effort, unsatisfied inspiration, and unsatisfied expiration) throughout each stage of a symptom-limited incremental-cycle exercise test. Following exercise, participants selected phrases that described their breathing at maximal exercise from a list of 15 standardized phrases. Intensity of breathing discomfort was significantly higher in women for a given ventilation, but differences disappeared when ventilation was expressed as a percentage of maximum voluntary ventilation. The dominant qualitative descriptor in both sexes throughout exercise was increased work/effort of breathing. At peak exercise, women were significantly more likely to select the following phrases: “my breathing feels shallow,” “I cannot get enough air in,” “I cannot take a deep breath in,” and “my breath does not go in all the way.” Women adopted a more rapid and shallow breathing pattern and had significantly higher end-inspiratory lung volumes relative to total lung capacity throughout exercise relative to men. These findings suggest that men and women do not differ in their perceived quality of dyspnea during submaximal exercise, but subjective differences appear at maximal exercise and may be related, at least in part, to underlying sex differences in breathing patterns and operating lung volumes during exercise. PMID:26338458

  8. MIMO FSO communication using subcarrier intensity modulation over double generalized gamma fading

    NASA Astrophysics Data System (ADS)

    Yi, Xiang; Yao, Mingwu; Wang, Xiaoyang

    2017-01-01

    Atmospheric turbulence-induced fading is known to have a serious detrimental effect on the performance of free-space optical (FSO) communication. The involvement of multiple lasers and photodetectors in FSO systems offers an effective way to overcome fading. Very recently, a new generic fading model, called double-generalized gamma (double GG), is developed for accurately describing irradiance fading over a wide range of turbulence conditions. Therefore, for a general and exact study of the multiple-input multiple-output (MIMO) FSO system, the double GG fading model is adopted in this paper. We investigate the MIMO FSO systems using subcarrier intensity modulation. Two typical transmit diversity schemes, repetition code (RC) and orthogonal space-time block code (OSTBC), are considered. We first propose a new power series expression for the probability density function of the double GG fading. Then we derive the average error rate expressions for both schemes in terms of double power series. The truncated forms of the derived power series enable the rapid and accurate numerical computation of the error rates. Furthermore, we present the asymptotic error rate analyses at high electrical signal-to-noise ratio (SNR) for both schemes. Closed-form diversity order and coding gain for both schemes are also obtained. Our numerical results, verified by simulation, confirm that RC outperforms OSTBC for MIMO FSO systems with subcarrier intensity modulation in double GG fading. The asymptotic coding gain of the RC scheme over the OSTBC scheme is analytically quantified for varying degrees of the fading strength.

  9. Little Relation of Adult Age with Cognition after Controlling General Influences

    ERIC Educational Resources Information Center

    Salthouse, Timothy A.

    2016-01-01

    Both general (i.e., shared across different cognitive measures) and specific (i.e., unique to particular cognitive measures) influences can be postulated to contribute to the relations between adult age and measures of cognitive functioning. Estimates of general and specific influences on measures of memory, speed, reasoning, and spatial…

  10. Cost considerations for the use of low-air-loss bed therapy in adult intensive care.

    PubMed

    Hibbert, C L; Edbrooke, D L; Corcoran, M; Bright, N N; Kingsley, J N

    1999-06-01

    The aim of this study was to consider the costs of low-air-loss bed therapy in the adult intensive care unit (ICU). A retrospective cost analysis was performed on 269 consecutive patients, 63 of whom had received low-air-loss bed therapy. Patients' APACHE II scores, length of stay (LOS), average daily TISS and ICU outcomes were also collected. Patients' APACHE II and LOS were further studied using odds ratios to test for an association between these factors and likelihood of receiving bed therapy. A prospective 10-week study to identify the amount of nursing time spent repositioning patients was also performed. The results of this study found the bed therapy to represent approximately 3% of the total average cost of care per patient. Patients requiring the bed therapy had higher APACHE II scores on admission, higher average daily TISS points and a longer length of ICU stay. Study of the odds ratios would suggest that the likelihood of patients receiving low-air-loss bed therapy increases if their APACHE II score on admission is between 11 and 20 and they stay > 4.5 days in the ICU. The results of the prospective study found the daily cost of repositioning patients to be 172.80 Pounds per patient.

  11. Disseminated tuberculosis following reduced-intensity cord blood transplantation for adult patients with hematological diseases.

    PubMed

    Maeda, T; Kusumi, E; Kami, M; Kawabata, M; Le Pavoux, A; Hara, S; Chizuka, A; Murashige, N; Tanimoto, T E; Matsumura, T; Yuji, K; Yuji, Ko; Wake, A; Miyakoshi, S; Morinaga, S; Taniguchi, S

    2005-01-01

    Allogeneic hematopoietic stem cell transplantation (allo-SCT) recipients are prone to infections. The incidences of mycobacterial infections after allo-SCT in several case series vary from less than 0.1-5.5%. However, no study has been published on tuberculosis following unrelated cord blood transplantation (UCBT). We retrospectively reviewed medical records of 113 adult patients with a median age of 54 years who underwent reduced-intensity UCBT (RI-UCBT) at Toranomon Hospital from March 2002 to May 2004. Mycobacterium tuberculosis infections were diagnosed in three patients (2.7%), of these two patients developed primary infection and one patient developed reactivation of latent tuberculosis. The interval between RI-UCBT and the diagnosis of tuberculosis was 34, 41 and 61 days. All the patients had disseminated disease at diagnosis. Histological examination showed the lack of granuloma in caseous necrosis. Combination antituberculous treatments showed limited efficacy, and two patients died immediately after diagnosis. M. tuberculosis caused life-threatening illness, rapidly progressing in RI-UCBT recipients. The lack of granuloma in caseous necrosis suggests the impaired T-cell function in early post transplant phase of RI-UCBT. We should consider M. tuberculosis in the differential diagnoses of fever of unknown source after RI-UCBT.

  12. Invasive fungal infection following reduced-intensity cord blood transplantation for adult patients with hematologic diseases.

    PubMed

    Miyakoshi, Shigesaburo; Kusumi, Eiji; Matsumura, Tomoko; Hori, Akiko; Murashige, Naoko; Hamaki, Tamae; Yuji, Koichiro; Uchida, Naoyuki; Masuoka, Kazuhiro; Wake, Atsushi; Kanda, Yoshinobu; Kami, Masahiro; Tanaka, Yuji; Taniguchi, Shuichi

    2007-07-01

    Invasive fungal infection (IFI) is a significant complication after allogeneic hematopoietic stem cell transplantation (HSCT); however, we have little information on its clinical features after reduced intensity cord blood transplantation (RICBT) for adults. We reviewed medical records of 128 patients who underwent RICBT at Toranomon Hospital between March 2002 and November 2005. Most of the patients received purine-analogbased preparative regimens. Graft-versus-host disease (GVHD) prophylaxis was a continuous infusion of either tacrolimus 0.03 mg/kg or cyclosporine 3 mg/kg. IFI was diagnosed according to the established EORTC/NIH-MSG criteria. IFI was diagnosed in 14 patients. Thirteen of the 14 had probable invasive pulmonary aspergillosis and the other had fungemia resulting from Trichosporon spp. Median onset of IFI was day 20 (range: 1-82), and no patients developed IFI after day 100. Three-year cumulative incidence of IA was 10.2%. Four of the 13 patients with invasive aspergillosis (IA) developed grade II-IV acute GVHD, and their IA was diagnosed before the onset of acute GVHD. The mortality rate of IFI was 86%. Multivariate analysis revealed that the use of prednisolone >0.2 mg/kg (relative risk 7.97, 95% confidence interval 2.24-28.4, P = .0014) was a significant risk factor for IA. This study suggests that IFI is an important cause of deaths after RICBT, and effective strategies are warranted to prevent IFI.

  13. Cytomegalovirus infections following umbilical cord blood transplantation using reduced intensity conditioning regimens for adult patients.

    PubMed

    Matsumura, Tomoko; Narimatsu, Hiroto; Kami, Masahiro; Yuji, Koichiro; Kusumi, Eiji; Hori, Akiko; Murashige, Naoko; Tanaka, Yuji; Masuoka, Kazuhiro; Wake, Atsushi; Miyakoshi, Shigesaburo; Kanda, Yoshinobu; Taniguchi, Shuichi

    2007-05-01

    Cytomegalovirus (CMV) infection is a major complication after allogeneic hematopoietic stem cell transplantation (Allo-HSCT); however, we have little information on the clinical features of CMV reactivation after cord blood transplantation using reduced-intensity regimens (RI-CBT) for adults. We reviewed medical records of 140 patients who underwent RI-CBT at Toranomon Hospital between January 2002 and March 2005. All the patients were monitored for CMV-antigenemia weekly, and, if turned positive, received preemptive foscarnet or ganciclovir. Seventy-seven patients developed positive antigenemia at a median onset of day 35 (range, 4-92) after transplant. Median of the maximal number of CMV pp65-positive cells per 50,000 cells was 22 (range, 1-1806). CMV disease developed in 22 patients on a median of day 35 (range, 15-106); 21 had enterocolitis and 1 had adrenalitis. CMV antigenemia had not been detected in 2 patients, when CMV disease was diagnosed. CMV disease was successfully treated using ganciclovir or foscarnet in 14 patients. The other 8 patients died without improvement of CMV disease. In multivariate analysis, grade II-IV acute graft-versus-host disease was a risk factor of CMV disease (relative risk 3.48, 95% confidential interval 1.47-8.23). CMV reactivation and disease develop early after RI-CBT. CMV enterocolitis may be a common complication after RI-CBT.

  14. Epidemiological features of influenza in Canadian adult intensive care unit patients.

    PubMed

    Taylor, G; Abdesselam, K; Pelude, L; Fernandes, R; Mitchell, R; McGeer, A; Frenette, C; Suh, K N; Wong, A; Katz, K; Wilkinson, K; Mersereau, T; Gravel, D

    2016-03-01

    To identify predictive factors and mortality of patients with influenza admitted to intensive care units (ICU) we carried out a prospective cohort study of patients hospitalized with laboratory-confirmed influenza in adult ICUs in a network of Canadian hospitals between 2006 and 2012. There were 626 influenza-positive patients admitted to ICUs over the six influenza seasons, representing 17·9% of hospitalized influenza patients, 3·1/10,000 hospital admissions. Variability occurred in admission rate and proportion of hospital influenza patients who were admitted to ICUs (proportion range by year: 11·7-29·4%; 21·3% in the 2009-2010 pandemic). In logistic regression models ICU patients were younger during the pandemic and post-pandemic period, and more likely to be obese than hospital non-ICU patients. Influenza B accounted for 14·2% of all ICU cases and had a similar ICU admission rate as influenza A. Influenza-related mortality was 17·8% in ICU patients compared to 2·0% in non-ICU patients.

  15. Gram-Negative Infections in Adult Intensive Care Units of Latin America and the Caribbean

    PubMed Central

    Luna, Carlos M.; Rodriguez-Noriega, Eduardo; Bavestrello, Luis; Guzmán-Blanco, Manuel

    2014-01-01

    This review summarizes recent epidemiology of Gram-negative infections in selected countries from Latin American and Caribbean adult intensive care units (ICUs). A systematic search of the biomedical literature (PubMed) was performed to identify articles published over the last decade. Where appropriate, data also were collected from the reference list of published articles, health departments of specific countries, and registries. Independent cohort data from all countries (Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Trinidad and Tobago, and Venezuela) signified a high rate of ICU infections (prevalence: Argentina, 24%; Brazil, 57%). Gram-negative pathogens, predominantly Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, accounted for >50% of ICU infections, which were often complicated by the presence of multidrug-resistant strains and clonal outbreaks. Empirical use of antimicrobial agents was identified as a strong risk factor for resistance development and excessive mortality. Infection control strategies utilizing hygiene measures and antimicrobial stewardship programs reduced the rate of device-associated infections. To mitigate the poor health outcomes associated with infections by multidrug-resistant Gram-negative bacteria, urgent focus must be placed on infection control strategies and local surveillance programs. PMID:25525515

  16. Trends in Antibiotic Prescribing in Adults in Dutch General Practice

    PubMed Central

    Haeseker, Michiel B.; Dukers-Muijrers, Nicole H. T. M.; Hoebe, Christian J. P. A.; Bruggeman, Cathrien A.; Cals, Jochen W. L.; Verbon, Annelies

    2012-01-01

    Background Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this study was to determine the antibiotic prescriptions of different antibiotic classes in general practice in relation to age. Methodology Retrospective study of 22 rural and urban general practices from the Dutch Registration Network Family Practices (RNH). Antibiotic prescribing data were extracted from the RNH database from 2000–2009. Trends over time in antibiotic prescriptions were assessed with multivariate logistic regression including interaction terms with age. Registered ADEs as a result of antibiotic prescriptions were also analyzed. Principal Findings In total 658,940 patients years were analyzed. In 11.5% (n = 75,796) of the patient years at least one antibiotic was prescribed. Antibiotic prescriptions increased for all age categories during 2000–2009, but the increase in elderly patients (>80 years) was most prominent. In 2000 9% of the patients >80 years was prescribed at least one antibiotic to 22% in 2009 (P<0.001). Elderly patients had more ADEs with antibiotics and co-medication was identified as the only independent determinant for ADEs. Conclusion/Discussion The rate of antibiotic prescribing for patients who made a visit to the GP is increasing in the Netherlands with the most evident increase in the elderly patients. This may lead to more ADEs, which might lead to higher consumption of health care and more antibiotic resistance. PMID:23251643

  17. E. coli outbreak in a neonate intensive care unit in a general hospital in Mexico City.

    PubMed

    Carrillo-Casas, Erika Margarita; Suástegui-Urquijo, Zaydy; Arroyo-Escalante, Sara; Morales-Espinosa, Rosario; Moncada-Barrón, David; Hernández-Delgado, Lorena; Méndez-Sánchez, José Luis; Delgado-Sapién, Gabriela; Navarro-Ocaña, Armando; Manjarrez-Hernández, Ángel; Xicohtencatl-Cortes, Juan; Hernández-Castro, Rigoberto

    2013-05-01

    Nosocomial infections are a major cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs). The aim of this paper was to describe an outbreak of Escherichia coli among infants admitted to the NICU of the General Hospital "Dr. Manuel Gea Gonzalez" in May of 2008. The isolated E. coli strains were identified using standard biochemical methods. The susceptibilities of these strains were analysed by determining their minimal inhibitory concentrations. Following this, their molecular relationships to each other were assessed by pulsed field gel electrophoresis (PFGE) analysis and corroborated by serology. Twelve E. coli strains were isolated from blood, urine, or indwelling catheter samples from five cases of preterm infants within a 3-day period. Patients were admitted to the NICU of the general hospital and, during the outbreak, developed sepsis caused by E. coli. For four of the patients, the average age was 23 days, while one patient was a 3-month-old infant. Prior to sepsis, the infants had received assisted ventilation and hyperalimentation through a central venous catheter. Two profiles were observed by PFGE; profile A was identified as the outbreak's cause and an outcome of cross-infection, while profile B showed genetic differences but serologically it was identified as part of the same serotype. We conclude that E. coli colonised the patients through horizontal transmission. A focal source of the microorganism in this outbreak was not identified, but cross-transmission through handling was the most probable route.

  18. Mortality Among Adults With Intellectual Disability in England: Comparisons With the General Population

    PubMed Central

    Hosking, Fay J.; Shah, Sunil M.; Harris, Tess; DeWilde, Stephen; Beighton, Carole; Cook, Derek G.

    2016-01-01

    Objectives. To describe mortality among adults with intellectual disability in England in comparison with the general population. Methods. We conducted a cohort study from 2009 to 2013 using data from 343 general practices. Adults with intellectual disability (n = 16 666; 656 deaths) were compared with age-, gender-, and practice-matched controls (n = 113 562; 1358 deaths). Results. Adults with intellectual disability had higher mortality rates than controls (hazard ratio [HR] = 3.6; 95% confidence interval [CI] = 3.3, 3.9). This risk remained high after adjustment for comorbidity, smoking, and deprivation (HR = 3.1; 95% CI = 2.7, 3.4); it was even higher among adults with intellectual disability and Down syndrome or epilepsy. A total of 37.0% of all deaths among adults with intellectual disability were classified as being amenable to health care intervention, compared with 22.5% in the general population (HR = 5.9; 95% CI = 5.1, 6.8). Conclusions. Mortality among adults with intellectual disability is markedly elevated in comparison with the general population, with more than a third of deaths potentially amenable to health care interventions. This mortality disparity suggests the need to improve access to, and quality of, health care among people with intellectual disability. PMID:27310347

  19. Urinary tract infections in adult general practice patients.

    PubMed Central

    Hummers-Pradier, Eva; Kochen, Michael M

    2002-01-01

    Urinary tract infections (UTIs) are symptomatic infections of the urinary tract, mainly caused by the bacterium Escherichia coli. One in two women suffers from a UTI at least once in her life. The young and sexually active are particulaly affected, but it is also seen in elderly, postmenopausal women. The likelihood of recurrence is high. Diagnosis is made with regard to typical complaints and the presence of leucocytes and nitrites in the urine. A culture is unnecessary in most cases. Uncomplicated UTI should be distinguished from complicated UTI, which has a risk of severe illness. The treatment of choice--short-term therapy with trimethoprim or nitrofurantoin--is successful in over 80% of the cases. Co-trimoxazol fluoroquinolones or cephalsporins are not considered first-choice drugs. There are indications that general practitioners' (GPs') management of UTI is not always optimal, specifically concerning diagnostic tests, the application of second-choice antibiotics, and the length of prescribed treatment courses. Many points relevant to GPs requirefurther research, such as epidemiology and resistance of urinary pathogens in the community and natural history of UTI, as well as optimal management in elderly or complicated patients and men. PMID:12236281

  20. High-Intensity Interval Training as an Efficacious Alternative to Moderate-Intensity Continuous Training for Adults with Prediabetes

    PubMed Central

    Jung, Mary E.; Bourne, Jessica E.; Beauchamp, Mark R.; Robinson, Emily; Little, Jonathan P.

    2015-01-01

    Aims. High-intensity interval training (HIIT) leads to improvements in various markers of cardiometabolic health but adherence to HIIT following a supervised laboratory intervention has yet to be tested. We compared self-report and objective measures of physical activity after one month of independent exercise in individuals with prediabetes who were randomized to HIIT (n = 15) or traditional moderate-intensity continuous training (MICT, n = 17). Method. After completing 10 sessions of supervised training participants were asked to perform HIIT or MICT three times per week for four weeks. Results. Individuals in HIIT (89 ± 11%) adhered to their prescribed protocol to a greater extent than individuals in MICT (71 ± 31%) as determined by training logs completed over one-month follow-up (P = 0.05, Cohen's d = 0.75). Minutes spent in vigorous physical activity per week measured by accelerometer were higher in HIIT (24 ± 18) as compared to MICT (11 ± 10) at one-month follow-up (P = 0.049, Cohen's d = 0.92). Cardiorespiratory fitness and systolic blood pressure assessed at one-month follow-up were equally improved (P's < 0.05). Conclusions. This study provides preliminary evidence that individuals with prediabetes can adhere to HIIT over the short-term and do so at a level that is greater than MICT. PMID:25918728

  1. Contribution of Occupation to High Doses of Light-Intensity Activity and Cardiovascular Risk Factors among Mexican American Adults

    PubMed Central

    Gay, Jennifer L.; Kohl, Harold W.; Salinas, Jennifer J.; McCormick, Joseph B.; Fisher-Hoch, Susan P.

    2015-01-01

    Background The association between light-intensity activity and cardiovascular disease risk is not well understood. The purpose of this study was to determine the association of light-intensity activity with census-based occupational activity classifications and cardiovascular risk factors among Mexican American adults. Methods 118 Mexican American adults (68.6% female) provided cross-sectional accelerometer and biological data. Self-reported occupations were classified by activity level (sedentary, low, moderate). Participants were classified as At-Risk for BMI, glucose, triglycerides, HDL, blood pressure, waist circumference, and percent body fat. Results Participants engaged in > 5 hours of light-intensity activity on average, and those in sedentary occupations engaged in fewer light-intensity activity minutes than low-active or moderately active workers (P < .001). Self-reported occupation explained 14% of the variation in light-intensity activity (P < .001). Participants in moderately active occupations were at increased risk for high %body fat than other workers (P = .01), but no other associations between occupation and cardiovascular risk were detected. Conclusion Early work in physical activity underscored the importance of occupational activity. This study presents evidence of a dose-response association for light-intensity activity by occupational category such that workers in sedentary occupations had less light-intensity activity than employees in more active occupations. Future research on how light-intensity activity derived from occupation may reduce the risk of chronic disease will contribute to improved interventions as light-intensity activity participation may be more feasible than meeting current physical activity guidelines. PMID:24368819

  2. Generalized Kapchinskij-Vladimirskij Distribution and Envelope Equation for High-intensity Beams in a Coupled Transverse Focusing Lattice

    SciTech Connect

    Hong Qin, Moses Chung, and Ronald C. Davidson

    2009-11-20

    In an uncoupled lattice, the Kapchinskij-Vladimirskij (KV) distribution function first analyzed in 1959 is the only known exact solution of the nonlinear Vlasov-Maxwell equations for high- intensity beams including self-fields in a self-consistent manner. The KV solution is generalized here to high-intensity beams in a coupled transverse lattice using the recently developed generalized Courant-Snyder invariant for coupled transverse dynamics. This solution projects to a rotating, pulsating elliptical beam in transverse configuration space, determined by the generalized matrix envelope equation.

  3. Lower survival probabilities for adult Florida manatees in years with intense coastal storms

    USGS Publications Warehouse

    Langtimm, C.A.; Beck, C.A.

    2003-01-01

    The endangered Florida manatee (Trichechus manatus latirostris) inhabits the subtropical waters of the southeastern United States, where hurricanes are a regular occurrence. Using mark-resighting statistical models, we analyzed 19 years of photo-identification data and detected significant annual variation in adult survival for a subpopulation in northwest Florida where human impact is low. That variation coincided with years when intense hurricanes (Category 3 or greater on the Saffir-Simpson Hurricane Scale) and a major winter storm occurred in the northern Gulf of Mexico. Mean survival probability during years with no or low intensity storms was 0.972 (approximate 95% confidence interval = 0.961-0.980) but dropped to 0.936 (0.864-0.971) in 1985 with Hurricanes Elena, Kate, and Juan; to 0.909 (0.837-0.951) in 1993 with the March "Storm of the Century"; and to 0.817 (0.735-0.878) in 1995 with Hurricanes Opal, Erin, and Allison. These drops in survival probability were not catastrophic in magnitude and were detected because of the use of state-of-the-art statistical techniques and the quality of the data. Because individuals of this small population range extensively along the north Gulf coast of Florida, it was possible to resolve storm effects on a regional scale rather than the site-specific local scale common to studies of more sedentary species. This is the first empirical evidence in support of storm effects on manatee survival and suggests a cause-effect relationship. The decreases in survival could be due to direct mortality, indirect mortality, and/or emigration from the region as a consequence of storms. Future impacts to the population by a single catastrophic hurricane, or series of smaller hurricanes, could increase the probability of extinction. With the advent in 1995 of a new 25- to 50-yr cycle of greater hurricane activity, and longer term change possible with global climate change, it becomes all the more important to reduce mortality and injury

  4. Reaction of cells to local, regional, and general low-intensive laser irradiation

    NASA Astrophysics Data System (ADS)

    Baibekov, Iskander M.; Kasymov, A. S.; Musaev, Erkin S.; Vorojeikin, V. M.; Artikov, S. N.

    1993-07-01

    Local influence of low intensive laser irradiation (LILI) of Helium-Neon (HNL), Copper vapor (CVL), Nitrogen (UVL) and Arsenic Gallium (AGL) lasers cause stimulation of processes of physiological and reparative regeneration in intact skin, and mucous membrane of stomach and duodenum, dermatome wounds and gastroduodenal ulcers. Structural bases of these effects are the acceleration of cell proliferation and differentiation and also the activation of intracellular structures and intensification of cell secretion. Regional influence of the pointed types of LILI on hepar in cirrhosis and hepatitis causes decreasing of the inflammatory and cirrhotic changes. After endo- and exo-vascular laser irradiations of blood the decreasing of the number of pathological forms of erythrocytes and the increasing of their catalase activity, are indicated. General (total) laser irradiation of the organism--laser shower, increases the bone marrow cells proliferation, especially myeloid series. It is accompanied with acceleration of their differentiation and migration in circulation. It was revealed, that HNL to a considerable extent influences the epithelial cells and CVL the connective tissue cells. UVL increases the amount of microorganisms on cell surfaces (membrane bound microorganisms). Regional irradiation of the LILI causes both direct and indirect influence of cells. Structural changes of bone marrow cells and gut mucous membrane cells indicate intersystemic interaction.

  5. Developmental aspects of fear: Comparing the acquisition and generalization of conditioned fear in children and adults

    PubMed Central

    Schiele, Miriam A.; Reinhard, Julia; Reif, Andreas; Domschke, Katharina; Romanos, Marcel; Deckert, Jürgen

    2016-01-01

    ABSTRACT Most research on human fear conditioning and its generalization has focused on adults whereas only little is known about these processes in children. Direct comparisons between child and adult populations are needed to determine developmental risk markers of fear and anxiety. We compared 267 children and 285 adults in a differential fear conditioning paradigm and generalization test. Skin conductance responses (SCR) and ratings of valence and arousal were obtained to indicate fear learning. Both groups displayed robust and similar differential conditioning on subjective and physiological levels. However, children showed heightened fear generalization compared to adults as indexed by higher arousal ratings and SCR to the generalization stimuli. Results indicate overgeneralization of conditioned fear as a developmental correlate of fear learning. The developmental change from a shallow to a steeper generalization gradient is likely related to the maturation of brain structures that modulate efficient discrimination between danger and (ambiguous) safety cues. © 2016 The Authors. Developmental Psychobiology Published by Wiley Periodicals, Inc. Dev Psychobiol 58: 471–481, 2016. PMID:26798984

  6. [Invasive candidiasis in non-neutropenic adults : Guideline-based management in the intensive care unit].

    PubMed

    Glöckner, A; Cornely, O A

    2013-12-01

    Invasive Candida infections represent a diagnostic and therapeutic challenge for clinicians particularly in the intensive care unit (ICU). Despite substantial advances in antifungal agents and treatment strategies, invasive candidiasis remains associated with a high mortality. Recent guideline recommendations on the management of invasive candidiasis by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) from 2012, the German Speaking Mycological Society and the Paul Ehrlich Society for Chemotherapy (DMykG/PEG) from 2011 and the Infectious Diseases Society of America (IDSA) from 2009 provide valuable guidance for diagnostic procedures and treatment of these infections but need to be interpreted in the light of the individual situation of the patient and the local epidemiology of fungal pathogens. The following recommendations for management of candidemia are common to all three guidelines. Any positive blood culture for Candida indicates disseminated infection or deep organ infection and requires antifungal therapy. Treatment should be initiated as soon as possible. Removal or changing of central venous catheters or other foreign material in the bloodstream is recommended whenever possible. Ophthalmological examination for exclusion of endophthalmitis and follow-up blood cultures during therapy are also recommended. Duration of therapy should be 14 days after clearance of blood cultures and resolution of symptoms. Consideration of surgical options and a prolonged antifungal treatment (weeks to months) are required when there is organ involvement. During the last decade several new antifungal agents were introduced into clinical practice. These innovative drugs showed convincing efficacy and favorable safety in randomized clinical trials. Consequently, they were integrated in recent therapeutic guidelines, often replacing former standard drugs as first-line options. Echinocandins have emerged as the generally preferred primary treatment in

  7. Associations among depressive symptoms, childhood abuse, neuroticism, and adult stressful life events in the general adult population

    PubMed Central

    Ono, Kotaro; Takaesu, Yoshikazu; Nakai, Yukiei; Shimura, Akiyoshi; Ono, Yasuyuki; Murakoshi, Akiko; Matsumoto, Yasunori; Tanabe, Hajime; Kusumi, Ichiro; Inoue, Takeshi

    2017-01-01

    Background Recent studies have suggested that the interactions among several factors affect the onset, progression, and prognosis of major depressive disorder. This study investigated how childhood abuse, neuroticism, and adult stressful life events interact with one another and affect depressive symptoms in the general adult population. Subjects and methods A total of 413 participants from the nonclinical general adult population completed the Patient Health Questionnaire-9, the Child Abuse and Trauma Scale, the neuroticism subscale of the shortened Eysenck Personality Questionnaire – Revised, and the Life Experiences Survey, which are self-report scales. Structural equation modeling (Mplus version 7.3) and single and multiple regressions were used to analyze the data. Results Childhood abuse, neuroticism, and negative evaluation of life events increased the severity of the depressive symptoms directly. Childhood abuse also indirectly increased the negative appraisal of life events and the severity of the depressive symptoms through enhanced neuroticism in the structural equation modeling. Limitations There was recall bias in this study. The causal relationship was not clear because this study was conducted using a cross-sectional design. Conclusion This study suggested that neuroticism is the mediating factor for the two effects of childhood abuse on adulthood depressive symptoms and negative evaluation of life events. Childhood abuse directly and indirectly predicted the severity of depressive symptoms. PMID:28243100

  8. A Class Of Generalized Kapchinskij-Vladimirskij Solutions And Associated Envelope Equations For High-intensity Charged Particle Beams

    SciTech Connect

    Hong Qin and Ronald C. Davidson

    2012-04-25

    A class of generalized Kapchinskij-Vladimirskij solutions of the nonlinear Vlasov-Maxwell equations and the associated envelope equations for high-intensity beams in a periodic lattice is derived. It includes the classical Kapchinskij-Vladimirskij solution as a special case. For a given lattice, the distribution functions and the envelope equations are specified by eight free parameters. The class of solutions derived captures a wider range of dynamical envelope behavior for high-intensity beams, and thus provides a new theoretical tool to investigate the dynamics of high-intensity beams.

  9. Evaluation of a Rural-Based Community Aged Intensive Recovery Program for Older Adults With Severe Mental Illness.

    PubMed

    Sadler, Paul; McIlvena, Andrea

    2015-09-01

    Community Aged Intensive Recovery (CAIR) programs are an integral part of Aged Persons Mental Health Services (APMHS); however, no study has investigated whether a rural-based intensive program benefits older clients with severe mental illness. The current sample comprised 119 older adults who were being managed by a CAIR program from July 2011 to June 2013. Three key results were found: (a) approximately three quarters of clients admitted to the CAIR program remained treated in the community; (b) the program assisted in significantly reducing the level of psychiatric symptom severity from CAIR entry to CAIR exit; and (c) the APMHS team with the CAIR program had a lower psychiatric inpatient rate compared to the APMHS team without the program. The current study highlights the importance of delivering effective rural-based CAIR programs to older adults experiencing severe mental illness.

  10. Short-term high-intensity interval and moderate-intensity continuous training reduce leukocyte TLR4 in inactive adults at elevated risk of type 2 diabetes.

    PubMed

    Robinson, Emily; Durrer, Cody; Simtchouk, Svetlana; Jung, Mary E; Bourne, Jessica E; Voth, Elizabeth; Little, Jonathan P

    2015-09-01

    Exercise can have anti-inflammatory effects in obesity, but the optimal type and intensity of exercise are not clear. This study compared short-term high-intensity interval training (HIIT) with moderate-intensity continuous training (MICT) in terms of improvement in cardiorespiratory fitness, markers of inflammation, and glucose control in previously inactive adults at elevated risk of developing type 2 diabetes. Thirty-nine inactive, overweight/obese adults (32 women) were randomly assigned to 10 sessions over 2 wk of progressive HIIT (n = 20, four to ten 1-min sessions at ∼90% peak heart rate, 1-min rest periods) or MICT (n = 19, 20-50 min at ∼65% peak heart rate). Before and 3 days after training, participants performed a peak O2 uptake test, and fasting blood samples were obtained. Both HIIT (1.8 ± 0.4 vs. 1.9 ± 0.4 l/min, pre vs. post) and MICT (1.8 ± 0.5 vs. 1.9 ± 0.5 l/min, pre vs. post) improved peak O2 uptake (P < 0.001) and lowered plasma fructosamine (P < 0.05). Toll-like receptor (TLR) 4 (TLR4) expression was reduced on lymphocytes and monocytes after both HIIT and MICT (P < 0.05) and on neutrophils after MICT (P < 0.01). TLR2 on lymphocytes was reduced after HIIT and MICT (P < 0.05). Plasma inflammatory cytokines were unchanged after training in both groups, but MICT led to a reduction in fasting plasma glucose (P < 0.05, 5.9 ± 1.0 vs. 5.6 ± 1.0 mmol/l, pre vs. post). Ten days of either HIIT or MICT can improve cardiorespiratory fitness and glucose control and lead to reductions in TLR2 and TLR4 expression. MICT, which involved a longer duration of exercise, may be superior for reducing fasting glucose.

  11. Pain intensity assessment: a comparison of selected pain intensity scales for use in cognitively intact and cognitively impaired African American older adults.

    PubMed

    Taylor, Laurie Jowers; Herr, Keela

    2003-06-01

    The purpose of this study was to determine the reliability and validity of selected pain intensity scales including the Faces Pain Scale (FPS), the Verbal Description Scale, the Numeric Rating Scale, and the Iowa Pain Thermometer to assess pain in cognitively impaired minority older adults. A descriptive correlational design was used, and a convenience sample of 57 volunteers age 58 and older residing in the South was recruited for this study. The sample consisted of 8 males and 49 females with a mean age of 76. Fifty-nine percent of the sample completed an 11th grade education or less, and 59% completed high school or college. Seventy-seven percent (n = 44) of the sample scored 24 or less on the mental status exam, indicating some degree of cognitive impairment. The remaining 23% (n = 13) were cognitively intact. All of the participants were able to use each of the scales to rate their pain. Concurrent validity of the scales was supported with Spearman rank correlation coefficients ranging from.74 to.83 in the cognitively impaired group and.81 to.96 in the cognitively intact group. Test-retest reliability at a 2-week interval was acceptable in the cognitively intact group (Spearman rank correlations ranged from.73 to.83) and to a lesser degree in the cognitively impaired group (correlations ranged from.52 to.79). When asked about scale preference, both the cognitively impaired and the intact group indicated a preference for the FPS. Findings from this study suggest that cognitive impairment did not inhibit older minority participants' ability to use a variety of pain intensity scales. Additionally, options should be provided that address individual needs of older adults considering specific cognitive level and disability, education, gender, ethnicity, and cultural influences concerning perceptions of the various pain intensity scales.

  12. Interactive television for an urban adult mental health service: the Guy's Psychiatric Intensive Care Unit Telepsychiatry Project.

    PubMed

    Haslam, R; McLaren, P

    2000-01-01

    We carried out a feasibility study of an interactive television (IATV) system to enhance the provision of psychiatric intensive care services to a remote adult acute psychiatric ward in the same National Health Service mental health trust. The system used videoconferencing equipment connected by ISDN at 128 kbit/s. The system was used for patient referral, assessment and monitoring by staff at the remote site 8 km away.

  13. Acquired hypernatremia in a general surgical Intensive Care Unit: Incidence and prognosis

    PubMed Central

    Alansari, Mariam A.; Abdulmomen, Ahmed; Hussein, Mohammed; Zubaidi, Ahmad Mohmmad; Alswaiti, Jalal T.

    2016-01-01

    Purpose: Intensive Care Unit (ICU)-acquired hypernatremia (IAH) is a serious electrolyte disturbance that recently was shown to present an independent risk factor for mortality in critically ill patients. IAH has not been widely investigated in Surgical ICU (SICU) patients. No study has specifically investigated IAH epidemiology in the Kingdome of Saudi Arabia (KSA) in general SICU. The objectives of this study are to assess the epidemiological characteristics and prognostic impact of IAH on SICU mortality and outcome in KSA and compare it with international figures. Materials and Methods: A retrospective observational study on a prospectively collected data of patients (14 years of age or older) admitted to SICU over 2 years, with normal serum sodium on admission and who developed IAH (serum sodium above 145 mmol/L) from day two of admission. Traumatic brain injury patients with therapeutic target sodium level above 145 mmol/L were excluded. Results: Over 2 years study period, 864 patients were admitted to SICU. A total of 50 (5.8%) developed IAH and were included in the study. Twenty-eight (56%) patients were male. The median age was 47 (14-84) years. The mean (± standard deviation) Acute Physiology and Chronic Health Evaluation II score was 17 ± 6.5. The incident density (the rate of occurrence of IAH per 100 days care for SICU admission for the first episode) was 0.71. Risk factors include mechanical ventilation, male sex, age ≥50 years, postgastrointestinal surgeries, weekend and night admission. SICU mortality was 40%. The SICU and hospital median (range) length of stay was 8.3 (2-53) and 28.8 (3-95), respectively. Conclusions: IAH is not uncommon in SICU patients and is associated with increased risk of SICU as well as hospital mortality. PMID:27833483

  14. New Research into General Psychiatric Services for Adults with Intellectual Disability and Mental Illness

    ERIC Educational Resources Information Center

    Chaplin, R.

    2009-01-01

    Background: There are a variety of models for the mental health care of adults with comorbid intellectual disability (ID) and mental illness. There has been a long-running debate as to whether this should be provided by general psychiatric or specialised ID services. A previous review concluded that there was no clear evidence to support either…

  15. Checklists for General Practitioner Diagnosis of Depression in Adults with Intellectual Disability

    ERIC Educational Resources Information Center

    Torr, J.; Iacono, T.; Graham, M. J.; Galea, J.

    2008-01-01

    Background: In Australia, diagnosis and management of depression in adults with intellectual disability (ID) often occurs within the primary care setting. Few tools are available to assist general practitioners (GPs) in the diagnostic process. The study aim was to assess properties of carer and GP checklists developed to address this problem.…

  16. Why Some Adults with Intellectual Disability Consult Their General Practitioner More Than Others

    ERIC Educational Resources Information Center

    Turk, V.; Kerry, S.; Corney, R.; Rowlands, G.; Khattran, S.

    2010-01-01

    Background: This research identifies factors affecting why some adults with intellectual disability (AWIDs) consult their general practitioner (GP) more than others. Little is known about these factors, despite AWIDs having higher health needs and reduced longevity. Current barriers to accessing health care need to be understood and overcome to…

  17. Psychosocial Experiences and Adjustment among Adult Swedes with Superior General Mental Ability

    ERIC Educational Resources Information Center

    Stalnacke, Jannica; Smedler, Ann-Charlotte

    2011-01-01

    In Sweden, special needs of high-ability individuals have received little attention. For this purpose, adult Swedes with superior general mental ability (GMA; N = 302), defined by an IQ score greater than 130 on tests of abstract reasoning, answered a questionnaire regarding their views of themselves and their giftedness. The participants also…

  18. Evaluation of a Peer-Led, Low-Intensity Physical Activity Program for Older Adults

    ERIC Educational Resources Information Center

    Werner, Danilea; Teufel, James; Brown, Stephen L.

    2014-01-01

    Background: Physical inactivity is a primary contributor to decreasing functional physical fitness and increasing chronic disease in older adults. Purpose: This study assessed the health-related benefits of ExerStart for Lay Leaders, a 20-week, community based, peer-led, low-impact exercise program for older adults. ExerStart focuses on aerobic…

  19. Barium versus Nonbarium Stimuli: Differences in Taste Intensity, Chemesthesis, and Swallowing Behavior in Healthy Adult Women

    ERIC Educational Resources Information Center

    Nagy, Ahmed; Steele, Catriona M.; Pelletier, Cathy A.

    2014-01-01

    Purpose: The authors examined the impact of barium on the perceived taste intensity of 7 different liquid tastant stimuli and the modulatory effect that these differences in perceived taste intensity have on swallowing behaviors. Method: Participants were 80 healthy women, stratified by age group (<40; >60) and genetic taste status…

  20. Stressors, social support, religious practice, and general well-being among Korean adult immigrants.

    PubMed

    Lee, Kyoung Hag; Woo, Hyeyoung

    2013-10-01

    Through this cross-sectional study the authors explore how stressors, social support, and religious practice are associated with the general well-being of 147 Korean adult immigrants through interviews. Hierarchical regression analysis reveals that low English proficiency and financial hardship are significantly related to low general well-being. However, high social support and religious practice are significantly associated with high general well-being. Social service and health care providers need to carefully assess stressors, social support systems, and spiritual issues for providing appropriate services/programs for English, culture, or social activities as well as spiritual intervention to maximize the strengths of Korean immigrants coping with health issues.

  1. Effects of high-intensity interval exercise versus continuous moderate-intensity exercise on postprandial glycemic control assessed by continuous glucose monitoring in obese adults.

    PubMed

    Little, Jonathan P; Jung, Mary E; Wright, Amy E; Wright, Wendi; Manders, Ralph J F

    2014-07-01

    The purpose of this study was to examine the impact of acute high-intensity interval training (HIIT) compared with continuous moderate-intensity (CMI) exercise on postprandial hyperglycemia in overweight or obese adults. Ten inactive, overweight or obese adults (41 ± 11 yrs, BMI = 36 ± 7 kg/m(2)) performed an acute bout of HIIT (10 × 1 min at approximately 90% peak heart rate (HRpeak) with 1-min recovery periods) or matched work CMI (30 min at approximately 65% HRpeak) in a randomized, counterbalanced fashion. Exercise was performed 2 h after breakfast, and glucose control was assessed by continuous glucose monitoring under standardized dietary conditions over 24 h. Postprandial glucose (PPG) responses to lunch, dinner, and the following day's breakfast were analyzed and compared with a no-exercise control day. Exercise did not affect the PPG responses to lunch, but performing both HIIT and CMI in the morning significantly reduced the PPG incremental area under the curve (AUC) following dinner when compared with control (HIIT = 110 ± 35, CMI = 125 ± 34, control = 162 ± 46 mmol/L × 2 h, p < 0.05). The PPG AUC (HIIT = 125 ± 53, CMI = 186 ± 55, control = 194 ± 96 mmol/L × 2 h) and the PPG spike (HIIT = Δ2.1 ± 0.9, CMI = Δ3.0 ± 0.9, control = Δ3.0 ± 1.5 mmol/l) following breakfast on the following day were significantly lower following HIIT compared with both CMI and control (p < 0.05). Absolute AUC and absolute glucose spikes were not different between HIIT, CMI, or control for any meal (p > 0.05 for all). We conclude that a single session of HIIT has greater and more lasting effects on reducing incremental PPG when compared with CMI.

  2. Professionalisation in General Adult Education in Germany--An Attempt to Cut a Path through a Jungle

    ERIC Educational Resources Information Center

    Dausien, Bettina; Schwendowius, Dorothee

    2009-01-01

    The article summarizes the findings of a study on adult learning professions in Europe (ALPINE) commissioned by DG Education and Culture. It explores the current professional and social situation of staff in non-vocational adult education in Germany. It describes the structures and organisations of general adult education in Germany and…

  3. A preliminary investigation on exercise intensities of gardening tasks in older adults.

    PubMed

    Park, Sin-Ae; Shoemaker, Candice A; Haub, Mark D

    2008-12-01

    Heart rate (HR) was measured continuously while men (n=6) and women (n=2) ages 71 to 85 years (M=77.4, SD=4.1) completed nine gardening tasks. HR and VO2 from a submaximal graded exercise test were used to estimate gardening VO2, energy expenditure, % HRmax, and metabolic equivalents (METs). Tasks were low to moderate intensity physical activity (1.6-3.6 METs); those which worked the upper and lower body were moderate intensity physical activity while those that worked primarily the upper body were low intensity physical activity.

  4. Analysis of large new South African dataset using two host-specificity indices shows generalism in both adult and larval ticks of mammals.

    PubMed

    Espinaze, Marcela P A; Hellard, Eléonore; Horak, Ivan G; Cumming, Graeme S

    2016-03-01

    Ticks and tick-borne pathogens can have considerable impacts on the health of livestock, wildlife and people. Knowledge of tick-host preferences is necessary for both tick and pathogen control. Ticks were historically considered as specialist parasites, but the range of sampled host species has been limited, infestation intensity has not been included in prior analyses, and phylogenetic distances between hosts have not been previously considered. We used a large dataset of 35 604 individual collections and two host-specificity indices to assess the specificity of 61 South African tick species, as well as distinctions between adult and juvenile ticks, for 95 mammalian hosts. When accounting for host phylogeny, most adult and juvenile ticks behaved as generalists, with juveniles being significantly more generalist than adults. When we included the intensity of tick infestation, ticks exhibited a wider diversity of specificity in all life stages. Our results show that ticks of mammals in South Africa tend to behave largely as generalists and that adult ticks are more host-specific. More generally, our analysis shows that the incorporation of life-stage differences, infestation intensity and phylogenetic distances between hosts, as well as the use of more than one specificity index, can all contribute to a deeper understanding of host-parasite interactions.

  5. Antidepressant Medication Augmented With Cognitive-Behavioral Therapy for Generalized Anxiety Disorder in Older Adults

    PubMed Central

    Wetherell, Julie Loebach; Petkus, Andrew J.; White, Kamila S.; Nguyen, Hoang; Kornblith, Sander; Andreescu, Carmen; Zisook, Sidney; Lenze, Eric J.

    2014-01-01

    Objective Generalized anxiety disorder is common among older adults and leads to diminished health and cognitive functioning. Although antidepressant medications are efficacious, many elderly individuals require augmentation treatment. Furthermore, little is known about maintenance strategies for older people. The authors examined whether sequenced treatment combining pharmacotherapy and cognitive-behavioral therapy (CBT) boosts response and prevents relapse in older adults with generalized anxiety disorder. Method Participants were individuals at least 60 years of age with generalized anxiety disorder (N=73) who were recruited from outpatient clinics at three sites. Participants received 12 weeks of open-label escitalopram and were then randomly assigned to one of four conditions:16 weeks of escitalopram (10–20 mg/day) plus modular CBT, followed by 28 weeks of maintenance escitalopram; escitalopram alone, followed by maintenance escitalopram; escitalopram plus CBT, followed by pill placebo; and escitalopram alone, followed by placebo. Results Escitalopram augmented with CBT increased response rates on the Penn State Worry Questionnaire but not on the Hamilton Anxiety Rating Scale compared with escitalopram alone. Both escitalopram and CBT prevented relapse compared with placebo. Conclusions This study demonstrates effective strategies for treatment of generalized anxiety disorder in older adults. The sequence of antidepressant medication augmented with CBT leads to worry reduction in the short-term. Continued medication prevents relapse, but for many individuals, CBT would allow sustained remission without requiring long-term pharmacotherapy. PMID:23680817

  6. Antidepressant medication augmented with cognitive-behavioral therapy for generalized anxiety disorder in older adults.

    PubMed

    Wetherell, Julie Loebach; Petkus, Andrew J; White, Kamila S; Nguyen, Hoang; Kornblith, Sander; Andreescu, Carmen; Zisook, Sidney; Lenze, Eric J

    2013-07-01

    OBJECTIVE Generalized anxiety disorder is common among older adults and leads to diminished health and cognitive functioning. Although antidepressant medications are efficacious, many elderly individuals require augmentation treatment. Furthermore, little is known about maintenance strategies for older people. The authors examined whether sequenced treatment combining pharmacotherapy and cognitive-behavioral therapy (CBT) boosts response and prevents relapse in older adults with generalized anxiety disorder. METHOD Participants were individuals at least 60 years of age with generalized anxiety disorder (N=73) who were recruited from outpatient clinics at three sites. Participants received 12 weeks of open-label escitalopram and were then randomly assigned to one of four conditions: 16 weeks of escitalopram (10-20 mg/day) plus modular CBT, followed by 28 weeks of maintenance escitalopram; escitalopram alone, followed by maintenance escitalopram; escitalopram plus CBT, followed by pill placebo; and escitalopram alone, followed by placebo. RESULTS Escitalopram augmented with CBT increased response rates on the Penn State Worry Questionnaire but not on the Hamilton Anxiety Rating Scale compared with escitalopram alone. Both escitalopram and CBT prevented relapse compared with placebo. CONCLUSIONS This study demonstrates effective strategies for treatment of generalized anxiety disorder in older adults. The sequence of antidepressant medication augmented with CBT leads to worry reduction in the short-term. Continued medication prevents relapse, but for many individuals, CBT would allow sustained remission without requiring long-term pharmacotherapy.

  7. Short-term high-intensity interval and moderate-intensity continuous training reduce leukocyte TLR4 in inactive adults at elevated risk of type 2 diabetes

    PubMed Central

    Robinson, Emily; Durrer, Cody; Simtchouk, Svetlana; Jung, Mary E.; Bourne, Jessica E.; Voth, Elizabeth

    2015-01-01

    Exercise can have anti-inflammatory effects in obesity, but the optimal type and intensity of exercise are not clear. This study compared short-term high-intensity interval training (HIIT) with moderate-intensity continuous training (MICT) in terms of improvement in cardiorespiratory fitness, markers of inflammation, and glucose control in previously inactive adults at elevated risk of developing type 2 diabetes. Thirty-nine inactive, overweight/obese adults (32 women) were randomly assigned to 10 sessions over 2 wk of progressive HIIT (n = 20, four to ten 1-min sessions at ∼90% peak heart rate, 1-min rest periods) or MICT (n = 19, 20-50 min at ∼65% peak heart rate). Before and 3 days after training, participants performed a peak O2 uptake test, and fasting blood samples were obtained. Both HIIT (1.8 ± 0.4 vs. 1.9 ± 0.4 l/min, pre vs. post) and MICT (1.8 ± 0.5 vs. 1.9 ± 0.5 l/min, pre vs. post) improved peak O2 uptake (P < 0.001) and lowered plasma fructosamine (P < 0.05). Toll-like receptor (TLR) 4 (TLR4) expression was reduced on lymphocytes and monocytes after both HIIT and MICT (P < 0.05) and on neutrophils after MICT (P < 0.01). TLR2 on lymphocytes was reduced after HIIT and MICT (P < 0.05). Plasma inflammatory cytokines were unchanged after training in both groups, but MICT led to a reduction in fasting plasma glucose (P < 0.05, 5.9 ± 1.0 vs. 5.6 ± 1.0 mmol/l, pre vs. post). Ten days of either HIIT or MICT can improve cardiorespiratory fitness and glucose control and lead to reductions in TLR2 and TLR4 expression. MICT, which involved a longer duration of exercise, may be superior for reducing fasting glucose. PMID:26139217

  8. Prevalence of Advance Directives Among Older Adults Admitted to Intensive Care Units and Requiring Mechanical Ventilation.

    PubMed

    Gamertsfelder, Elise M; Seaman, Jennifer Burgher; Tate, Judith; Buddadhumaruk, Praewpannarai; Happ, Mary Beth

    2016-04-01

    Because older adults are at high risk for hospitalization and potential decisional incapacity, advance directives are important components of pre-hospital advanced care planning, as they document individual preferences for future medical care. The prevalence of pre-hospital advance directive completion in 450 critically ill older adults requiring mechanical ventilation from two Mid-Atlantic hospitals is described, and demographic and clinical predictors of pre-hospital advance directive completion are explored. The overall advance directive completion rate was 42.4%, with those in older age groups (75 to 84 years and 85 and older) having approximately two times the odds of completion. No significant differences in the likelihood of advance directive completion were noted by sex, race, or admitting diagnosis. The relatively low prevalence of advance directive completion among older adults with critical illness and high mortality rate (24%) suggest a need for greater awareness and education.

  9. The longest telomeres: a general signature of adult stem cell compartments

    PubMed Central

    Flores, Ignacio; Canela, Andres; Vera, Elsa; Tejera, Agueda; Cotsarelis, George; Blasco, María A.

    2008-01-01

    Identification of adult stem cells and their location (niches) is of great relevance for regenerative medicine. However, stem cell niches are still poorly defined in most adult tissues. Here, we show that the longest telomeres are a general feature of adult stem cell compartments. Using confocal telomere quantitative fluorescence in situ hybridization (telomapping), we find gradients of telomere length within tissues, with the longest telomeres mapping to the known stem cell compartments. In mouse hair follicles, we show that cells with the longest telomeres map to the known stem cell compartments, colocalize with stem cell markers, and behave as stem cells upon treatment with mitogenic stimuli. Using K15-EGFP reporter mice, which mark hair follicle stem cells, we show that GFP-positive cells have the longest telomeres. The stem cell compartments in small intestine, testis, cornea, and brain of the mouse are also enriched in cells with the longest telomeres. This constitutes the description of a novel general property of adult stem cell compartments. Finally, we make the novel finding that telomeres shorten with age in different mouse stem cell compartments, which parallels a decline in stem cell functionality, suggesting that telomere loss may contribute to stem cell dysfunction with age. PMID:18283121

  10. Emotional intensity reduces later generalized anxiety disorder symptoms when fear of anxiety and negative problem-solving appraisal are low.

    PubMed

    Sugiura, Yoshinori; Sugiura, Tomoko

    2015-08-01

    While research based on the emotion dysregulation model indicates a positive relationship between intense emotions and generalized anxiety disorder (GAD) symptoms, emotion-focused intervention involves the use of techniques to enhance emotional experiences, based on the notion that GAD patients are engaging in avoidance strategies. To reveal the conditions under which intense emotions lead to reduced GAD symptoms, we designed a longitudinal study to monitor changes in GAD symptoms among students (N = 129) over 3 months. Our focus was on possible moderators of the effect of emotional intensity. Results indicated that when fear of emotions and negative appraisals about problem solving were low, negative emotional intensity reduced later GAD symptoms. Moreover, under the condition of high responsibility to continue thinking, emotional intensity tended to reduce later GAD symptoms. Results suggest that reduced fear of emotions and reduced negative appraisals about problem solving may enhance the use of emotional processing techniques (e.g., emotional exposure). The interaction between responsibility to continue thinking and emotional intensity requires further examination.

  11. Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

    PubMed Central

    Mazzeffi, Michael; Johnson, Kyle; Paciullo, Christopher

    2015-01-01

    Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review. PMID:25849690

  12. Assessing Job Search Intensity and Unemployment-Related Attitudes among Young Adults: Intergender Differences.

    ERIC Educational Resources Information Center

    Kulik, Liat

    2001-01-01

    In a study of 225 Israeli young adults applying for their first job, women were more likely to reject jobs due to work conditions, family considerations, or masculine sex-typing. Men rejected jobs only because of feminine sex-typing. Women had greater nonfinancial commitment to work. Men were more stigmatized by unemployment. There were no…

  13. Affective and Enjoyment Responses to High-Intensity Interval Training in Overweight-to-Obese and Insufficiently Active Adults.

    PubMed

    Martinez, Nic; Kilpatrick, Marcus W; Salomon, Kristen; Jung, Mary E; Little, Jonathan P

    2015-04-01

    High-intensity interval training (HIIT) has many known physiological benefits, but research investigating the psychological aspects of this training is limited. The purpose of the current study is to investigate the affective and enjoyment responses to continuous and high-intensity interval exercise sessions. Twenty overweight-to-obese, insufficiently active adults completed four counterbalanced trials: a 20-min trial of heavy continuous exercise and three 24-min HIIT trials that used 30-s, 60-s, and 120-s intervals. Affect declined during all trials (p < .05), but affect at the completion of trials was more positive in the shorter interval trials (p < .05). Enjoyment declined in the 120-s interval and heavy continuous conditions only (p < .05). Postexercise enjoyment was higher in the 60-s trial than in the 120-s trial and heavy continuous condition (p < .05). Findings suggest that pleasure and enjoyment are higher during shorter interval trials than during a longer interval or heavy continuous exercise.

  14. Long-Term Outcome After Static Intensity-Modulated Total Body Radiotherapy Using Compensators Stratified by Pediatric and Adult Cohorts

    SciTech Connect

    Schneider, Ralf A. Schultze, Juergen; Jensen, J. Martin; Hebbinghaus, Dieter; Galalae, Razvan M.

    2008-01-01

    Purpose: To report the long-term outcome after total body irradiation with intensity-modulating compensators and allogeneic/autologous transplantation, especially in terms of therapy-related toxicity in pediatric and adult cohorts. Methods and Materials: A total of 257 consecutive patients (40 children and 217 adults) have been treated since 1983 with TBI using static intensity-modulated radiotherapy for hematologic malignancies. The total dose of 12 Gy was applied in six fractions within 3 days before allogeneic (n = 174) or autologous (n = 83) transplantation. The median follow-up was 9.2 years. Results: The 5-year overall survival rate was 47.9% (49.8% for the adults and 37.5% for the children, p = 0.171). The 5-year tumor-related mortality rate was 23%, and the 5-year treatment-related mortality rate 29.2% (29.5% in the adults and 27.5% in the pediatric patients). Interstitial pneumonitis developed in 28 (10.9%) of 257 patients and in 12.5% of the pediatric cohort. The interstitial pneumonitis rate was 25% in pediatric patients treated with a 12-Gy lung dose compared with 4.2% for those treated to an 11-Gy lung dose. The overall survival rate stratified by lung dose was 26.7% for 12 Gy and 52.4% for 11 Gy (p = 0.001). The incidence of veno-occlusive disease and cataract was 5.8% and 6.6% in all patients and 12.5% and 15% in the pediatric patients, respectively (p < 0.05). Secondary malignancies were found in 4.3% of all patients, all in the adult cohort at transplantation. Conclusion: Static intensity-modulated total body irradiation with a total dose of 12 Gy before allogeneic/autologous transplantation is a successful treatment with good long-term outcome and acceptable therapy-related toxicities. Constraining the lung dose to 11 Gy substantially lowered the actuarial treatment-related mortality. This effect was especially striking in the pediatric patients.

  15. Effects of intensive physical rehabilitation on neuromuscular adaptations in adults with poststroke hemiparesis.

    PubMed

    Andersen, Lars L; Zeeman, Peter; Jørgensen, Jørgen R; Bech-Pedersen, Daniel T; Sørensen, Janne; Kjær, Michael; Andersen, Jesper L

    2011-10-01

    Hemiparesis-disability and muscle weakness of 1 side of the body-is a common consequence of stroke. High-intensity strength training may be beneficial to regain function, but strength coaches in the field of rehabilitation need evidence-based guidelines. The purpose of this study was to evaluate the effect of intensive physical rehabilitation on neuromuscular and functional adaptations in outpatients suffering from hemiparesis after stroke. A within-subject repeated-measures design with the paretic leg as the experimental leg and the nonparetic leg as the control leg was used. Eleven outpatients with hemiparesis after stroke participated in 12 weeks of intensive physical rehabilitation comprising unilateral high-intensity strength training with near-maximal loads (4-12 repetition maximum) and body weight supported treadmill training. At baseline and 12-week follow-up, the patients went through testing consisting of isokinetic muscle strength, neuromuscular activation measured with electromyography (EMG), electrically evoked muscle twitch contractile properties, and gait performance (10-m Walk Test and 6-min Walk Test). After the 12-week conditioning program, knee extensor and flexor strength increased during all contraction modes and velocities in the paretic leg. Significant increases were observed for agonist EMG amplitude at slow concentric and slow eccentric contraction. Twitch torque increased, whereas twitch time-to-peak tension remained unchanged. By contrast, no significant changes were observed in the nonparetic control leg. Gait performance increased 52-68%. In conclusion, intensive physical rehabilitation after stroke leads to clinically relevant neuromuscular improvements, leading to increased voluntary strength during a wide range of contraction modes and velocities, and improved gait velocity. Strength training coaches working in the field of rehabilitation can use this knowledge to safely and efficiently add high-intensity strength training to

  16. Effect of very low-intensity resistance training with slow movement on muscle size and strength in healthy older adults.

    PubMed

    Watanabe, Yuya; Madarame, Haruhiko; Ogasawara, Riki; Nakazato, Koichi; Ishii, Naokata

    2014-11-01

    We previously reported that low-intensity [50% of one repetition maximum (1RM)] resistance training with slow movement and tonic force generation (LST) causes muscle hypertrophy and strength gain in older participants. The aim of this study was to determine whether resistance training with slow movement and much more reduced intensity (30%1RM) increases muscle size and strength in older adults. Eighteen participants (60-77 years) were randomly assigned to two groups. One group performed very low-intensity (30% 1RM) knee extension exercise with continuous muscle contraction (LST: 3-s eccentric, 3-s concentric, and 1-s isometric actions with no rest between each repetition) twice a week for 12 weeks. The other group underwent intermitted muscle contraction (CON: 1-s concentric and 1-s eccentric actions with 1-s rest between each repetition) for the same time period. The 1RM, isometric and isokinetic strengths, and cross-sectional image of the mid-thigh obtained by magnetic resonance imaging were examined before and after the intervention. LST significantly increased the cross-sectional area of the quadriceps muscle (5.0%, P<0.001) and isometric and isokinetic knee extension strengths (P<0.05). CON failed to increase muscle size (1.1%, P = 0.12), but significantly improved its strength (P<0.05). These results indicate that even if the intensity is as low as 30% 1RM, LST can increase muscle size and strength in healthy older adults. The large total contraction time may be related to muscle hypertrophy and strength gain. LST would be useful for preventing sarcopenia in older individuals.

  17. Effects of high-intensity interval training and moderate-intensity continuous training on endothelial function and cardiometabolic risk markers in obese adults.

    PubMed

    Sawyer, Brandon J; Tucker, Wesley J; Bhammar, Dharini M; Ryder, Justin R; Sweazea, Karen L; Gaesser, Glenn A

    2016-07-01

    We hypothesized that high-intensity interval training (HIIT) would be more effective than moderate-intensity continuous training (MICT) at improving endothelial function and maximum oxygen uptake (V̇o2 max) in obese adults. Eighteen participants [35.1 ± 8.1 (SD) yr; body mass index = 36.0 ± 5.0 kg/m(2)] were randomized to 8 wk (3 sessions/wk) of either HIIT [10 × 1 min, 90-95% maximum heart rate (HRmax), 1-min active recovery] or MICT (30 min, 70-75% HRmax). Brachial artery flow-mediated dilation (FMD) increased after HIIT (5.13 ± 2.80% vs. 8.98 ± 2.86%, P = 0.02) but not after MICT (5.23 ± 2.82% vs. 3.05 ± 2.76%, P = 0.16). Resting artery diameter increased after MICT (3.68 ± 0.58 mm vs. 3.86 ± 0.58 mm, P = 0.02) but not after HIIT (4.04 ± 0.70 mm vs. 4.09 ± 0.70 mm; P = 0.63). There was a significant (P = 0.02) group × time interaction in low flow-mediated constriction (L-FMC) between MICT (0.63 ± 2.00% vs. -2.79 ± 3.20%; P = 0.03) and HIIT (-1.04 ± 4.09% vs. 1.74 ± 3.46%; P = 0.29). V̇o2 max increased (P < 0.01) similarly after HIIT (2.19 ± 0.65 l/min vs. 2.64 ± 0.88 l/min) and MICT (2.24 ± 0.48 l/min vs. 2.55 ± 0.61 l/min). Biomarkers of cardiovascular risk and endothelial function were unchanged. HIIT and MICT produced different vascular adaptations in obese adults, with HIIT improving FMD and MICT increasing resting artery diameter and enhancing L-FMC. HIIT required 27.5% less total exercise time and ∼25% less energy expenditure than MICT.

  18. Generalized Kapchinskij-Vladimirskij Distribution and Beam Matrix for Phase-Space Manipulations of High-Intensity Beams

    NASA Astrophysics Data System (ADS)

    Chung, Moses; Qin, Hong; Davidson, Ronald C.; Groening, Lars; Xiao, Chen

    2016-11-01

    In an uncoupled linear lattice system, the Kapchinskij-Vladimirskij (KV) distribution formulated on the basis of the single-particle Courant-Snyder invariants has served as a fundamental theoretical basis for the analyses of the equilibrium, stability, and transport properties of high-intensity beams for the past several decades. Recent applications of high-intensity beams, however, require beam phase-space manipulations by intentionally introducing strong coupling. In this Letter, we report the full generalization of the KV model by including all of the linear (both external and space-charge) coupling forces, beam energy variations, and arbitrary emittance partition, which all form essential elements for phase-space manipulations. The new generalized KV model yields spatially uniform density profiles and corresponding linear self-field forces as desired. The corresponding matrix envelope equations and beam matrix for the generalized KV model provide important new theoretical tools for the detailed design and analysis of high-intensity beam manipulations, for which previous theoretical models are not easily applicable.

  19. Health and wellbeing of Victorian adults with intellectual disability compared to the general Victorian population.

    PubMed

    Haider, Syed Imran; Ansari, Zahid; Vaughan, Loretta; Matters, Helen; Emerson, Eric

    2013-11-01

    Multiple measures of health and wellbeing of people with intellectual disability (ID) and the general Victorian population were compared using representative population level data. The sample consisted of adults with ID (N=897) and the general Victorian population (N=34,168) living in the state of Victoria in Australia. Proxy respondents were interviewed on behalf of people with ID, while respondents from the general Victorian population were interviewed directly. The data were weighted to reflect the age/sex/geographic distribution of the population. Results revealed that adults with ID reported higher prevalence of poor social determinants of health, behavioural risk factors, depression, diabetes, poor or fair health. A higher proportion of people with ID reported blood pressure and blood glucose checks, while a lower proportion reported cervical and breast cancer screening, compared with the general Victorian population. The survey identified areas where targeted approaches may be undertaken to improve the health outcomes of people with ID and provide an important understanding of the health and wellbeing of these Victorians.

  20. Blood parasites of two Costa Rican amphibians with comments on detection and microfilaria density associated with adult filarial worm intensity.

    PubMed

    McKenzie, Valerie J; Starks, Hilary A

    2008-08-01

    The 2 objectives of this study were: (1) to compare parasite detectability in blood smears obtained from toe-clips versus the heart from amphibian hosts; and (2) to test whether microfilariae density is correlated with adult filarial worm intensity. We examined blood parasites of 2 species of amphibians, Rana vaillanti (n = 45) and Eleutherodactylus fitzingeri (n = 36), from Costa Rica collected during the summer of 2003. Separate blood smears were obtained from toe-clips and the heart during necrospy. Eight species of blood parasites were identified from R. vaillanti and 1 from E. fitzingeri. Each parasite species was counted in a 2 x 2.2-cm2 area on each blood smear, and the density of host red blood cells (RBCs) was estimated using a sub-sampling approach, allowing parasite infections to be expressed as individuals per RBC. The detection failure rate for toe-cut smears ranged from 71-100% (x = 92.3%) and from 0-9% (x = 2.4%) for heart smears, depending on parasite species. The density of RBCs was significantly higher in smears produced from heart samples and may explain the differences in detectability. Foleyellides striatus microfilariae densities (per RBC) were significantly correlated with adult female worm intensity (R2 = 0.32, P = 0.011).

  1. Randomized study of reduced-intensity chemotherapy combined with imatinib in adults with Ph-positive acute lymphoblastic leukemia.

    PubMed

    Chalandon, Yves; Thomas, Xavier; Hayette, Sandrine; Cayuela, Jean-Michel; Abbal, Claire; Huguet, Françoise; Raffoux, Emmanuel; Leguay, Thibaut; Rousselot, Philippe; Lepretre, Stéphane; Escoffre-Barbe, Martine; Maury, Sébastien; Berthon, Céline; Tavernier, Emmanuelle; Lambert, Jean-François; Lafage-Pochitaloff, Marina; Lhéritier, Véronique; Chevret, Sylvie; Ifrah, Norbert; Dombret, Hervé

    2015-06-11

    In this study, we randomly compared high doses of the tyrosine kinase inhibitor imatinib combined with reduced-intensity chemotherapy (arm A) to standard imatinib/hyperCVAD (cyclophosphamide/vincristine/doxorubicin/dexamethasone) therapy (arm B) in 268 adults (median age, 47 years) with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL). The primary objective was the major molecular response (MMolR) rate after cycle 2, patients being then eligible for allogeneic stem cell transplantation (SCT) if they had a donor, or autologous SCT if in MMolR and no donor. With fewer induction deaths, the complete remission (CR) rate was higher in arm A than in arm B (98% vs 91%; P = .006), whereas the MMolR rate was similar in both arms (66% vs 64%). With a median follow-up of 4.8 years, 5-year event-free survival and overall survival (OS) rates were estimated at 37.1% and 45.6%, respectively, without difference between the arms. Allogeneic transplantation was associated with a significant benefit in relapse-free survival (hazard ratio [HR], 0.69; P = .036) and OS (HR, 0.64; P = .02), with initial white blood cell count being the only factor significantly interacting with this SCT effect. In patients achieving MMolR, outcome was similar after autologous and allogeneic transplantation. This study validates an induction regimen combining reduced-intensity chemotherapy and imatinib in Ph+ ALL adult patients and suggests that SCT in first CR is still a good option for Ph+ ALL adult patients. This trial was registered at www.clinicaltrials.gov as #NCT00327678.

  2. Late effects in adult survivors of childhood cancer: considerations for the general practitioner.

    PubMed

    Schmidt, Debra; Anderson, Lynnette; Bingen, Kristin; Hoag, Jennifer; Kupst, Mary Jo; Warwick, Anne B

    2010-04-01

    Childhood cancer survivorship is a national public health priority, with an increasing number of survivors who face late effects from both disease and treatment. As childhood cancer survivors are living into adulthood, care of the late effects associated with their diagnosis and treatment can become complex. Often these patients no longer have follow-up with the treating pediatric hospital and seek medical care from an adult primary care professional. Combining the results of current survivorship research with clinical experience, we describe common late effects that general internists and primary care professionals may encounter during routine visits with adult survivors of childhood cancer. Recommendations and resources are provided for identifying and managing late effects.

  3. Generalized intense pruritus during canagliflozin treatment: Is it an adverse drug reaction?

    PubMed

    Vasapollo, Piero; Cione, Erika; Luciani, Filippo; Gallelli, Luca

    2016-04-05

    Selective agents able to locate and identify unique targets represent a crucial aspect of modern pharmacology. The exclusive location of sodium-glucose co-transporter-2 (SGLUT2) on kidneys prompt companies to develop SGLT2 inhibitors that today are the latest class of drugs for diabetes treatment. In particular, canagliflozin blocks the re-absorption of glucose in the kidney lowering blood glucose levels by increasing glucose excretion. We report a 61-year old woman who developed an intense and severe pruritus during the treatment with canagliflozin. Clinical and laboratory findings excluded the presence of systemic or skin diseases able to induce pruritus. The discontinuation of canagliflozin and the treatment with pioglitazone/metformin fixed combination induced a remission of pruritus. This case emphasizes the need to consider pruritus as a differential diagnosis during the treatment with canagliflozin.

  4. Personalised Prescription of Scalable High Intensity Interval Training to Inactive Female Adults of Different Ages

    PubMed Central

    Mair, Jacqueline L.

    2016-01-01

    Stepping is a convenient form of scalable high-intensity interval training (HIIT) that may lead to health benefits. However, the accurate personalised prescription of stepping is hampered by a lack of evidence on optimal stepping cadences and step heights for various populations. This study examined the acute physiological responses to stepping exercise at various heights and cadences in young (n = 14) and middle-aged (n = 14) females in order to develop an equation that facilitates prescription of stepping at targeted intensities. Participants completed a step test protocol consisting of randomised three-minute bouts at different step cadences (80, 90, 100, 110 steps·min-1) and step heights (17, 25, 30, 34 cm). Aerobic demand and heart rate values were measured throughout. Resting metabolic rate was measured in order to develop female specific metabolic equivalents (METs) for stepping. Results revealed significant differences between age groups for METs and heart rate reserve, and within-group differences for METs, heart rate, and metabolic cost, at different step heights and cadences. At a given step height and cadence, middle-aged females were required to work at an intensity on average 1.9 ± 0.26 METs greater than the younger females. A prescriptive equation was developed to assess energy cost in METs using multilevel regression analysis with factors of step height, step cadence and age. Considering recent evidence supporting accumulated bouts of HIIT exercise for health benefits, this equation, which allows HIIT to be personally prescribed to inactive and sedentary women, has potential impact as a public health exercise prescription tool. PMID:26848956

  5. Assessment of intensity effort of middle-aged adults practicing regular walking

    PubMed Central

    Silva, Anderson A.; Lima, Daniela A.; Vieira, Gabriella F.; Fernandes, Aline A.; Pereira, Danielle A. G.

    2015-01-01

    Background: Walking is one of the most commonly recommended activities for sedentary individuals. When performed at the correct intensity, it can provide cardiovascular, respiratory, metabolic, and other benefits by providing a training effect in addition to reducing the risk of death from cardiovascular diseases and other chronic health conditions. Objectives: The primary aim of this study was to assess whether individuals who practiced regular unsupervised walking carry out the activity safely and with sufficient effort intensity parameters to have a positive physiological (training) effect. The secondary objective was to compare the training heart rate (HR) and the stability of the HR within the ideal range of training between the sexes. Method: Individuals were selected from walking tracks within the city of Belo Horizonte, Brazil. The study included subjects from 40 to 60 years of age who had practiced walking for at least two months prior to the study, walking at least three times a week. Individuals who agreed to participate in the survey were asked to walk 15 minutes at their usual pace with their HR measured every 5 minutes using a heart rate monitor. Their average walking HR was compared to the average training HR based on the formula: (220 - age) × 70 to 80% that would result in a positive physiological training effect. Results: Of the 142 individuals evaluated, 25.4% achieved the average training HR. This result was significantly lower than those who did not achieve the average training HR while walking (p=0.002). There were significant differences between men and women who had reached the training HR (p=0.0001). Conclusion: The authors found that individuals who walk regularly performed outside the range of the ideal HR intensity that would cause a positive physiological effect and therefore would probably not achieve a beneficial training effect while walking. PMID:26647751

  6. Exploring the Options. Curriculum Documents and Support Materials for the General Curriculum Options Stream of the Certificates of General Education for Adults.

    ERIC Educational Resources Information Center

    Johnson, Marlene, Ed.; Brearley, Laura, Ed.

    This document contains detailed curriculum outlines and teacher support materials for the General Curriculum Options (GCO) stream of the Certificates of General Education (CGE) for Adults in Victoria, Australia. The following topics are discussed in the introduction: purpose of the guide, details of GCO subject areas, accreditation framework and…

  7. Risk Factors of Emergence Agitation in Adults Undergoing General Anesthesia for Nasal Surgery

    PubMed Central

    Kim, Hyo-Jin; Kim, Hyo-Yeol; Kim, Jin-Kyoung; Choi, Seung-Won

    2015-01-01

    Objectives To identify the incidence and the risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery. Methods We retrospectively examined 792 patients aged ≥18 years who underwent general anesthesia for elective nasal surgery between July 2012 and August 2013. Patients in the postanesthesia care unit with a Richmond Agitation Sedation Scale≥+1 at any time were considered to have emergence agitation. Results The overall incidence of emergence agitation is 22.2%. From multivariate regression analysis, the following six variables were found to be significantly associated with emergence agitation (P<0.05): younger age, recent smoking, sevoflurane anesthesia, postoperative pain on the numerical rating scale (NRS)≥5, presence of a tracheal tube, and presence of a urinary catheter. Presence of a tracheal tube was the greatest risk factor, increasing the risk of developing emergence agitation by approximately fivefold (odds ratio, 5.448; 95% confidence interval, 2.973 to 9.982). Younger age was also a strong risk factor (odds ratio, 0.975 for each 1-year increase; 95% confidence interval, 0.964 to 0.987). Current smoking, sevoflurane anesthesia, postoperative pain of NRS≥5, and the presence of a urinary catheter nearly doubled the risk of emergence agitation. Conclusion Emergence agitation following general anesthesia is a common complication in adult nasal surgery patients. To reduce the occurrence and consequences of agitation episodes, elimination of the associated risk factors is necessary, especially in at-risk patients. PMID:25729495

  8. Dietary Patterns in Relation to General and Central Obesity among Adults in Southwest China

    PubMed Central

    Zhang, Qiang; Chen, Xinguang; Liu, Zhitao; Varma, Deepthi S.; Wan, Rong; Wan, Qingqing; Zhao, Shiwen

    2016-01-01

    Dietary patterns represent a broader picture of food consumption, and are better correlated with a variety of health outcomes. However, few studies have been conducted to explore the associations between dietary patterns and obesity in Southwest China. Data from the 2010–2012 National Nutrition Survey in the province of Yunnan, Southwest China, were analyzed (n = 1604, aged 18–80 years). Dietary data were collected using the 24 h dietary recall over three consecutive days. Height, weight, and waist circumference were measured following standard methods. Exploratory factor analysis was used to identify dietary patterns. Logistic regression was used to explore the association between dietary patterns and obesity. Three distinct dietary patterns were identified, which were labeled as traditional, modern, and tuber according to their key components. With potential confounders adjusted, adults in the highest quartile of the modern pattern were at higher risk of general and central obesity (odds ratio (OR) 1.95, 95% confidence interval (CI) 1.15–3.48; OR 2.01, 95% CI 1.37–2.93). In contrast, adults in the highest quartile of the tuber pattern were at lower risk of general and central obesity (OR 0.34, 95% CI 0.15–0.61; OR 0.64, 95% CI 0.43–0.95) but at higher risk of underweight (OR 2.57, 95% CI 1.20–6.45). No significant association was found between the traditional pattern and obesity. Moreover, dietary pattern differences occurred due to the differences in socio-demographic characteristics. In conclusion, the modern dietary pattern was positively, and the tuber pattern negatively, associated with general and central obesity among adults in Southwest China. PMID:27827895

  9. A prospective study of the modified Atkins diet for adults with idiopathic generalized epilepsy.

    PubMed

    Kverneland, Magnhild; Selmer, Kaja K; Nakken, Karl O; Iversen, Per O; Taubøll, Erik

    2015-12-01

    For children with pharmacoresistant epilepsy, the ketogenic diet is an established treatment option worldwide. However, for adults, this treatment is less frequently offered, and its efficacy less well-documented. The aim of this study was to examine efficacy and tolerability of such a diet as an adjuvant therapy to antiepileptic drugs for adult patients with pharmacoresistant generalized epilepsy. Thirteen patients (12 women) aged 16-57 years were included prospectively. They were treated with a modified Atkins diet for 12 weeks. Nine of the 13 participants had juvenile myoclonic epilepsy (JME), two had childhood absence epilepsy, one had Jeavons syndrome, and one had generalized epilepsy of unknown type. Six participants, all with JME, completed the 12-week study period. Among these six, four had >50% seizure reduction. Their seizure severity, using the revised Liverpool Seizure Severity Scale, was reduced by 1, 5, 57.5, and 70 points, respectively (scale: 1-100 points). In three of these four responders, quality of life, assessed by QOLIE-89, increased more than 20 points (scale: 0-100 points). Mean reduction of body weight after 12 weeks on diet was 6.5 (range: 4.3-8.1) kg. Lack of motivation, poor compliance, and seizure aggravation were the main reasons for premature termination of the diet. Apart from one patient who developed gallstones when ending the treatment after 10 months, no adverse effects were noted. In conclusion, using a modified Atkins diet for 12 weeks led to a clinically relevant reduction of seizure frequency in four of thirteen adult patients with pharmacoresistant generalized epilepsy. All responders were diagnosed with JME. In three of the four, the benefits of diet were so considerable that they chose to continue the treatment.

  10. Secular trends in the prevalence of general and abdominal obesity among Chinese adults, 1993-2009.

    PubMed

    Xi, B; Liang, Y; He, T; Reilly, K H; Hu, Y; Wang, Q; Yan, Y; Mi, J

    2012-03-01

    The objective of this study is to examine the trends in body mass index (BMI), waist circumference (WC) and prevalence of overweight (BMI 25-27.49 kg m(-2) ), general obesity (BMI ≥ 27.5 kg m(-2) ) and abdominal obesity (WC ≥ 90 cm for men and ≥80 cm for women) among Chinese adults from 1993 to 2009. Data were obtained from the China Health and Nutrition Survey, which was conducted from 1993 to 2009 and included a total of 52,621 Chinese adults. During the period of 1993-2009, mean BMI values increased by 1.6 kg m(-2) among men and 0.8 kg m(-2) among women; mean WC values increased by 7.0 cm among men and 4.7 cm among women. The prevalence of overweight increased from 8.0 to 17.1% among men (P < 0.001) and from 10.7 to 14.4% among women (P < 0.001); the prevalence of general obesity increased from 2.9 to 11.4% among men (P < 0.001) and from 5.0 to 10.1% among women (P < 0.001); the prevalence of abdominal obesity increased from 8.5 to 27.8% among men (P < 0.001) and from 27.8 to 45.9% among women (P < 0.001). Similar significant trends were observed in nearly all age groups and regions for both men and women. The prevalence of overweight, general obesity and abdominal obesity among Chinese adults has increased greatly during the past 17 years.

  11. Managing Transition with Support: Experiences of Transition from Child and Adolescent Psychiatry to General Adult Psychiatry Narrated by Young Adults and Relatives

    PubMed Central

    Söderberg, Siv; Skär, Lisa

    2014-01-01

    Young adults with mental illness who need continuing care when they turn 18 are referred from child and adolescent psychiatry to general adult psychiatry. During this process, young adults are undergoing multiple transitions as they come of age while they transfer to another unit in healthcare. The aim of this study was to explore expectations and experiences of transition from child and adolescent psychiatry to general adult psychiatry as narrated by young adults and relatives. Individual interviews were conducted with three young adults and six relatives and analysed according to grounded theory. The analysis resulted in a core category: managing transition with support, and three categories: being of age but not mature, walking out of security and into uncertainty, and feeling omitted and handling concerns. The young adults' and relatives' main concerns were that they might be left out and feel uncertainty about the new situation during the transition process. To facilitate the transition process, individual care planning is needed. It is essential that young adults and relatives are participating in the process to be prepared for the changes and achieve a successful transition. Knowledge about the simultaneous processes seems to be an important issue for facilitating transition. PMID:24829900

  12. Use of generalized population ratios to obtain Fe XV line intensities and linewidths at high electron densities

    NASA Technical Reports Server (NTRS)

    Kastner, S. O.; Bhatia, A. K.

    1980-01-01

    A generalized method for obtaining individual level population ratios is used to obtain relative intensities of extreme ultraviolet Fe XV emission lines in the range 284-500 A, which are density dependent for electron densities in the tokamak regime or higher. Four lines in particular are found to attain quite high intensities in the high-density limit. The same calculation provides inelastic contributions to linewidths. The method connects level populations and level widths through total probabilities t(ij), related to 'taboo' probabilities of Markov chain theory. The t(ij) are here evaluated for a real atomic system, being therefore of potential interest to random-walk theorists who have been limited to idealized systems characterized by simplified transition schemes.

  13. Comparison of Younger and Older Adults' Acceptability of Treatment for Generalized Anxiety Disorder Co-Occurring with Parkinson's Disease

    ERIC Educational Resources Information Center

    Lundervold, Duane A.; Ament, Patrick A.; Holt, Peter S.; Hunt, Lauren S.

    2013-01-01

    Acceptability ratings of medication or Behavioral Relaxation Training (BRT), for general anxiety disorder (GAD) co-occurring with Parkinson's Disease (PD) were obtained from younger ("n" = 79) and older ("n" = 54) adults. Participants read a case description of an older adult with PD and comorbid GAD followed by a description…

  14. Penetration of High Intensity Radiated Fields (HIRF) Into General Aviation Aircraft

    NASA Technical Reports Server (NTRS)

    Balanis, Constantine A.; Birtcher, Craig R.; Georgakopoulos, Stavros V.; Panaretos, Anastasios H.

    2004-01-01

    The ability to design and achieve electromagnetic compatibility is becoming more challenging with the rapid development of new electronic products and technologies. The importance of electromagnetic interference (EMI) and electromagnetic compatibility (EMC) issues stems from the fact that the ambient electromagnetic environment has become very hostile; that is, it increases both in density and intensity, while the current trend in technology suggests the number of electronic devices increases in homes, businesses, factories, and transportation vehicles. Furthermore, the operating frequency of products coming into the market continuously increases. While cell phone technology has exceeded 1 GHz and Bluetooth operates at 2.4 GHz, products involving satellite communications operate near 10 GHz and automobile radar systems involve frequencies above 40 GHz. The concern about higher frequencies is that they correspond to smaller wavelengths, therefore electromagnetic waves are able to penetrate equipment enclosure through apertures or even small cracks more easily. In addition, electronic circuits have become small in size, and they are usually placed on motherboards or housed in boxes in very close proximity. Cosite interference and coupling in all electrical and electronic circuit assemblies are two essential issues that have to be examined in every design.

  15. Antibiotic prescription and cost patterns in a general intensive care unit

    PubMed Central

    Krivoy, Norberto; El-Ahal, Wissam Abed; Bar-Lavie, Yaron; Haddad, Salim

    Antibiotic prescription habits, cost pattern, and the prospective intervention in an Intensive Care Unit were analyzed. Methods Data on antibiotic utilization and costs were collected prospectively from individual electronic charts from August 2003 to January 2004, and retrospectively from August to December 2002. Results A total of 180 and 107 patients were surveyed in 2002 and 2003. In 2002, Piperacillin-Tazobactam (13.8%) and Imipenem/Cilastin (11.2%) were the most prescribed medications; while, in 2003, Vancomycin (12.6%) and Imipenem/Cilastin (11.3%) were prescribed, respectively. Total defined daily dose (DDD) and Drug Utilization 90% (DU90%) index for 2002 and 2003 were 2031.15 and 2325.90 DDDs (p>0.1) and 1777.57 and 2079.61 DU90%, respectively (p>0.1). The Median Total Cost /100 admission days (CI 95%) were NIS13,310 (11,110;18,420) and NIS13,860 (6,710;18,020) (p=0.66), respectively. Conclusions Interventional programs should focus on promoting infectious control with rational antibiotic prescription aimed at minimizing the future emergence of bacterial resistance and futile expenses. PMID:25214920

  16. Continuous EEG monitoring in adults in the intensive care unit (ICU).

    PubMed

    André-Obadia, N; Parain, D; Szurhaj, W

    2015-03-01

    Continuous EEG monitoring in the ICU is different from planned EEG due to the rather urgent nature of the indications, explaining the fact that recording is started in certain cases by the clinical team in charge of the patient's care. Close collaboration between neurophysiology teams and intensive care teams is essential. Continuous EEG monitoring can be facilitated by quantified analysis systems. This kind of analysis is based on certain signal characteristics, such as amplitude or frequency content, but raw EEG data should always be interpreted if possible, since artefacts can sometimes impair quantified EEG analysis. It is preferable to work within a tele-EEG network, so that the neurophysiologist has the possibility to give an interpretation on call. Continuous EEG monitoring is thus useful in the diagnosis of non-convulsive epileptic seizures or purely electrical discharges and in the monitoring of status epilepticus when consciousness disorders persist after initial treatment. A number of other indications are currently under evaluation.

  17. Information processing bias and pharmacotherapy outcome in older adults with generalized anxiety disorder.

    PubMed

    Steiner, Amanda R W; Petkus, Andrew J; Nguyen, Hoang; Wetherell, Julie Loebach

    2013-08-01

    Information processing bias was evaluated in a sample of 25 older adults with generalized anxiety disorder (GAD) over the course of 12 weeks of escitalopram pharmacotherapy. Using the CANTAB Affective Go/No Go test, treatment response (as measured by the Hamilton Anxiety Rating Scale, Penn State Worry Questionnaire, and Generalized Anxiety Disorder Severity Scale) was predicted from a bias score (i.e., difference score between response latencies for negative and positive words) using mixed-models regression. A more positive bias score across time predicted better response to treatment. Faster responses to positive words relative to negative words were associated with greater symptomatic improvement over time as reflected by scores on the GADSS. There was a trend toward significance for PSWQ scores and no significant effects related to HAMA outcomes. These preliminary findings offer further insights into the role of biased cognitive processing of emotional material in the manifestation of late-life anxiety symptoms.

  18. Intensive care discharge summaries for general practice staff: a focus group study

    PubMed Central

    Bench, Suzanne; Cornish, Jocelyn; Xyrichis, Andreas

    2016-01-01

    Background Understanding how patients and relatives can be supported after hospital discharge is a UK research priority. Intensive Care Unit (ICU) discharge summaries are a simple way of providing GPs with the information they require to coordinate ongoing care, but little evidence is available to guide best practice. Aim This study aimed at better understanding the information needs of GP staff (GPs and practice nurses) supporting former patients of ICUs and their families following discharge from hospital, and identifying the barriers/facilitators associated with ICU–primary care information transfer. Design and setting This was a qualitative exploratory study of practices and participants throughout the UK. Method Audiotaped focus group discussions, complemented by small-group/individual interviews, were conducted with 15 former patients of ICUs, four relatives, and 20 GP staff between June and September 2015. Demographic data were captured by questionnaire and qualitative data were thematically analysed. Results Findings suggest variability in discharge information experiences and blurred lines of responsibility between hospital and GP staff, and patients/relatives. Continuity of care was affected by delayed or poor communication from the hospital; GPs’ limited contact with patients from critical care; and a lack of knowledge of the effects of critical illness or resources available to ameliorate these difficulties. Time pressures and information technology were, respectively, the most commonly mentioned barrier and facilitator. Conclusion Effective rehabilitation after a critical illness requires a coordinated and comprehensive approach, incorporating the provision of well-completed, timely, and relevant ICU–primary care discharge information. Health professionals need an improved understanding of critical illness, and patients and families must be included in all aspects of the information-sharing process. PMID:27872086

  19. Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy.

    PubMed

    Zieleskiewicz, Laurent; Chantry, Anne; Duclos, Gary; Bourgoin, Aurelie; Mignon, Alexandre; Deneux-Tharaux, Catherine; Leone, Marc

    2016-10-01

    In developed countries, the rate of obstetric ICU admissions (admission during pregnancy or the postpartum period) is between 0.5 and 4 per 1000 deliveries and the overall case-fatality rate is about 2%. The most two common causes of obstetric ICU admissions concerned direct obstetric pathologies: obstetric hemorrhage and hypertensive disorders of pregnancy. This review summarized the principles of management of critically ill pregnant patient. Its imply taking care of two patients in the same time. A coordinated multidisciplinary team including intensivists, anesthesiologists, obstetricians, pediatricians and pharmacists is therefore necessary. This team must work effectively together with regular staff aiming to evaluate daily the need to maintain the patient in intensive care unit or to prompt delivery. Keeping mother and baby together and fetal well-being must be balanced with the need of specialized advanced life support for the mother. The maternal physiological changes imply various consequences on management. The uterus aorto-caval compression implies tilting left the parturient. In case of cardiac arrest, uterus displacement and urgent cesarean delivery are needed. The high risk of aspiration and difficult tracheal intubation must be anticipated. Even during acute respiratory distress syndrome, hypoxemia and permissive hypercapnia must be avoided due to their negative impact on the fetus. Careful analysis of the benefit-risk ratio is needed before all drug administration. Streptococcal toxic shock syndrome and perineal fasciitis must be feared and a high level of suspicion of sepsis must be maintained. Finally the potential benefits of an ultrasound-based management are detailed.

  20. Recognition of Intensive Valence and Arousal Affective States via Facial Electromyographic Activity in Young and Senior Adults

    PubMed Central

    Li, Hang; Walter, Steffen; Hrabal, David; Rukavina, Stefanie; Limbrecht-Ecklundt, Kerstin; Hoffman, Holger; Traue, Harald C.

    2016-01-01

    Background Research suggests that interaction between humans and digital environments characterizes a form of companionship in addition to technical convenience. To this effect, humans have attempted to design computer systems able to demonstrably empathize with the human affective experience. Facial electromyography (EMG) is one such technique enabling machines to access to human affective states. Numerous studies have investigated the effects of valence emotions on facial EMG activity captured over the corrugator supercilii (frowning muscle) and zygomaticus major (smiling muscle). The arousal emotion, specifically, has not received much research attention, however. In the present study, we sought to identify intensive valence and arousal affective states via facial EMG activity. Methods Ten blocks of affective pictures were separated into five categories: neutral valence/low arousal (0VLA), positive valence/high arousal (PVHA), negative valence/high arousal (NVHA), positive valence/low arousal (PVLA), and negative valence/low arousal (NVLA), and the ability of each to elicit corresponding valence and arousal affective states was investigated at length. One hundred and thirteen participants were subjected to these stimuli and provided facial EMG. A set of 16 features based on the amplitude, frequency, predictability, and variability of signals was defined and classified using a support vector machine (SVM). Results We observed highly accurate classification rates based on the combined corrugator and zygomaticus EMG, ranging from 75.69% to 100.00% for the baseline and five affective states (0VLA, PVHA, PVLA, NVHA, and NVLA) in all individuals. There were significant differences in classification rate accuracy between senior and young adults, but there was no significant difference between female and male participants. Conclusion Our research provides robust evidences for recognition of intensive valence and arousal affective states in young and senior adults. These

  1. Adult attachment, emotion dysregulation, and symptoms of depression and generalized anxiety disorder.

    PubMed

    Marganska, Anna; Gallagher, Michelle; Miranda, Regina

    2013-01-01

    Differences in attachment style have been linked to both emotion regulation and psychological functioning, but the emotion regulatory mechanism through which attachment style might impact symptoms of depression and anxiety is unclear. The present study examined the explanatory role of emotion dysregulation in the relation between adult attachment style and symptoms of depression and generalized anxiety disorder (GAD) in a sample of 284 adults. Secure attachment was associated with lower depression and GAD symptoms and lower emotion dysregulation, whereas insecure attachment styles were generally associated with higher depression and GAD scores and higher emotion dysregulation. Perceived inability to generate effective emotion regulation strategies mediated the relation between insecure attachment and both depression and GAD symptoms. Nonacceptance of negative emotions and inability to control impulsive behaviors emerged as additional mediators of the relation between insecure attachment styles and GAD symptoms. The differential contribution of attachment style and emotion regulation to the prediction of depression and GAD symptoms may reflect differences in vulnerability to depression and GAD.

  2. Intimate partner victimization among adults aged 60 and older: an analysis of the 1999 and 2004 General Social Survey.

    PubMed

    Poole, Christopher; Rietschlin, John

    2012-04-01

    Accounts in both the scientific literature and popular media have brought about increased recognition of the reality of elder abuse. However, relatively little work has examined intimate partner victimization with respect to older adults. In this study, weighted data from cycles 13 (1999) and 18 (2004) of the General Social Survey are pooled to examine how factors uniquely influence the prevalence and risk of emotional, financial, and physical abuse among adults aged 60 and over. Considerations regarding elder abuse committed by spouses, versus abuse of older adults more broadly (by their children and other adults), are also discussed.

  3. Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis

    PubMed Central

    Zhang, Zhongheng; Chen, Kun; Ni, Hongying; Zhang, Xiaoling; Fan, Haozhe

    2017-01-01

    Sedatives are commonly used for mechanically ventilated patients in intensive care units (ICU). However, a variety of sedatives are available and their efficacy and safety have been compared in numerous trials with inconsistent results. To resolve uncertainties regarding usefulness of these sedatives, we performed a systematic review and network meta-analysis. Randomized controlled trials comparing sedatives in mechanically ventilated ICU patients were included. Graph-theoretical methods were employed for network meta-analysis. A total of 51 citations comprising 52 RCTs were included in our analysis. Dexmedetomidine showed shorter MV duration than lorazepam (mean difference (MD): 68.7; 95% CI: 18.2–119.3 hours), midazolam (MD: 10.2; 95% CI: 7.7–12.7 hours) and propofol (MD: 3.4; 95% CI: 0.9–5.9 hours). Compared with dexmedetomidine, midazolam was associated with significantly increased risk of delirium (OR: 2.47; 95% CI: 1.17–5.19). Our study shows that dexmedetomidine has potential benefits in reducing duration of MV and lowering the risk of delirium. PMID:28322337

  4. Effects of a low-volume, vigorous intensity step exercise program on functional mobility in middle-aged adults.

    PubMed

    Doheny, Emer P; McGrath, Denise; Ditroilo, Massimiliano; Mair, Jacqueline L; Greene, Barry R; Caulfield, Brian; De Vito, Giuseppe; Lowery, Madeleine M

    2013-08-01

    Aging-related decline in functional mobility is associated with loss of independence. This decline may be mitigated through programs of physical activity. Despite reports of aging-related mobility impairment in middle-aged adults, this age group has been largely overlooked in terms of exercise programs that target functional mobility and the preservation of independence in older age. A method to quantitatively assess changes in functional mobility could direct rehabilitation in a proactive rather than reactive manner. Thirty-three healthy but sedentary middle-aged adults participated in a four week low-volume, vigorous intensity stepping exercise program. Two baseline testing sessions and one post-training testing session were conducted. Functional mobility was assessed using the timed up and go (TUG) test, with its constituent sit-to-walk and walk-to-sit phases examined using a novel inertial sensor-based method. Additionally, semi-tandem balance and knee extensor muscle isometric torque were assessed. Trunk acceleration during walk-to-sit reduced significantly post-training, suggesting altered movement control due to the exercise program. No significant training-induced changes in sit-to-walk acceleration, TUG time, balance or torque were observed. The novel method of functional mobility assessment presented provides a reliable means to quantify subtle changes in mobility during postural transitions. Over time, this exercise program may improve functional mobility.

  5. Improved Glycemic Control in Intensively Treated Adult Subjects with Type 1 Diabetes Using Insulin Guidance Software

    PubMed Central

    Bookout, Tevin R.; McFann, Kim K.; Kelly, William C.; Beatson, Christie; Ellis, Samuel L.; Gutin, Raymond S.; Gottlieb, Peter A.

    2008-01-01

    Abstract Background Management of type 1 diabetes could be significantly improved with the availability of computerized insulin algorithms for home use. Methods This was a 1-year open label randomized control trial involving 123 adult subjects with type 1 diabetes (hemoglobin A1c values 7.5–11%) assigned to either the insulin guidance software (ACCU-CHEK® [Roche, Indianapolis, IN] Advisor) for personal data assistant (experimental group) or the control group. The primary aim of the study was to see if subjects using insulin dosing advisor software will improve glucose control over 1 year. The principal end point was an improvement in A1c at 6 and 12 months by ≥0.4%. Results Baseline demographics were similar in the two groups. Mean A1c was 8.54 ± 0.11% in the control group and 8.42 ± 0.11% (P = 0.4265) in the experimental group. The mean A1c was significantly lower from 3 to 12 months in the experimental group (P < 0.02). A1c reduction of ≥0.6% was maintained at 12 months in the experimental group. Also, a significantly higher number of subjects achieved A1c <7.5% in the experimental group from 3 to 9 months. Within target range glycemia (70–150 mg/dL) was higher in the experimental group at 3–9 months without any change in insulin dose or weight. Above target range glycemia was lower in the experimental group throughout the study. Frequency of testing per day was higher in the experimental group. Nocturnal hypoglycemia was not different between groups; however, the experimental group experienced more severe hypoglycemic events. Conclusions This is the first report that shows improved glycemic control can be maintained over 12 months in patients with type 1 diabetes by using Advisor with no change in insulin dose and weight. PMID:18715213

  6. A family nursing educational intervention supports nurses and families in an adult intensive care unit.

    PubMed

    Eggenberger, Sandra K; Sanders, Marita

    2016-11-01

    The family experience of critical illness is filled with distress that may have a lasting impact on family coping and family health. A nurse can become a source of comfort that helps the family endure. Yet, nurses often report a lack of confidence in communicating with families and families report troubling relationships with nurses. In spite of strong evidence supporting nursing practice focused on the family, family nursing interventions often not implemented in the critical care setting. This pilot study examined the influence of an educational intervention on nurses' attitudes towards and confidence in providing family care, as well as families' perceptions of support from nurses in an adult critical care setting. An academic-clinical practice partnership used digital storytelling as an educational strategy. A Knowledge to Action Process Framework guided this study. Results of pre-intervention data collection from families and nurses were used to inform the educational intervention. A convenience sample of family members completed the Iceland Family Perceived Support Questionnaire (ICE-FPSQ) to measure perception of support provided by nurses. Video, voice, and narrative stories of nurses describing their experiences caring for family members during a critical illness and family members' experiences with a critically ill family member also guided education plans. When comparing the pre and post results of the Family Nurse Practice Scale (FNPS), nurses reported increased confidence, knowledge, and skill following the educational intervention. Qualitative data from nurses reported satisfaction with the educational intervention. Findings suggest that engaging nurses in educational opportunities focused on families while using storytelling methods encourages empathic understandings. Academic-clinician teams that drive directions show promise in supporting families and nurses in critical care settings. Plans are moving forward to use this study design and methods in

  7. Prospective Study of Single vs. Two Unit Umbilical Cord Blood Transplantation Following Reduced Intensity Conditioning in Adults with Hematologic Malignancies

    PubMed Central

    Kindwall-Keller, Tamila L.; Hegerfeldt, Yael; Meyerson, Howard J.; Margevicius, Seunghee; Fu, Pingfu; van Heeckeren, Willem; Lazarus, Hillard M.; Cooper, Brenda W.; Gerson, Stanton L.; Barr, Paul; Tse, William W.; Curtis, Christine; Fanning, Laura R.; Creger, Richard J.; Carlson-Barko, Joanne M.; Laughlin, Mary J.

    2011-01-01

    As the threshold nucleated cell dose for single unit umbilical cord blood (UCB) in adults has not to date been firmly established, we prospectively compared single vs. 2-unit UCB transplantation after reduced intensity conditioning (RIC) in adult patients with hematologic malignancies. Study design specified one UCB unit if the cryopreserved total nucleated cell (TNC) dose was ≥2.5×107/kg recipient weight, otherwise 2-units matched at minimum 4/6 HLA loci to the patient and 3/6 to each other were infused. Twenty-seven patients received 1 unit; 23 patients received 2 units. Median time to absolute neutrophil count (ANC) >500/μL was 24 days (95% CI 22–28 days), 25 days for 1-unit and 23 days for 2-units (p=0.99). At day 100, ANC >500/μL was 88.4% and 91.3% in the 1 and 2-unit groups (p=0.99), respectively. Three-year event free survival (EFS) was 28.6% and 39.1% in the 1 and 2-unit groups (p=0.71), respectively. Infusion of 2 units was associated with significantly lower relapse risk, 30.4% vs. 59.3% (p=0.045). Infused cell doses (TNC, CD3+, CD34+, CD56+CD3neg) did not impact engraftment, overall survival (OS), or EFS. Taken together, single unit UCB transplantation with threshold cell dose ≥2.5×107/kg recipient weight after RIC is a viable option for adults, although infusion of 2 units confers a lower relapse incidence. PMID:22002488

  8. The evolution of generalized fault symptoms and fault intensities as indicators of observation redundancy and coming system breakdown

    NASA Astrophysics Data System (ADS)

    Cempel, CzesŁaw

    2011-11-01

    Application of SVD to fault extraction from the machine symptom observation matrix ( SOM) seems to be validated enough, especially by data taken from many real diagnostic cases. However, decomposition has two sets of components, singular vectors, and singular vales. The first component we obtain directly as the lifetime discrete function and it has direct diagnostic meaning in condition monitoring. The second component has not so direct interpretation but with some software update one can see how singular value evolves along the system lifetime. Strangely, it is a good indicator of observation redundancy, and it is the measure of generalized fault intensity. More importantly, this measure is not sensitive to the changing condition of machine work, like working load, and we do not need to filter our observation or generalized symptoms in any way. This seems to be the most important conclusion of this paper, but needs more validation.

  9. Adult language use and infant comprehension of English: associations with encoding and generalization across cues at 20 months.

    PubMed

    Phung, Janice N; Milojevich, Helen M; Lukowski, Angela F

    2014-11-01

    Adult-provided language shapes event memory in children who are preverbal and in those who are able to discuss the past using language. The research conducted to date, however, has not yet established whether infant language comprehension abilities moderate the extent to which preverbal infants benefit from adult-provided supportive language. The present study was conducted to address this question by examining immediate imitation and 1-week delayed generalization across cues in 20-month-old infants as a function of (a) variability in adult-provided linguistic support at encoding and test, (b) infant language comprehension abilities, and (c) their interaction. The provision of supportive adult language at encoding and test was associated with delayed generalization across cues although supportive adult language at encoding did not influence performance at immediate imitation. Infant language comprehension abilities were associated with performance at immediate imitation and delayed generalization across cues. In addition, infant language comprehension abilities moderated the extent to which infants benefited from adult-provided supportive language at encoding and test. The findings contribute to the literature by demonstrating that adult language use and infant language comprehension are independently and differentially associated with immediate imitation and 1-week delayed generalization across cues but also serve to jointly structure event memory in the second year of life.

  10. Acute high-intensity exercise-induced cognitive enhancement and brain-derived neurotrophic factor in young, healthy adults.

    PubMed

    Hwang, Jungyun; Brothers, R Matthew; Castelli, Darla M; Glowacki, Elizabeth M; Chen, Yen T; Salinas, Mandy M; Kim, Jihoon; Jung, Yeonhak; Calvert, Hannah G

    2016-09-06

    Acute exercise can positively impact cognition. The present study examined the effect of acute high-intensity aerobic exercise on prefrontal-dependent cognitive performance and brain-derived neurotrophic factor (BDNF). Fifty-eight young adults were randomly assigned to one of two experimental groups: (a) an acute bout of high-intensity exercise (n=29) or (b) a non-exercise control (n=29). Participants in the exercise group improved performance on inhibitory control in Stroop interference and on cognitive flexibility in Trail Making Test (TMT) Part-B compared with participants in the control group and increased BDNF immediately after exercise. There was a significant relationship between BDNF and TMT Part-B on the pre-post change following exercise. These findings provide support for the association between improved prefrontal-dependent cognitive performance and increased BDNF in response to acute exercise. We conclude that the changes in BDNF concentration may be partially responsible for prefrontal-dependent cognitive functioning following an acute bout of exercise.

  11. Resistance exercise performance variability at submaximal intensities in older and younger adults

    PubMed Central

    Grosicki, Gregory J; Miller, Michael E; Marsh, Anthony P

    2014-01-01

    We assessed the variability in the number of repetitions completed at submaximal loads in three resistance tasks in older (N=32, 16 female, 74.3±5.4 years) and younger (N=16, 8 female, 22.8±1.8 years) men and women. One repetition maximum (1RM) was determined on two separate visits on three tasks: leg press (LP), leg extension (LE), and bicep curl (BC). Subjects then completed repetitions to failure on each of the three tasks during two visits, a minimum of 48 hours apart, at either 60% 1RM or 80% 1RM. High reliability for all 1RM assessments was observed. Greater muscular strength was observed in younger compared to older men and women on all tasks (P<0.05). At both 60% and 80% 1RM, considerable interindividual variability was observed in the number of repetitions completed. However, the average number of repetitions completed by younger and older men and women at 60% and 80% 1RM in each of the three tasks was similar, with the only significant difference occurring between younger and older men at 80% 1RM on the leg press (P=0.0258). We did not observe any abnormal blood pressure responses to either the 1RM testing or maximal repetition testing sessions. Considerable interindividual variability was observed in the number of repetitions completed by younger and older men and women at relative intensities typical of resistance training programs. Practitioners should give consideration to individual variability when attempting to maximize the benefits of resistance training. PMID:24465127

  12. Hepatic injury following reduced intensity unrelated cord blood transplantation for adult patients with hematological diseases.

    PubMed

    Kusumi, Eiji; Kami, Masahiro; Kanda, Yoshinobu; Murashige, Naoko; Seki, Kunihiko; Fujiwara, Masayo; Koyama, Rikako; Komatsu, Tsunehiko; Hori, Akiko; Tanaka, Yuji; Yuji, Koichiro; Matsumura, Tomoko; Masuoka, Kazuhiro; Wake, Atsushi; Miyakoshi, Shigesaburo; Taniguchi, Shuichi

    2006-12-01

    Liver injury is a common complication in allogeneic hematopoietic stem cell transplantation. Its major causes comprise graft-versus-host disease (GVHD), infection, and toxicities of preparative regimens and immunosuppressants; however, we have little information on liver injuries after reduced intensity cord blood transplantation (RICBT). We reviewed medical records of 104 recipients who underwent RICBT between March 2002 and May 2004 at Toranomon Hospital. Preparative regimen and GVHD prophylaxis comprised fludarabine/melphalan/total body irradiation and cyclosporine or tacrolimus. We assessed the etiology of liver injuries based on the clinical presentation, laboratory results, comorbid events, and imaging studies in 85 patients who achieved primary engraftment. The severity of liver dysfunction was assessed according to the National Cancer Institute Common Toxicity Criteria version 2.0. Hyperbilirubinemia was graded according to a report by Hogan et al (Blood. 2004;103:78-84). Moderate to very severe liver injuries were observed in 36 patients. Their causes included cholestatic liver disease (CLD) related to GVHD or sepsis (n = 15), GVHD (n = 7), cholangitis lenta (n = 5), and others (n = 9). Median onsets of CLD, GVHD, and cholangitis lenta were days 37, 40, and 22, respectively. Frequencies of grade 3-4 alanine aminotransferase elevation were comparable across the 3 types of hepatic injuries. Serum gamma-glutamil transpeptidase was not elevated in any patients with cholangitis lenta, whereas 27% and 40% of patients with CLD and GVHD, respectively, developed grade 3-4 gamma-glutamil transpeptidase elevation. Multivariate analysis identified 2 risk factors for hyperbilirubinemia; grade II-IV acute GVHD (relative risk, 2.23; 95% confidential interval, 1.11-4.47; P = .024) and blood stream infection (relative risk, 3.77; 95% confidential interval, 1.91-7.44; P = .00013). In conclusion, the present study has demonstrated that the hepatic injuries are significant

  13. Adult Celiac Disease: Patients Are Shorter Compared with Their Peers in the General Population

    PubMed Central

    Esmaeilzadeh, Abbas; Ganji, Azita; Goshayeshi, Ladan; Ghafarzadegan, Kamran; Afzal Aghayee, Mehdi; Mosanen Mozafari, Homan; Saadatniya, Hassan; Hayatbakhs, Abdolrasol; Ghavami Ghanbarabadi, Vahid

    2016-01-01

    BACKGROUND Delay in diagnosis of celiac disease (CD) occurs frequently, although its consequences are mostly not known. One of the presented symptoms in pediatric patients with CD is the short stature. However, far too little attention has been paid to physical features including height of adult patients with CD. This study was undertaken to evaluate whether patients suffering from CD are shorter in comparison with the general population without CD. As well, we evaluated probable correlations between demographic and physical features, main complains, serum anti tTG level, and intestinal pathology damage between short (lower quartile) versus tall stature (upper quartile) patients with CD. METHODS This was a retrospective cross-sectional study on 219 adult patients diagnosed as having CD in the Celiac Disease Center, between June 2008 and June 2014 in Mashhad, Iran. The exclusion criteria were ages less than 18 and more than 60 years. Height was compared with a group of 657 age- and sex matched control cases from the healthy population. The probable influencing factors on height such as intestinal pathology, serum level of anti-tissue transglutaminase(anti-tTG), serum vitamin D, and hemoglobin level at the time of diagnosis were assessed and were compared in short (lower quartile) versus tall stature (upper quartile) patients with CD. RESULTS Both male (n=65) and female (n=154) patients with CD were shorter than their counterpart in the general population (males: 168.5±8.6 to 171.3±7.2cm, p <0.01 and females: 154.8±10.58 to 157.8±7.2 cm, p <0.01). Spearman linear correlation showed height in patient with CD was correlated with serum hemoglobin (p <0.001, r=0.285) and bone mineral density (p<0.001) and not with serum vitamin D levels (p =0.024, r=0.237), but was not correlated with anti-tTG serum levels (p=0.97). CD patients with upper and lower quartile of height in men and women had no significant difference in the anti-tTG level and degree of duodenal pathology

  14. On-FarmWelfare Assessment Protocol for Adult Dairy Goats in Intensive Production Systems.

    PubMed

    Battini, Monica; Stilwell, George; Vieira, Ana; Barbieri, Sara; Canali, Elisabetta; Mattiello, Silvana

    2015-09-25

    Within the European AWIN project, a protocol for assessing dairy goats' welfareon the farm was developed. Starting from a literature review, a prototype includinganimal-based indicators covering four welfare principles and 12 welfare criteria was set up.The prototype was tested in 60 farms for validity, reliability, and feasibility. After testing theprototype, a two-level assessment protocol was proposed in order to increase acceptabilityamong stakeholders. The first level offers a more general overview of the welfare status,based on group assessment of a few indicators (e.g., hair coat condition, latency to thefirst contact test, severe lameness, Qualitative Behavior Assessment), with no or minimalhandling of goats and short assessment time required. The second level starts if welfareAnimals 2015, 5 935problems are encountered in the first level and adds a comprehensive and detailed individualevaluation (e.g., Body Condition Score, udder asymmetry, overgrown claws), supported byan effective sampling strategy. The assessment can be carried out using the AWIN Goatapp. The app results in a clear visual output, which provides positive feedback on welfareconditions in comparison with a benchmark of a reference population. The protocol maybe a valuable tool for both veterinarians and technicians and a self-assessment instrumentfor farmers.

  15. Cognitive Behavioral Treatment for Older Adults with Generalized Anxiety Disorder: A Therapist Manual for Primary Care Settings

    ERIC Educational Resources Information Center

    Stanley, Melinda A.; Diefenbach, Gretchen J.; Hopko, Derek R.

    2004-01-01

    At least four academic clinical trials have demonstrated the utility of cognitive behavior therapy (CBT) for older adults with generalized anxiety disorder (GAD). These data may not generalize, however, to more heterogeneous and functionally impaired patients and the medical settings in which they typically receive care. A recent pilot project…

  16. The PACE study: lifetime and past-year prevalence of headache in Parma's adult general population.

    PubMed

    Taga, Arens; Russo, Marco; Manzoni, Gian Camillo; Torelli, Paola

    2017-02-17

    Headache is a widespread disorder and therefore it has a strong impact on quality of life. In the present work we focused on lifetime and past-year prevalence of headache in general and by gender, in a population-based sample in Parma. A total of 904 subjects representative of Parma's adult general population were interviewed face-to-face by a physician from the Parma Headache Centre, using a validated questionnaire. The lifetime prevalence of headache was 69.1%, i.e. 75.8% in women and 60.6% in men; the crude past-year prevalence of headache was 42.8%, i.e. 52.0% in women and 31.1% in men. Both lifetime and past-year prevalence rates were significantly higher in females than in males (odds ratio, respectively, 2.0 and 2.4). In our study, past-year prevalence decreased after age 50 in both genders. Most people suffer from one headache subtype. In over 80% of cases, headache starts before age 40 and therefore people were not very likely to develop headache after 50 years. The past-year and lifetime prevalence rate of headache in general that we found in our study falls within the lower range of values for headache prevalence in European countries. Further researches need to be set in the Italian epidemiological background.

  17. Training for generalization in Theory of Mind: a study with older adults

    PubMed Central

    Cavallini, Elena; Bianco, Federica; Bottiroli, Sara; Rosi, Alessia; Vecchi, Tomaso; Lecce, Serena

    2015-01-01

    Theory of Mind (ToM) refers to the ability to attribute independent mental states to self and others in order to explain and predict social behavior. Recent research in this area has shown a decline in ToM abilities associated with normal aging that is of a moderate magnitude or greater. Very few studies have investigated whether it is possible to improve older adults’ ToM abilities. The present study was designed to address this gap in the literature by evaluating the impact of a ToM training on practiced and transfer tasks. We provided older adults with a variety of activities designed to facilitate the generalization of benefits to other ToM-demanding tasks. Participants were 63 healthy older adults, native Italian speakers (Mage = 71.44, SD = 5.24, age range: 63–81 years). Participants were randomly assigned to one of two groups: the ToM training (age range: 63–81 years) and the physical-conversation training (age range: 64–81 years). Training effects were measured using the strange stories (practiced task) and the animation task (transfer task). Results revealed the efficacy of the training in producing improvements on practiced but also on transfer tasks. PMID:26300818

  18. More than words: fast acquisition and generalization of orthographic regularities during novel word learning in adults.

    PubMed

    Laine, Matti; Polonyi, Tünde; Abari, Kálmán

    2014-08-01

    In literates, reading is a fundamental channel for acquiring new vocabulary both in the mother tongue and in foreign languages. By using an artificial language learning task, we examined the acquisition of novel written words and their embedded regularities (an orthographic surface feature and a syllabic feature) in three groups of university students with different exposures (Group 1 saw 2 words once, Group 2 saw 20 words once, Group 3 saw 20 words three times). Recognition memory results for Groups 2 and 3 indicated that adults can learn novel written words even with just a single exposure, albeit repeated exposure improved target detection. A generalization task revealed that even the minimal exposure in Group 1 was enough for acquisition of the two embedded regularities. More exemplars and repeated exposure provided more robust effects for the syllable regularity. Finally, post-test interview showed that repeated exposure was needed to become aware of the regularities. The present results show that adults learn novel written words and their inherent regularities in a fast and effective fashion.

  19. Major Dietary Patterns in Relation to General and Central Obesity among Chinese Adults

    PubMed Central

    Yu, Canqing; Shi, Zumin; Lv, Jun; Du, Huaidong; Qi, Lu; Guo, Yu; Bian, Zheng; Chang, Liang; Tang, Xuefeng; Jiang, Qilian; Mu, Huaiyi; Pan, Dongxia; Chen, Junshi; Chen, Zhengming; Li, Liming

    2015-01-01

    Limited evidence exists for the association between diet pattern and obesity phenotypes among Chinese adults. In the present study, we analyzed the cross-sectional data from 474,192 adults aged 30–79 years from the China Kadoorie Biobank baseline survey. Food consumption was collected by an interviewer-administered questionnaire. Three dietary patterns were extracted by factor analysis combined with cluster analysis. After being adjusted for potential confounders, individuals following a traditional southern dietary pattern had the lowest body mass index (BMI) and waist circumference (WC); the Western/new affluence dietary pattern had the highest BMI; and the traditional northern dietary pattern had the highest WC. Compared to the traditional southern dietary pattern in multivariable adjusted logistic models, individuals following a Western/new affluence dietary pattern had a significantly increased risk of general obesity (prevalence ratio (PR): 1.06, 95% confidence interval (CI): 1.03–1.08) and central obesity (PR: 1.07, 95% CI: 1.06–1.08). The corresponding risks for the traditional northern dietary pattern were 1.05 (1.02–1.09) and 1.17 (1.25–1.18), respectively. In addition, the associations were modified by lifestyle behaviors, and the combined effects with alcohol drinking, tobacco smoking, and physical activity were analyzed. Further prospective studies are needed to elucidate the diet-obesity relationships. PMID:26184308

  20. Electrophysiological evidence for a general auditory prediction deficit in adults who stutter.

    PubMed

    Daliri, Ayoub; Max, Ludo

    2015-11-01

    We previously found that stuttering individuals do not show the typical auditory modulation observed during speech planning in nonstuttering individuals. In this follow-up study, we further elucidate this difference by investigating whether stuttering speakers' atypical auditory modulation is observed only when sensory predictions are based on movement planning or also when predictable auditory input is not a consequence of one's own actions. We recorded 10 stuttering and 10 nonstuttering adults' auditory evoked potentials in response to random probe tones delivered while anticipating either speaking aloud or hearing one's own speech played back and in a control condition without auditory input (besides probe tones). N1 amplitude of nonstuttering speakers was reduced prior to both speaking and hearing versus the control condition. Stuttering speakers, however, showed no N1 amplitude reduction in either the speaking or hearing condition as compared with control. Thus, findings suggest that stuttering speakers have general auditory prediction difficulties.

  1. Intestinal helminth infections amongst HIV-infected adults in Mthatha General Hospital, South Africa

    PubMed Central

    Yogeswaran, Parimalaranie; Wright, Graham

    2015-01-01

    Background In South Africa, studies on the prevalence of intestinal helminth co-infection amongst HIV-infected patients as well as possible interactions between these two infections are limited. Aim To investigate the prevalence of intestinal helminth infestation amongst adults living with HIV or AIDS at Mthatha General Hospital. Setting Study participants were recruited at the outpatient department of Mthatha General Hospital, Mthatha, South Africa. Methods This cross-sectional study was conducted between October and December 2013 amongst consecutive consenting HIV-positive adult patients. Socio-demographic and clinical information were obtained using data collection forms and structured interviews. Stool samples were collected to investigate the presence of helminths whilst blood samples were obtained for the measurement of CD4+ T-cell count and viral load. Results Data were obtained on 231 participants, with a mean age of 34.9 years, a mean CD4 count of 348 cells/µL and a mean viral load of 4.8 log10 copies/mL. Intestinal helminth prevalence was 24.7%, with Ascaris Lumbricoides (42.1%) the most prevalent identified species. Statistically significant association was found between CD4 count of less than 200 cells/µL and helminth infection (p = 0.05). No statistically significant association was found between intestinal helminth infection and the mean CD4 count (p = 0.79) or the mean viral load (p = 0.98). Conclusion A high prevalence of intestinal helminth infections was observed amongst the study population. Therefore, screening and treatment of helminths should be considered as part of the management of HIV and AIDS in primary health care. PMID:26842519

  2. Infections in intensive care unit adult patients harboring multidrug-resistant Pseudomonas aeruginosa: implications for prevention and therapy.

    PubMed

    Borgatta, B; Lagunes, L; Imbiscuso, A T; Larrosa, M N; Lujàn, M; Rello, J

    2017-01-16

    The purpose of this paper was to report the burden and characteristics of infection by multidrug-resistant Pseudomonas aeruginosa (MDR-PA) in clinical samples from intensive care unit (ICU) adults, and to identify predictors. This was a retrospective observational study at four medical-surgical ICUs. The case cohort comprised adults with documented isolation of an MDR-PA strain from a clinical specimen during ICU stay. Multivariate analysis was performed to identify predictors for MDR-PA infection. During the study period, 5667 patients were admitted to the ICU and P. aeruginosa was isolated in 504 (8.8%). MDR-PA was identified in 142 clinical samples from 104 patients (20.6%); 62 (43.6%) of these samples appeared to be true infections. One hundred and eighteen (83.1%) isolates were susceptible only to amikacin and colistin, and 13 (9.2%) were susceptible only to colistin. Overall, the MIC50 to meropenem was 16 μg/mL and the MIC90 was >32 μg/mL, with 60.4% of respiratory samples being MIC >32 μg/mL to meropenem. Independent predictors for MDR-PA infection were fever/hypothermia [odds ratio (OR) 9.09], recent antipseudomonal cephalosporin therapy (OR 6.31), vasopressors at infection onset (OR 4.40), and PIRO (predisposition, infection, response, and organ dysfunction) score >2 (OR 2.06). This study provides novel information that may be of use for the clinical management of patients harboring MDR-PA and for the control of the spread of this organism.

  3. Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain

    PubMed Central

    2009-01-01

    Introduction Patients with influenza A (H1N1)v infection have developed rapidly progressive lower respiratory tract disease resulting in respiratory failure. We describe the clinical and epidemiologic characteristics of the first 32 persons reported to be admitted to the intensive care unit (ICU) due to influenza A (H1N1)v infection in Spain. Methods We used medical chart reviews to collect data on ICU adult patients reported in a standardized form. Influenza A (H1N1)v infection was confirmed in specimens using real-time reverse transcriptase-polymerase-chain-reaction (RT PCR) assay. Results Illness onset of the 32 patients occurred between 23 June and 31 July, 2009. The median age was 36 years (IQR = 31 - 52). Ten (31.2%) were obese, 2 (6.3%) pregnant and 16 (50%) had pre-existing medical complications. Twenty-nine (90.6%) had primary viral pneumonitis, 2 (6.3%) exacerbation of structural respiratory disease and 1 (3.1%) secondary bacterial pneumonia. Twenty-four patients (75.0%) developed multiorgan dysfunction, 7 (21.9%) received renal replacement techniques and 24 (75.0%) required mechanical ventilation. Six patients died within 28 days, with two additional late deaths. Oseltamivir administration delay ranged from 2 to 8 days after illness onset, 31.2% received high-dose (300 mg/day), and treatment duration ranged from 5 to 10 days (mean 8.0 ± 3.3). Conclusions Over a 5-week period, influenza A (H1N1)v infection led to ICU admission in 32 adult patients, with frequently observed severe hypoxemia and a relatively high case-fatality rate. Clinicians should be aware of pulmonary complications of influenza A (H1N1)v infection, particularly in pregnant and young obese but previously healthy persons. PMID:19747383

  4. The activity intensities reached when playing active tennis gaming relative to sedentary gaming, tennis game-play, and current activity recommendations in young adults.

    PubMed

    Scanlan, Aaron T; Arkinstall, Hayley; Dalbo, Vincent J; Humphries, Brendan J; Jennings, Cameron T; Kingsley, Michael I C

    2013-09-01

    Although active gaming is popular and can increase energy expenditure in young adults, its efficacy as a prescriptive exercise tool is not well understood. This study aimed to: (a) compare the activity intensities experienced by young adults while playing active tennis gaming with conventional sedentary gaming, tennis game-play, and current activity recommendations for health; and (b) identify changes in activity intensities across playing time. After habitualization, 10 active young adults (age: 20.2 ± 0.4 years; stature: 1.74 ± 0.03 m; body mass: 67.7 ± 3.3 kg) completed 3 experimental trials (sedentary gaming, active tennis gaming, and tennis game-play) on separate days in a randomized order. Heart rate (HR) and metabolic equivalents (METs) were averaged across 5 minutes and 10 minutes intervals, and the entire 20 minutes bout within each condition. Active gaming produced greater intensities across 5-10, 10-15, and 15-20 minutes time intervals compared with sedentary gaming (p < 0.01). Tennis game-play elicited greater HR (67 ± 5% HR(max)) and METs (5.0 ± 0.2) responses than both sedentary (40 ± 2% HR(max), 1.1 ± 0.1 METs) and active gaming (45 ± 2% HR(max), 1.4 ± 0.1 METs) (p < 0.001). Only tennis game-play produced activity intensities meeting current recommendations for health benefit. Lower HR intensities were reached across 0-5 minutes than during later time intervals during active gaming (6%) and tennis game-play (9%) (p < 0.01). Activity intensities elicited by active gaming were greater than sedentary gaming but less than tennis game-play and insufficient to contribute toward promoting and maintaining good health in young adults. These data suggest that active tennis gaming should not be recommended by exercise professionals as a substitute for actual sports participation in young adults.

  5. Brain responses before and after intensive second language learning: proficiency based changes and first language background effects in adult learners.

    PubMed

    White, Erin Jacquelyn; Genesee, Fred; Steinhauer, Karsten

    2012-01-01

    This longitudinal study tracked the neuro-cognitive changes associated with second language (L2) grammar learning in adults in order to investigate how L2 processing is shaped by a learner's first language (L1) background and L2 proficiency. Previous studies using event-related potentials (ERPs) have argued that late L2 learners cannot elicit a P600 in response to L2 grammatical structures that do not exist in the L1 or that are different in the L1 and L2. We tested whether the neuro-cognitive processes underlying this component become available after intensive L2 instruction. Korean- and Chinese late-L2-learners of English were tested at the beginning and end of a 9-week intensive English-L2 course. ERPs were recorded while participants read English sentences containing violations of regular past tense (a grammatical structure that operates differently in Korean and does not exist in Chinese). Whereas no P600 effects were present at the start of instruction, by the end of instruction, significant P600s were observed for both L1 groups. Latency differences in the P600 exhibited by Chinese and Korean speakers may be attributed to differences in L1-L2 reading strategies. Across all participants, larger P600 effects at session 2 were associated with: 1) higher levels of behavioural performance on an online grammaticality judgment task; and 2) with correct, rather than incorrect, behavioural responses. These findings suggest that the neuro-cognitive processes underlying the P600 (e.g., "grammaticalization") are modulated by individual levels of L2 behavioural performance and learning.

  6. Machiavellianism and Adult Attachment in General Interpersonal Relationships and Close Relationships

    PubMed Central

    Ináncsi, Tamás; Láng, András; Bereczkei, Tamás

    2015-01-01

    Up to the present, the relationship between Machiavellianism and adult attachment has remained a question to be answered in the psychological literature. That is why this study focused on the relationship between Machiavellianism and attachment towards significant others in general interpersonal relationships and in intimate-close relationships. Two attachment tests (Relationship Questionnaire and long-form of Experiences in Close Relationship) and the Mach-IV test were conducted on a sample consisting of 185 subjects. Results have revealed that Machiavellian subjects show a dismissing-avoidant attachment style in their general interpersonal relationships, while avoidance is further accompanied by some characteristics of attachment anxiety in their intimate-close relationships. Our findings further refine the relationship between Machiavellianism and dismissing-avoidant attachment. Machiavellian individuals not only have a negative representation of significant others, but they also tend to seek symbiotic closeness in order to exploit their partners. This ambitendency in distance regulation might be particularly important in understanding the vulnerability of Machiavellian individuals. PMID:27247647

  7. Effect of Exercise Intensity on Percent Body Fat Determined by Leg-to-Leg and Segmental Bioelectrical Impedance Analyses in Adults

    ERIC Educational Resources Information Center

    Andreacci, Joseph L.; Nagle, Trisha; Fitzgerald, Elise; Rawson, Eric S.; Dixon, Curt B.

    2013-01-01

    Purpose: We examined the impact that cycle ergometry exercise had on percent body fat (%BF) estimates when assessed using either leg-to-leg or segmental bioelectrical impedance analysis (LBIA; SBIA) and whether the intensity of the exercise bout impacts the %BF magnitude of change. Method: Seventy-four college-aged adults participated in this…

  8. Up-regulation of exploratory tendencies does not enhance general learning abilities in juvenile or young-adult outbred mice.

    PubMed

    Light, Kenneth R; Kolata, Stefan; Hale, Gregory; Grossman, Henya; Matzel, Louis D

    2008-09-01

    "General cognitive ability" describes a trait that transcends specific learning domains and impacts a wide range of cognitive skills. Individual animals (including humans) exhibit wide variations in their expression of this trait. We have previously determined that the propensity for exploration is highly correlated with the general cognitive abilities of individual outbred mice. Here, we asked if inducing an increase in exploratory behaviors would causally promote an increase in animals' general learning abilities. In three experiments, juvenile and young-adult male CD-1 outbred mice were exposed to 12 novel environments starting at post-natal days 39 (juvenile) and 61 (young adult), after which they underwent a series of cognitive and exploratory tests as adults (beginning at post-natal day 79). Exposure to novel environments promoted increases in exploration (across multiple measures) on two different tasks, including an elevated plus maze. However, a subsequent test of general learning abilities (aggregate performance across five distinct learning tasks) determined that exposure to novel environments as juveniles or young-adults had no effect on general learning abilities in adulthood. Therefore, while exposure to novel environments promotes long-lasting increases in mice's exploratory tendencies, these increases in exploration do not appear to causally impact general learning abilities.

  9. Hippocampal structure, metabolism, and inflammatory response after a 6-week intense aerobic exercise in healthy young adults: a controlled trial.

    PubMed

    Wagner, Gerd; Herbsleb, Marco; de la Cruz, Feliberto; Schumann, Andy; Brünner, Franziska; Schachtzabel, Claudia; Gussew, Alexander; Puta, Christian; Smesny, Stefan; Gabriel, Holger W; Reichenbach, Jürgen R; Bär, Karl-Jürgen

    2015-10-01

    Interventional studies suggest that changes in physical fitness affect brain function and structure. We studied the influence of high intensity physical exercise on hippocampal volume and metabolism in 17 young healthy male adults during a 6-week exercise program compared with matched controls. We further aimed to relate these changes to hypothesized changes in exercised-induced brain-derived neurotrophic factor (BDNF), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α). We show profound improvement of physical fitness in most subjects and a positive correlation between the degree of fitness improvement and increased BDNF levels. We unexpectedly observed an average volume decrease of about 2%, which was restricted to right hippocampal subfields CA2/3, subiculum, and dentate gyrus and which correlated with fitness improvement and increased BDNF levels negatively. This result indicates that mainly those subjects who did not benefit from the exercise program show decreased hippocampal volume, reduced BDNF levels, and increased TNF-α concentrations. While spectroscopy results do not indicate any neuronal loss (unchanged N-acetylaspartate levels) decreased glutamate-glutamine levels were observed in the right anterior hippocampus in the exercise group only. Responder characteristics need to be studied in more detail. Our results point to an important role of the inflammatory response after exercise on changes in hippocampal structure.

  10. Reduced-intensity hematopoietic stem-cell transplantation for malignant lymphoma: a retrospective survey of 112 adult patients in Japan.

    PubMed

    Kusumi, E; Kami, M; Kanda, Y; Murashige, N; Kishi, Y; Suzuki, R; Takeuchi, K; Tanimoto, T E; Mori, T; Muta, K; Tamaki, T; Tanaka, Y; Ogawa, H; Yamane, T; Taniguchi, S; Takaue, Y

    2005-08-01

    We conducted a nation-wide survey of 112 adult Japanese patients who underwent reduced-intensity stem cell transplantation (RIST) from 1999 to 2002. Underlying diseases included indolent (n=45), aggressive (n=58) and highly aggressive lymphomas (n=9). Median age of the patients was 49 years. A total of 40 patients (36%) had relapsed diseases after autologous stem cell transplantation and 36 patients (32%) had received radiotherapy. RIST regimens were fludarabine-based (n=95), low-dose total body irradiation-based (n=6) and others (n=11). Cumulative incidences of grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD were, respectively, 49 and 59%. Cumulative incidences of progression and progression-free mortality were 18 and 25%, respectively. With a median follow-up of 23.9 months, 3-year overall survival rates were 59%. A multivariate analysis identified three significant factors for progression, which are history of radiation (relative risk (RR) 3.45, confidential interval (CI) 1.12-10.0, P=0.03), central nervous system involvement (RR 6.25, CI 2.08-20.0, P=0.001) and development of GVHD (RR 0.28, CI 0.090-0.86, P=0.026). RIST may have decreased the rate of transplant-related mortality, and GVHD may have induced a graft-versus-lymphoma effect. However, whether or not these potential benefits can be directly translated into improved patient survival should be evaluated in further studies.

  11. A BRIEF NOTE ON THE VALIDITY AND RELIABILITY OF THE RATING OF PERCEIVED EXERTION SCALE IN MONITORING EXERCISE INTENSITY AMONG CHINESE OLDER ADULTS IN HONG KONG.

    PubMed

    Chung, Pak-Kwong; Zhao, Yanan; Liu, Jing-Dong; Quach, Binh

    2015-12-01

    This study examined the validity and reliability of the Cantonese Borg 6-20 Rating of Perceived Exertion (RPE) scale in monitoring exercise intensity among Chinese older adults. A total of 40 apparently healthy older adults (16 men, 24 women; M age=69.8 yr., SD=4.56) performed two trials of three intermittent exercise tests administered in random order using the cycle ergometer. Results revealed significant differences of RPE, HR, and VO2 between different workloads, and there were moderate to high correlations between RPE and HR and VO2, respectively. Results also found moderate consistency of RPE between Trial 1 and Trial 2. These indicated that the Cantonese 6-20 RPE scale can be used as a valid and reliable tool for monitoring exercise intensity among the Chinese older adults.

  12. Mortality in adult intensive care patients with severe systemic inflammatory response syndromes is strongly associated with the hypo-immune TNF -238A polymorphism.

    PubMed

    Pappachan, John V; Coulson, Tim G; Child, Nicholas J A; Markham, David J; Nour, Sarah M; Pulletz, Mark C K; Rose-Zerilli, Matthew J; de Courcey-Golder, Kim; Barton, Sheila J; Yang, Ian A; Holloway, John W

    2009-10-01

    The systemic inflammatory response syndrome (SIRS) is associated with activation of innate immunity. We studied the association between mortality and measures of disease severity in the intensive care unit (ICU) and functional polymorphisms in genes coding for Toll-like receptor 4 (TLR4), macrophage migratory inhibitory factor (MIF), tumour necrosis factor (TNF) and lymphotoxin-alpha (LTA). Two hundred thirty-three patients with severe SIRS were recruited from one general adult ICU in a tertiary centre in the UK. DNA from patients underwent genotyping by 5' nuclease assay. Genotype was compared to phenotype. Primary outcome was mortality in ICU. Minor allele frequencies were TLR4 +896G 7%, MIF 173C 16%, TNF -238A 10% and LTA +252G 34%. The frequency of the hypoimmune minor allele TNF -238A was significantly higher in patients who died in ICU compared to those who survived (p = 0.0063) as was the frequency of the two haplotypes LTA +252G, TNF -1031T, TNF -308G, TNF -238A and LTA +252G, TNF-1031T, TNF-308A and TNF-238A (p = 0.0120 and 0.0098, respectively). These findings re-enforce the view that a balanced inflammatory/anti-inflammatory response is the most important determinant of outcome in sepsis. Genotypes that either favour inflammation or its counter-regulatory anti-inflammatory response are likely to influence mortality and morbidity.

  13. Pregabalin: a review of its use in adults with generalized anxiety disorder.

    PubMed

    Frampton, James E

    2014-09-01

    Pregabalin (Lyrica(®)), a well established anxiolytic agent, has been approved in the EU for the treatment of generalized anxiety disorder (GAD) in adults. It has a distinct mechanism of action relative to other anti-anxiety agents (α2δ binding at presynaptic voltage dependent calcium channels leading to inhibition of excitatory neurotransmission), a rapid onset of effect (typically ≤1 week) and broad spectrum activity against both the psychic and somatic symptoms of GAD. In long-term studies, pregabalin maintained improvements in anxiety symptoms that occurred in response to short-term treatment and delayed the time to relapse of GAD compared with placebo. Common comorbidities of GAD, such as insomnia, gastrointestinal symptoms and subsyndromal depression, have no effect on the anxiolytic efficacy of, and moreover are specifically improved by, pregabalin. Treatment with pregabalin is generally well tolerated; the drug has an adverse event profile that includes dizziness, somnolence and weight gain. The potential for abuse of pregabalin is low; the risk of withdrawal symptoms is generally low when the drug is discontinued gradually (over 1 week). Alongside selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs), pregabalin is considered a first-line agent for the long-term treatment of GAD by the World Federation of Societies of Biological Psychiatry. It should be stressed, however, that definitive head-to-head studies comparing pregabalin with SSRI/SNRIs, including in patients with GAD and co-morbid major depressive disorder, are currently lacking. Recently, a study of SSRI/SNRI augmentation with pregabalin yielded positive results, while another study of switching from long-term benzodiazepine therapy to pregabalin was inconclusive; further investigations on these topics are warranted.

  14. 38 CFR 52.61 - General requirements for adult day health care program.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52... knowledge and skills necessary to manage care requirements in the home. Adult day health care is...

  15. Childhood maltreatment, the corticotropin-releasing hormone receptor gene and adult depression in the general population.

    PubMed

    Grabe, Hans Jörgen; Schwahn, Christian; Appel, Katja; Mahler, Jessie; Schulz, Andrea; Spitzer, Carsten; Fenske, Kristin; Barnow, Sven; Lucht, Michael; Freyberger, Harald Jürgen; John, Ulrich; Teumer, Alexander; Wallaschofski, Henri; Nauck, Matthias; Völzke, Henry

    2010-12-05

    Dysregulations of the hypothalamic-pituitary-adrenal (HPA) axis have been implicated in the pathogenesis of depressive disorders and the corticotropin-releasing hormone (CRH) was found to modulate emotional memory consolidation. Recently, two studies have reported an interaction between childhood abuse and the TAT-haplotype of the CRH-Receptor Gene (CRHR1) connecting childhood adversities and genetic susceptibility to adult depression. We tested the hypothesis of an interaction of childhood maltreatment with single nucleotide polymorphisms (SNPs) and haplotypes of the CRHR1 gene not previously investigated. Caucasian subjects (n = 1,638) from the German general population (Study of Health in Pomerania, SHIP) were analyzed. As in the previous studies, childhood abuse and neglect were assessed with the Childhood Trauma Questionnaire (CTQ) and depression with the Beck Depression Inventory (BDI-2). The CRHR1-SNPs were genotyped on the Affymetrix Genome-Wide Human SNP Array 6.0 platform. We identified an interaction between the TAT-haplotype and childhood physical neglect. The interaction with physical neglect showed significant (P < 0.05) results in 23 of the 28 SNPs, with rs17689882 (P = 0.0013) reaching "gene-wide" significance. Although we did not replicate the specific interaction of abuse and the TAT-haplotype of the CRHR1 gene we confirmed the relevance of an interplay between variants within the CRHR1 gene and childhood adversities in the modulation of depression in adults. The largest effect was found for rs17689882, a SNP previously not analyzed. Relevant sample differences between this and prior studies like lower BDI-2 scores, less childhood maltreatment and higher psychosocial functioning may account for the differences in gene-environment interaction findings. © 2010 Wiley-Liss, Inc.

  16. Lifestyle and genetic determinants of folate and vitamin B12 levels in a general adult population.

    PubMed

    Thuesen, Betina H; Husemoen, Lise Lotte N; Ovesen, Lars; Jørgensen, Torben; Fenger, Mogens; Linneberg, Allan

    2010-04-01

    Danish legislation regarding food fortification has been very restrictive resulting in few fortified food items on the Danish market. Folate and vitamin B12 deficiency is thought to be common due to inadequate intakes but little is known about the actual prevalence of low serum folate and vitamin B12 in the general population. The aim of the present study was to evaluate the folate and vitamin B12 status of Danish adults and to investigate associations between vitamin status and distinct lifestyle and genetic factors. The study included a random sample of 6784 individuals aged 30-60 years. Information on lifestyle factors was obtained by questionnaires and blood samples were analysed for serum folate and vitamin B12 concentrations and several genetic polymorphisms. The overall prevalence of low serum folate ( < 6.8 nmol/l) was 31.4 %. Low serum folate was more common among men than women and the prevalence was lower with increasing age. Low serum folate was associated with smoking, low alcohol intake, high coffee intake, unhealthy diet, and the TT genotype of the methylenetetrahydrofolate reductase (MTHFR)-C677T polymorphism. The overall prevalence of low serum vitamin B12 ( < 148 pmol/l) was 4.7 %. Low serum vitamin B12 was significantly associated with female sex, high coffee intake, low folate status, and the TT genotype of the MTHFR-C677T polymorphism. In conclusion, low serum folate was present in almost a third of the adult population in the present study and was associated with several lifestyle factors whereas low serum concentrations of vitamin B12 were less common and only found to be associated with a few lifestyle factors.

  17. Validity and Reliability of General Nutrition Knowledge Questionnaire for Adults in Uganda

    PubMed Central

    Bukenya, Richard; Ahmed, Abhiya; Andrade, Jeanette M.; Grigsby-Toussaint, Diana S.; Muyonga, John; Andrade, Juan E.

    2017-01-01

    This study sought to develop and validate a general nutrition knowledge questionnaire (GNKQ) for Ugandan adults. The initial draft consisted of 133 items on five constructs associated with nutrition knowledge; expert recommendations (16 items), food groups (70 items), selecting food (10 items), nutrition and disease relationship (23 items), and food fortification in Uganda (14 items). The questionnaire validity was evaluated in three studies. For the content validity (study 1), a panel of five content matter nutrition experts reviewed the GNKQ draft before and after face validity. For the face validity (study 2), head teachers and health workers (n = 27) completed the questionnaire before attending one of three focus groups to review the clarity of the items. For the construct and test-rest reliability (study 3), head teachers (n = 40) from private and public primary schools and nutrition (n = 52) and engineering (n = 49) students from Makerere University took the questionnaire twice (two weeks apart). Experts agreed (content validity index, CVI > 0.9; reliability, Gwet’s AC1 > 0.85) that all constructs were relevant to evaluate nutrition knowledge. After the focus groups, 29 items were identified as unclear, requiring major (n = 5) and minor (n = 24) reviews. The final questionnaire had acceptable internal consistency (Cronbach α > 0.95), test-retest reliability (r = 0.89), and differentiated (p < 0.001) nutrition knowledge scores between nutrition (67 ± 5) and engineering (39 ± 11) students. Only the construct on nutrition recommendations was unreliable (Cronbach α = 0.51, test-retest r = 0.55), which requires further optimization. The final questionnaire included topics on food groups (41 items), selecting food (2 items), nutrition and disease relationship (14 items), and food fortification in Uganda (22 items) and had good content, construct, and test-retest reliability to evaluate nutrition knowledge among Ugandan adults. PMID:28230779

  18. Enjoyment for High-Intensity Interval Exercise Increases during the First Six Weeks of Training: Implications for Promoting Exercise Adherence in Sedentary Adults.

    PubMed

    Heisz, Jennifer J; Tejada, Mary Grace M; Paolucci, Emily M; Muir, Cameron

    2016-01-01

    This is the first study to show that enjoyment for high-intensity interval exercise increases with chronic training. Prior acute studies typically report high-intensity interval training (HIT) as being more enjoyable than moderate continuous training (MCT) unless the high-intensity intervals are too strenuous or difficult to complete. It follows that exercise competency may be a critical factor contributing to the enjoyment of HIT, and therefore building competency through chronic training may be one way to increase its enjoyment. To test this, we randomly assigned sedentary young adults to six weeks of HIT or MCT, and tracked changes in their enjoyment for the exercise. Enjoyment for HIT increased with training whereas enjoyment for MCT remained constant and lower. Changes in exercise enjoyment were predicted by increases in workload, suggesting that strength adaptions may be important for promoting exercise enjoyment. The results point to HIT as a promising protocol for promoting exercise enjoyment and adherence in sedentary young adults.

  19. Exposure to traffic and lung function in adults: a general population cohort study

    PubMed Central

    Carlsen, Hanne Krage; Modig, Lars; Levinsson, Anna; Kim, Jeong-Lim; Toren, Kjell; Nyberg, Fredrik; Olin, Anna-Carin

    2015-01-01

    Objectives To investigate the association between living near dense traffic and lung function in a cohort of adults from a single urban region. Design Cross-sectional results from a cohort study. Setting The adult-onset asthma and exhaled nitric oxide (ADONIX) cohort, sampled during 2001–2008 in Gothenburg, Sweden. Exposure was expressed as the distance from participants’ residential address to the nearest road with dense traffic (>10 000 vehicles per day) or very dense traffic (>30 000 vehicles per day). The exposure categories were: low (>500 m; reference), medium (75–500 m) or high (<75 m). Participants The source population was a population-based cohort of adults (n=6153). The study population included 5441 participants of European descent with good quality spirometry and information about all outcomes and covariates. Outcome measures Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured at a clinical examination. The association with exposure was examined using linear regression adjusting for age, gender, body mass index, smoking status and education in all participants and stratified by sex, smoking status and respiratory health status. Results We identified a significant dose–response trend between exposure category and FEV1 (p=0.03) and borderline significant trend for FVC (p=0.06) after adjusting for covariates. High exposure was associated with lower FEV1 (−1.0%, 95% CI −2.5% to 0.5%) and lower FVC (−0.9%, 95% CI −2.2% to 0.4%). The effect appeared to be stronger in women. In highly exposed individuals with current asthma or chronic obstructive pulmonary disease, FVC was lower (−4.5%, 95% CI −8.8% to −0.1%). Conclusions High traffic exposure at the residential address was associated with lower than predicted FEV1 and FVC lung function compared with living further away in a large general population cohort. There were particular effects on women and individuals with obstructive disease. PMID

  20. Director-General's Report on the Third International Conference on Adult Education.

    ERIC Educational Resources Information Center

    United Nations Educational, Scientific, and Cultural Organization, Paris (France).

    The Third International Conference on Adult Education in the context of live-long education was held in Tokyo from July 25 to August 7, 1972. Those attending the Conference examined the following topics: main trends in adult education during the last ten years; adult education as a factor in the democratization of education and in economic, social…

  1. Prevalence of adult Huntington's disease in the UK based on diagnoses recorded in general practice records

    PubMed Central

    Evans, Stephen JW; Douglas, Ian; Rawlins, Michael D; Wexler, Nancy S; Tabrizi, Sarah J; Smeeth, Liam

    2013-01-01

    Background and purpose The prevalence of Huntington's disease (HD) in the UK is uncertain. Recently, it has been suggested that the prevalence may be substantially greater than previously reported. This study was undertaken to estimate the overall UK prevalence in adults diagnosed with HD, using data from primary care. Methods The electronic medical records of patients aged 21 years or more, with recorded diagnoses of HD, were retrieved from the UK's General Practice Research Database. Prevalence was estimated from the number of persons with recorded diagnoses of HD, on 1 July each year, between 1990 and 2010. This number was divided by the total number of persons registered with participating general practices on that same date. These data were also used to estimate both age specific prevalence and prevalence in various regions of the UK. Results A total of 1136 patients diagnosed with HD, aged 21 years or more, were identified from the database. The estimated prevalence (expressed per 100 000 population) rose from 5.4 (95% CI 3.8 to 7.5) in 1990 to 12.3 (95% CI 11.2 to 13.5) in 2010. Although an increased prevalence was observed within every age group, the most dramatic was in older patients. Age specific prevalence was highest in the 51–60 year age range (15.8 95% CI 9.0 to 22.3). The prevalence of adult HD was lowest in the London region (5.4 (95% CI 3.0 to 8.9)) and highest in the North East of England (18.3 (95% CI 8.6 to 34.6)) and Scotland (16.1 (95% CI 10.8 to 22.9)). Conclusions The prevalence of diagnosed HD is clearly substantially higher in the UK than suggested from previous studies. By extrapolation to the UK as a whole, it is estimated that there are more than 5700 people, aged 21 years or more, with HD. There has also been a surprising doubling of the HD population between 1990 and 2010. Many factors may have caused this increase, including more accurate diagnoses, better and more available therapies and an improved life expectancy

  2. Use of novel psychoactive substances by inpatients on general adult psychiatric wards

    PubMed Central

    Stanley, Jack L; Mogford, Daniel V; Lawrence, Rebecca J; Lawrie, Stephen M

    2016-01-01

    Objectives Non-illicit alternatives to controlled drugs, known as novel psychoactive substances (NPS), have recently risen to prominence. They are readily available, with uncertain pharmacology and no widely available assay. Given that psychiatric patients are at risk of comorbid substance abuse, we hypothesised that NPS use would be present in the psychiatric population, and sought to determine its prevalence and investigate the characteristics of those who use these drugs with a retrospective review of discharge letters. Setting General adult inpatient wards of a psychiatric hospital in a Scottish city. Participants All adult inpatients (18–65) discharged from general psychiatric wards between 1 July 2014 and 31 December 2014. Of the 483 admissions identified, 46 were admissions for maintenance electroconvulsive therapy (ECT) and were excluded. Of the remaining 437 admissions, 49 discharge letters were unobtainable, leaving 388 admissions to analyse. Primary outcome measure The mention, or lack thereof, of NPS use in discharge letters was our planned primary outcome measure and was also the primary outcome measure we used in our analysis. Results NPS use was identified in 22.2% of admissions, contributing to psychiatric symptoms in 59.3%. In comparison to non-users, NPS users were younger (p<0.01), male and more likely to have a forensic history ((p<0.001) for both). The diagnosis of drug-induced psychosis was significantly more likely in NPS users (p<0.001, OR 18.7, 95% CI 8.1 to 43.0) and the diagnosis of depression was significantly less likely (p<0.005, OR 0.133, CI 0.031 to 0.558). Use of cannabis was significantly more likely in NPS users (p<0.001, OR 4.2, CI 2.5 to 7.1), as was substitute opiate prescribing (p<0.001, OR 3.7, CI 1.8 to 7.4). Conclusions NPS use was prevalent among young, male psychiatric inpatients, in particular those with drug-induced psychosis and often occurred alongside illicit drug use. PMID:27165643

  3. Evaluation of the preliminary effectiveness of hand massage therapy on postoperative pain of adults in the intensive care unit after cardiac surgery: a pilot randomized controlled trial.

    PubMed

    Boitor, Mădălina; Martorella, Géraldine; Arbour, Caroline; Michaud, Cécile; Gélinas, Céline

    2015-06-01

    Although many intensive care unit patients experience significant pain, very few studies explored massage to maximize their pain relief. This study aimed to evaluate the preliminary effects of hand massage on pain after cardiac surgery in the adult intensive care unit. A pilot randomized controlled trial was used for this study. The study was conducted in a Canadian medical-surgical intensive care unit. Forty adults who were admitted to the intensive care unit after undergoing elective cardiac surgery in the previous 24 hours participated in the study. They were randomly assigned to the experimental (n = 21) or control (n = 19) group. The experimental group received a 15-minute hand massage, and the control group received a 15-minute hand-holding without massage. In both groups the intervention was followed by a 30-minute rest period. The interventions were offered on 2-3 occasions within 24 hours after surgery. Pain, muscle tension, and vital signs were assessed. Pain intensity and behavioral scores were decreased for the experimental group. Although hand massage decreased muscle tension, fluctuations in vital signs were not significant. This study supports potential benefits of hand massage for intensive care unit postoperative pain management. Although larger randomized controlled trials are necessary, this low-cost nonpharmacologic intervention can be safely administered.

  4. A Multicenter Evaluation of Off-Label Medication Use and Associated Adverse Drug Reactions in Adult Medical Intensive Care Units

    PubMed Central

    Smithburger, Pamela L.; Buckley, Mitchell S.; Culver, Mark A.; Sokol, Sarah; Lat, Ishaq; Handler, Steven M.; Kirisci, Levent; Kane-Gill, Sandra L.

    2016-01-01

    Objective Prior research indicates off-label use is common in the intensive care unit (ICU); however the safety of off-label use has not been assessed. The study objective was to determine the incidence of adverse drug reactions (ADRs) associated with off-label use and evaluate off-label use as a risk factor for the development of ADRs in an adult ICU population. Setting Medical ICUs at three academic medical centers Patients Adult patients (age ≥ 18 years old) receiving medication therapy Interventions All administered medications were evaluated for Food and Drug Administration (FDA) approved or off-label use. Patients were assessed daily for the development of an ADR through active surveillance. Three ADR assessment instruments were used to determine the probability of an ADR resulting from drug therapy. Severity and harm of the ADR were also assessed. Cox proportional hazard regression was used to identify a set of covariates that influenced the rate of ADRs. Measurements and Main Results Overall, 1654 patient days (327 patients) and 16,391 medications were evaluated, with 43% of medications being used off-label. One hundred and sixteen ADRs were categorized dichotomously (FDA or off-label), with 56% and 44% being associated with FDA approved and off-label use, respectively. The number of ADRs for medications administered and number of harmful and severe ADRs did not differ for medications used for FDA approved or off-label use (0.74% vs 0.67%, p = 0.336; 33 vs. 31 events, p=0.567; 24 vs. 24 events, p = 0.276). Age, sex, number of high-risk medications, number of off-label medications, and severity of illness score were included in the Cox proportional hazard regression. It was found that the rate of ADRs increases by 8% for every one additional off-label medication (HR = 1.08; 95 % CI: 1.018–1.154). Conclusion While ADRs do not occur more frequently with off-label use, ADR risk increases with each additional off-label medication used. PMID:25855897

  5. Mental-Physical Comorbidity in Korean Adults: Results from a Nationwide General Population Survey in Korea

    PubMed Central

    Kim, Ji-Hyun; Bae, Jae Nam; Cho, Seong-Jin; Lee, Jun-Young; Kim, Byung-Soo; Cho, Maeng Je

    2016-01-01

    Objective The aims of this study were to estimate the prevalence of mental-physical comorbidity and health-threatening risk factors in subjects with mental disorders, and the risks of mental disorders in those with physical diseases for the last 12 months in the general Korean population. Methods Korean Epidemiologic Catchment Area study replication (KECA-R) was conducted for 6,510 adults between August 2006 and April 2007. The Korean version of Composite International Diagnostic Interview 2.1 (K-CIDI) was used in the survey. Prevalence of mental and physical disorders, and risk factors for physical health were calculated, and their associations were evaluated with adjustment for age and sex. Results Subjects with any mental disorder showed significantly higher prevalence of chronic physical conditions (adjusted odds ratio, AOR=1.5 to 2.8, p<0.001) and medical risk factors including smoking, heavy drinking, overweight, and hypertension (AOR=1.5 to 4.0, p<0.001). Of those with chronic physical conditions, 21.6% had one or more comorbid mental disorder compared with 10.5% of the subjects without chronic physical disorders (AOR=2.6, p<0.001). Contrary to expectations, depressive disorders did not show significant association with hypertension and prevalence of obesity was not influenced by presence of mental disorders. Further studies should assess these findings. Conclusion This is the first identification of significant mental-physical comorbidity in the general Korean population. Clinicians and health care officials should keep in mind of its potential adverse effects on treatment outcome and aggravated disease-related socioeconomic burden. PMID:27757127

  6. Attentional bias in older adults: effects of generalized anxiety disorder and cognitive behavior therapy.

    PubMed

    Mohlman, Jan; Price, Rebecca B; Vietri, Jeff

    2013-08-01

    Attentional biases are known to play a contributing, and perhaps even causal role in the etiology of anxiety and other negative affective states. The prevalence of anxiety disorders in the older cohort is growing, and there are both theoretical and empirical reasons to suspect that age-related factors could moderate attentional bias effects in the context of late-life anxiety. The current study included one of the most widely-used measures of attentional bias, the dot-probe task (Mathews & MacLeod, 1985). Participants were older adults who were either nonanxious or diagnosed with generalized anxiety disorder. The patient subsample also completed cognitive behavior therapy (CBT) or an equivalent wait list condition, after which the dot probe was administered a second time. Results showed that clinical anxiety had no particular importance for the deployment of attention, casting doubt on the universality of biased attention in older anxiety patients. Although there were no maladaptive biases detected toward either threat or depression words at pretreatment, there was nevertheless a marginally significant differential reduction in bias toward threat words following CBT. This reduction did not occur among those in the wait list condition. Implications are discussed.

  7. Aetiological characteristics of adult acute diarrhoea in a general hospital of Shanghai.

    PubMed

    Zhao, X; Ni, B; Wang, Y; Shen, X; Zhang, C; Liu, J; Li, S

    2017-02-01

    Epidemic surveillance is an effective means to determine the characteristics of acute diarrhoea and the benefits of disease control and prevention. The epidemiological, clinical, and aetiological data of adult (aged ⩾15 years) acute diarrhoea in a general hospital in Shanghai were collected and analysed. Out of 2430 acute diarrhoea patients, 162 subjects were sampled (sample ratio 15:1). The sampled subjects had an average age (±s.d.) of 44 ± 18 years; 142 (87·7%) had a history that indicated ingestion of contaminated food; and 40 (24·7%), 54 (33·3%), and 73 (45·1%) patients had diarrhoea that was attributed to viral, bacterial, and unknown aetiological origins respectively. Viral diarrhoea is mainly prevalent during the winter and spring months, while bacterial and diarrhoea of unknown aetiology occur mainly in the summer months. The average age of the unknown aetiology group (48 ± 19 years) was significantly older than that of the viral diarrhoea group (39 ± 16 years). The number of patients with vomiting in the viral group (30·6%) was significantly higher than that in the bacterial (17·1%) and unknown aetiology (8·2%) groups. Viral and bacterial infections are the main cause of acute diarrhoea in Shanghai. However, further effective technological means are needed to improve the surveillance, control, and prevention of acute diarrhoea.

  8. Occupational exposures and asthma in 14,000 adults from the general population.

    PubMed

    Le Moual, Nicole; Kennedy, Susan M; Kauffmann, Francine

    2004-12-01

    The association of asthma with occupational exposures was studied in 14,151 adults, aged 25-59 years, from the general population of the 1975 French Pollution Atmospherique et Affections Respiratoires Chroniques (PAARC) Survey. Associations of asthma with specific jobs, such as personal care workers, waiters, and stock clerks, were observed, with age-, sex-, and smoking-adjusted odds ratios between 1.5 and 1.7. Exposures to 18 asthmagenic agents (low and high molecular weight and mixed environment) were estimated by an asthma-specific job exposure matrix. Risks associated with asthma increased when subjects with imprecise estimates of exposure were excluded. Risks increased further with increasing specificity of the definition of asthma when considering jobs or specific agents, such as industrial cleaning agents, latex, flour, highly reactive chemicals, and textiles. For example, for industrial cleaning agents, odds ratios increased from 1.55 (95% confidence interval (CI): 1.08, 2.23) for "ever asthma," to 2.17 (95% CI: 1.41, 3.34) for asthma onset after age 14 years, to 2.35 (95% CI: 1.38, 4.00) for asthma onset after beginning current job, and to 2.51 (95% CI: 1.33, 4.75) for asthma with airflow limitation. Results underlined the importance of the specificity of exposure and asthma definitions and indicated a deleterious role of occupational exposure on asthma, especially for cleaning agents.

  9. Occupational exposures and asthma in 14,000 adults from the general population

    PubMed Central

    Le Moual, Nicole; Kennedy, Susan M.; Kauffmann, Francine

    2004-01-01

    The association of occupational exposures and asthma were studied in 14151 adults, aged 25–59 years, from the general population of the French PAARC (Pollution Atmospherique et Affections Respiratoires Chroniques, 1975) Survey. Associations of asthma to specific jobs such as personal care workers, waiters, stock clerks were observed, with age, sex, smoking adjusted odds ratios between 1.5 and 1.7. Exposures to 18 asthmagenic agents (low, high molecular weight and mixed environment) were estimated by an asthma-specific job exposure matrix. Risks associated with asthma increased when excluding subjects with imprecise estimates of exposure. Risks further increased when increasing specificity of the definition of asthma considering jobs or specific agents such as industrial cleaning agents, latex, flour, highly reactive chemicals, and textiles. For example, for industrial cleaning agents, odds ratios increased from 1.55 (95% CI: 1.08, 2.23) for ever asthma, to 2.51 (95% CI: 1.33, 4.75) for asthma with airflow limitation, to 2.17 (95% CI: 1.41, 3.34) for asthma onset after age 14, and to 2.35 (95% CI: 1.38, 4.00) for asthma onset after beginning of current job. Results underlined the importance of the specificity of exposure and asthma definitions and indicated a deleterious role of occupational exposure on asthma, especially for cleaning agents. PMID:15561990

  10. Cognitive behaviour therapy for generalized anxiety disorder: Is CBT equally efficacious in adults of working age and older adults?

    PubMed

    Kishita, Naoko; Laidlaw, Ken

    2017-03-01

    The current meta-analysis compared the efficacy of CBT for GAD between adults of working age and older people. In addition, we conducted a qualitative content analysis of treatment protocols used in studies with older clients to explore potential factors that may enhance treatment outcomes with this particular client group. Applying the inclusion criteria resulted in the identification of 15 studies with 22 comparisons between CBT and control groups (770 patients). When examining overall effect sizes for CBT for GAD between older people and adults of working age there were no statistically significant differences in outcome. However, overall effect size of CBT for GAD was moderate for older people (g=0.55, 95% CI 0.22-0.88) and large for adults of working age (g=0.94, 95% CI 0.52-1.36), suggesting that there is still room for improvement in CBT with older people. The main difference in outcome between CBT for GAD between the two age groups was related to methodological quality in that no older people studies used an intention-to-treat design. The content analysis demonstrated that studies with older clients were conducted according to robust CBT protocols but did not take account of gerontological evidence to make them more age-appropriate.

  11. Intensive lifestyle intervention improves physical function among obese adults with knee pain: findings from the Look AHEAD trial.

    PubMed

    Foy, Capri G; Lewis, Cora E; Hairston, Kristen G; Miller, Gary D; Lang, Wei; Jakicic, John M; Rejeski, W Jack; Ribisl, Paul M; Walkup, Michael P; Wagenknecht, Lynne E

    2011-01-01

    Lifestyle interventions have resulted in weight loss or improved physical fitness among individuals with obesity, which may lead to improved physical function. This prospective investigation involved participants in the Action for Health in Diabetes (Look AHEAD) trial who reported knee pain at baseline (n = 2,203). The purposes of this investigation were to determine whether an Intensive Lifestyle Intervention (ILI) condition resulted in improvement in self-reported physical function from baseline to 12 months vs. a Diabetes Support and Education (DSE) condition, and whether changes in weight or fitness mediated the effect of the ILI. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and physical function subscales, and WOMAC summary score. ILI participants exhibited greater adjusted mean weight loss (s.e.) vs. DSE participants (-9.02 kg (0.48) vs. -0.78 kg (0.49); P < 0.001)). ILI participants also demonstrated more favorable change in WOMAC summary scores vs. DSE participants (β (s.e.) = -1.81 (0.63); P = 0.004). Multiple regression mediation analyses revealed that weight loss was a mediator of the effect of the ILI intervention on change in WOMAC pain, function, and summary scores (P < 0.001). In separate analyses, increased fitness also mediated the effect of the ILI intervention upon WOMAC summary score (P < 0.001). The ILI condition resulted in significant improvement in physical function among overweight and obese adults with diabetes and knee pain. The ILI condition also resulted in significant weight loss and improved fitness, which are possible mechanisms through which the ILI condition improved physical function.

  12. Intensive Lifestyle Intervention Improves Physical Function Among Obese Adults With Knee Pain: Findings From the Look AHEAD Trial

    PubMed Central

    Foy, Capri G.; Lewis, Cora E.; Hairston, Kristen G.; Miller, Gary D.; Lang, Wei; Jakicic, John M.; Rejeski, W. Jack; Ribisl, Paul M.; Walkup, Michael P.; Wagenknecht, Lynne E.

    2011-01-01

    Lifestyle interventions have resulted in weight loss or improved physical fitness among individuals with obesity, which may lead to improved physical function. This prospective investigation involved participants in the Action for Health in Diabetes (Look AHEAD) trial who reported knee pain at baseline (n = 2,203). The purposes of this investigation were to determine whether an Intensive Lifestyle Intervention (ILI) condition resulted in improvement in self-reported physical function from baseline to 12 months vs. a Diabetes Support and Education (DSE) condition, and whether changes in weight or fitness mediated the effect of the ILI. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and physical function subscales, and WOMAC summary score. ILI participants exhibited greater adjusted mean weight loss (s.e.) vs. DSE participants (−9.02 kg (0.48) vs. −0.78 kg (0.49); P < 0.001)). ILI participants also demonstrated more favorable change in WOMAC summary scores vs. DSE participants (β (s.e.) = −1.81 (0.63); P = 0.004). Multiple regression mediation analyses revealed that weight loss was a mediator of the effect of the ILI intervention on change in WOMAC pain, function, and summary scores (P < 0.001). In separate analyses, increased fitness also mediated the effect of the ILI intervention upon WOMAC summary score (P < 0.001). The ILI condition resulted in significant improvement in physical function among overweight and obese adults with diabetes and knee pain. The ILI condition also resulted in significant weight loss and improved fitness, which are possible mechanisms through which the ILI condition improved physical function. PMID:20559303

  13. Effects of Social Reinforcement Contingent on Conventional or Unconventional Responses on Generalized Creativity by Older Adults in Residential Care

    ERIC Educational Resources Information Center

    Polenick, Courtney Allyn; Flora, Stephen Ray

    2012-01-01

    The effects of social praise contingent on either usual (conventional) or unusual (unconventional) responses during an object uses task were assessed on measures of generalized creativity in two novel, unrelated tasks. Participants were 20 older adults, ages 63 to 89 years (M = 80.90), who were recruited from a joint skilled nursing and assisted…

  14. General and persistent effects of high-intensity sweeteners on body weight gain and caloric compensation in rats.

    PubMed

    Swithers, Susan E; Baker, Chelsea R; Davidson, T L

    2009-08-01

    In an earlier work (S. E. Swithers & T. L. Davidson, 2008), rats provided with a fixed amount of a yogurt diet mixed with saccharin gained more weight and showed impaired caloric compensation relative to rats given the same amount of yogurt mixed with glucose. The present 4 experiments examined the generality of these findings and demonstrated that increased body weight gain was also demonstrated when animals consumed a yogurt diet sweetened with an alternative high-intensity sweetener (acesulfame potassium; AceK) as well as in animals given a saccharin-sweetened base diet (refried beans) that was calorically similar but nutritionally distinct from low-fat yogurt. These studies also extended earlier findings by showing that body weight differences persist after saccharin-sweetened diets are discontinued and following a shift to a diet sweetened with glucose. In addition, rats first exposed to a diet sweetened with glucose still gain additional weight when subsequently exposed to a saccharin-sweetened diet. The results of these experiments add support to the hypothesis that exposure to weak or nonpredictive relationships between sweet tastes and caloric consequences may lead to positive energy balance.

  15. Streaming Physiological Data: General Public Perceptions of Secondary Use and Application to Research in Neonatal Intensive Care.

    PubMed

    McGregor, Carolyn; Heath, Jennifer; Choi, Yvonne

    2015-01-01

    High speed physiological data represents one of the most untapped resources in healthcare today and is a form of Big Data. Physiological data is captured and displayed on a wide range of devices in healthcare environments. Frequently this data is transitory and lost once initially displayed. Researchers wish to store and analyze these datasets, however, there is little evidence of any engagement with citizens regarding their perceptions of physiological data capture for secondary use. This paper presents the findings of a self-administered household survey (n=165, response rate = 34%) that investigated Australian and Canadian citizens' perceptions of such physiological data capture and re-use. Results indicate general public support for the secondary use of physiological streaming data. Discussion considers the potential application of such data in neonatal intensive care contexts in relation to our Artemis research. Consideration of the perceptions of secondary use of the streaming data as early as possible will assist in building appropriate use models, with a focus on parents in the neonatal context.

  16. TROIKA: a general framework for heart rate monitoring using wrist-type photoplethysmographic signals during intensive physical exercise.

    PubMed

    Zhang, Zhilin; Pi, Zhouyue; Liu, Benyuan

    2015-02-01

    Heart rate monitoring using wrist-type photoplethysmographic signals during subjects' intensive exercise is a difficult problem, since the signals are contaminated by extremely strong motion artifacts caused by subjects' hand movements. So far few works have studied this problem. In this study, a general framework, termed TROIKA, is proposed, which consists of signal decomposiTion for denoising, sparse signal RecOnstructIon for high-resolution spectrum estimation, and spectral peaK trAcking with verification. The TROIKA framework has high estimation accuracy and is robust to strong motion artifacts. Many variants can be straightforwardly derived from this framework. Experimental results on datasets recorded from 12 subjects during fast running at the peak speed of 15 km/h showed that the average absolute error of heart rate estimation was 2.34 beat per minute, and the Pearson correlation between the estimates and the ground truth of heart rate was 0.992. This framework is of great values to wearable devices such as smartwatches which use PPG signals to monitor heart rate for fitness.

  17. Point prevalence and epidemiological characteristics of chronic cough in the general adult population

    PubMed Central

    Kang, Min-Gyu; Song, Woo-Jung; Kim, Hyun-Jung; Won, Ha-Kyeong; Sohn, Kyoung-Hee; Kang, Sung-Yoon; Jo, Eun-Jung; Kim, Min-Hye; Kim, Sae-Hoon; Kim, Sang-Heon; Park, Heung-Woo; Chang, Yoon-Seok; Lee, Byung-Jae; Morice, Alyn H.; Cho, Sang-Heon

    2017-01-01

    Abstract Cough is frequently self-limiting, but may persist longer in certain individuals. Most of previous studies on the epidemiology of chronic cough have only measured period prevalence, and thus have afforded limited information on the burden and natural course. We aimed to investigate the epidemiology of chronic cough by using a point prevalence measure in a large-scale general population. We analyzed cross-sectional data collected from 18,071 adults who participated in the Korean National Health and Nutrition Examination Survey 2010–2012. Presence and duration of current cough was ascertained by structured questionnaires, and cough was classified into acute (<3 weeks), subacute (3–8 weeks), or chronic cough (≥8 weeks). Demographic and clinical parameters were examined in relation to chronic cough. The point prevalences of acute, subacute, and chronic cough were 2.5 ± 0.2%, 0.8 ± 0.1% and 2.6 ± 0.2%, respectively. The proportion of current cough showed a steep decrease after 1 week of duration. However, 2 peaks in the prevalence of current cough were revealed; cough durations of less than 1 week and longer than 1 year were most common (31.1% and 27.7% of current cough, respectively). Subacute and chronic cough were more prevalent in the elderly (≥65 years); the positive associations with older age were independent of other confounders, including current smoking and comorbidities. This is the first report on the epidemiology of cough using a point prevalence measure in a nationally representative population sample. Our findings indicate a high burden of chronic cough among adults with current cough in the community. The dual-peak of cough duration suggested that the pathophysiology of acute and chronic cough may differ. The preponderance of elderly people in the prevalence of chronic cough warrants further investigation. In addition, more sophistication and validation of tools to define chronic cough will help our understanding of the

  18. A General Audiovisual Temporal Processing Deficit in Adult Readers with Dyslexia

    ERIC Educational Resources Information Center

    Francisco, Ana A.; Jesse, Alexandra; Groen, Margriet A.; McQueen, James M.

    2017-01-01

    Purpose: Because reading is an audiovisual process, reading impairment may reflect an audiovisual processing deficit. The aim of the present study was to test the existence and scope of such a deficit in adult readers with dyslexia. Method: We tested 39 typical readers and 51 adult readers with dyslexia on their sensitivity to the simultaneity of…

  19. Physical, lifestyle, psychological, and social determinants of pain intensity, pain disability, and the number of pain locations in depressed older adults.

    PubMed

    Hanssen, Denise J C; Naarding, Paul; Collard, Rose M; Comijs, Hannie C; Oude Voshaar, Richard C

    2014-10-01

    Late-life depression and pain more often co-occur than can be explained by chance. Determinants of pain in late-life depression are unknown, even though knowledge on possible determinants of pain in depression is important for clinical practice. Therefore, the objectives of the present study were 1) to describe pain characteristics of depressed older adults and a nondepressed comparison group, and 2) to explore physical, lifestyle, psychological, and social determinants of acute and chronic pain intensity, disability, and multisite pain in depressed older adults. Data from the Netherlands Study of Depression in Older Persons cohort, consisting of 378 depressed persons, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria, and 132 nondepressed persons aged 60 years and older, were used in a cross-sectional design. Pain characteristics were measured by the Chronic Graded Pain Scale. Multiple linear regression analyses were performed to explore the contribution of physical, lifestyle, psychological, and social determinants to outcomes pain intensity, disability, and the number of pain locations. Depressed older adults more often reported chronic pain and experienced their pain as more intense and disabling compared to nondepressed older adults. Adjusted for demographic, physical, and lifestyle characteristics, multinomial logistic regression analyses showed increased odds ratios (OR) for depression in acute pain (OR 3.010; P=0.005) and chronic pain (OR 4.544, P<0.001). In addition, linear regression analyses showed that acute and chronic pain intensity, disability, and multisite pain were associated with several biopsychosocial determinants, of which anxiety was most pronounced. Further research could focus on the temporal relationship between anxiety, late-life depression, and pain.

  20. Renal replacement therapy in adult and pediatric intensive care : Recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD).

    PubMed

    Vinsonneau, Christophe; Allain-Launay, Emma; Blayau, Clarisse; Darmon, Michael; Ducheyron, Damien; Gaillot, Theophile; Honore, Patrick M; Javouhey, Etienne; Krummel, Thierry; Lahoche, Annie; Letacon, Serge; Legrand, Matthieu; Monchi, Mehran; Ridel, Christophe; Robert, René; Schortgen, Frederique; Souweine, Bertrand; Vaillant, Patrick; Velly, Lionel; Osman, David; Van Vong, Ly

    2015-12-01

    Acute renal failure (ARF) in critically ill patients is currently very frequent and requires renal replacement therapy (RRT) in many patients. During the last 15 years, several studies have considered important issues regarding the use of RRT in ARF, like the time to initiate the therapy, the dialysis dose, the types of catheter, the choice of technique, and anticoagulation. However, despite an abundant literature, conflicting results do not provide evidence on RRT implementation. We present herein recommendations for the use of RRT in adult and pediatric intensive care developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of French Intensive Care Society (SRLF), with the participation of the French Society of Anesthesia and Intensive Care (SFAR), the French Group for Pediatric Intensive Care and Emergencies (GFRUP), and the French Dialysis Society (SFD). The recommendations cover 4 fields: criteria for RRT initiation, technical aspects (access routes, membranes, anticoagulation, reverse osmosis water), practical aspects (choice of the method, peritoneal dialysis, dialysis dose, adjustments), and safety (procedures and training, dialysis catheter management, extracorporeal circuit set-up). These recommendations have been designed on a practical point of view to provide guidance for intensivists in their daily practice.

  1. Acute rhinosinusitis (ARS). Diagnosis and treatment of adults in general practice.

    PubMed

    Hansen, Jens Georg

    2014-02-01

    The idea behind this thesis is to present how ARS and especially acute maxillary sinusitis in adults is diagnosed and treated in general practice. The study extends over many years, beginning with the first survey in 1991. Based on doctors' answers, we then investigated the diagnostic values ​​of the symptoms, signs and examinations which the doctors reported using. All patients over 18 years suspected of acute maxillary sinusitis were included consecutively and only once and, after a clinical examination with the GP, they were offered the opportunity to enter into the prospective study referred to acute CT scan and by changes in the CT, immediately referred to sinus puncture. Both examinations were conducted at Aalborg Hospital. The disease was found most frequently in younger and 2/3 were women. The reason for this gender difference is unknown. We have assessed the diagnostic values of the symptoms, objective findings and investigations ​​using 3 different reference standards: sinus puncture, microbiological diagnosis and CT scan described in three articles. In all examinations, it appeared that the usual signs and symptoms of acute maxillary sinusitis occur almost equally often and with a few exceptions in patients, with and without pus in the sinus cavities. Pain in the sinus cavities occurring in 95% of patients, and only elevated levels of CRP and ESR are significantly and independently associated with pus in the sinus cavities. This finding is surprising, because they are two nonspecific markers. CRP tested by near-patient testing has, within the investigations period, been introduced in general practice, and from 1999 the doctors also get reimbursed for performing the test. We have on this background originally defined a clinical criterion with pain over the sinuses accompanied by elevated values ​​of CRP and/or ESR giving a sensitivity of 0.82, specificity 0.57, ppv 0.68 and npv 0.74. But looking at the ROC curve we suggest that a more clinical

  2. Combined effects of major depression, pain and somatic disorders on general functioning in the general adult population.

    PubMed

    Baune, Bernhard T; Caniato, Riccardo N; Garcia-Alcaraz, Miguel A; Berger, Klaus

    2008-08-31

    This study was carried out to assess the prevalence of major depressive disorder (MDD) in persons suffering from pain symptoms in various locations, both with and without comorbid somatic disorders and to analyze the single and combined effects of MDD, pain symptoms and somatic disorders on general functioning in the community. The 12-month prevalence of MDD, somatic disorders and pain symptoms, grouped according to location, were determined among 4181 participants from a community sample. Depression was assessed utilising the Composite International Diagnostic Interview. Pain symptoms were self-reported by participants whereas medical diagnoses were validated by medical examinations. General functioning was evaluated utilising the established MOS-SF-36 scale. The prevalence of MDD was significantly increased for persons with pain in any location. In the absence of a somatic disorder, MDD prevalence was highest in persons with abdominal/chest pain (9.3%) and arm or leg pain (7.9%) and lowest in persons with back pain (6.2%). Mental and physical well-being were lowest for persons with both MDD and a somatic disorder, irrespective of pain locations. Increasing numbers of pain locations impaired mental and physical well-being across all groups, but the effect on mental well-being was most marked in participants with MDD and comorbid somatic disorders. The presence of pain increases risk of associated MDD. The number of pain locations experienced, rather than the specific location of pain, has the greatest impact on general functioning. Not only chronic pain, but pain of any type may be an indicator of MDD and decreased general functioning.

  3. The Effect of Training Intensity on VO2max in Young Healthy Adults: A Meta-Regression and Meta-Analysis.

    PubMed

    Scribbans, Trisha D; Vecsey, Stephan; Hankinson, Paul B; Foster, William S; Gurd, Brendon J

    Exercise training at a variety of intensities increases maximal oxygen uptake (VO2max), the strongest predictor of cardiovascular and all-cause mortality. The purpose of the present study was to perform a systematic review, meta-regression and meta-analysis of available literature to determine if a dose-response relationship exists between exercise intensity and training-induced increases in VO2max in young healthy adults. Twenty-eight studies involving human participants (Mean age: 23±1 yr; Mean VO2max: 3.4±0.8 l·min(-1)) were included in the meta-regression with exercise training intensity, session dose, baseline VO2max, and total training volume used as covariates. These studies were also divided into 3 tertiles based on intensity (tertile 1: ~60-70%; 2: ~80-92.5%; 3: ~100-250%VO2max), for comparison using separate meta-analyses. The fixed and random effects meta-regression models examining training intensity, session dose, baseline VO2max and total training volume was non-significant (Q4=1.36; p=0.85; R(2)=0.05). There was no significant difference between tertiles in mean change in VO2max (tertile 1:+0.29±0.15 l/min, ES (effect size) =0.77; 2:+0.26±0.10 l/min, ES=0.68; 3:+0.35±0.17 l/min, ES=0.80), despite significant (p<0.05) reductions in session dose and total training volume as training intensity increased. These data suggest that exercise training intensity has no effect on the magnitude of training-induced increases in maximal oxygen uptake in young healthy human participants, but similar adaptations can be achieved in low training doses at higher exercise intensities than higher training doses of lower intensity (endurance training).

  4. The Effect of Training Intensity on VO2max in Young Healthy Adults: A Meta-Regression and Meta-Analysis

    PubMed Central

    SCRIBBANS, TRISHA D.; VECSEY, STEPHAN; HANKINSON, PAUL B.; FOSTER, WILLIAM S.; GURD, BRENDON J.

    2016-01-01

    Exercise training at a variety of intensities increases maximal oxygen uptake (VO2max), the strongest predictor of cardiovascular and all-cause mortality. The purpose of the present study was to perform a systematic review, meta-regression and meta-analysis of available literature to determine if a dose-response relationship exists between exercise intensity and training-induced increases in VO2max in young healthy adults. Twenty-eight studies involving human participants (Mean age: 23±1 yr; Mean VO2max: 3.4±0.8 l·min−1) were included in the meta-regression with exercise training intensity, session dose, baseline VO2max, and total training volume used as covariates. These studies were also divided into 3 tertiles based on intensity (tertile 1: ~60–70%; 2: ~80–92.5%; 3: ~100–250%VO2max), for comparison using separate meta-analyses. The fixed and random effects meta-regression models examining training intensity, session dose, baseline VO2max and total training volume was non-significant (Q4=1.36; p=0.85; R2=0.05). There was no significant difference between tertiles in mean change in VO2max (tertile 1:+0.29±0.15 l/min, ES (effect size) =0.77; 2:+0.26±0.10 l/min, ES=0.68; 3:+0.35±0.17 l/min, ES=0.80), despite significant (p<0.05) reductions in session dose and total training volume as training intensity increased. These data suggest that exercise training intensity has no effect on the magnitude of training-induced increases in maximal oxygen uptake in young healthy human participants, but similar adaptations can be achieved in low training doses at higher exercise intensities than higher training doses of lower intensity (endurance training). PMID:27182424

  5. Substance Use, Health, and Functioning Characteristics of Medical Marijuana Program Participants Compared to the General Adult Population in Ontario (Canada).

    PubMed

    Fischer, Benedikt; Ialomiteanu, Anca R; Aeby, Samantha; Rudzinski, Katherine; Kurdyak, Paul; Rehm, Jürgen

    2017-01-01

    Existent profiles of Medical Marijuana Program (MMP) participants indicate common and co-morbid chronic diseases, yet evidence on disability or functioning as well as comparisons with general populations are largely lacking. This study compared health, substance use, and functioning status among formally approved MMP participants with the general adult population in Ontario (Canada). A community-recruited sample (n = 53) of MMP participants was compared to a sub-sample (n = 510) of the representative Centre for Addiction and Mental Health (CAMH) Monitor (2015 cycle) survey of Ontario general population adults (ages 18+) based on identical telephone-based interviews regarding substance use, health, and functioning measures. Means and standard deviations for all indicators were computed by sex, controlled for age and education, and compared by regression techniques. MMP participants were more likely to be male, younger, and less socio-economically integrated; they indicated more common psychoactive substance (e.g., tobacco, daily cannabis) and psychotropic medication use, as well as overall worse physical and mental health and functioning status. Marked differences between MMP participants and general population adults were observed. MMPs appear to attract individuals with complex chronic health problems; however, little is known about the impact of MMP participation on these.

  6. Training and generalization of agrammatic aphasic adults' wh-interrogative productions.

    PubMed

    Wambaugh, J L; Thompson, C K

    1989-11-01

    The stimulus and response generalization effects of training wh-interrogative production were examined in 4 agrammatic Broca's aphasic subjects using a multiple baseline design across behaviors and subjects. Throughout treatment, response generalization to untrained questions and stimulus generalization to several nontraining conditions were assessed. Variable response generalization to untrained exemplars of trained wh-interrogative forms and little generalization to grammatically different wh constructions occurred. Stimulus generalization to only one of three conditions was noted. However, generalization treatment involving sequential modification of training across conditions was found to be effective in facilitating generalization to an additional stimulus condition for 2 of the 4 subjects.

  7. Model VESL Program Guide, Office Information Systems, International: One Semester Intensive Training Certificate of Achievement Programs in General, Medical, and Legal Office.

    ERIC Educational Resources Information Center

    Alvarez, Irma J.

    The Office Information Systems-International Program at Southwestern College, in California, was designed to provide Hispanic students with training for entry-level office employment. This model program guide stems from a project to improve curricula and delivery and focuses on changes in three intensive bilingual programs in general, medical, and…

  8. Generalized Courant-Snyder Theory and Kapchinskij-Vladimirskij Distribution For High-intensity Beams In A Coupled Transverse Focusing Lattice

    SciTech Connect

    Hong QIn, Ronald Davidson

    2011-07-18

    The Courant-Snyder (CS) theory and the Kapchinskij-Vladimirskij (KV) distribution for high-intensity beams in a uncoupled focusing lattice are generalized to the case of coupled transverse dynamics. The envelope function is generalized to an envelope matrix, and the envelope equation becomes a matrix envelope equation with matrix operations that are non-commutative. In an uncoupled lattice, the KV distribution function, first analyzed in 1959, is the only known exact solution of the nonlinear Vlasov-Maxwell equations for high-intensity beams including self-fields in a self-consistent manner. The KV solution is generalized to high-intensity beams in a coupled transverse lattice using the generalized CS invariant. This solution projects to a rotating, pulsating elliptical beam in transverse configuration space. The fully self-consistent solution reduces the nonlinear Vlasov-Maxwell equations to a nonlinear matrix ordinary differential equation for the envelope matrix, which determines the geometry of the pulsating and rotating beam ellipse. These results provide us with a new theoretical tool to investigate the dynamics of high-intensity beams in a coupled transverse lattice. A strongly coupled lattice, a so-called N-rolling lattice, is studied as an example. It is found that strong coupling does not deteriorate the beam quality. Instead, the coupling induces beam rotation, and reduces beam pulsation.

  9. Generalized Courant-Snyder theory and Kapchinskij-Vladimirskij distribution for high-intensity beams in a coupled transverse focusing lattice

    SciTech Connect

    Qin Hong; Davidson, Ronald C.

    2011-05-15

    The Courant-Snyder (CS) theory and the Kapchinskij-Vladimirskij (KV) distribution for high-intensity beams in an uncoupled focusing lattice are generalized to the case of coupled transverse dynamics. The envelope function is generalized to an envelope matrix, and the envelope equation becomes a matrix envelope equation with matrix operations that are noncommutative. In an uncoupled lattice, the KV distribution function, first analyzed in 1959, is the only known exact solution of the nonlinear Vlasov-Maxwell equations for high-intensity beams including self-fields in a self-consistent manner. The KV solution is generalized to high-intensity beams in a coupled transverse lattice using the generalized CS invariant. This solution projects to a rotating, pulsating elliptical beam in transverse configuration space. The fully self-consistent solution reduces the nonlinear Vlasov-Maxwell equations to a nonlinear matrix ordinary differential equation for the envelope matrix, which determines the geometry of the pulsating and rotating beam ellipse. These results provide us with a new theoretical tool to investigate the dynamics of high-intensity beams in a coupled transverse lattice. A strongly coupled lattice, a so-called N-rolling lattice, is studied as an example. It is found that strong coupling does not deteriorate the beam quality. Instead, the coupling induces beam rotation and reduces beam pulsation.

  10. Effect of Moderate Versus High-Intensity Interval Exercise Training on Heart Rate Variability Parameters in Inactive Latin-American Adults: A Randomised Clinical Trial.

    PubMed

    Ramírez-Vélez, Robinson; Tordecilla-Sanders, Alejandra; Téllez-T, Luis Andrés; Camelo-Prieto, Diana; Hernández-Quiñonez, Paula Andrea; Correa-Bautista, Jorge Enrique; Garcia-Hermoso, Antonio; Ramírez-Campillo, Rodrigo; Izquierdo, Mikel

    2017-02-01

    We investigated the effect of moderate versus high-intensity interval exercise training on the HRV indices in physically inactive adults. Twenty inactive adults were randomly allocated to receive either moderate intensity training (MCT group) or high-intensity interval training (HIT group). The MCT group performed aerobic training at an intensity of 55-75%, which consisted of walking on a treadmill at 60-80% of the maximum heart rate (HRmax) until the expenditure of 300 kcal. The HIT group ran on a treadmill for 4 minutes at 85-95% peak HRmax and had a recovery of 4 minutes at 65% peak HRmax until the expenditure of 300 kcal. Supine resting HRV indices (time domain: SDNN, standard deviation of normal-to-normal intervals; rMSSD, Root mean square successive difference of RR intervals and frequency domain: HFLn, high-frequency spectral power; LF, low-frequency spectral power and HF/LF ratio) were measured at baseline and 12 weeks thereafter. The SDNN changes were 3.4 (8.9) ms in the MCT group and 29.1 (7.6) ms in the HIT group (difference between groups 32.6 [95% CI, 24.9 to 40.4 (P = 0.01)]. The LF/HFLn ratio change 0.19 (0.03) ms in the MCT group and 0.13 (0.01) ms in the HIT group (P between groups = 0.016). No significant group differences were observed for the rMSSD, HF and LF parameters. In inactive adults, this study showed that a 12-week HIT training program could increase short-term HRV, mostly in vagally mediated indices such as SDNN and HF/LFLn ratio power.

  11. Enhanced Medical Rehabilitation increases therapy intensity and engagement and improves functional outcomes in post-acute rehabilitation of older adults: a randomized controlled trial

    PubMed Central

    Lenze, Eric J.; Host, Helen H.; Hildebrand, Mary W.; Morrow-Howell, Nancy; Carpenter, Brian; Freedland, Kenneth E.; Baum, Carolyn A.; Dixon, David; Doré, Peter; Wendleton, Leah; Binder, Ellen F.

    2012-01-01

    Objectives For millions of disabled older adults each year, post-acute care in skilled nursing facilities (SNFs) is a brief window of opportunity to regain enough function to return home and live independently. Too often this goal is not achieved, possibly due to therapy that is inadequately intense or engaging. This study tested Enhanced Medical Rehabilitation, an intervention designed to increase patient engagement in, and intensity of, daily physical and occupational therapy sessions in post-acute care rehabilitation. Design Randomized controlled trial of Enhanced Medical Rehabilitation versus standard-of-care rehabilitation. Setting Post-acute care unit of a skilled nursing facility in St Louis, MO. Participants 26 older adults admitted from a hospital for post-acute rehabilitation. Intervention Based on models of motivation and behavior change, Enhanced Medical Rehabilitation is a set of behavioral skills for physical and occupational therapists (PT/OT) that increase patient engagement and intensity, with the goal of improving functional outcome, through: (1) a patient-directed, interactive approach, (2) increased rehabilitation intensity, and (3) frequent feedback to patients on their effort and progress. Measurements Therapy intensity: assessment of patient active time in therapy sessions. Therapy engagement: Rehabilitation Participation Scale. Functional and performance outcomes: Barthel Index, gait speed, and six-minute walk. Results Participants randomized to Enhanced Medical Rehabilitation had higher intensity therapy and were more engaged in their rehabilitation sessions; they had more improvement in gait speed (improving from 0.08 to 0.38 meter/sec vs. 0.08 to 0.22 in standard of care,p=0.003) and six-minute walk (from 73 to 266 feet vs. 40 to 94 feet in standard of care, p=0.026), with a trend for better improvement of Barthel Index (+43 points vs. 26 points in standard of care, p=0.087), compared to participants randomized to standard

  12. Novel all-extremity high-intensity interval training improves aerobic fitness, cardiac function and insulin resistance in healthy older adults.

    PubMed

    Hwang, Chueh-Lung; Yoo, Jeung-Ki; Kim, Han-Kyul; Hwang, Moon-Hyon; Handberg, Eileen M; Petersen, John W; Christou, Demetra D

    2016-09-01

    Aging is associated with decreased aerobic fitness and cardiac remodeling leading to increased risk for cardiovascular disease. High-intensity interval training (HIIT) on the treadmill has been reported to be more effective in ameliorating these risk factors compared with moderate-intensity continuous training (MICT) in patients with cardiometabolic disease. In older adults, however, weight-bearing activities are frequently limited due to musculoskeletal and balance problems. The purpose of this study was to examine the feasibility and safety of non-weight-bearing all-extremity HIIT in older adults. In addition, we tested the hypothesis that all-extremity HIIT will be more effective in improving aerobic fitness, cardiac function, and metabolic risk factors compared with all-extremity MICT. Fifty-one healthy sedentary older adults (age: 65±1years) were randomized to HIIT (n=17), MICT (n=18) or non-exercise control (CONT; n=16). HIIT (4×4min 90% of peak heart rate; HRpeak) and isocaloric MICT (70% of HRpeak) were performed on a non-weight-bearing all-extremity ergometer, 4×/week for 8weeks under supervision. All-extremity HIIT was feasible in older adults and resulted in no adverse events. Aerobic fitness (peak oxygen consumption; VO2peak) and ejection fraction (echocardiography) improved by 11% (P<0.0001) and 4% (P=0.001), respectively in HIIT, while no changes were observed in MICT and CONT (P≥0.1). Greater improvements in ejection fraction were associated with greater improvements in VO2peak (r=0.57; P<0.0001). Insulin resistance (homeostatic model assessment) decreased only in HIIT by 26% (P=0.016). Diastolic function, body composition, glucose and lipids were unaffected (P≥0.1). In conclusion, all-extremity HIIT is feasible and safe in older adults. HIIT, but not MICT, improved aerobic fitness, ejection fraction, and insulin resistance.

  13. Contextual Constraint Treatment for coarse coding deficit in adults with right hemisphere brain damage: Generalization to narrative discourse comprehension

    PubMed Central

    Blake, Margaret Lehman; Tompkins, Connie A.; Scharp, Victoria L.; Meigh, Kimberly M.; Wambaugh, Julie

    2014-01-01

    Coarse coding is the activation of broad semantic fields that can include multiple word meanings and a variety of features, including those peripheral to a word’s core meaning. It is a partially domain-general process related to general discourse comprehension and contributes to both literal and non-literal language processing. Adults with damage to the right cerebral hemisphere (RHD) and a coarse coding deficit are particularly slow to activate features of words that are relatively distant or peripheral. This manuscript reports a pre-efficacy study of Contextual Constraint Treatment (CCT), a novel, implicit treatment designed to increase the efficiency of coarse coding with the goal of improving narrative comprehension and other language performance that relies on coarse coding. Participants were four adults with RHD. The study used a single-subject controlled experimental design across subjects and behaviors. The treatment involves pre-stimulation, using a hierarchy of strong- and moderately-biased contexts, to prime the intended distantly-related features of critical stimulus words. Three of the four participants exhibited gains in auditory narrative discourse comprehension, the primary outcome measure. All participants exhibited generalization to untreated items. No strong generalization to processing nonliteral language was evident. The results indicate that CCT yields both improved efficiency of the coarse coding process and generalization to narrative comprehension. PMID:24983133

  14. Dental coping strategies, general anxiety, and depression among adult patients with dental anxiety but with different dental-attendance patterns.

    PubMed

    Bernson, Jenny M; Elfström, Magnus L; Hakeberg, Magnus

    2013-06-01

    The aim of the present study was to investigate dental coping strategies, general anxiety, and depression in relation to regularity of dental treatment among persons with either regular dental care or phobic avoidance, whilst controlling for sociodemographic factors. Psychometric questionnaires on dental anxiety, dental coping strategies, general anxiety, and depression were delivered to 263 adult patients with dental phobic avoidance behavior who were seeking help from a specialized dental fear clinic and to 141 adult patients with dental anxiety who were receiving regular dental care from various public dental clinics. The results showed that the levels of dental and general anxiety and of depression were significantly higher among irregular attendees compared with regular attendees. Irregular attendees admitted fewer adaptive coping strategies. Predictive of irregular dental care were gender, dental anxiety, general anxiety, and the nonuse of the coping strategy 'optimism'. This study further confirms earlier preliminary results that the use of optimistic thinking is predictive for regular dental attendance habits and that male gender is a risk factor for irregular attendance. Moreover, this study adds that a high level of general anxiety indicates a higher risk for irregular dental care.

  15. Impact of long-term high-intensity interval and moderate-intensity continuous training on subclinical inflammation in overweight/obese adults

    PubMed Central

    Gerosa-Neto, José; Antunes, Barbara M.M.; Campos, Eduardo Z.; Rodrigues, Jhennyfer; Ferrari, Gustavo D.; Rosa Neto, José C.; Bueno, Carlos R.; Lira, Fábio S.

    2016-01-01

    Obesity is a risk factor able to trigger several inflammatory alterations and the imbalance between pro- and anti-inflammatory cytokine productions. Physical exercise is an important strategy for reduction of inflammatory established process. The aim of this study was to evaluate the effect of 16 weeks of three exercise training programs in the inflammatory profile and insulin resistance in overweight/obesity. Thirty two men and women (46.4±10.1 years; 162.0±9.1 cm; 82.0±13.6 kg) were divided into three groups for training on a treadmill: continuous at 70% maximum heart rate (HRmax) 5 times a week (CONT); 1×4 min (1-bout) and 4×4 min (high intensity interval training, HIIT) at 90% HRmax 3 times a week. Interleukin (IL) 6 and IL-10, tumor necrosis factor-alpha (TNF-α), insulin and adiponectin levels were analyzed by enzyme-linked immunosorbent assay, and homeostasis model assessment insulin resistance was calculated. After 16 weeks of training blood concentrations of IL-6 decreased in the HIIT group (P=0.035), TNF-α decreased in the CONT (P=0.037) and increased in HIIT (P=0.001) and adiponectin decreased in the three training models. There was a trend towards decreased body weight and body mass index (BMI) after HIIT only (P=0.059 and P=0.060, respectively). Despite the decrease of adiponectin and the increase of TNF-α in HIIT group, insulin sensitivity showed a trend for improvement (P=0.08). HIIT program decreased IL-6 at rest and although not significant was the only who tended to decrease total body weight and BMI. Taken together, our data suggest that both HIIT as well as CONT exercises training program promotes changes in inflammatory profile in overweight/obesity, but dissimilar response is seen in TNF-α levels. PMID:28119880

  16. Impact of long-term high-intensity interval and moderate-intensity continuous training on subclinical inflammation in overweight/obese adults.

    PubMed

    Gerosa-Neto, José; Antunes, Barbara M M; Campos, Eduardo Z; Rodrigues, Jhennyfer; Ferrari, Gustavo D; Rosa Neto, José C; Bueno, Carlos R; Lira, Fábio S

    2016-12-01

    Obesity is a risk factor able to trigger several inflammatory alterations and the imbalance between pro- and anti-inflammatory cytokine productions. Physical exercise is an important strategy for reduction of inflammatory established process. The aim of this study was to evaluate the effect of 16 weeks of three exercise training programs in the inflammatory profile and insulin resistance in overweight/obesity. Thirty two men and women (46.4±10.1 years; 162.0±9.1 cm; 82.0±13.6 kg) were divided into three groups for training on a treadmill: continuous at 70% maximum heart rate (HRmax) 5 times a week (CONT); 1×4 min (1-bout) and 4×4 min (high intensity interval training, HIIT) at 90% HRmax 3 times a week. Interleukin (IL) 6 and IL-10, tumor necrosis factor-alpha (TNF-α), insulin and adiponectin levels were analyzed by enzyme-linked immunosorbent assay, and homeostasis model assessment insulin resistance was calculated. After 16 weeks of training blood concentrations of IL-6 decreased in the HIIT group (P=0.035), TNF-α decreased in the CONT (P=0.037) and increased in HIIT (P=0.001) and adiponectin decreased in the three training models. There was a trend towards decreased body weight and body mass index (BMI) after HIIT only (P=0.059 and P=0.060, respectively). Despite the decrease of adiponectin and the increase of TNF-α in HIIT group, insulin sensitivity showed a trend for improvement (P=0.08). HIIT program decreased IL-6 at rest and although not significant was the only who tended to decrease total body weight and BMI. Taken together, our data suggest that both HIIT as well as CONT exercises training program promotes changes in inflammatory profile in overweight/obesity, but dissimilar response is seen in TNF-α levels.

  17. Influence of the Perceived Taste Intensity of Chemesthetic Stimuli on Swallowing Parameters Given Age and Genetic Taste Differences in Healthy Adult Women

    ERIC Educational Resources Information Center

    Pelletier, Cathy A.; Steele, Catriona M.

    2014-01-01

    Purpose: This study examined whether the perceived taste intensity of liquids with chemesthetic properties influenced lingua-palatal pressures and submental surface electromyography (sEMG) in swallowing, compared with water. Method: Swallowing was studied in 80 healthy women, stratified by age group and genetic taste status. General Labeled…

  18. Exercise Intensity-Dependent Effects on Cognitive Control Function during and after Acute Treadmill Running in Young Healthy Adults

    PubMed Central

    Wohlwend, Martin; Olsen, Alexander; Håberg, Asta K.; Palmer, Helen S.

    2017-01-01

    The idea that physical activity differentially impacts upon performance of various cognitive tasks has recently gained increased interest. However, our current knowledge about how cognition is altered by acute physical activity is incomplete. To measure how different intensity levels of physical activity affect cognition during and after 1 bout of physical activity, 30 healthy, young participants were randomized to perform a not-X continuous performance test (CPT) during low (LI)- and moderate intensity (MI) running. The same participants were subsequently randomized to perform the not-X CPT post LI, MI, and high intensity (HI) running. In addition, exercise related mood changes were assessed through a self-report measure pre and post running at LI, MI, and HI. Results showed worsening of performance accuracy on the not-X CPT during one bout of moderate compared to low intensity running. Post running, there was a linear decrease in reaction time with increasing running intensity and no change in accuracy or mood. The decreased reaction times post HI running recovered back to baseline within 20 min. We conclude that accuracy is acutely deteriorated during the most straining physical activity while a transient intensity-dependent enhancement of cognitive control function is present following physical activity. PMID:28377735

  19. Enjoyment for High-Intensity Interval Exercise Increases during the First Six Weeks of Training: Implications for Promoting Exercise Adherence in Sedentary Adults

    PubMed Central

    Heisz, Jennifer J.; Tejada, Mary Grace M.; Paolucci, Emily M.; Muir, Cameron

    2016-01-01

    This is the first study to show that enjoyment for high-intensity interval exercise increases with chronic training. Prior acute studies typically report high-intensity interval training (HIT) as being more enjoyable than moderate continuous training (MCT) unless the high-intensity intervals are too strenuous or difficult to complete. It follows that exercise competency may be a critical factor contributing to the enjoyment of HIT, and therefore building competency through chronic training may be one way to increase its enjoyment. To test this, we randomly assigned sedentary young adults to six weeks of HIT or MCT, and tracked changes in their enjoyment for the exercise. Enjoyment for HIT increased with training whereas enjoyment for MCT remained constant and lower. Changes in exercise enjoyment were predicted by increases in workload, suggesting that strength adaptions may be important for promoting exercise enjoyment. The results point to HIT as a promising protocol for promoting exercise enjoyment and adherence in sedentary young adults. PMID:27973594

  20. Participation in the 2005 General Election by Adults with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Keeley, H.; Redley, M.; Holland, A. J.; Clare, I. C. H.

    2008-01-01

    Background: International and UK legislation confirms and supports the right of adults with intellectual disabilities (ID) to vote. It is widely accepted, although not previously empirically confirmed, that citizens with ID are under-represented at the polls. Method: To document the extent of their under-representation at the polls, the names and…

  1. An Economical Method for the Evaluation of General Intelligence in Adults.

    ERIC Educational Resources Information Center

    Dodrill, Carl B.

    1981-01-01

    Evaluated the ability of the Wonderlic Personnel Test to replicate the Wechsler Adult Intelligence Scale (WAIS) with (N=120) normal persons divided into principal and cross-validation groups. Correlations between the Wonderlic IQs and the WAIS Full Scale IQs were .93 for the main group and .91 for the cross-validation group. (Author)

  2. "Subtypes" in the Presentation of Autistic Traits in the General Adult Population

    ERIC Educational Resources Information Center

    Palmer, Colin J.; Paton, Bryan; Enticott, Peter G.; Hohwy, Jakob

    2015-01-01

    The present study examined the presentation of autistic traits in a large adult population sample (n = 2,343). Cluster analysis indicated two subgroups with clearly distinguishable trait profiles. One group (n = 1,059) reported greater social difficulties and lower detail orientation, while the second group (n = 1,284) reported lesser social…

  3. The Mental Health of British Adults with Intellectual Impairments Living in General Households

    ERIC Educational Resources Information Center

    Hatton, Chris; Emerson, Eric; Robertson, Janet; Baines, Susannah

    2017-01-01

    Background: People with intellectual disability or borderline intellectual functioning may have poorer mental health than their peers. The present authors sought to (i) estimate the risk of poorer mental health among British adults with and without intellectual impairments and (ii) estimate the extent to which any between-group differences in…

  4. Learned Attention in Adult Language Acquisition: A Replication and Generalization Study and Meta-Analysis

    ERIC Educational Resources Information Center

    Ellis, Nick C.; Sagarra, Nuria

    2011-01-01

    This study investigates associative learning explanations of the limited attainment of adult compared to child language acquisition in terms of learned attention to cues. It replicates and extends Ellis and Sagarra (2010) in demonstrating short- and long-term learned attention in the acquisition of temporal reference in Latin. In Experiment 1,…

  5. The influence of childhood abuse, adult life events, and affective temperaments on the well-being of the general, nonclinical adult population

    PubMed Central

    Kanai, Yoshiaki; Takaesu, Yoshikazu; Nakai, Yukiei; Ichiki, Masahiko; Sato, Mitsuhiko; Matsumoto, Yasunori; Ishikawa, Jun; Ono, Yasuyuki; Murakoshi, Akiko; Tanabe, Hajime; Kusumi, Ichiro; Inoue, Takeshi

    2016-01-01

    Background Previous studies have shown the effects of childhood abuse, life events, and temperaments on well-being (positive affect) and ill-being (negative affect). We hypothesized that childhood abuse, affective temperaments, and adult life events interact with one another and influence positive and negative affects in the general adult population and tested this hypothesis using structural equation modeling. Methods A total of 415 participants from the general, nonclinical adult population were studied using the following self-administered questionnaires: the Subjective Well-Being Inventory (SUBI); Life Experiences Survey (LES); Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A); and the Child Abuse and Trauma Scale (CATS). The data were analyzed with single and multiple regression analyses and structural equation modeling (Mplus). Results Childhood abuse indirectly predicted the worsening of positive and negative affects through cyclothymic, anxious, and irritable temperaments as measured by the TEMPS-A in the structural equation model. The cyclothymic, anxious, and irritable temperaments directly worsened the positive and negative affects and the negative appraisal of life events that occurred during the past year, while the hyperthymic temperament had the opposite effects. Limitations The subjects of this study were nonclinical volunteers. The findings might not be generalizable to psychiatric patients. Conclusion This study demonstrated that childhood abuse, particularly neglect, indirectly worsened the well-being of individuals through cyclothymic, anxious, and irritable affective temperaments. An important “mediator” role of affective temperaments in the effect of childhood abuse on well-being was suggested. PMID:27110116

  6. Drought reduces chytrid fungus (Batrachochytrium dendrobatidis) infection intensity and mortality but not prevalence in adult crawfish frogs (Lithobates areolatus).

    PubMed

    Terrell, Vanessa C K; Engbrecht, Nathan J; Pessier, Allan P; Lannoo, Michael J

    2014-01-01

    To fully understand the impacts of the chytrid fungus Batrachochytrium dendrobatidis (Bd) on amphibians it is necessary to examine the interactions between populations and their environment. Ecologic variables can exacerbate or ameliorate Bd prevalence and infection intensity, factors that are positively related when Bd is acting on naive amphibian populations as an epidemic disease. In crawfish frogs (Lithobates areolatus), a North American species with a complex life history, we have shown that Bd acts as an endemic disease with impacts that vary seasonally; the highest infection prevalences and intensities and highest frog mortality occurred during late spring in postbreeding individuals. In this study, conducted between 28 February and 23 August 2011 in southwestern Indiana on the same population, we report an uncoupling of the previously observed relationship between Bd prevalence and intensity following an extreme drought. Specifically, there was a postdrought reduction in Bd infection intensity and mortality, but not in infection prevalence. This result suggests that the relationship between prevalence and intensity observed in Bd epidemics can be uncoupled in populations harboring endemic infections. Further, constant prevalence rates suggest either that crawfish frogs are being exposed to Bd sources independent of ambient moisture or that low-level infections below detection thresholds persist from year to year. Drought has several ecologically beneficial effects for amphibians with complex life histories, including eliminating fish and invertebrate populations that feed on larvae. To these ecologic benefits we suggest another, that drought can reduce the incidence of the severe skin disease (chytridiomycosis) due to Bd infection.

  7. Time to exhaustion and time spent at a high percentage of VO2max in severe intensity domain in children and adults.

    PubMed

    Leclair, Erwan; Mucci, Patrick; Borel, Benoit; Baquet, Georges; Carter, Helen; Berthoin, Serge

    2011-04-01

    The aim of the study was to compare time spent at a high percentage of VO2max (>90% of VO2max) (ts90%), time to achieve 90% of VO2max (ta90%), and time to exhaustion (TTE) for exercise in the severe intensity domain in children and adults. Fifteen prepubertal boys (10.3 ± 0.9 years) and 15 men (23.5 ± 3.6 years) performed a maximal graded exercise to determine VO2max, maximal aerobic power (MAP) and power at ventilatory threshold (PVTh). Then, they performed 4 constant load exercises in a random order at PVTh plus 50 and 75% of the difference between MAP and PVTh (PΔ50 and PΔ75) and 100 and 110% of MAP (P100 and P110). VO2max was continuously monitored. The P110 test was used to determine maximal accumulated oxygen deficit (MAOD). No significant difference was found in ta90% between children and adults. ts90% and TTE were not significantly different between children and adults for the exercises at PΔ50 and PΔ75. However, ts90% and TTE during P100 (p < 0.05 and p < 0.01, respectively) and P110 (p < 0.001) exercises were significantly shorter in children. Children had a significantly lower MAOD than adults (34.3 ± 9.4 ml · kg vs. 53.6 ± 11.1 ml · kg). A positive relationship (p < 0.05) was obtained between MAOD and TTE values during the P100 test in children. This study showed that only for intensities at, or higher than MAP, lower ts90% in children was linked to a reduced TTE, compared to adults. Shorter TTE in children can partly be explained by a lower anaerobic capacity (MAOD). These results give precious information about exercise intensity ranges that could be used in children's training sessions. Moreover, they highlight the implication of both aerobic and anaerobic processes in endurance performances in both populations.

  8. [Management of patients under 18years of age by adult intensive care unit professionals: Level of training, workload, and specific challenges].

    PubMed

    Brossier, D; Villedieu, F; Letouzé, N; Pinto Da Costa, N; Jokic, M

    2017-03-01

    In routine practice, intensive care physicians rarely have to manage children under 18years of age, particularly those under 15. This study's objectives were to assess the quality of training in pediatrics of adult intensive care teams, to document the workload generated by care of pediatric patients, and to identify the difficulties encountered in managing minors as patients. A survey was administered in Lower Normandy from 4 April 2012 to 1 September 2012. Physicians, residents, nurses, and nurses' aides practicing in one of the nine intensive care units of Lower Normandy were asked to complete an electronic or paper format questionnaire. This questionnaire assessed their level of pediatric training, the workload management of pediatric patients entailed, and the challenges posed by these patients. One hundred and nine questionnaires were returned (by 26 attending physicians, 18 residents, 38 nurses, and 27 nurses' aides). Eighty-three of the respondents (76%) had no experience in a pediatric unit of any kind. Forty-two percent thought that the pediatric age range lies between 3months and 15years of age. However, more than 50% of respondents would like the upper limit to be 16years or even older. Ninety-three respondents (85%) estimated having some exposure to pediatric patients in their routine practice, but this activity remained quite low. Seventy-three (67%) reported difficulties with the management of these young patients. This survey provides current information regarding the level of training of adult intensive care unit professionals and their concerns about managing patients under 18years of age, both in terms of workload and specific challenges.

  9. INFLUENCE OF THE PERCEIVED TASTE INTENSITY OF CHEMESTHETIC STIMULI ON SWALLOWING PARAMETERS GIVEN AGE AND GENETIC TASTE DIFFERENCES IN HEALTHY ADULT WOMEN

    PubMed Central

    Pelletier, Cathy A.; Steele, Catriona M.

    2015-01-01

    Purpose This study examined whether the perceived taste intensity of liquids with chemesthetic properties influenced lingua-palatal pressures and submental surface electromyography (sEMG) in swallowing, compared to water. Method Swallowing behaviors were studied in 80 healthy women, stratified by age-group and genetic taste-status. General Labeled Magnitude Scale ratings of taste intensity were collected for deionized water; carbonated water; 2.7 % w/v citric acid; and diluted ethanol. These stimuli were swallowed, with measurement of tongue-palate pressures and submental sEMG. Path analysis differentiated stimulus, genetic taste-status, age, and perceived taste intensity effects on swallowing. Signal amplitude during effortful saliva swallowing served as a covariate accounting for differences in participant strength. Results Significant differences in taste intensity were seen across liquids: citric acid > ethanol > carbonated water > water. Supertasters perceived greater taste intensity than nontasters. Lingua-palatal pressure and sEMG amplitudes were correlated with the strength covariate. Anterior palate pressures and sEMG amplitudes were significantly higher for the citric acid stimulus. Perceived taste intensity was a significant mediator of stimulus differences. Conclusions These data support the idea that sensory input transmitted via chorda tympani and trigeminal afferent pathways may lead to cortical facilitation and/or modulation of swallowing. PMID:24687466

  10. Acute Low-Volume High-Intensity Interval Exercise and Continuous Moderate-Intensity Exercise Elicit a Similar Improvement in 24-h Glycemic Control in Overweight and Obese Adults.

    PubMed

    Parker, Lewan; Shaw, Christopher S; Banting, Lauren; Levinger, Itamar; Hill, Karen M; McAinch, Andrew J; Stepto, Nigel K

    2016-01-01

    Background: Acute exercise reduces postprandial oxidative stress and glycemia; however, the effects of exercise intensity are unclear. We investigated the effect of acute low-volume high-intensity interval-exercise (LV-HIIE) and continuous moderate-intensity exercise (CMIE) on glycemic control and oxidative stress in overweight and obese, inactive adults. Methods: Twenty-seven adults were randomly allocated to perform a single session of LV-HIIE (9 females, 5 males; age: 30 ± 1 years; BMI: 29 ± 1 kg·m(-2); mean ± SEM) or CMIE (8 females, 5 males; age: 30 ± 2.0; BMI: 30 ± 2.0) 1 h after consumption of a standard breakfast. Plasma redox status, glucose and insulin were measured. Continuous glucose monitoring (CGM) was conducted during the 24-h period before (rest day) and after exercise (exercise day). Results: Plasma thiobarbituric acid reactive substances (TBARS; 29 ±13%, p < 0.01; mean percent change ±90% confidence limit), hydrogen peroxide (44 ± 16%, p < 0.01), catalase activity (50 ± 16%, p < 0.01), and superoxide dismutase activity (21 ± 6%, p < 0.01) significantly increased 1 h after breakfast (prior to exercise) compared to baseline. Exercise significantly decreased postprandial glycaemia in whole blood (-6 ± 5%, p < 0.01), irrespective of the exercise protocol. Only CMIE significantly decreased postprandial TBARS (CMIE: -33 ± 8%, p < 0.01; LV-HIIE: 11 ± 22%, p = 0.34) and hydrogen peroxide (CMIE: -25 ± 15%, p = 0.04; LV-HIIE: 7 ± 26%; p = 0.37). Acute exercise provided a similar significant improvement in 24-h average glucose levels (-5 ± 2%, p < 0.01), hyperglycemic excursions (-37 ± 60%, p < 0.01), peak glucose concentrations (-8 ± 4%, p < 0.01), and the 2-h postprandial glucose response to dinner (-9 ± 4%, p < 0.01), irrespective of the exercise protocol. Conclusion: Despite elevated postprandial oxidative stress compared to CMIE, LV-HIIE is an equally effective exercise mode for improving 24-h glycemic control in overweight and obese

  11. Acute Low-Volume High-Intensity Interval Exercise and Continuous Moderate-Intensity Exercise Elicit a Similar Improvement in 24-h Glycemic Control in Overweight and Obese Adults

    PubMed Central

    Parker, Lewan; Shaw, Christopher S.; Banting, Lauren; Levinger, Itamar; Hill, Karen M.; McAinch, Andrew J.; Stepto, Nigel K.

    2017-01-01

    Background: Acute exercise reduces postprandial oxidative stress and glycemia; however, the effects of exercise intensity are unclear. We investigated the effect of acute low-volume high-intensity interval-exercise (LV-HIIE) and continuous moderate-intensity exercise (CMIE) on glycemic control and oxidative stress in overweight and obese, inactive adults. Methods: Twenty-seven adults were randomly allocated to perform a single session of LV-HIIE (9 females, 5 males; age: 30 ± 1 years; BMI: 29 ± 1 kg·m−2; mean ± SEM) or CMIE (8 females, 5 males; age: 30 ± 2.0; BMI: 30 ± 2.0) 1 h after consumption of a standard breakfast. Plasma redox status, glucose and insulin were measured. Continuous glucose monitoring (CGM) was conducted during the 24-h period before (rest day) and after exercise (exercise day). Results: Plasma thiobarbituric acid reactive substances (TBARS; 29 ±13%, p < 0.01; mean percent change ±90% confidence limit), hydrogen peroxide (44 ± 16%, p < 0.01), catalase activity (50 ± 16%, p < 0.01), and superoxide dismutase activity (21 ± 6%, p < 0.01) significantly increased 1 h after breakfast (prior to exercise) compared to baseline. Exercise significantly decreased postprandial glycaemia in whole blood (−6 ± 5%, p < 0.01), irrespective of the exercise protocol. Only CMIE significantly decreased postprandial TBARS (CMIE: −33 ± 8%, p < 0.01; LV-HIIE: 11 ± 22%, p = 0.34) and hydrogen peroxide (CMIE: −25 ± 15%, p = 0.04; LV-HIIE: 7 ± 26%; p = 0.37). Acute exercise provided a similar significant improvement in 24-h average glucose levels (−5 ± 2%, p < 0.01), hyperglycemic excursions (−37 ± 60%, p < 0.01), peak glucose concentrations (−8 ± 4%, p < 0.01), and the 2-h postprandial glucose response to dinner (−9 ± 4%, p < 0.01), irrespective of the exercise protocol. Conclusion: Despite elevated postprandial oxidative stress compared to CMIE, LV-HIIE is an equally effective exercise mode for improving 24-h glycemic control in

  12. "Aging males" symptoms and general health of adult males: a cross-sectional study.

    PubMed

    Yuen, John W; Ng, Chi-Fai; Chiu, Peter Ka Fung; Teoh, Jeremy Yuen Chun; Yee, C H

    2016-06-01

    A cross-sectional study was conducted to explore the prevalence and severity of health-related complaints perceived by adult males of Hong Kong by using the Hong Kong Traditional Chinese versions of the Aging males' symptoms (AMS) scale and the 5-dimensional and 3-level European Quality of life (EQ-5D-3L) questionnaire. A total of 825 adult males aged 40 years or above were surveyed, and observed that 80% of the population was living with little-to-mild levels of aging symptoms with mean total scores ranged between 26.02 ± 7.91 and 32.99 ± 7.91 in different age groups. Such symptoms were correlated with age, especially for the somato-vegetative and sexual symptoms. The most severe AMS symptoms were observed in the oldest age group at 70 years or above, with 76%, 34% and 70% living with moderate-to-severe levels of somato-vegetative, psychological and sexual symptoms, respectively. The result was highly correlated with the EQ-5D-3L questionnaire. Secondly, the Hong Kong Aging males' symptoms (AMS) scale was shown to have good reliability with test-retest coefficient at 0.79 (ranged 0.66-0.87) and Cronbach's alpha coefficient at 0.88 (ranged 0.70-0.84). In summary, the population of Hong Kong male adults was commonly living with little-to-mild levels of aging symptoms, whereas their severity was correlated with age.

  13. [A case of a pediatric patient with tuberous sclerosis (Bourneville-Pringle disease) and frequent epileptic seizure for intensive dental treatment under general anesthesia].

    PubMed

    Mimura, Shinichiro; Kikura, Mutsuhito; Itagaki, Taiga; Inokuma, Mie; Iwamoto, Tatsuaki; Kawakubo, Atsushi; Hirano, Kazuhiro; Sato, Shigehito

    2006-04-01

    Tuberous sclerosis (Bourneville-Pringle disease) is a rare disease with a triad of mental retardation, epilepsy, and facial spot. Management of the patients with tuberous sclerosis under general anesthesia has been previously reported. However, there are few case reports about management under general anesthesia of a pediatric patient with tuberous sclerosis with frequent epileptic seizure. Here, we report a case of a pediatric patient with tuberous sclerosis and frequent epileptic seizure who underwent intensive dental treatment under general anesthesia with careful management of epilepsy. The patient was discharged on the day of surgery without any complications. In this case report, we discussed the appropriate assessment of the complications of tuberous sclerosis; such as, of central nervous, circulatory, respiratory, endocrine, and urinary systems including the management of general anesthesia.

  14. Differences in Learning Style Preferences, Environmental Press Perceptions and Job Satisfaction between Surgical Intensive Care and General Surgical Unit Nurses

    DTIC Science & Technology

    1991-01-01

    the general theories of learning, environment, and satisfaction , as well as research findings related to learning styles, environmental press, and job...Price (1972) distinguished " satisfaction " from "general satisfaction ," which refers to a level of satisfaction with life as a whole. Pervin (1968...concluded that nurses perceived job satisfaction in complex terms, and that interpersonal relationships as well as intrinsic and extrinsic rewards need to be

  15. Evidence for aggressive mimicry in an adult brood parasitic bird, and generalized defences in its host.

    PubMed

    Feeney, W E; Troscianko, J; Langmore, N E; Spottiswoode, C N

    2015-07-07

    Mimicry of a harmless model (aggressive mimicry) is used by egg, chick and fledgling brood parasites that resemble the host's own eggs, chicks and fledglings. However, aggressive mimicry may also evolve in adult brood parasites, to avoid attack from hosts and/or manipulate their perception of parasitism risk. We tested the hypothesis that female cuckoo finches (Anomalospiza imberbis) are aggressive mimics of female Euplectes weavers, such as the harmless, abundant and sympatric southern red bishop (Euplectes orix). We show that female cuckoo finch plumage colour and pattern more closely resembled those of Euplectes weavers (putative models) than Vidua finches (closest relatives); that their tawny-flanked prinia (Prinia subflava) hosts were equally aggressive towards female cuckoo finches and southern red bishops, and more aggressive to both than to their male counterparts; and that prinias were equally likely to reject an egg after seeing a female cuckoo finch or bishop, and more likely to do so than after seeing a male bishop near their nest. This is, to our knowledge, the first quantitative evidence for aggressive mimicry in an adult bird, and suggests that host-parasite coevolution can select for aggressive mimicry by avian brood parasites, and counter-defences by hosts, at all stages of the reproductive cycle.

  16. Evidence for aggressive mimicry in an adult brood parasitic bird, and generalized defences in its host

    PubMed Central

    Feeney, W. E.; Troscianko, J.; Langmore, N. E.; Spottiswoode, C. N.

    2015-01-01

    Mimicry of a harmless model (aggressive mimicry) is used by egg, chick and fledgling brood parasites that resemble the host's own eggs, chicks and fledglings. However, aggressive mimicry may also evolve in adult brood parasites, to avoid attack from hosts and/or manipulate their perception of parasitism risk. We tested the hypothesis that female cuckoo finches (Anomalospiza imberbis) are aggressive mimics of female Euplectes weavers, such as the harmless, abundant and sympatric southern red bishop (Euplectes orix). We show that female cuckoo finch plumage colour and pattern more closely resembled those of Euplectes weavers (putative models) than Vidua finches (closest relatives); that their tawny-flanked prinia (Prinia subflava) hosts were equally aggressive towards female cuckoo finches and southern red bishops, and more aggressive to both than to their male counterparts; and that prinias were equally likely to reject an egg after seeing a female cuckoo finch or bishop, and more likely to do so than after seeing a male bishop near their nest. This is, to our knowledge, the first quantitative evidence for aggressive mimicry in an adult bird, and suggests that host–parasite coevolution can select for aggressive mimicry by avian brood parasites, and counter-defences by hosts, at all stages of the reproductive cycle. PMID:26063850

  17. Physical therapy in critically ill adult patients: recommendations from the Brazilian Association of Intensive Care Medicine Department of Physical Therapy.

    PubMed

    França, Eduardo Ériko Tenório de; Ferrari, Francimar; Fernandes, Patrícia; Cavalcanti, Renata; Duarte, Antonio; Martinez, Bruno Prata; Aquim, Esperidião Elias; Damasceno, Marta Cristina Paulete

    2012-03-01

    Complications from immobility in intensive care unit patients contribute to functional decline, increased healthcare costs, reduced quality of life and higher post-discharge mortality. Physical therapy focuses on promoting recovery and preserving function, and it may minimize the impact of these complications. A group of Brazilian Association of Intensive Care Medicine physical therapy experts developed this document that contains minimal physical therapy recommendations appropriate to the Brazilian real-world clinical situation. Prevention and treatment of atelectasis, procedures related to the removal of secretions and treatment of conditions related to physical deconditioning and functional decline are discussed. Equally important is the consideration that prescribing and executing activities, mobilizations and exercises are roles of the physical therapist, whose diagnosis should precede any intervention.

  18. Have I Ever Done Anything Like This Before? Older Adults Solving Ill-Defined Problems in Intensive Volunteering.

    PubMed

    Cheek, Cheryl; Piercy, Kathleen W; Kohlenberg, Meranda

    2015-01-01

    This study examined the ways in which individuals over 50 years old solved problems while volunteering in intensive humanitarian and disaster relief service. Thirty-seven men and women in the sample were sponsored by three religious organizations well known for providing humanitarian and disaster relief service. Semistructured interviews yielded data that were analyzed qualitatively, using McCracken's five-step process for analysis. We found that volunteers used three different abilities to solve problems: drawing upon experience to create strategies, maintaining emotional stability in the midst of trying circumstances, and applying strategies in a context-sensitive manner. These findings illustrate that these factors, which are comparable to those used in solving everyday problems, are unique in the way they are applied to intensive volunteering. The volunteers' sharing of knowledge, experience, and support with each other were also noticeable in their accounts of their service. This sharing contributed strongly to their sense of emotional stability and effectiveness in solving problems.

  19. GABAergic Control of Neurite Outgrowth and Remodeling During Development and Adult Neurogenesis: General Rules and Differences in Diverse Systems

    PubMed Central

    Sernagor, Evelyne; Chabrol, François; Bony, Guillaume; Cancedda, Laura

    2010-01-01

    During development, Gamma-aminobutyric acidergic (GABAergic) neurons mature at early stages, long before excitatory neurons. Conversely, GABA reuptake transporters become operative later than glutamate transporters. GABA is therefore not removed efficiently from the extracellular domain and it can exert significant paracrine effects. Hence, GABA-mediated activity is a prominent source of overall neural activity in developing CNS networks, while neurons extend dendrites and axons, and establish synaptic connections. One of the unique features of GABAergic functional plasticity is that in early development, activation of GABAA receptors results in depolarizing (mainly excitatory) responses and Ca2+ influx. Although there is strong evidence from several areas of the CNS that GABA plays a significant role in neurite growth not only during development but also during adult neurogenesis, surprisingly little effort has been made into putting all these observations into a common framework in an attempt to understand the general rules that regulate these basic and evolutionary well-conserved processes. In this review, we discuss the current knowledge in this important field. In order to decipher common, universal features and highlight differences between systems throughout development, we compare findings about dendritic proliferation and remodeling in different areas of the nervous system and species, and we also review recent evidence for a role in axonal elongation. In addition to early developmental aspects, we also consider the GABAergic role in dendritic growth during adult neurogenesis, extending our discussion to the roles played by GABA during dendritic proliferation in early developing networks versus adult, well established networks. PMID:20428495

  20. Two decades (1993-2012) of adult intensive care unit design: a comparative study of the physical design features of the best practice examples.

    PubMed

    Rashid, Mahbub

    2014-01-01

    In 2006, Critical Care Nursing Quarterly published a study of the physical design features of a set of best practice example adult intensive care units (ICUs). These adult ICUs were awarded between 1993 and 2003 by the Society of Critical Care Medicine (SCCM), the American Association of Critical-Care Nurses, and the American Institute of Architects/Academy of Architecture for Health for their efforts to promote the critical care unit environment through design. Since 2003, several more adult ICUs were awarded by the same organizations for similar efforts. This study includes these newer ICUs along with those of the previous study to cover a period of 2 decades from 1993 to 2012. Like the 2006 study, this study conducts a systematic content analysis of the materials submitted by the award-winning adult ICUs. On the basis of the analysis, the study compares the 1993-2002 and 2003-2012 adult ICUs in relation to construction type, unit specialty, unit layout, unit size, patient room size and design, support and service area layout, and family space design. The study also compares its findings with the 2010 Guidelines for Design and Construction of Health Care Facilities of the Facility Guidelines Institute and the 2012 Guidelines for Intensive Care Unit Design of the SCCM. The study indicates that the award-winning ICUs of both decades used several design features that were associated with positive outcomes in research studies. The study also indicates that the award-winning ICUs of the second decade used more evidence-based design features than those of the first decades. In most cases, these ICUs exceeded the requirements of the Facility Guidelines Institute Guidelines to meet those of the SCCM Guidelines. Yet, the award-winning ICUs of both decades also used several features that had very little or no supporting research evidence. Since they all were able to create an optimal critical care environment for which they were awarded, having knowledge of the physical

  1. Pilot study comparing multi-family therapy to single family therapy for adults with anorexia nervosa in an intensive eating disorder program.

    PubMed

    Dimitropoulos, Gina; Farquhar, Jamie C; Freeman, Victoria Emily; Colton, Patricia Anne; Olmsted, Marion Patricia

    2015-07-01

    Multi-family therapy (MFT) has yet to be evaluated in families of adults with anorexia nervosa (AN). The study aims were: (i) assess the feasibility of MFT for AN; and, (ii) assess whether MFT is associated with improved outcomes for families compared with single-family therapy (SFT). Adult patients with AN consecutively referred to an eating disorder treatment program were assigned (non-randomly) to receive eight sessions of SFT or MFT. Assessment occurred pre-therapy, immediately post-therapy, and at 3-month follow-up. A total of 37 female patients (13 SFT, 24 MFT) and 45 family members (16 SFT, 29 MFT) completed treatment. There were significant time effects for patients' BMI, eating disorder-related psychopathology and multiple family outcome measures. There were no differences between MFT and SFT on family outcome measures at end of treatment and 3 months post treatment. MFT is a feasible intervention that can be used in adult intensive treatment for those with AN.

  2. [Video games: are the motivations and intensity of use changing with age? Comparison between a population of adolescent and adult gamers].

    PubMed

    Caillon, J; Bouju, G; Grall-Bronnec, M

    2014-03-01

    Despite the popularity of video games, few studies have been conducted in France on their use. The objective of this study was to gather data from a sample of French video game players to learn more about this population. This approach also aimed to examine whether differences exist between adolescent and adult gamers in terms of their motivations to play and whether this practice met the criteria for problem video game playing. A questionnaire collecting sociodemographic data and assessing the problems associated with the use of video games, as well as motivations to play, was distributed during a video game festival and on the Internet. A total of 778 people responded to the questionnaire. The results showed that there were few differences between adolescent and adult gamers. Both groups had an intense video game habit. The majority of them sometimes had the feeling of losing control of their use and sacrificed other activities to play video games. This last dimension was most frequently cited by adults. The feeling of spending more time playing was most frequently cited by adolescents. Concerning motivations to play, the two groups differed only on the score of the "social" dimension, significantly higher among adolescents.

  3. Cognitive behavioral treatment for older adults with generalized anxiety disorder. A therapist manual for primary care settings.

    PubMed

    Stanley, Melinda A; Diefenbach, Gretchen J; Hopko, Derek R

    2004-01-01

    At least four academic clinical trials have demonstrated the utility of cognitive behavior therapy (CBT) for older adults with generalized anxiety disorder (GAD). These data may not generalize, however, to more heterogeneous and functionally impaired patients and the medical settings in which they typically receive care. A recent pilot project suggested the potential benefits of a new version of CBT for GAD among older patients in primary care. The manual developed and tested in this pilot project is presented here. Treatment components include motivation and education, relaxation skills, cognitive therapy, problem-solving-skills training, exposure exercises, and sleep-management-skills training. Procedures are designed to be administered flexibly to maximize attention to individual patient needs. Examples of session summaries, patient handouts, and homework forms are provided.

  4. Effects of priming exercise on the speed of adjustment of muscle oxidative metabolism at the onset of moderate-intensity step transitions in older adults.

    PubMed

    De Roia, Gabriela; Pogliaghi, Silvia; Adami, Alessandra; Papadopoulou, Christina; Capelli, Carlo

    2012-05-15

    Aging is associated with a functional decline of the oxidative metabolism due to progressive limitations of both O(2) delivery and utilization. Priming exercise (PE) increases the speed of adjustment of oxidative metabolism during successive moderate-intensity transitions. We tested the hypothesis that such improvement is due to a better matching of O(2) delivery to utilization within the working muscles. In 21 healthy older adults (65.7 ± 5 yr), we measured contemporaneously noninvasive indexes of the overall speed of adjustment of the oxidative metabolism (i.e., pulmonary Vo(2) kinetics), of the bulk O(2) delivery (i.e., cardiac output), and of the rate of muscle deoxygenation (i.e., deoxygenated hemoglobin, HHb) during moderate-intensity step transitions, either with (ModB) or without (ModA) prior PE. The local matching of O(2) delivery to utilization was evaluated by the ΔHHb/ΔVo(2) ratio index. The overall speed of adjustment of the Vo(2) kinetics was significantly increased in ModB compared with ModA (P < 0.05). On the contrary, the kinetics of cardiac output was unaffected by PE. At the muscle level, ModB was associated with a significant reduction of the "overshoot" in the ΔHHb/ΔVo(2) ratio compared with ModA (P < 0.05), suggesting an improved O(2) delivery. Our data are compatible with the hypothesis that, in older adults, PE, prior to moderate-intensity exercise, beneficially affects the speed of adjustment of oxidative metabolism due to an acute improvement of the local matching of O(2) delivery to utilization.

  5. Polypharmacy in older adults with human immunodeficiency virus infection compared with the general population

    PubMed Central

    Gimeno-Gracia, Mercedes; Crusells-Canales, María José; Armesto-Gómez, Francisco Javier; Compaired-Turlán, Vicente; Rabanaque-Hernández, María José

    2016-01-01

    Background The percentage of older HIV-positive patients is growing, with an increase in age-related comorbidities and concomitant medication. Objectives To quantify polypharmacy and profile types of non-antiretroviral drugs collected at community pharmacies in 2014 by HIV-positive individuals on antiretroviral therapy and to compare these findings with those of the general population. Methods HIV-positive patients (n=199) were compared with a group of patients from the general population (n=8,172), aged between 50 and 64 years. The factors compared were prevalence of polypharmacy (≥5 comedications with cumulative defined daily dose [DDD] per drug over 180), percentage of patients who collected each therapeutic class of drug, and median duration for each drug class (based on DDD). Results were stratified by sex. Results Polypharmacy was more common in HIV-positive males than in the male general population (8.9% vs 4.4%, P=0.010). Polypharmacy was also higher in HIV-positive females than in the female general population (11.3% vs 3.4%, P=0.002). Percentage of HIV-positive patients receiving analgesics, anti-infectives, gastrointestinal drugs, central nervous system (CNS) agents, and respiratory drugs was higher than in the general population, with significant differences between male populations. No differences were observed in proportion of patients receiving cardiovascular drugs. The estimated number of treatment days (median DDDs) were higher in HIV-positive males than in males from the general population for anti-infectives (32.2 vs 20.0, P<0.001) and CNS agents (238.7 vs 120.0, P=0.002). A higher percentage of HIV-positive males than males from the general population received sulfonamides (17.1% vs 1.5%, P<0.001), macrolides (37.1% vs 24.9%, P=0.020), and quinolones (34.3% vs 21.2%, P=0.009). Conclusion Polypharmacy is more common in HIV-positive older males and females than in similarly aged members of the general population. HIV-positive patients received

  6. Healthcare transitions of older adults: an overview for the general practitioner.

    PubMed

    Vognar, Lidia; Mujahid, Nadia

    2014-04-01

    Healthcare transition refers to the care "hand-off" of a patient among providers and treatment settings. Older adults experience more frequent care transitions than younger patients due to the presence of co-morbidities, cognitive impairment, increased dependence and medication use. Hospitalization and subsequent readmission after discharge to a nursing home represents a unique care transition situation. It is estimated that as many as 60% of readmissions from nursing homes can be avoided. Poor communication between hospital and nursing home staff; delayed, inaccurate, or missing discharge summaries; lack of accurate medication reconciliation; pending test results; inappropriate follow-up; and poor education of patient and families all contribute to poor care transition quality, and increase the probability of rehospitalization. Interventions for improved care transitions are suggested. They focus on patient and family-centered care effectiveness, minimizing adverse events, and increasing timely, accurate and complete communication.

  7. Integrated IMR for Psychiatric and General Medical Illness for Adults Aged 50 or Older With Serious Mental Illness

    PubMed Central

    Bartels, Stephen J.; Pratt, Sarah I.; Mueser, Kim T.; Naslund, John A.; Wolfe, Rosemarie S.; Santos, Meghan; Xie, Haiyi; Riera, Erik G.

    2016-01-01

    Objectives Self-management is promoted as a strategy for improving outcomes for serious mental illness as well as for chronic general medical conditions. This study evaluated the feasibility and effectiveness of an eight-month program combining training in self-management for both psychiatric and general medical illness, including embedded nurse care management. Methods Participants were 71 middle-aged and older adults (mean age=60.3±6.5) with serious mental illness and chronic general medical conditions who were randomly assigned to receive integrated Illness Management and Recovery (I-IMR) (N=36) or usual care (N=35). Feasibility was determined by attendance at I-IMR and nurse sessions. Effectiveness outcomes were measured two and six months after the intervention (ten- and 14-month follow-ups) and included self-management of psychiatric and general medical illness, participation in psychiatric and general medical encounters, and self-reported acute health care utilization. Results I-IMR participants attended 15.8±9.5 I-IMR and 8.2±5.9 nurse sessions, with 75% attending at least ten I-IMR and five nurse sessions. Compared with usual care, I-IMR was associated with greater improvements in participant and clinician ratings for psychiatric illness self-management, greater diabetes self-management, and an increased preference for detailed diagnosis and treatment information during primary care encounters. The proportion of I-IMR participants with at least one psychiatric or general medical hospitalization decreased significantly between baseline and ten- and 14-month follow-ups. Conclusions I-IMR is a feasible intervention for this at-risk group and demonstrated potential effectiveness by improving self-management of psychiatric illness and diabetes and by reducing the proportion of participants requiring psychi atric or general medical hospitalizations. PMID:24292559

  8. Caution: Alcohol Advertising and the Surgeon General's Alcohol Warnings May Have Adverse Effects on Young Adults.

    ERIC Educational Resources Information Center

    Blood, Deborah J.; Snyder, Leslie B.

    A study investigated the effects of the newly introduced Surgeon General's alcohol warnings and advertisements on college students. One hundred fifty-nine undergraduates in communication sciences at the University of Connecticut viewed slides of alcohol products, with or without advertisements and warnings. Following the viewings, subjects filled…

  9. Risk It: A Youth Curriculum Resource for the Certificates in General Education for Adults.

    ERIC Educational Resources Information Center

    2000

    This document is a youth curriculum resource designed to accommodate learners in Australia's Certificates in General Education (CGEA) program. The document begins by discussing the following topics: the curriculum framework; the curriculum's content and its relationship to the CGEA program's numeracy learning outcomes and criteria; successful…

  10. Procedural pain does not raise plasma levels of cortisol or catecholamines in adult intensive care patients after cardiac surgery.

    PubMed

    van Gulik, L; Ahlers, Sjgm; van Dijk, M; Bruins, P; Meima, M E; de Rijke, Y B; Biemond-Moeniralam, H S; Tibboel, D; Knibbe, C A J

    2016-01-01

    The gold standard for quantification of pain is a person's self-report. However, we need objective parameters for pain measurement when intensive care patients, for example, are not able to report pain themselves. An increase in pain is currently thought to coincide with an increase in stress hormones. This observational study investigated whether procedure-related pain is associated with an increase of plasma cortisol, adrenaline, and noradrenaline. In 59 patients receiving intensive care after cardiac surgery, cortisol, adrenaline, and noradrenaline plasma levels were measured immediately before and immediately after patients were turned for washing, either combined with the removal of chest tubes or not. Numeric rating scale scores were obtained before, during, and after the procedure. Unacceptably severe pain (numeric rating scale ≥ 4) was reported by seven (12%), 26 (44%), and nine (15%) patients, before, during and after the procedure, respectively. There was no statistically significant association between numeric rating scale scores and change in cortisol, adrenaline, and noradrenaline plasma levels during the procedure. Despite current convictions that pain coincides with an increase in stress hormones, procedural pain was not associated with a significant increase in plasma stress hormone levels in patients who had undergone cardiac surgery. Thus, plasma levels of cortisol, adrenaline, and noradrenaline seem unsuitable for further research on the measurement of procedural pain.

  11. The grieving adult and the general practitioner: a literature review in two parts (Part 2).

    PubMed Central

    Woof, W R; Carter, Y H

    1997-01-01

    In part 1 of this review, published last month, literature exploring the psychological bereavement theories and the health consequences of bereavement are summarized. The second part builds on this to outline the debate surrounding the characteristics of abnormal bereavement, while also focusing on risk factors for this morbidity. This leads on to a summary of the literature on bereavement care, particularly from a general practice point of view. Finally, areas for further research are highlighted. PMID:9302794

  12. [Geriatric emergencies versus adult emergencies: retrospective analysis of medical emergencies at a general hospital].

    PubMed

    Rodríguez Artalejo, F; González Montalvo, J I; Sanz Segovia, F; Jaramillo Gómez, E; Banegas Banegas, J R; Rodríguez Mañas, L; Carbonell Collar, A

    1989-10-14

    The aim of the study was to evaluate the process of the attention to emergencies in patients older than 65 years and to compare it with the same process in adult patients. To this end, 965 clinical records of medical emergencies from the Hospital Central de la Cruz Roja in Madrid were retrospectively evaluated, and data were obtained regarding age, the cause for consultation, the investigations performed and their yield, the administration of drug therapy, the major diagnosis at the time of discharge from the service and the clinical course. It was found that all evaluated diagnostic investigations were carried out with equal or higher frequency in patients older than 65 years and that their mean clinical effectiveness was also higher. In addition, it was found that the patients older than 65 years were more commonly admitted to the hospital through the emergency service than the rest of the population. It was concluded, therefore, that the process of attention to emergencies has differential characteristics in the elderly population, and that if the number and proportion of old people increase as it will presumably happen during the two next decades, the cost of attention to emergencies and the number of emergency hospital admissions will also increase.

  13. Simultaneous investigation of influenza and enteric viruses in the stools of adult patients consulting in general practice for acute diarrhea

    PubMed Central

    2012-01-01

    Background Gastrointestinal symptoms are not an uncommon manifestation of an influenza virus infection. In the present study, we aimed to investigate the presence of influenza viruses in the stools of adult patients consulting their general practitioner for uncomplicated acute diarrhea (AD) and the proportion of concurrent infections by enteric and influenza viruses. Method A case-control study was conducted from December 2010 to April 2011. Stool specimens were collected and tested for influenza viruses A (seasonal A/H3N2 and pandemic A/H1N1) and B, and for four enteric viruses (astrovirus, group A rotavirus, human enteric adenovirus, norovirus of genogroups I – NoVGI - and genogroup II - NoVGII). Results General practitioners enrolled 138 cases and 93 controls. Of the 138 stool specimens collected, 92 (66.7%) were positive for at least one of the four enteric viruses analysed and 10 (7.2%) tested positive for one influenza virus. None of these 10 influenza positive patients reported respiratory symptoms. In five influenza-positive patients (3.6%), we also detected one enteric virus, with 4 of them being positive for influenza B (2 had co-detection with NoVGI, 1 with NoVGII, and 1 with astrovirus). None of the 93 controls tested positive for one of the enteric and/or other influenza viruses we investigated. Conclusions In this study we showed that the simultaneous detection of influenza and enteric viruses is not a rare event. We have also reported, for the first time in general practice, the presence of seasonal and pandemic influenza viruses in the stools of adult patients consulting for uncomplicated AD. A simultaneous investigation of enteric and influenza viruses in patients complaining of gastrointestinal symptoms could be useful for future studies to better identify the agents responsible for AD. PMID:22709374

  14. Internet-delivered treatment: its potential as a low-intensity community intervention for adults with symptoms of depression: protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Depression is a high prevalence disorder, displaying high rates of lifetime incidence, early age onset, high chronicity, and role impairment. In Ireland 12-month prevalence of depression has been reported to be 10.3%. A large percentage of affected individuals have no medical diagnosis nor seek treatment. Cognitive Behavior Therapy (CBT) has established itself as an option for the treatment of depression. Many Irish adults with depression find it difficult to access evidence-based CBT, this is due to several factors, like stigma and costs. However, systematic factors including the shortage of trained professionals and the relative underdevelopment of services also make access difficult. Stepped-care can increase access to evidence-based CBT. One option is tailored internet-delivered treatment programs. Preliminary research from Ireland needs now to include large-scale studies on effectiveness. Thus the current study seeks to examine the potential of an internet-delivered low-intensity treatment for symptoms of depression in an Irish adult community sample. Method/Design The study is a randomized controlled trial of an online CBT (iCBT) program for the treatment of adults with depressive symptoms. The trial will include an active treatment group and a waiting-list control group. The active condition will consist of 8 weekly modules of iCBT, with post-session feedback support. Participants in the waiting list will receive access to the treatment at week 8. Participants will complete the Beck Depression Inventory (BDI-II) and eligibility criteria will also apply. Primary outcomes are depressive symptoms. Secondary outcomes include quality of life indicators, significant events and satisfaction with online treatment. Data will be collected at baseline and at post-treatment, week 8, and at follow-up week 20 (3-months) and week 32 (6-months). Analysis will be conducted on the intention-to-treat basis. Discussion The study seeks to evaluate the effectiveness of

  15. Maintaining connections: some thoughts on the value of intensive care unit rounding for general medicine ward teams.

    PubMed

    Howell, Joel D

    2011-09-06

    When established ward patients are unexpectedly transferred to an intensive care unit (ICU), the ward team should continue to follow them. Although there may be reasons not to do so, the advantages outweigh the obstacles. Great pedagogic value can be gained from following patients after acute decompensation, but a more important reason is that by following patients into the ICU, the ward team can enact for both patients and their families the twin virtues of caring and continuity. Doing so also demonstrates the highest ideals of medicine-that we are focused not on defined areas of turf, but on our patient's well-being. It shows that we are not merely doing narrowly defined "shift work," but that we truly care about our patients. Rounding on established patients who have been transferred into the ICU is the sort of behavior that undergirds the fundamental bases of professionalism. It takes a few minutes from a busy day, but it can be incredibly beneficial for families, patients, and the ideals of medicine.

  16. High-intensity interval training on an aquatic treadmill in adults with osteoarthritis: effect on pain, balance, function, and mobility.

    PubMed

    Bressel, Eadric; Wing, Jessica E; Miller, Andrew I; Dolny, Dennis G

    2014-08-01

    Although aquatic exercise is considered a potentially effective treatment intervention for people with osteoarthritis (OA), previous research has focused primarily on calisthenics in a shallow pool with the inherent limitations on regulating exercise intensity. The purpose of this study was to quantify the efficacy of a 6-week aquatic treadmill exercise program on measures of pain, balance, function, and mobility. Eighteen participants (age = 64.5 ± 10.2 years) with knee OA completed a non-exercise control period followed by a 6-week exercise period. Outcome measures included visual analog scales for pain, posturography for balance, sit-to-stand test for function, and a 10-m walk test for mobility. The exercise protocol included balance training and high-intensity interval training (HIT) in an aquatic treadmill using water jets to destabilize while standing and achieve high ratings of perceived exertion (14-19) while walking. In comparison with pretests, participants displayed reduced joint pain (pre = 50.3 ± 24.8 mm vs. post = 15.8 ± 10.6 mm), improved balance (equilibrium pre = 66.6 ± 11.0 vs. post = 73.5 ± 7.1), function (rising index pre = 0.49 ± 0.19% vs. post = 0.33 ± 0.11%), and mobility (walk pre = 8.6 ± 1.4 s vs. post = 7.8 ± 1.1 s) after participating in the exercise protocol (p = 0.03-0.001). The same benefits were not observed after the non-exercise control period. Adherence to the exercise protocol was exceptional and no participants reported adverse effects, suggesting that aquatic treadmill exercise that incorporates balance and HIT training was well tolerated by patients with OA and may be effective at managing symptoms of OA.

  17. Adult patient with pulmonary agenesis: focusing on one-lung ventilation during general anesthesia

    PubMed Central

    Yu, Yuetian; Zhu, Cheng; Qian, Xiaozhe

    2016-01-01

    Congenital pulmonary agenesis is a rare condition with high mortality. Mechanical ventilation in these patients is challenging and there has no such case been reported in the literature. We reported a 61-year-old female with lung agenesis who presented to our hospital with pneumonia and pelvic mass. In the past, she had undergone repairing of atrial septal defect and mitral valve forming surgery at 6-year-old. Thereafter she had remained asymptomatic until this time of hospital admission. The patient underwent operation for the pelvic mass with one-lung ventilation (OLV) under general anesthesia. We highlighted the use of protective ventilation (PV) strategy during OLV. PMID:26904240

  18. Adult patient with pulmonary agenesis: focusing on one-lung ventilation during general anesthesia.

    PubMed

    Yu, Yuetian; Zhu, Cheng; Qian, Xiaozhe; Gao, Yuan; Zhang, Zhongheng

    2016-01-01

    Congenital pulmonary agenesis is a rare condition with high mortality. Mechanical ventilation in these patients is challenging and there has no such case been reported in the literature. We reported a 61-year-old female with lung agenesis who presented to our hospital with pneumonia and pelvic mass. In the past, she had undergone repairing of atrial septal defect and mitral valve forming surgery at 6-year-old. Thereafter she had remained asymptomatic until this time of hospital admission. The patient underwent operation for the pelvic mass with one-lung ventilation (OLV) under general anesthesia. We highlighted the use of protective ventilation (PV) strategy during OLV.

  19. Clinical value of whole-body magnetic resonance imaging in health screening of general adult population

    PubMed Central

    Tarnoki, David Laszlo; Tarnoki, Adam Domonkos; Richter, Antje; Karlinger, Kinga; Berczi, Viktor; Pickuth, Dirk

    2015-01-01

    Background Whole-body magnetic resonance imaging (WB-MRI) and angiography (WB-MRA) has become increasingly popular in population-based research. We evaluated retrospectively the frequency of potentially relevant incidental findings throughout the body. Materials and methods 22 highly health-conscious managers (18 men, mean age 47±9 years) underwent WB-MRI and WB-MRA between March 2012 and September 2013 on a Discovery MR750w wide bore 3 Tesla device (GE Healthcare) using T1 weighted, short tau inversion recovery (STIR) and diffusion weighted imaging (DWI) acquisitions according to a standardized protocol. Results A suspicious (pararectal) malignancy was detected in one patient which was confirmed by an endorectal sonography. Incidental findings were described in 20 subjects, including hydrocele (11 patients), benign bony lesion (7 patients) and non-specific lymph nodes (5 patients). Further investigations were recommended in 68% (ultrasound: 36%, computed tomography: 28%, mammography: 9%, additional MRI: 9%). WB-MRA were negative in 16 subjects. Vascular normal variations were reported in 23%, and a 40% left proximal common carotid artery stenosis were described in one subject. Conclusions WB-MRI and MRA lead to the detection of clinically relevant diseases and unexpected findings in a cohort of healthy adults that require further imaging or surveillance in 68%. WB-MR imaging may play a paramount role in health screening, especially in the future generation of (epi)genetic based screening of malignant and atherosclerotic disorders. Our study is the first which involved a highly selected patient group using a high field 3-T wide bore magnet system with T1, STIR, MRA and whole-body DWI acquisitions as well. PMID:25810696

  20. A general magnitude system in human adults: Evidence from a subliminal priming paradigm.

    PubMed

    Lourenco, Stella F; Ayzenberg, Vladislav; Lyu, Jennifer

    2016-08-01

    Despite general agreement that number and other magnitudes share analog format, there is disagreement about the extent to which representations of numerical and non-numerical magnitude recruit common cognitive and neural resources. Cross-dimensional interactions between number and other magnitudes on Stroop-like tasks have been taken as evidence for integration across magnitudes, but such effects are subject to alternative interpretations that allow for differentiated representations. Here we use a subliminal priming paradigm to test for interactions between different magnitudes (number and area) when one magnitude is not consciously detectable. Across two experiments, we first provide evidence for the feasibility of this paradigm by demonstrating that transfer occurs within the dimension of number; that is, symbolic numerals (Arabic digits) that were subliminally primed affected judgments of non-symbolic numerosities in target displays. Crucially, we also found transfer across magnitudes-from subliminally primed numerals to target displays of cumulative surface area whether participants made an ordinal judgment (i.e., "which array is larger in area?") or judged whether two arrays were the same or different in area. These findings suggest that representations of number and area are not fully differentiated. Moreover, they provide unique support for a general magnitude system that includes direct connections, or overlap, between the neural codes for numerical and non-numerical magnitudes.

  1. Rate of Pressure Ulcers in Intensive Units and General Wards of Iranian Hospitals and Methods for Their Detection

    PubMed Central

    AKBARI SARI, Ali; DOSHMANGHIR, Leila; NEGHAHBAN, Zahra; GHIASIPOUR, Maryam; BEHESHTIZAVAREH, Zeinab

    2014-01-01

    Abstract Background This study aimed to estimate the rate of pressure ulcers in intensive care units (ICUs) and medical and surgical wards of Iranian hospitals and compare the performance of methods of medical record review as well as direct observation for their detection. Methods The research team visited 308 patients in medical and surgical wards of hospitals affiliated with Tehran University of Medical Sciences and a further 90 patients in their ICUs between March 2009 and April 2010. In addition 310 patient records were randomly selected from patients discharged from the ICUs between March 2009 and April 2010. And a further 600 patient records were randomly selected from the patients that were discharged from medical and surgical wards between March 2010 and April 2011. These 910 selected records were retrospectively reviewed to identify pressure ulcers. Data were collected by a structured checklist. Results In ICUs 24 of 90 patients (26.7%, 95% CI: 17.56 to 35.84) that were directly observed and 59 of 310 patients (19.0%, 95% CI: 14.63 to 23.37) that were studied by retrospective review of medical records had pressure ulcers. In medical and surgical wards, 5 of 308 patients (1.6%, 95% CI: 0.20 to 3.00) that were directly observed had pressure ulcers, but no pressure ulcer was detected by review of 600 medical records. Conclusion Pressure ulcers are significantly more frequent in ICUs than in medical and surgical wards and a significant proportion of pressure ulcers are not reported. PMID:26110149

  2. Long-Term Quality of Life in Adult Patients with Strabismus after Corrective Surgery Compared to the General Population

    PubMed Central

    Xu, Meiping; Yu, Huanyun; Chen, Yuanyuan; Xu, Jinling; Zheng, Jingwei; Yu, Xinping

    2016-01-01

    Purpose To evaluate the status of and factors associated with long-term health-related quality of life (HRQOL) in adult patients with strabismus following corrective surgery. Methods Prospective cross-sectional study. A total of 122 adults who underwent corrective surgery and were followed up for at least 1 year were recruited. Pre- and post-operative HRQOL were evaluated using the Chinese version of the Adult Strabismus 20 (AS-20). Demographics and clinical characteristics were recorded. Eighty-nine age-matched, normal individuals without a history of strabismus were recruited as a control group. Results AS-20 scores improved significantly in the psychosocial subscale and total scale after surgery for all122 patients, but not in the function subscale. HRQOL was better in the successful cases than in the non-successful cases (p<0.005). Subjects who recovered stereo function had better HRQOL than those who did not (p<0.01). Compared to the control population, the patients had poorer HRQOL post-operatively, with only approximately 30% of the subjects having scores within the normal threshold scores. The self-sense of a lack of ocular deviation and a successful surgical outcome were significant factors associated with post-operative HRQOL status. Conclusions HRQOL, as evaluated by AS-20 scores, improved in the patients after surgery but was worse than that in the general population. Successful surgical outcomes and a sense of good alignment were the main factors that correlated with increased post-operative HRQOL. Positive assessments of surgical results by patients may benefit post-operative HRQOL. PMID:27846304

  3. Vigorous, Aerobic Exercise versus General Motor Training Activities: Effects on Maladaptive and Stereotypic Behaviors of Adults with Both Autism and Mental Retardation.

    ERIC Educational Resources Information Center

    Elliott, Reed O., Jr.; And Others

    1994-01-01

    Six adults with both autism and moderate/profound mental retardation were assessed in a controlled environment for changes in frequency of maladaptive and stereotypic behaviors following nonexercise activities, general motor training activities, and aerobic exercise. Although antecedent aerobic exercise reduced undesirable behaviors, general motor…

  4. Generalized convulsive status epilepticus in adults and children: treatment guidelines and protocols.

    PubMed

    Shearer, Peter; Riviello, James

    2011-02-01

    Generalized convulsive status epilepticus (GCSE) has a high morbidity and mortality, such that the rapid delivery of anticonvulsant therapy should be initiated within minutes of seizure onset to prevent permanent neuronal damage. GCSE is not a specific disease but is a manifestation of either a primary central nervous system (CNS) insult or a systemic disorder with secondary CNS effects. It is mandatory to look for an underlying cause. First-line therapies for seizures and status epilepticus include the use of a benzodiazepine, followed by an infusion of a phenytoin with a possible role for intravenous valproate or phenobarbital. If these first-line medications fail to terminate the GCSE, treatment includes the continuous infusion of midazolam, pentobarbital, or propofol.

  5. Electrophysiological evidence for a general auditory prediction deficit in adults who stutter

    PubMed Central

    Daliri, Ayoub; Max, Ludo

    2015-01-01

    We previously found that stuttering individuals do not show the typical auditory modulation observed during speech planning in nonstuttering individuals. In this follow-up study, we further elucidate this difference by investigating whether stuttering speakers’ atypical auditory modulation is observed only when sensory predictions are based on movement planning or also when predictable auditory input is not a consequence of one’s own actions. We recorded 10 stuttering and 10 nonstuttering adults’ auditory evoked potentials in response to random probe tones delivered while anticipating either speaking aloud or hearing one’s own speech played back and in a control condition without auditory input (besides probe tones). N1 amplitude of nonstuttering speakers was reduced prior to both speaking and hearing versus the control condition. Stuttering speakers, however, showed no N1 amplitude reduction in either the speaking or hearing condition as compared with control. Thus, findings suggest that stuttering speakers have general auditory prediction difficulties. PMID:26335995

  6. Cognitive control adjustments in healthy older and younger adults: Conflict adaptation, the error-related negativity (ERN), and evidence of generalized decline with age.

    PubMed

    Larson, Michael J; Clayson, Peter E; Keith, Cierra M; Hunt, Isaac J; Hedges, Dawson W; Nielsen, Brent L; Call, Vaughn R A

    2016-03-01

    Older adults display alterations in neural reflections of conflict-related processing. We examined response times (RTs), error rates, and event-related potential (ERP; N2 and P3 components) indices of conflict adaptation (i.e., congruency sequence effects) a cognitive control process wherein previous-trial congruency influences current-trial performance, along with post-error slowing, correct-related negativity (CRN), error-related negativity (ERN) and error positivity (Pe) amplitudes in 65 healthy older adults and 94 healthy younger adults. Older adults showed generalized slowing, had decreased post-error slowing, and committed more errors than younger adults. Both older and younger adults showed conflict adaptation effects; magnitude of conflict adaptation did not differ by age. N2 amplitudes were similar between groups; younger, but not older, adults showed conflict adaptation effects for P3 component amplitudes. CRN and Pe, but not ERN, amplitudes differed between groups. Data support generalized declines in cognitive control processes in older adults without specific deficits in conflict adaptation.

  7. The Relationship Between Early Maladaptive Schemas, Depression, and Generalized Anxiety among Adults Seeking Residential Treatment for Substance Use Disorders.

    PubMed

    Shorey, Ryan C; Elmquist, Joanna; Anderson, Scott; Stuart, Gregory L

    2015-01-01

    Previous research has shown that early maladaptive schemas (EMS) play an important role in substance use, depression, and anxiety. However, few studies have examined the role of EMS within the context of all three concurrently. The goal of this study was to determine the role of EMS in predicting symptoms of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) among adults in residential treatment for substance dependence. We used pre-existing patient records of adults diagnosed with a substance use disorder from a residential substance use treatment facility (N=122). The EMS domains of disconnection and rejection and impaired limits were associated with symptoms of MDD and the domain of impaired autonomy and performance was associated with symptoms of GAD, even after controlling for age, gender, years of education, alcohol use, drug use, and symptoms of MDD (when predicting GAD) and GAD (when predicting MDD). Findings suggest that EMS may play an important role in comorbid mental health problems among men and women in residential substance use treatment. Continued treatment outcome research is needed to examine whether modification of EMS results in improved mental health and substance use outcomes.

  8. Prevalence of general and abdominal obesity in the adult population of Spain, 2008-2010: the ENRICA study.

    PubMed

    Gutiérrez-Fisac, J L; Guallar-Castillón, P; León-Muñoz, L M; Graciani, A; Banegas, J R; Rodríguez-Artalejo, F

    2012-04-01

    This is the first study to report the prevalence of general obesity and abdominal obesity (AO) in the adult population of Spain based on measurements of weight, height and waist circumference. The data are taken from the ENRICA study, a cross-sectional study carried out between June 2008 and October 2010 in 12,883 individuals representative of the non-institutionalized population on Spain aged 18 years and older. Anthropometry was performed under standardized conditions in the households by trained interviewers. Overweight was considered as body mass index (BMI) 25-29.9 kg m(-2) , and obesity as BMI ≥ 30 kg m(-2) . AO was defined as waist circumference >102 cm in men and >88 cm in women. The prevalence of obesity was 22.9% (24.4% in men and 21.4% in women). About 36% of adults had AO (32% of men and 39% of women). The frequency of obesity and of AO increased with age and affected, respectively, 35 and 62% of persons aged 65 and over. The frequency of obesity and AO decreased with increasing educational level. For example, 29% of women with primary education or less had obesity vs. only 11% of those with university studies. The prevalence of obesity was very high in the Canary Islands and in the south of Spain.

  9. Clinical Profiles and Factors Associated with Death in Adults with Dengue Admitted to Intensive Care Units, Minas Gerais, Brazil.

    PubMed

    Amâncio, Frederico Figueiredo; Heringer, Tiago Pires; de Oliveira, Cristina da Cunha Hueb Barata; Fassy, Liliane Boaventura; de Carvalho, Frederico Bruzzi; Oliveira, Daniela Pagliari; de Oliveira, Claudio Dornas; Botoni, Fernando Otoni; Magalhães, Fernanda do Carmo; Lambertucci, José Roberto; Carneiro, Mariângela

    2015-01-01

    The purpose of our study was to describe the clinical profile of dengue-infected patients admitted to Brazilian intensive care units (ICU) and evaluate factors associated with death. A longitudinal, multicenter case series study was conducted with laboratory-confirmed dengue patients admitted to nine Brazilian ICUs situated in Minas Gerais state, southeastern Brazil from January 1, 2008, to December 31, 2013. Demographic, clinical and laboratory data; disease severity scores; and mortality were evaluated. A total of 97 patients were studied. The in-ICU and in-hospital mortality rates were 18.6% and 19.6%, respectively. Patients classified as having severe dengue according to current World Health Organization classifications showed an increased risk of death in a univariate analysis. Nonsurvivors were older, exhibited lower serum albumin concentrations and higher total leukocyte counts and serum creatinine levels. Other risk factors (vomiting, lethargy/restlessness, dyspnea/respiratory distress) were also associated with death in a univariate analysis. Multivariate analysis indicated that in-hospital mortality was significantly associated with Acute Physiology and Chronic Health Evaluation II and the Sequential Organ Failure Assessment score. The ICU and in-hospital mortality observed in this study were higher than values reported in similar studies. An increased frequency of ICU admission due to severe organ dysfunction, higher severity indices and scarcity of ICU beds may partially explain the higher mortality.

  10. Clinical Profiles and Factors Associated with Death in Adults with Dengue Admitted to Intensive Care Units, Minas Gerais, Brazil

    PubMed Central

    Amâncio, Frederico Figueiredo; Heringer, Tiago Pires; de Oliveira, Cristina da Cunha Hueb Barata; Fassy, Liliane Boaventura; de Carvalho, Frederico Bruzzi; Oliveira, Daniela Pagliari; de Oliveira, Claudio Dornas; Botoni, Fernando Otoni; Magalhães, Fernanda do Carmo; Lambertucci, José Roberto; Carneiro, Mariângela

    2015-01-01

    The purpose of our study was to describe the clinical profile of dengue-infected patients admitted to Brazilian intensive care units (ICU) and evaluate factors associated with death. A longitudinal, multicenter case series study was conducted with laboratory-confirmed dengue patients admitted to nine Brazilian ICUs situated in Minas Gerais state, southeastern Brazil from January 1, 2008, to December 31, 2013. Demographic, clinical and laboratory data; disease severity scores; and mortality were evaluated. A total of 97 patients were studied. The in-ICU and in-hospital mortality rates were 18.6% and 19.6%, respectively. Patients classified as having severe dengue according to current World Health Organization classifications showed an increased risk of death in a univariate analysis. Nonsurvivors were older, exhibited lower serum albumin concentrations and higher total leukocyte counts and serum creatinine levels. Other risk factors (vomiting, lethargy/restlessness, dyspnea/respiratory distress) were also associated with death in a univariate analysis. Multivariate analysis indicated that in-hospital mortality was significantly associated with Acute Physiology and Chronic Health Evaluation II and the Sequential Organ Failure Assessment score. The ICU and in-hospital mortality observed in this study were higher than values reported in similar studies. An increased frequency of ICU admission due to severe organ dysfunction, higher severity indices and scarcity of ICU beds may partially explain the higher mortality. PMID:26090676

  11. [Severe imported malaria in adults: a retrospective study of thirteen cases admitted to the Intensive Care Unit in Marrakech].

    PubMed

    El Mezouari, El Mostafa; Belhadj, Ayoub; Ziani, Mohamed; Boughanem, Mohamed; Moutaj, Redouane

    2016-01-01

    Imported malaria is being seen with increasing frequency in non-endemic areas. Severe forms represent 10% of cases of Plasmodium falciparum malaria. In Morocco, more than 50 cases of malaria occur each year, 83% of which with Plasmodium falciparum malaria. All patients with severe malaria admitted to the Intensive Care Unit during the period between 1 November 2009 and 31 December 2015 were enrolled in our study. The main epidemiological data, the reasons for admission, the management and the outcomes of patients were studied. Thirteen patients were included in our study. The average age was 31 years. All patients had been living in sub-Saharan Africa and had no immunity to malaria. Chemoprophylaxis was adequate in 33% of cases. The mean time between symptom onset and treatment initiation was six days. Mean initial parasitemia was 12%. The main reasons for ICU admission included coma (15%), convulsion (07%), respiratory distress 07%), prostration (07%), renal failure (07%), shock associated with jaundice and acidosis (07%) and kidney failure associated with coma (07%). All patients were treated with intravenous quinine loading dose. Mortality rate was 23%. The causes of death were multi-system organ failure and acute respiratory distress syndrome. Mortality associated with severe malaria remains high. The adequacy of chemoprophylaxis associated with early diagnosis and treatment would significantly improve the prognosis of this parasitic infection.

  12. Reduced-intensity stem-cell transplantation for adult acute lymphoblastic leukemia: a retrospective study of 33 patients.

    PubMed

    Hamaki, T; Kami, M; Kanda, Y; Yuji, K; Inamoto, Y; Kishi, Y; Nakai, K; Nakayama, I; Murashige, N; Abe, Y; Ueda, Y; Hino, M; Inoue, T; Ago, H; Hidaka, M; Hayashi, T; Yamane, T; Uoshima, N; Miyakoshi, S; Taniguchi, S

    2005-03-01

    Efficacy of reduced-intensity stem-cell transplantation (RIST) for acute lymphoblastic leukemia (ALL) was investigated in 33 patients (median age, 55 years). RIST sources comprised 20 HLA-identical related donors, five HLA-mismatched related, and eight unrelated donors. Six patients had undergone previous transplantation. Disease status at RIST was first remission (n=13), second remission (n=6), and induction failure or relapse (n=14). All patients tolerated preparatory regimens and achieved neutrophil engraftment (median, day 12.5). Acute and chronic graft-versus-host disease (GVHD) developed in 45 and 64%, respectively. Six patients received donor lymphocyte infusion (DLI), for prophylaxis (n=1) or treatment of recurrent ALL (n=5). Nine patients died of transplant-related mortality, with six deaths due to GVHD. The median follow-up of surviving patients was 11.6 months (range, 3.5-37.3 months). The 1-year relapse-free and overall survival rates were 29.8 and 39.6%, respectively. Of the 14 patients transplanted in relapse, five remained relapse free for longer than 6 months. Cumulative rates of progression and progression-free mortality at 3 years were 50.9 and 30.4%, respectively. These findings suggest the presence of a graft-versus-leukemia effect for ALL. RIST for ALL is worth considering for further evaluation.

  13. Bloodstream infection after umbilical cord blood transplantation using reduced-intensity stem cell transplantation for adult patients.

    PubMed

    Narimatsu, Hiroto; Matsumura, Tomoko; Kami, Masahiro; Miyakoshi, Shigesaburo; Kusumi, Eiji; Takagi, Shinsuke; Miura, Yuji; Kato, Daisuke; Inokuchi, Chiho; Myojo, Tomohiro; Kishi, Yukiko; Murashige, Naoko; Yuji, Koichiro; Masuoka, Kazuhiro; Yoneyama, Akiko; Wake, Atsushi; Morinaga, Shinichi; Kanda, Yoshinobu; Taniguchi, Shuichi

    2005-06-01

    Bloodstream infection (BSI) is a significant problem after cord blood transplantation (CBT). However, little information has been reported on BSI after reduced-intensity CBT (RI-CBT). We retrospectively reviewed the medical records of 102 patients. The median age of the patients was 55 years (range, 17-79 years). Preparative regimens comprised fludarabine 125 to 150 mg/m 2 , melphalan 80 to 140 mg/m 2 , or busulfan 8 mg/kg and total body irradiation 2 to 8 Gy. Prophylaxis against graft-versus-host disease comprised cyclosporin or tacrolimus. BSI developed within 100 days of RI-CBT in 32 patients. The cumulative incidence of BSI was 25% at day 30 and 32% at day 100. The median onset was day 15 (range, 1-98 days). Causative organisms included Pseudomonas aeruginosa (n = 12), Staphylococcus epidermidis (n = 11), Staphylococcus aureus (n = 6), Enterococcus faecium (n = 4), Enterococcus faecalis (n = 4), Stenotrophomonas maltophilia (n = 4), and others (n = 7). Of the 32 patients with BSI, 25 (84%) died within 100 days after RI-CBT. BSI was the direct cause of death in 8 patients (25%). Univariate analysis failed to identify any significant risk factors. BSI clearly represents a significant and fatal complication after RI-CBT. Further studies are warranted to determine clinical characteristics, identify patients at high risk of BSI, and establish therapeutic strategies.

  14. The effects of exercise modality and intensity on energy expenditure and cardiorespiratory response in adults with obesity and treated obstructive sleep apnoea.

    PubMed

    Evans, Rachael A; Dolmage, Thomas E; Robles, Priscila G; Brooks, Dina; Goldstein, Roger S

    2016-04-13

    To inform recommendations for the exercise component of a healthy lifestyle intervention for adults with obesity and treated obstructive sleep apnoea (OSA), we investigated the total energy expenditure (EE) and cardiorespiratory response to weight-supported (cycling) and unsupported (walking) exercise. Individuals with treated OSA and a body mass index (BMI) > 30 kg/m(2)performed an incremental cardiopulmonary exercise test on a cycle ergometer and a treadmill to determine the peak oxygen uptake[Formula: see text] Participants subsequently completed two endurance tests on each modality, matched at 80% and 60% of the highest[Formula: see text]determined by the incremental tests, to intolerance. The cardiorespiratory response was measured and total EE was estimated from the[Formula: see text] Sixteen participants completed all six tests: mean [SD] age 57 [13] years and median [IQ range] BMI 33.3 [30.8-35.3] kg/m(2) Total EE during treadmill walking was greater than cycling at both high (158 [101] vs. 29 [15] kcal;p< 0.001) and moderate (178 [100] vs. 85 [59] kcal;p= 0.002) intensities, respectively, with similar cardiorespiratory responses and pattern of EE during rest, exercise and recovery. Contrary to current guidelines, walking might be the preferred training modality to achieve the combination of weight loss and increased cardiorespiratory fitness in adults with obesity and treated OSA.

  15. Bad Dream Frequency in Older Adults with Generalized Anxiety Disorder: Prevalence, Correlates, and Effect of Cognitive Behavioral Treatment for Anxiety

    PubMed Central

    Nadorff, Michael R.; Porter, Ben; Rhoades, Howard M.; Greisinger, Anthony J.; Kunik, Mark E.; Stanley, Melinda A.

    2012-01-01

    This study investigated the relation between generalized anxiety disorder (GAD) and frequency of bad dreams in older adults. A secondary analysis from a randomized clinical trial comparing cognitive behavioral therapy for anxiety (CBT) to enhanced usual care (EUC), it assessed bad dream frequency at baseline, post-treatment (3 months), and 6, 9, 12 and 15 months. Of 227 participants (mean age = 67.4), 134 met GAD diagnostic criteria (CBT = 70, EUC = 64), with the remaining 93 serving as a comparison group. Patients with GAD had significantly more bad dreams than those without, and bad dream frequency was significantly associated with depression, anxiety, worry, and poor quality of life. CBT for anxiety significantly reduced bad dream frequency at post-treatment and throughout follow-up compared to EUC. PMID:23470116

  16. Bad dream frequency in older adults with generalized anxiety disorder: prevalence, correlates, and effect of cognitive behavioral treatment for anxiety.

    PubMed

    Nadorff, Michael R; Porter, Ben; Rhoades, Howard M; Greisinger, Anthony J; Kunik, Mark E; Stanley, Melinda A

    2014-01-01

    This study investigated the relation between generalized anxiety disorder (GAD) and frequency of bad dreams in older adults. A secondary analysis from a randomized clinical trial comparing cognitive behavioral therapy (CBT) for anxiety to enhanced usual care (EUC) assessed bad dream frequency at baseline, post treatment (3 months), and at 6, 9, 12, and 15 months. Of 227 participants (mean age = 67.4), 134 met GAD diagnostic criteria (CBT = 70, EUC = 64), with the remaining 93 serving as a comparison group. Patients with GAD had significantly more bad dreams than those without, and bad dream frequency was significantly associated with depression, anxiety, worry, and poor quality of life. CBT for anxiety significantly reduced bad dream frequency at post treatment and throughout follow up compared to EUC.

  17. A Single Session of Low-Intensity Exercise Is Sufficient to Enhance Insulin Sensitivity Into the Next Day in Obese Adults

    PubMed Central

    Newsom, Sean A.; Everett, Allison C.; Hinko, Alexander; Horowitz, Jeffrey F.

    2013-01-01

    OBJECTIVE The purpose of this study was to determine the effect of a relatively modest session of exercise on insulin sensitivity and fatty acid uptake the next day in obese adults. RESEARCH DESIGN AND METHODS Eleven sedentary obese adults (male/female: 3/8; BMI 37 ± 1 kg/m2; peak oxygen uptake [VO2peak] 20 ± 1 mL/kg/min) completed three experimental trials. On two of these occasions, subjects exercised to expend 350 kcal in the afternoon. These two exercise trials were identical except for the exercise intensity (50% VO2peak [EX50] and 65% VO2peak [EX65]) and the duration of exercise necessary to expend 350 kcal (EX50 = ∼70 min; EX65 = ∼55 min). Subjects also completed a control trial (CON), without exercise. The next morning, we measured insulin sensitivity (hyperinsulinemic-euglycemic clamp) and whole-body fatty acid uptake (palmitate rate of disappearance from plasma [Rd]). RESULTS Exercise increased insulin sensitivity the next day, but whereas the 35% improvement after EX50 compared with CON was statistically significant (P = 0.01), the 20% improvement after EX65 was not (P = 0.17). Despite nearly identical values between CON and EX65 (P = 0.88), systemic fatty acid uptake was lower after EX50 compared with EX65 (P = 0.02), but not quite significant compared with CON (P = 0.07). Importantly, the change in fatty acid uptake after exercise compared with CON was negatively correlated with the change in insulin sensitivity for all trials (r = −0.60, P = 0.003). CONCLUSIONS A relatively modest single session of exercise in obese adults improved insulin sensitivity the next day, and a reduction in systemic fatty acid uptake in the several hours after exercise may be important for this effect. PMID:23757424

  18. Intensity-modulated radiation therapy and volumetric-modulated arc therapy for adult craniospinal irradiation—A comparison with traditional techniques

    SciTech Connect

    Studenski, Matthew T.; Shen, Xinglei; Yu, Yan; Xiao, Ying; Shi, Wenyin; Biswas, Tithi; Werner-Wasik, Maria; Harrison, Amy S.

    2013-04-01

    Craniospinal irradiation (CSI) poses a challenging planning process because of the complex target volume. Traditional 3D conformal CSI does not spare any critical organs, resulting in toxicity in patients. Here the dosimetric advantages of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) are compared with classic conformal planning in adults for both cranial and spine fields to develop a clinically feasible technique that is both effective and efficient. Ten adult patients treated with CSI were retrospectively identified. For the cranial fields, 5-field IMRT and dual 356° VMAT arcs were compared with opposed lateral 3D conformal radiotherapy (3D-CRT) fields. For the spine fields, traditional posterior-anterior (PA) PA fields were compared with isocentric 5-field IMRT plans and single 200° VMAT arcs. Two adult patients have been treated using this IMRT technique to date and extensive quality assurance, especially for the junction regions, was performed. For the cranial fields, the IMRT technique had the highest planned target volume (PTV) maximum and was the least efficient, whereas the VMAT technique provided the greatest parotid sparing with better efficiency. 3D-CRT provided the most efficient delivery but with the highest parotid dose. For the spine fields, VMAT provided the best PTV coverage but had the highest mean dose to all organs at risk (OAR). 3D-CRT had the highest PTV and OAR maximum doses but was the most efficient. IMRT provides the greatest OAR sparing but the longest delivery time. For those patients with unresectable disease that can benefit from a higher, definitive dose, 3D-CRT–opposed laterals are the most clinically feasible technique for cranial fields and for spine fields. Although inefficient, the IMRT technique is the most clinically feasible because of the increased mean OAR dose with the VMAT technique. Quality assurance of the beams, especially the junction regions, is essential.

  19. Secondary stroke in patients with polytrauma and traumatic brain injury treated in an Intensive Care Unit, Karlovac General Hospital, Croatia.

    PubMed

    Belavić, M; Jančić, E; Mišković, P; Brozović-Krijan, A; Bakota, B; Žunić, J

    2015-11-01

    Traumatic brain injury (TBI) is divided into primary and secondary brain injury. Primary brain injury occurs at the time of injury and is the direct consequence of kinetic energy acting on the brain tissue. Secondary brain injury occurs several hours or days after primary brain injury and is the result of factors including shock, systemic hypotension, hypoxia, hypothermia or hyperthermia, intracranial hypertension, cerebral oedema, intracranial bleeding or inflammation. The aim of this retrospective analysis of a prospective database was to determine the prevalence of secondary stroke and stroke-related mortality, causes of secondary stroke, treatment and length of stay in the ICU and hospital. This study included patients with TBI with or without other injuries who were hospitalised in a general ICU over a five-year period. The following parameters were assessed: demographics (age, sex), scores (Glasgow Coma Score, APACHE II, SOFA), secondary stroke (prevalence, time of occurrence after primary brain injury, causes of stroke and associated mortality), length of stay in the ICU and hospital, vital parameters (state of consciousness, cardiac function, respiration, circulation, thermoregulation, diuresis) and laboratory values (leukocytes, C-reactive protein [CRP], blood glucose, blood gas analysis, urea, creatinine). Medical data were analysed for 306 patients with TBI (median age 56 years, range 18-93 years) who were treated in the general ICU. Secondary stroke occurred in 23 patients (7.5%), 10 of whom died, which gives a mortality rate of 43.4%. Three patients were excluded as the cause of the injury was missile trauma. The study data indicate that inflammation is the most important cause of secondary insults. Levels of CRP were elevated in 65% of patients with secondary brain injury; leukocytosis was present in 87% of these patients, and blood glucose was elevated in 73%. The lungs and urinary tract were the most common sites of infection. In conclusion

  20. The use of the bispectral index in the detection of pain in mechanically ventilated adults in the intensive care unit: A review of the literature

    PubMed Central

    Coleman, Robin Marie; Tousignant-Laflamme, Yannick; Ouellet, Paul; Parenteau-Goudreault, Élizabeth; Cogan, Jennifer; Bourgault, Patricia

    2015-01-01

    BACKGROUND: Pain assessment is an immense challenge for clinicians, especially in the context of the intensive care unit, where the patient is often unable to communicate verbally. Several methods of pain assessment have been proposed to assess pain in this environment. These include both behavioural observation scales and evaluation of physiological measurements such as heart rate and blood pressure. Although numerous validation studies pertaining to behavioural observation scales have been published, several limitations associated with using these measures for pain assessment remain. Over the past few years, researchers have been interested in the use of the bispectral index monitoring system as a proxy for the evaluation of encephalography readings to assess the level of anesthesia and, potentially, analgesia. OBJECTIVES: To synthesize the main studies exploring the use of the bispectral index monitoring system for pain assessment, to guide future research in adults under sedation in the intensive care unit. METHOD: The EMBASE, Medline, CINAHL and PsycINFO databases were searched for studies published between 1996 and 2013 that evaluated the use of the bispectral index in assessing pain. RESULTS: Most studies conclude that nociceptive stimulation causes a significant increase in the bispectral index and revealed the importance of controlling certain confounding variables such as the level of sedation. DISCUSSION: Further studies are needed to clearly demonstrate the relationship between nociceptive stimuli and the bispectral index, as well as the specificity of the bispectral index in detecting pain. PMID:25050877

  1. Diagnosis and management of generalized anxiety disorder and panic disorder in adults.

    PubMed

    Locke, Amy B; Kirst, Nell; Shultz, Cameron G

    2015-05-01

    Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States, and they can negatively impact a patient's quality of life and disrupt important activities of daily living. Evidence suggests that the rates of missed diagnoses and misdiagnosis of GAD and PD are high, with symptoms often ascribed to physical causes. Diagnosing GAD and PD requires a broad differential and caution to identify confounding variables and comorbid conditions. Screening and monitoring tools can be used to help make the diagnosis and monitor response to therapy. The GAD-7 and the Severity Measure for Panic Disorder are free diagnostic tools. Successful outcomes may require a combination of treatment modalities tailored to the individual patient. Treatment often includes medications such as selective serotonin reuptake inhibitors and/or psychotherapy, both of which are highly effective. Among psychotherapeutic treatments, cognitive behavior therapy has been studied widely and has an extensive evidence base. Benzodiazepines are effective in reducing anxiety symptoms, but their use is limited by risk of abuse and adverse effect profiles. Physical activity can reduce symptoms of GAD and PD. A number of complementary and alternative treatments are often used; however, evidence is limited for most. Several common botanicals and supplements can potentiate serotonin syndrome when used in combination with antidepressants. Medication should be continued for 12 months before tapering to prevent relapse.

  2. The Relationship between General Causality Orientation and Treatment Outcome among Marijuana-Dependent Adults

    PubMed Central

    Blevins, Claire E.; Banes, Kelsey E.; Walker, Denise D.; Stephens, Robert S.; Roffman, Roger A.

    2015-01-01

    General causality orientations are motivational styles that are indicative of a person’s belief about personal change and their motivation to change. The purpose of the current study was to investigate whether causality orientations were associated with marijuana treatment outcomes in a sample of marijuana-dependent individuals. A total of 74 participants (66% male) were recruited from the Seattle, Washington area and randomly assigned to receive a combination of motivational enhancement and cognitive behavioral therapy or the combination treatment plus additional “check-up” sessions. Follow-up assessments evaluated frequency of use, use-related problems, and marijuana use disorder symptoms through 9 months. Causality orientations were relatively stable over time. Posttreatment Autonomy orientations were associated with lower frequency of use and Controlled orientations were associated with a reduction in use, problems, and marijuana use disorder symptoms. Autonomy and Controlled orientations were associated with readiness to change. Results suggest that both autonomous and controlled orientations have implications for response to treatment; perhaps for different reasons. Causality orientations may be a promising avenue of research to predict treatment response and outcome. PMID:26562679

  3. Structural invariance of General Behavior Inventory (GBI) scores in Black and White young adults.

    PubMed

    Pendergast, Laura L; Youngstrom, Eric A; Brown, Christopher; Jensen, Dane; Abramson, Lyn Y; Alloy, Lauren B

    2015-03-01

    In the United States, Black and White individuals show discrepant rates of diagnosis of bipolar disorder versus schizophrenia and antisocial personality disorder, as well as disparate access to and utilization of treatment for these disorders (e.g., Alegria, Chatterji, et al., 2008; Chrishon, Anderson, Arora, & Bailey, 2012). Such diagnostic discrepancies might stem from racially related cognitive biases in clinical judgment or from racial biases in measurements of bipolar disorder. The General Behavior Inventory (GBI) is among the most well-validated and widely used measures of bipolar mood symptoms, but the psychometric properties of the GBI have been examined primarily in predominantly White samples. In this study, we used multigroup confirmatory factor analyses (CFA) to examine the invariance of GBI scores across racial groups with a nonclinical sample. Fit was acceptable for tests of configural invariance, equal factor loadings, and equal intercepts, but not invariance of residuals. Findings indicate that GBI scores provide functionally invariant measurement of mood symptoms in both Black and White samples. The use of GBI scores may contribute consistent information to clinical assessments and could potentially reduce diagnostic discrepancies and associated differences in access to and utilization of mental health services.

  4. Stacking sequence determines Raman intensities of observed interlayer shear modes in 2D layered materials--A general bond polarizability model.

    PubMed

    Luo, Xin; Lu, Xin; Cong, Chunxiao; Yu, Ting; Xiong, Qihua; Quek, Su Ying

    2015-10-15

    2D layered materials have recently attracted tremendous interest due to their fascinating properties and potential applications. The interlayer interactions are much weaker than the intralayer bonds, allowing the as-synthesized materials to exhibit different stacking sequences, leading to different physical properties. Here, we show that regardless of the space group of the 2D materials, the Raman frequencies of the interlayer shear modes observed under the typical z(xx)z configuration blue shift for AB stacked materials, and red shift for ABC stacked materials, as the number of layers increases. Our predictions are made using an intuitive bond polarizability model which shows that stacking sequence plays a key role in determining which interlayer shear modes lead to the largest change in polarizability (Raman intensity); the modes with the largest Raman intensity determining the frequency trends. We present direct evidence for these conclusions by studying the Raman modes in few layer graphene, MoS2, MoSe2, WSe2 and Bi2Se3, using both first principles calculations and Raman spectroscopy. This study sheds light on the influence of stacking sequence on the Raman intensities of intrinsic interlayer modes in 2D layered materials in general, and leads to a practical way of identifying the stacking sequence in these materials.

  5. Assessment of the intensity-duration-frequency (IDF) curves for storms in Peninsular Malaysia based on the generalized extreme value distribution

    NASA Astrophysics Data System (ADS)

    Mohd Ariff, Noratiqah; Jemain, Abdul Aziz; Wan Zin, Wan Zawiah

    2013-04-01

    Rainfall characteristics can be analyzed by using storm events with storms representing actual rainfall events instead of rainfall amounts in fixed time frames. One of the most commonly used methods in rainfall analysis is the construction of intensity-duration-frequency (IDF) curves. IDF curves help in designing hydraulic structures by providing a mathematical relationship between storm intensity, duration and return period. In Peninsular Malaysia, these curves are often built using the generalized extreme value (GEV) distribution to represent annual maximum storm intensity. The mathematical formula for the curves is usually taken from either known empirical equations or from quantile functions of probability distributions. However, there is no research which compares and analyzes the differences between the curves obtained for storms in Peninsular Malaysia based on the empirical and quantile functions. Thus, the aim of this study is to build IDF curves for storms in Peninsular Malaysia using typical empirical equations and the quantile function of the GEV distribution. Then, the analysis of differences is performed on the curves obtained from both approaches. The analysis consists of the coefficient of variation of root mean square error mean percentage difference and the coefficient of determination, R2. The analysis shows small differences between the curves based on the empirical equations and those obtained using the quantile function of GEV distribution. According to these results, it can be concluded that the simple empirical equations are sufficient in constructing IDF curves based on GEV distribution for storms in Peninsular Malaysia.

  6. Hormonal, metabolic, and cardiorespiratory responses of young and adult athletes to a single session of high-intensity cycle exercise.

    PubMed

    Engel, Florian; Härtel, Sascha; Wagner, Matthias Oliver; Strahler, Jana; Bös, Klaus; Sperlich, Billy

    2014-11-01

    This study aimed to determine the effects of a single high-intensity interval training (HIIT) session on salivary cortisol (SC) levels, physiological responses, and performance in trained boys and men. Twenty-three boys (11.5 ± 0.8 years) and 25 men (29.7 ± 4.6 years) performed HIIT (4 consecutive Wingate Anaerobic Tests). SC in boys and men increased after HIIT from 5.55 ± 3.3 nmol/l to 15.13 ± 9.7 nmol/l (+173%) and from 7.07 ± 4.7 nmol/l to 19.19 ± 12.7 nmol/l (+171%), respectively (p < .01). Pretest SC as well as posttest changes were comparable in both groups (both p < .01). Peak blood lactate concentration was significantly lower in boys (12.6 ± 3.5 mmol/l) than in men (16.3 ± 3.1 mmol/l; p < .01). Throughout the HIIT, mean heart rates in boys were higher (p < .001) but relative peak oxygen uptake (ml·min-1·kg-1; p < .05) and performance were lower (p < .001) in boys than in men. HIIT in young athletes is associated with a higher activation of the hormonal stress axis than other types of exercise regimes as described in the literature. This study is the first to show a pronounced SC increase to HIIT in trained boys accompanied by elevated levels of blood lactate concentrations and heart rate suggesting a high cardio-respiratory, metabolic, and hormonal response to HIIT in 11-year-old boys.

  7. Effects of pomegranate extract on blood flow and vessel diameter after high-intensity exercise in young, healthy adults.

    PubMed

    Roelofs, Erica J; Smith-Ryan, Abbie E; Trexler, Eric T; Hirsch, Katie R; Mock, Meredith G

    2017-04-01

    The effects of pomegranate extract (PE) supplementation were evaluated on high-intensity exercise performance, blood flow, vessel diameter, oxygen saturation (SPO2), heart rate (HR), and blood pressure (BP). In a randomized, crossover design, nineteen recreationally resistance-trained participants were randomly assigned to PE (1000 mg) or placebo (PL), which were consumed 30 min prior to a repeated sprint ability (RSA) test and repetitions to fatigue (RTF) on bench and leg press. The RSA consisted of ten six-second sprints on a friction-loaded cycle ergometer with 30 s recovery. Brachial artery blood flow and vessel diameter were assessed by ultrasound. Blood flow, vessel diameter, SPO2, HR, and BP were assessed at baseline, 30 min post ingestion, immediately post exercise (IPost), and 30 min post exercise (30minPost). With PE, blood flow significantly increased IPost RSA (mean difference = 18.49 mL min(-1); P < .05), and IPost and 30minPost RTF (P < .05) according to confidence intervals (CI). Vessel diameter increased significantly 30minPost RSA according to CI and resulted in a significant interaction IPost and 30minPost RTF (P < .05). With PE, according to CI, average and peak power output increased significantly in sprint 5 of the RSA (P < .05). There was no significant difference between PE and PL for bench (P = .25) or leg press (P = .15) repetitions. Acute PE supplementation enhanced vessel diameter and blood flow, suggesting possible exercise performance enhancement from increased delivery of substrates and oxygen. The acute timing and capsule form of PE may be advantageous to athletic populations due to ergogenic effects, taste, and convenience.

  8. [GENERAL PRINCIPLE OF THE CORPUS CALLOSUM INTERNAL STRUCTURE IN ADULT HUMAN].

    PubMed

    Boiagina, O

    2017-01-01

    The structure of the corpus callosum is a certain form of order of the nerve fibers, glial cells and blood microvessels and it is actually unexplored. We set the goal to understand the general constructive principle of the myeloarchitectonics of human corpus callosum. We used whole mounts of the corpus callosum (5 men and 5 women aged from 36 to 60 years) after their two-week fixation in 10% formalin solution. The next stage was to dissect plate sections of the corpus callosum brainstem in two mutually perpendicular planes. Some of them were subjected to impregnation in 1% osmium tetroxide solution, according to the method adopted in transmission electron microscopy. To prepare these plate sections of the corpus callosum for further study in the light microscope we used the method of plastination in epoxy resin. After complete polymerization plastinated mounts were used for making slices. For further research at high magnification light microscopy they were thinned up to 0.3 mm thickness and were subjected to coloration using 1% solution of methylene blue on 1% borax solution. They were studied using a binocular microscope МБС-9 and microscope "Konus" equipped with digital camera. It was found that the human corpus callosum consists of a number of transversely oriented bands of nerve fibers (commissural cords). Each of them consists of a tightly appressed stratified sections, fascicular rations, which are separated by interstitial layers. In turn, these interfascicular layers give short lateral spurs that divide fascicular rations into individual segments - subfascicular rations. Multiple cells containing interfascicular oligodendrocytes associated with individual subfascicular sets of nerve tracts are dispersed in the cluster order among myelinated nerve fibers of fascicular rations. Fundamentally important point is that the interstitial layers in the corpus callosum as a whole form a complex three-dimensional network structure which is subordinated to the

  9. Injuries Reported and Recorded for Adults with Intellectual Disabilities Who Live with Paid Support in Scotland: A Comparison with Scottish Adults in the General Population

    ERIC Educational Resources Information Center

    Petropoulou, Evangelia; Finlayson, Janet; Hay, Margaret; Spencer, Wendy; Park, Richard; Tannock, Hugh; Galbraith, Erin; Godwin, Jon; Skelton, Dawn A.

    2017-01-01

    Background: Providers of supported living services to adults with intellectual disabilities (IDs) in the United Kingdom have procedures in place to monitor injuries; this provides opportunity to learn about the injuries being reported and recorded. The aim was to determine the incidence, causes and types of injuries experienced by 593 adults with…

  10. Epidemiology of multimorbidity within the Brazilian adult general population: Evidence from the 2013 National Health Survey (PNS 2013)

    PubMed Central

    de Azevedo-Marques, João Mazzoncini; Coxon, Domenica; Santos, Jair Lício Ferreira

    2017-01-01

    Middle-income countries are facing a growing challenge of adequate health care provision for people with multimorbidity. The objectives of this study were to explore the distribution of multimorbidity and to identify patterns of multimorbidity in the Brazilian general adult population. Data from 60202 adults, aged ≥18 years that completed the individual questionnaire of the National Health Survey 2013 (Portuguese: “Pesquisa Nacional de Saúde”–“PNS”) was used. We defined multimorbidity as the presence of two or more chronic conditions, including self-reported diagnoses and responses to the 9-item Patient Health Questionnaire for depression. Multivariate Poisson regression analyses were used to explore relationship between multimorbidity and demographic factors. Exploratory tetrachoric factor analysis was performed to identify multimorbidity patterns. 24.2% (95% CI 23.5–24.9) of the study population were multimorbid, with prevalence rate ratios being significantly higher in women, older people and those with lowest educational level. Multimorbidity occurred earlier in women than in men, with half of the women and men aged 55–59 years and 65–69 years, respectively, were multimorbid. The absolute number of people with multimorbidity was approximately 2.5-fold higher in people younger than 65 years than older counterparts (9920 vs 3945). Prevalence rate ratios of any mental health disorder significantly increased with the number of physical conditions. 46.7% of the persons were assigned to at least one of three identified patterns of multimorbidity, including: “cardio-metabolic”, “musculoskeletal-mental” and “respiratory” disorders. Multimorbidity in Brazil is as common as in more affluent countries. Women in Brazil develop diseases at younger ages than men. Our findings can inform a national action plan to prevent multimorbidity, reduce its burden and align health-care services more closely with patients’ needs. PMID:28182778

  11. Overweight and General and Abdominal Obesity in a Representative Sample of Spanish Adults: Findings from the ANIBES Study

    PubMed Central

    López-Sobaler, Ana M.; Aparicio, Aránzazu; Aranceta-Bartrina, Javier; Gil, Ángel; González-Gross, Marcela; Serra-Majem, Lluis; Varela-Moreiras, Gregorio; Ortega, Rosa M.

    2016-01-01

    Objective. To analyze the anthropometric parameters from a representative sample of Spanish adults participating in ANIBES study and the prevalence of general and abdominal obesity. Methods. This cross-sectional study focused on 1655 adults aged 18–64 years. Weight, height, and waist circumference (WC) were evaluated, and body mass index (BMI) and waist to height ratio (WHtR) were calculated. A composite index combining BMI and WHtR was designed to establish five groups with different anthropometric status. Results. The prevalence of overweight (OW) was 35.8% and that of obesity was 19.9%. Obesity (OB) was higher among men (OR 1.725, 1.415–2.104; p = 0.000) and each year of age increased the risk of obesity (OR 1.054, 1.045–1.064; p = 0.000). The prevalence of abdominal obesity (WHtR ≥ 0.5) was 58.4%. Only 36.1% of the population had an optimal anthropometric situation (BMI < 25 kg/m2, WHtR < 0.5), whereas 50.1% had weight excess and high WHtR (BMI ≥ 25 kg/m2, WHtR ≥ 0.5). Conclusions. More than half of Spanish population has weight excess and cardiometabolic risk. The results of this study provide an understanding of the current anthropometric situation in the Spanish population, as a first step toward planning interventions and assessing their effectiveness in the future. PMID:27382572

  12. Less indoor cleaning is associated with poor health and unhappiness in adults: Japanese General Social Survey, 2010.

    PubMed

    Shiue, Ivy

    2015-12-01

    Indoor environment is important to human health and well-being. The aim of the present study was to investigate the relationships among indoor cleaning, rubbish disposal and human health and well-being in a national and population-based setting. Data was retrieved from the Japanese General Social Survey, 2010. Information on demographics, lifestyle factors, frequency of indoor cleaning and rubbish disposal and self-reported health and well-being in Japanese adults was obtained by household interview. Analysis included chi-square test, logistic and multi-nominal regression modelling. Of 5003 Japanese adults (aged 20-89) included in the study cohort, 11.4 % (n = 566) never cleaned their living place, 39.1 % had occasional cleaning and 49.6 % had frequent cleaning. Moreover, 17.5 % (n = 869) never disposed rubbish, 24.9 % had occasional rubbish disposal and 57.6 % had frequent rubbish disposal. 15.0 % of Japanese adults claimed poor self-rated health, and 5.9 % reported unhappiness. Compared to people who frequently cleaned the living place, others tended to report poor self-rated health condition (relative risk ratios (RRR) 1.52, 95 % confidence intervals (CI) 1.24-1.85, P < 0.001) and unhappiness (RRR 1.47, 95 % CI 1.10-1.95, P < 0.001). The combined effects of never cleaning and never rubbish disposal significantly impacted on poor self-rated health (RRR 2.61, 95 % CI 1.40-4.88, P = 0.003) and unhappiness (RRR 2.72, 95 % CI 1.72-4.30, P < 0.001). Only half of the Japanese population frequently cleaned their living place and disposed rubbish. Less or never cleaning and rubbish disposal were associated with poor self-rated health, subjective happiness and potentially other health conditions. Public education on maintaining clean indoor environments to optimise psychological well-being in addition to the known physical health would be suggested.

  13. Poor Growth, Thyroid Dysfunction and Vitamin D Deficiency Remain Prevalent Despite Reduced Intensity Chemotherapy for Hematopoietic Stem Cell Transplantation in Children and Young Adults

    PubMed Central

    Myers, Kasiani C; Howell, Jonathan C.; Wallace, Gregory; Dandoy, Christopher; El-Bietar, Javier; Lane, Adam; Davies, Stella M.; Jodele, Sonata; Rose, Susan R.

    2016-01-01

    Myeloablative conditioning regimens for hematopoietic stem cell transplant (HSCT) are known to affect endocrine function, but little is known regarding reduced intensity conditioning (RIC) regimens. We retrospectively reviewed 114 children and young adults after single RIC HSCT. Analysis was grouped by age (<2y and ≥2y), and diagnosis (HLH/XLP, other immune disorders, metabolic/genetic disorders). All groups displayed short stature by mean height adjusted Z-score (HAZ) before −1.29 and after HSCT (HAZ −1.38, p=0.47). After HSCT, younger children with HLH/XLP grew better (HAZ −3.41 vs −1.65, p= 0.006), while older subjects had worsening (HAZ −0.8 vs −1.01, p= 0.06). Those with steroid therapy beyond standard GVHD prophylaxis were shorter than those without (p 0.04). After HSCT, older subjects with HLH/XLP became thinner with mean BMI Z-score of 1.20 vs. 0.64, p=0.02, likewise in metabolic/genetic disorders (BMI-Z= 0.59 vs. −0.99, p<0.001). BMI increased among younger children in these same groups. Thyroid function was abnormal in 24% (18/76). 25-OH vitamin D levels, were insufficient in 73% (49/65), with low bone mineral density in 8 of 19 evaluable subjects. Despite RIC, children and young adults still have significant late endocrine effects. Further research is required to compare post-transplant endocrine effects after RIC to standard chemotherapy protocols. PMID:26974276

  14. A decade of adult intensive care unit design: a study of the physical design features of the best-practice examples.

    PubMed

    Rashid, Mahbub

    2006-01-01

    This article reports a study of the physical design characteristics of a set of adult intensive care units (ICUs), built between 1993 and 2003. These ICUs were recognized as the best-practice examples by the Society of Critical Care Medicine, the American Association of Critical Care Nurses, and the American Institute of Architects. This study is based on a systematic analysis of the materials found on these ICUs in the booklet and videos jointly published by the above organizations in 2005. The study finds that most of these examples of best-practice adult ICUs have the following negative characteristics: (1) they are built as renovation projects with more health and safety hazards during construction; (2) most of them are mixed-service units with more safety and staffing problems; (3) the overall layout and the layout of staff work areas in these ICUs do not have any common design solutions for improved patient and staff outcomes; and (4) in these ICUs, family space is often located outside the unit, and family access to the patient room is restricted, even though family presence at the bedside may be important for improved patient outcomes. Some of these negative characteristics are offset by the following positive characteristics in most ICUs: (1) they have only private patient rooms for improved patient care, safety, privacy, and comfort; (2) most patient beds are freestanding for easy access to patients from all sides; (3) they have handwashing sinks and waste disposal facilities in the patient room for improved safety; and (4) most patient rooms have natural light to help patients with circadian rhythms. The article discusses, in detail, the implications of its findings, and the role of the ICU design community in a very complicated design context.

  15. High rates of diabetes reversal in newly diagnosed Asian Indian young adults with type 2 diabetes mellitus with intensive lifestyle therapy

    PubMed Central

    Sarathi, Vijaya; Kolly, Anish; Chaithanya, H. B.; Dwarakanath, C. S.

    2017-01-01

    Aims: There are variable reports on the reversibility of type 2 diabetes mellitus (type 2 DM) with higher rates among younger patients with short duration of diabetes. Hence, we studied the reversibility of diabetes among young adults with newly diagnosed type 2 DM. Methods: This prospective study included 32 patients with newly diagnosed type 2 DM. All type 2 DM patients were initially treated with intensive lifestyle therapy (ILT) (low-calorie diet [1500 kcal/day] and brisk walking for 1 h/day]). Four patients who with HbA1C <9.0% were treated with ILT alone. Except for three patients with concomitant infections who were treated with insulin, remaining 25 patients with HbA1C ≥9.0% were treated with metformin (1000–2000 g) in addition to ILT. When fasting plasma glucose was <126 mg/dl or HbA1C was <6.5% antidiabetic drug dose was reduced or stopped. The patients were followed for a minimum period of 2 years. Results: Reversal/remission rates at 3 months, 1 year, and 2 years were 24 (75%), 24 (75%), and 22 (68.75%), respectively. Seventeen (53.1%) patients achieved complete reversal and seven (21.9%) patients achieved partial reversal at 3 months. Rates of complete and partial remission at 1 year were 50% and 25% and at 2 years were 46.9% and 21.9%, respectively. Conclusion: Young adults with newly diagnosed type 2 DM have high rates of diabetes reversal and should receive ILT to achieve reversal of diabetes. PMID:28250676

  16. Intensive Group Learning and On-Site Services to Improve Sexual and Reproductive Health Among Young Adults in Liberia: A Randomized Evaluation of HealthyActions

    PubMed Central

    Firestone, Rebecca; Moorsmith, Reid; James, Simon; Urey, Marilyn; Greifinger, Rena; Lloyd, Danielle; Hartenberger-Toby, Lisa; Gausman, Jewel; Sanoe, Musa

    2016-01-01

    ABSTRACT Introduction: Young Liberians, particularly undereducated young adults, face substantial sexual and reproductive health (SRH) challenges, with low uptake of contraceptive methods, high rates of unintended pregnancy, and low levels of knowledge about HIV status. The purpose of this study was to assess the impact of a 6-day intensive group learning intervention combined with on-site SRH services (called HealthyActions) among out-of-school young adults, implemented through an existing alternative education program, on uptake of contraception and HIV testing and counseling (HTC). Methods: The intervention was implemented among young women and men ages 15–35 who were enrolled in alternative basic education learning sites in 5 counties of Liberia. We conducted a randomized evaluation to assess program impact. Baseline data were collected in January–March 2014, and endline data in June–July 2014. Key outcomes of condom use, contraceptive use, and HTC were estimated with difference-in-difference models using fixed effects. All analyses were conducted in Stata 13. Results: We assessed outcomes for 1,157 learners at baseline and 1,052 learners at endline, across 29 treatment and 26 control sites. After adjusting for potential confounders, learners in the HealthyActions intervention group were 12% less likely to report never using a condom with a regular partner over the last month compared with the control group (P = .02). Female learners who received HealthyActions were 13% more likely to use any form of modern contraception compared with learners in control sites (P<.001), with the greatest increase in the use of contraceptive implants. Learners in HealthyActions sites were 45% more likely to have received HTC (P<.001). Conclusion: Providing intensive group learning in a supportive environment coupled with on-site health services improved SRH outcomes among participating learners. The focus of HealthyActions on participatory learning for low

  17. Patients Hospitalized in General Wards via the Emergency Department: Early Identification of Predisposing Factors for Death or Unexpected Intensive Care Unit Admission—A Historical Prospective

    PubMed Central

    Boulain, Thierry; Runge, Isabelle; Delorme, Nathalie; Bouju, Angèle; Valéry, Antoine

    2014-01-01

    Background. To identify, upon emergency department (ED) admission, predictors of unexpected death or unplanned intensive care/high dependency units (ICU/HDU) admission during the first 15 days of hospitalization on regular wards. Methods. Prospective cohort study in a medical-surgical adult ED in a teaching hospital, including consecutive patients hospitalized on regular wards after ED visit, and identification of predictors by logistic regression and Cox proportional hazards model. Results. Among 4,619 included patients, 77 (1.67%) target events were observed: 32 unexpected deaths and 45 unplanned transfers to an ICU/HDU. We identified 9 predictors of the target event including the oxygen administration on the ED, unknown current medications, and use of psychoactive drug(s). All predictors put the patients at risk during the first 15 days of hospitalization. A logistic model for hospital mortality prediction (death of all causes) still comprised oxygen administration on the ED, unknown current medications, and the use of psychoactive drug(s) as risk factors. Conclusion. The “use of oxygen therapy on the ED,” the “current use of psychoactive drug(s)”, and the “lack of knowledge of current medications taken by the patients” were important predisposing factors to severe adverse events during the 15 days of hospitalization on regular wards following the ED visit. PMID:24624300

  18. A comparison of zinc metabolism, inflammation, and disease severity in critically ill infected and noninfected adults early after intensive care unit admission123

    PubMed Central

    Besecker, Beth Y; Exline, Matthew C; Hollyfield, Jennifer; Phillips, Gary; DiSilvestro, Robert A; Wewers, Mark D; Knoell, Daren L

    2011-01-01

    Background: Zinc deficiency is a cause of immune dysfunction and infection. Previous human studies have shown that the activation of the acute phase response alters zinc metabolism. Whether the alteration in zinc metabolism is predictive of disease severity in the setting of critical illness is unclear. Objective: We sought to determine whether differences occur in zinc metabolism at the onset of critical illness between infected (septic) and noninfected subjects. Design: We conducted this prospective study in an adult medical intensive care unit (MICU) at a tertiary care hospital. Subjects were enrolled within 24 h of intensive care unit admission. Subjects who did not meet sepsis criteria were considered for the critically ill control (CIC) arm. After patient consent, blood was immediately collected to measure plasma zinc and cytokine concentrations and zinc transporter gene expression in peripheral blood monocytes. Clinical data during the MICU stay were also recorded. Results: A total of 56 patients were evaluated (22 septic, 22 CIC, and 12 healthy subjects). Plasma zinc concentrations were below normal in CIC patients and further reduced in the septic cohort (57.2 ± 18.2 compared with 45.5 ± 18.1 μg/dL). Cytokine concentrations increased with decreasing plasma zinc concentrations (P = 0.05). SLC39A8 gene expression was highest in patients with the lowest plasma zinc concentrations and the highest severity of illness. Conclusions: The alteration of zinc metabolism was more pronounced in septic patients than in noninfected critically ill patients. Specifically, sepsis was associated with lower plasma zinc concentrations and higher SLC39A8 mRNA expression, which correlated with an increased severity of illness, including cardiovascular dysfunction. PMID:21525204

  19. Effectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial

    PubMed Central

    Stergiopoulos, Vicky; Gozdzik, Agnes; Misir, Vachan; Skosireva, Anna; Connelly, Jo; Sarang, Aseefa; Whisler, Adam; Hwang, Stephen W.; O’Campo, Patricia; McKenzie, Kwame

    2015-01-01

    Housing First (HF) is being widely disseminated in efforts to end homelessness among homeless adults with psychiatric disabilities. This study evaluates the effectiveness of HF with Intensive Case Management (ICM) among ethnically diverse homeless adults in an urban setting. 378 participants were randomized to HF with ICM or treatment-as-usual (TAU) in Toronto (Canada), and followed for 24 months. Measures of effectiveness included housing stability, physical (EQ5D-VAS) and mental (CSI, GAIN-SS) health, social functioning (MCAS), quality of life (QoLI20), and health service use. Two-thirds of the sample (63%) was from racialized groups and half (50%) were born outside Canada. Over the 24 months of follow-up, HF participants spent a significantly greater percentage of time in stable residences compared to TAU participants (75.1% 95% CI 70.5 to 79.7 vs. 39.3% 95% CI 34.3 to 44.2, respectively). Similarly, community functioning (MCAS) improved significantly from baseline in HF compared to TAU participants (change in mean difference = +1.67 95% CI 0.04 to 3.30). There was a significant reduction in the number of days spent experiencing alcohol problems among the HF compared to TAU participants at 24 months (ratio of rate ratios = 0.47 95% CI 0.22 to 0.99) relative to baseline, a reduction of 53%. Although the number of emergency department visits and days in hospital over 24 months did not differ significantly between HF and TAU participants, fewer HF participants compared to TAU participants had 1 or more hospitalizations during this period (70.4% vs. 81.1%, respectively; P=0.044). Compared to non-racialized HF participants, racialized HF participants saw an increase in the amount of money spent on alcohol (change in mean difference = $112.90 95% CI 5.84 to 219.96) and a reduction in physical community integration (ratio of rate ratios = 0.67 95% CI 0.47 to 0.96) from baseline to 24 months. Secondary analyses found a significant reduction in the number of days

  20. Genome-wide association study of autistic-like traits in a general population study of young adults.

    PubMed

    Jones, Rachel Maree; Cadby, Gemma; Melton, Phillip E; Abraham, Lawrence J; Whitehouse, Andrew J; Moses, Eric K

    2013-01-01

    Lay abstract: It has been proposed that autistic-like traits in the general population lie on a continuum, with clinical Autism Spectrum Disorder (ASD), representing the extreme end of this distribution. The current study undertook a genome-wide association (GWA) scan of 965 young Western Australian adults to identify novel risk variants associated with autistic-like traits. No associations reached genome-wide significance; however, a review of nominally associated single nucleotide polymorphisms (SNPs) indicated two positional candidate loci that have been previously implicated in autistic-like trait etiology. Scientific abstract: Research has proposed that autistic-like traits in the general population lie on a continuum, with clinical ASD representing the extreme end of this distribution. Inherent in this proposal is that biological mechanisms associated with clinical ASD may also underpin variation in autistic-like traits within the general population. A GWA study using 2,462,046 SNPs was undertaken for ASD in 965 individuals from the Western Australian Pregnancy Cohort (Raine) Study. No SNP associations reached genome-wide significance (p < 5.0 × 10(-8)). However, investigations into nominal observed SNP associations (p < 1.0 × 10(-5)) add support to two positional candidate genes previously implicated in ASD etiology, PRKCB1, and CBLN1. The rs198198 SNP (p = 9.587 × 10(-6)), is located within an intron of the protein kinase C, beta 1 (PRKCB1) gene on chromosome 16p11. The PRKCB1 gene has been previously reported in linkage and association studies for ASD, and its mRNA expression has been shown to be significantly down regulated in ASD cases compared with controls. The rs16946931 SNP (p = 1.78 × 10(-6)) is located in a region flanking the Cerebellin 1 (CBLN1) gene on chromosome 16q12.1. The CBLN1 gene is involved with synaptogenesis and is part of a gene family previously implicated in ASD. This GWA study is only the second

  1. Increased objectively assessed vigorous-intensity exercise is associated with reduced stress, increased mental health and good objective and subjective sleep in young adults.

    PubMed

    Gerber, Markus; Brand, Serge; Herrmann, Christian; Colledge, Flora; Holsboer-Trachsler, Edith; Pühse, Uwe

    2014-08-01

    The role of physical activity as a factor that protects against stress-related mental disorders is well documented. Nevertheless, there is still a dearth of research using objective measures of physical activity. The present study examines whether objectively assessed vigorous physical activity (VPA) is associated with mental health benefits beyond moderate physical activity (MPA). Particularly, this study examines whether young adults who accomplish the American College of Sports Medicine's (ACSM) vigorous-intensity exercise recommendations differ from peers below these standards with regard to their level of perceived stress, depressive symptoms, perceived pain, and subjective and objective sleep. A total of 42 undergraduate students (22 women, 20 men; M=21.24years, SD=2.20) volunteered to take part in the study. Stress, pain, depressive symptoms, and subjective sleep were assessed via questionnaire, objective sleep via sleep-EEG assessment, and VPA via actigraphy. Meeting VPA recommendations had mental health benefits beyond MPA. VPA was associated with less stress, pain, subjective sleep complaints and depressive symptoms. Moreover, vigorous exercisers had more favorable objective sleep pattern. Especially, they had increased total sleep time, more stage 4 and REM sleep, more slow wave sleep and a lower percentage of light sleep. Vigorous exercisers also reported fewer mental health problems if exposed to high stress. This study provides evidence that meeting the VPA standards of the ACSM is associated with improved mental health and more successful coping among young people, even compared to those who are meeting or exceeding the requirements for MPA.

  2. Writing Our Practice. Support Documents for the Reading & Writing and the Oral Communication Streams of the "Certificates of General Education for Adults within the Victorian Adult English Language, Literacy and Numeracy Accreditation Framework."

    ERIC Educational Resources Information Center

    Adult, Community, and Further Education Board, Melbourne (Australia).

    This collection of 14 articles focuses on the Reading and Writing and Oral Communication Streams of the Certificates of General Education (CGE) for Adults in the context of literacy teaching practices. Section 1 contains 11 case studies and articles with a practical focus. Practitioners discuss aspects of their curriculum development related to…

  3. Assessment of Generalized Anxiety Disorder Diagnostic Criteria in the National Comorbidity Survey and Virginia Adult Twin Study of Psychiatric and Substance Use Disorders

    ERIC Educational Resources Information Center

    Kubarych, Thomas S.; Aggen, Steven H.; Hettema, John M.; Kendler, Kenneth S.; Neale, Michael C.

    2008-01-01

    The authors investigated measurement properties of the "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition," generalized anxiety disorder (GAD) criteria in the National Comorbidity Survey and the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPSUD). The two studies used different widely used…

  4. Short-Term Changes in General and Memory-Specific Control Beliefs and Their Relationship to Cognition in Younger and Older Adults

    ERIC Educational Resources Information Center

    Bielak, Allison A. M.; Hultsch, David F.; Levy-Ajzenkopf, Judi; MacDonald, Stuart W. S.; Hunter, Michael A.; Strauss, Esther

    2007-01-01

    We examined short-term changes in younger and older adults' control beliefs. Participants completed measures of general and memory-specific competence and locus of control on 10 bi-monthly occasions. At each occasion, participants rated their control beliefs prior to and following completion of a battery of cognitive tasks. Exposure to the set of…

  5. Computer-Based Video Instruction to Teach Young Adults with Moderate Intellectual Disabilities to Perform Multiple Step, Job Tasks in a Generalized Setting

    ERIC Educational Resources Information Center

    Mechling, Linda C.; Ortega-Hurndon, Fanny

    2007-01-01

    This study evaluated the effectiveness of computer-based video instruction (CBVI) to teach three young adults with moderate intellectual disabilities to perform complex, multiple step, job tasks in a generalized setting. A multiple probe design across three job tasks and replicated across three students was used to evaluate the effectiveness of…

  6. Modelo Pedagogico de Educacion Primaria para Adultos: Guia General de Apoyo para el Estudiante de Primaria (Pedagogical Model for Adult Primary Education: General Guide for the Student).

    ERIC Educational Resources Information Center

    Instituto Nacional para la Educacion de los Adultos, Mexico City (Mexico).

    This book, part of a Mexican series of instructional materials, is directed toward people over the age of 15 who are interested in beginning, continuing or finishing their basic education. It explains the pedagogical model developed for adult education in Mexico based on the following features: (1) the content of the textbooks must be useful for…

  7. A Cohort Study of Adult Patients with Severe Dengue in Taiwanese Intensive Care Units: The Elderly and APTT Prolongation Matter for Prognosis

    PubMed Central

    Cia, Cong-Tat; Lee, Jen-Chieh; Sung, Junne-Ming; Lee, Nan-Yao; Chen, Po-Lin; Kuo, Te-Hui; Chao, Jo-Yen; Ko, Wen-Chien

    2017-01-01

    Background There was a large dengue outbreak in Taiwan in 2015, in which the ages of the affected individuals were higher than those in other countries. The aim of this study was to explore the characteristics and prognostic factors for adults with severe dengue in intensive care units (ICUs). Methods All adults admitted to ICUs with dengue virus infection (DENV) at a medical center from July 1, 2015 to December 31, 2015 were enrolled. DENV was diagnosed by the presence of serum NS1 antigen, IgM antibodies to dengue virus, or dengue virus RNA by real-time reverse transcriptase polymerase chain reaction. Demographic data, clinical features, and lab data were collected, and a multivariate Cox model was used to identify the predictive factors for in-hospital mortality. Results Seventy-five patients admitted to ICUs with laboratory-confirmed DENV were enrolled (mean age 72.3±9.3 years). The most common comorbidities included hypertension (72.0%), diabetes (43.7%), and chronic kidney disease (22.7%). The in-hospital case fatality rate (CFR) was 41.3%. The patients who died were predominantly female, had higher disease severity at ICU admission, shorter ICU/hospital stay, longer initial activated partial thromboplastin time (APTT), and higher initial serum aspartate transaminase levels. Cardiac arrest before ICU admission (hazard ratio [HR]: 6.26 [1.91–20.54]), prolonged APTT (>48 seconds; HR: 3.91 [1.69–9.07]), and the presence of acute kidney injury on admission (HR: 2.48 [1.07–5.74]), were independently associated with in-hospital fatality in the Cox multivariate analysis. Conclusion During the 2015 dengue outbreak in Taiwan, the patients with severe dengue in ICUs were characterized by old age, multiple comorbidities, and a high CFR. Organ failure (including cardiac failure, and renal failure) and coagulation disturbance (prolongation of initial APTT) were independent predictive factors for in-hospital fatality. PMID:28060934

  8. High Intensity Interval Training in a Real World Setting: A Randomized Controlled Feasibility Study in Overweight Inactive Adults, Measuring Change in Maximal Oxygen Uptake

    PubMed Central

    Lunt, Helen; Draper, Nick; Marshall, Helen C.; Logan, Florence J.; Hamlin, Michael J.; Shearman, Jeremy P.; Cotter, James D.; Kimber, Nicholas E.; Blackwell, Gavin; Frampton, Christopher M. A.

    2014-01-01

    Background In research clinic settings, overweight adults undertaking HIIT (high intensity interval training) improve their fitness as effectively as those undertaking conventional walking programs but can do so within a shorter time spent exercising. We undertook a randomized controlled feasibility (pilot) study aimed at extending HIIT into a real world setting by recruiting overweight/obese, inactive adults into a group based activity program, held in a community park. Methods Participants were allocated into one of three groups. The two interventions, aerobic interval training and maximal volitional interval training, were compared with an active control group undertaking walking based exercise. Supervised group sessions (36 per intervention) were held outdoors. Cardiorespiratory fitness was measured using VO2max (maximal oxygen uptake, results expressed in ml/min/kg), before and after the 12 week interventions. Results On ITT (intention to treat) analyses, baseline (N = 49) and exit (N = 39) O2 was 25.3±4.5 and 25.3±3.9, respectively. Participant allocation and baseline/exit VO2max by group was as follows: Aerobic interval training N =  16, 24.2±4.8/25.6±4.8; maximal volitional interval training N = 16, 25.0±2.8/25.2±3.4; walking N = 17, 26.5±5.3/25.2±3.6. The post intervention change in VO2max was +1.01 in the aerobic interval training, −0.06 in the maximal volitional interval training and −1.03 in the walking subgroups. The aerobic interval training subgroup increased VO2max compared to walking (p = 0.03). The actual (observed, rather than prescribed) time spent exercising (minutes per week, ITT analysis) was 74 for aerobic interval training, 45 for maximal volitional interval training and 116 for walking (p =  0.001). On descriptive analysis, the walking subgroup had the fewest adverse events. Conclusions In contrast to earlier studies, the improvement in cardiorespiratory fitness in a cohort of overweight

  9. All-trans retinoic acid as adjunct to intensive treatment in younger adult patients with acute myeloid leukemia: results of the randomized AMLSG 07-04 study.

    PubMed

    Schlenk, Richard F; Lübbert, Michael; Benner, Axel; Lamparter, Alexander; Krauter, Jürgen; Herr, Wolfgang; Martin, Hans; Salih, Helmut R; Kündgen, Andrea; Horst, Heinz-A; Brossart, Peter; Götze, Katharina; Nachbaur, David; Wattad, Mohammed; Köhne, Claus-Henning; Fiedler, Walter; Bentz, Martin; Wulf, Gerald; Held, Gerhard; Hertenstein, Bernd; Salwender, Hans; Gaidzik, Verena I; Schlegelberger, Brigitte; Weber, Daniela; Döhner, Konstanze; Ganser, Arnold; Döhner, Hartmut

    2016-12-01

    The aim of this clinical trial was to evaluate the impact of all-trans retinoic acid (ATRA) in combination with chemotherapy and to assess the NPM1 status as biomarker for ATRA therapy in younger adult patients (18-60 years) with acute myeloid leukemia (AML). Patients were randomized for intensive chemotherapy with or without open-label ATRA (45 mg/m(2), days 6-8; 15 mg/m(2), days 9-21). Two cycles of induction therapy were followed by risk-adapted consolidation with high-dose cytarabine or allogeneic hematopoietic cell transplantation. Due to the open label character of the study, analysis was performed on an intention-to-treat (ITT) and a per-protocol (PP) basis. One thousand one hundred patients were randomized (556, STANDARD; 544, ATRA) with 38 patients treated vice versa. Median follow-up for survival was 5.2 years. ITT analyses revealed no difference between ATRA and STANDARD for the total cohort and for the subset of NPM1-mutated AML with respect to event-free (EFS; p = 0.93, p = 0.17) and overall survival (OS; p = 0.24 and p = 0.32, respectively). Pre-specified PP analyses revealed better EFS in NPM1-mutated AML (p = 0.05) and better OS in the total cohort (p = 0.03). Explorative subgroup analyses on an ITT basis revealed better OS (p = 0.05) in ATRA for genetic low-risk patients according to ELN recommendations. The clinical trial is registered at clinicaltrialsregister.eu (EudraCT Number: 2004-004321-95).

  10. Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review

    PubMed Central

    Briggs, Andrew M; Smith, Anne J; Straker, Leon M; Bragge, Peter

    2009-01-01

    Background Thoracic spine pain (TSP) is experienced across the lifespan by healthy individuals and is a common presentation in primary healthcare clinical practice. However, the epidemiological characteristics of TSP are not well documented compared to neck and low back pain. A rigorous evaluation of the prevalence, incidence, correlates and risk factors needs to be undertaken in order for epidemiologic data to be meaningfully used to develop evidence-based prevention and treatment recommendations for TSP. Methods A systematic review method was followed to report the evidence describing prevalence, incidence, associated factors and risk factors for TSP among the general population. Nine electronic databases were systematically searched to identify studies that reported either prevalence, incidence, associated factors (cross-sectional study) or risk factors (prospective study) for TSP in healthy children, adolescents or adults. Studies were evaluated for level of evidence and method quality. Results Of the 1389 studies identified in the literature, 33 met the inclusion criteria for this systematic review. The mean (SD) quality score (out of 15) for the included studies was 10.5 (2.0). TSP prevalence data ranged from 4.0–72.0% (point), 0.5–51.4% (7-day), 1.4–34.8% (1-month), 4.8–7.0% (3-month), 3.5–34.8% (1-year) and 15.6–19.5% (lifetime). TSP prevalence varied according to the operational definition of TSP. Prevalence for any TSP ranged from 0.5–23.0%, 15.8–34.8%, 15.0–27.5% and 12.0–31.2% for 7-day, 1-month, 1-year and lifetime periods, respectively. TSP associated with backpack use varied from 6.0–72.0% and 22.9–51.4% for point and 7-day periods, respectively. TSP interfering with school or leisure ranged from 3.5–9.7% for 1-year prevalence. Generally, studies reported a higher prevalence for TSP in child and adolescent populations, and particularly for females. The 1 month, 6 month, 1 year and 25 year incidences were 0–0.9%, 10.3%, 3

  11. Telephone-delivered psychotherapy for rural-dwelling older adults with generalized anxiety disorder: study protocol of a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Generalized Anxiety Disorder (GAD), characterized by excessive and uncontrollable worry, has a negative impact on the health, well-being, and functioning of older adults. Cognitive behavioral therapy has demonstrated efficacy in reducing anxiety and worry in older adults, but the generalizability of these findings to community-dwelling older adults is unknown. The aim of the current study is to examine the efficacy of a cognitive-behavioral intervention delivered by telephone in reducing anxiety and worry in rural community-dwelling older adults with GAD. Methods/Design We propose a randomized controlled trial comparing telephone-delivered cognitive behavioral therapy (CBT-T) with nondirective supportive therapy (NST-T). One hundred seventy six adults 60 years and older diagnosed with GAD will be randomized to one of the two treatment conditions. The primary outcomes are self-report worry and clinician-rated anxiety. Secondary outcomes include depressive symptoms, sleep, quality of life, and functional status. Discussion It is hypothesized that CBT-T will be superior to NST-T in reducing anxiety and worry among older adults with GAD. Further, CBT-T is hypothesized to be superior to NST-T in reducing problems with depressive symptoms, sleep, functional status and quality of life. If this program is successful, it could be implemented as a low-cost program to treat late-life anxiety, especially in rural areas or in circumstances where older adults may not have access to qualified mental health providers. Trial registration clinicaltrials.gov Identifier: NCT01259596 PMID:24506950

  12. Sex differences in resilience to childhood maltreatment: effects of trauma history on hippocampal volume, general cognition and subclinical psychosis in healthy adults.

    PubMed

    Samplin, Erin; Ikuta, Toshikazu; Malhotra, Anil K; Szeszko, Philip R; Derosse, Pamela

    2013-09-01

    Recent data suggests that a history of childhood maltreatment is associated with reductions in hippocampal volume in healthy adults. Because this association is also evident in adults with psychiatric illness, it has been suggested that reductions in hippocampal volume associated with childhood maltreatment may be a risk factor for psychiatric illness. Such an interpretation suggests that healthy adults with a history of childhood maltreatment are more resilient to the effects of maltreatment. Current models of resilience suggest, however, that resiliency should be measured across multiple domains of functioning. The present study sought to investigate childhood maltreatment in relationship to hippocampal volumes in healthy adults and to address the question of whether the putative resiliency extends to other domains of functioning. Sixty-seven healthy Caucasian adults were assessed for a history of childhood emotional abuse, emotional neglect and physical abuse and received high resolution structural MR imaging scans. Participants with and without histories of abuse or neglect were compared on measures of total hippocampal volume, general cognitive ability and subclinical psychopathology. Our results suggest that childhood emotional abuse is associated with reduced hippocampus volume in males, but not in females. However, emotional abuse was associated with higher levels of subclinical psychopathology in both males and females. These data suggest that while females may be more resilient to the neurological effects of childhood maltreatment, they are not more resilient to the psychiatric symptoms associated with childhood maltreatment. Further research is needed to elucidate the mechanisms involved in these different levels of resilience.

  13. Hispanic Inpatient Pain Intensity.

    PubMed

    McDonald, Deborah Dillon; Ambrose, Margaret; Morey, Barbara

    2015-11-01

    Hispanic adults experience significant pain, but little is known about their pain during hospitalization. The purpose of this research was to describe Hispanic inpatients' pain intensity and compare their pain intensity with that of non-Hispanic patients. A post hoc descriptive design was used to examine 1,466 Hispanic inpatients' medical records (63.2% English speakers) and 12,977 non-Hispanic inpatients' medical records from one hospital for 2012. Mean documented pain intensity was mild for both Hispanic and non-Hispanic inpatients. Pain intensity was greater for English-speaking Hispanic patients than Spanish speakers. The odds of being documented with moderate or greater pain intensity decreased 30% for Spanish-speaking patients. Greater pain intensity documented for English-speaking Hispanic inpatients suggests underreporting of pain intensity by Spanish-speaking patients. Practitioners should use interpreter services when assessing and treating pain with patients who speak languages different from the practitioners' language(s).

  14. Valproic Acid versus Lamotrigine as First-line Monotherapy in Newly Diagnosed Idiopathic Generalized Tonic –Clonic Seizures in Adults – A Randomized Controlled Trial

    PubMed Central

    Giri, Om Prakash; Khan, Farhan Ahmad; Kumar, Narendra; Kumar, Ajay; Haque, Ataul

    2016-01-01

    Introduction Idiopathic Generalized Tonic-Clonic Seizures (GTCS) are frequently encountered in adults. Their successful control is necessary to improve the quality of life of these patients. Valproic acid is a simple branched-chain carboxylic acid and lamotrigine is a phenyltriazine derivative. Opinions differ in regards to their effectiveness in idiopathic GTCS. Aim To compare the effectiveness of valproic acid and lamotrigine in newly diagnosed adults with idiopathic generalized tonic-clonic seizures. Materials and Methods The present prospective randomized study was conducted on 60 patients suffering from idiopathic GTCS. Thirty patients received valproic acid and rest 30 patients received lamotrigine. All patients were followed regularly monthly for one year for treatment response and adverse effects. Results After 12 months follow-up, 76.67% patients taking valproic acid and 56.67% patients taking lamotrigine were seizure-free. Common adverse effects recorded were nausea, dyspepsia, headache and skin rash. Conclusion Valproic acid is more effective than lamotrigine as first-line drug in the treatment of adults with newly diagnosed idiopathic generalized tonic-clonic seizures. PMID:27630862

  15. Incidence of inferior vena cava thrombosis detected by transthoracic echocardiography in the immediate postoperative period after adult cardiac and general surgery.

    PubMed

    Saranteas, T; Kostopanagiotou, G; Tzoufi, M; Drachtidi, K; Knox, G M; Panou, F

    2013-11-01

    Venous thromboembolism is an important complication after general and cardiac surgery. Using transthoracic echocardiography, this study assessed the incidence of inferior vena cava (IVC) thrombosis among a total of 395 and 289 cardiac surgical and major surgical patients in the immediate postoperative period after cardiac and major surgery, respectively. All transthoracic echocardiography was performed by a specialist intensivist within 24 hours after surgery with special emphasis on using the subcostal view in the supine position to visualise the IVC. Of the 395 cardiac surgical patients studied, the IVC was successfully visualised using the subcostal view in 315 patients (79.8%) and eight of these patients (2.5%) had a partially obstructive thrombosis in the IVC. In 250 out of 289 (85%) general surgical patients, the IVC was also clearly visualised, but only one patient (0.4%) had an IVC thrombosis (2.5 vs 0.4%, P <0.05). In summary, visualisation of the IVC was feasible in most patients in the immediate postoperative period after both adult cardiac and major surgery. IVC thrombosis appeared to be more common after adult cardiac surgery than general surgery. A large prospective cohort study is needed to define the risk factors for IVC thrombus and whether early thromboprophylaxis can reduce the incidence of IVC thrombus after adult cardiac surgery.

  16. Effects of a 10-Day Intensive Health Promotion Program Combining Diet and Physical Activity on Body Composition, Physical Fitness, and Blood Factors of Young Adults: A Randomized Pilot Study.

    PubMed

    Lee, Kyoung Soon; Lee, Jae Koo; Yeun, Young Ran

    2017-04-11

    BACKGROUND A lifestyle characterized by poor eating habits and physical inactivity is a risk factor for multiple lifestyle diseases in young adults. This study assessed the effects of implementing an intensive 10-day health promotion program combining diet and physical activities on body composition, physical fitness, and biochemical parameters of young adults. MATERIAL AND METHODS In this randomized pilot study, 30 female undergraduate students were randomly allocated to an intervention and a control group. The health promotion program consisted of unlimited amounts of vegetarian food; aerobic, flexibility, and strength exercises (3 hours/day); lectures on health (3 hours/day); massage practice (2 hours/day); and healthy cooking practice (1 hour/day). The effects of the intervention were analyzed using the Mann-Whitney U test and the Wilcoxon signed-rank test. RESULTS The intensive 10-day health promotion program significantly reduced body weight, body mass index, triglyceride, total cholesterol, low-density lipoprotein cholesterol, blood glucose, and the homeostasis model assessment of insulin resistance. At the same time, participants demonstrated increased back muscle, leg muscle, and grip strength; waist and shoulder flexibility; balance; and cardiorespiratory endurance. CONCLUSIONS The intensive 10-day health promotion program is a viable intervention for improving body composition, physical fitness, glycemic control, and blood lipid levels in young adults.

  17. [Preoperative evaluation of adult patients prior to elective, non-cardiac surgery. Joint recommendations of German Society of Anesthesiology and Intensive Care Medicine, German Society of Surgery and German Society of Internal Medicine].

    PubMed

    2011-09-01

    Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest-x-ray) can contribute to a reduction of perioperative risk is often not very well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate and publish recommendations on the preoperative evaluation of adult patients prior to elective, non-cardiac and non-lung resection surgery. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.

  18. Secondary Education Systems and the General Skills of Less- and Intermediate-Educated Adults: A Comparison of 18 Countries

    ERIC Educational Resources Information Center

    Heisig, Jan Paul; Solga, Heike

    2015-01-01

    We investigate the impact of external differentiation and vocational orientation of (lower and upper) secondary education on country variation in the mean numeracy skills of, and skills gaps between, adults with low and intermediate formal qualifications. We use data on 30- to 44-year-olds in 18 countries from the 2011-12 round of the Program for…

  19. Teaching Generalized Reading of Product Warning Labels to Young Adults with Autism Using the Constant Time Delay Procedure

    ERIC Educational Resources Information Center

    Dogoe, Maud S.; Banda, Devender R.; Lock, Robin H.; Feinstein, Rita

    2011-01-01

    This study examined the effectiveness of the constant timed delay procedure for teaching two young adults with autism to read, define, and state the contextual meaning of keywords on product warning labels of common household products. Training sessions were conducted in the dyad format using flash cards. Results indicated that both participants…

  20. Prolonged infusion of sedatives and analgesics in adult intensive care patients: A systematic review of pharmacokinetic data reporting and quality of evidence.

    PubMed

    Tse, Andrew H W; Ling, Lowell; Joynt, Gavin M; Lee, Anna

    2017-03-01

    Although pharmacokinetic (PK) data for prolonged sedative and analgesic agents in intensive care unit (ICU) has been described, the number of publications in this important area appear relatively few, and PK data presented is not comprehensive. Known pathophysiological changes in critically ill patients result in altered drug PK when compared with non-critically ill patients. ClinPK Statement was recently developed to promote consistent reporting in PK studies, however, its applicability to ICU specific PK studies is unclear. In this systematic review, we assessed the overall ClinPK Statement compliance rate, determined the factors affecting compliance rate, graded the level of PK evidence and assessed the applicability of the ClinPK Statement to future ICU PK studies. Of the 33 included studies (n=2016), 22 (67%) were low evidence quality descriptive studies (Level 4). Included studies had a median compliance rate of 80% (IQR 66% to 86%) against the ClinPK Statement. Overall pooled compliance rate (78%, 95% CI 73% to 83%) was stable across time (P=0.38), with higher compliance rates found in studies fitting three compartments models (88%, P<0.01), two compartments models (83%, P<0.01) and one compartment models (77%, P=0.17) than studies fitting noncompartmental or unspecified models (69%) (P<0.01). Data unique to the interpretation of PK data in critically ill patients, such as illness severity (48%), organ dysfunction (36%) and renal replacement therapy use (32%), were infrequently reported. Discrepancy between the general compliance rate with ClinPK Statement and the under-reporting of ICU specific parameters suggests that the applicability of the ClinPK Statement to ICU PK studies may be limited in its current form.

  1. Do prenatally methamphetamine-exposed adult male rats display general predisposition to drug abuse in the conditioned place preference test?

    PubMed

    Šlamberová, R; Pometlová, M; Schutová, B; Hrubá, L; Macúchová, E; Nová, E; Rokyta, R

    2012-01-01

    Drug abuse of pregnant women is a growing problem. The effect of prenatal drug exposure may have devastating effect on development of the offsprings that may be long-term or even permanent. One of the most common drug abused by pregnant women is methamphetamine (MA), which is also the most frequently abused illicit drug in the Czech Republic. Our previous studies demonstrated that prenatal MA exposure alters behavior, cognition, pain and seizures in adult rats in sex-specific manner. Our most recent studies demonstrate that prenatal MA exposure makes adult rats more sensitive to acute injection of the same or related drugs than their controls. The aim of the present study was to examine the effect of prenatal MA exposure on drug-seeking behavior of adult male rats tested in the Conditioned place preference (CPP). Adult male rats were divided to: prenatally MA-exposed (5 mg/kg daily for the entire prenatal period), prenatally saline-exposed (1 ml/kg of physiological saline) and controls (without maternal injections). The following drugs were used in the CPP test in adulthood: MA (5 mg/kg), amphetamine (5 mg/kg), cocaine (5 and 10 mg/kg), morphine (5 mg/kg), MDMA (5 mg/kg) and THC (2 mg/kg). Our data demonstrated that prenatally MA-exposed rats displayed higher amphetamine-seeking behavior than both controls. MA as well as morphine induced drug-seeking behavior of adult male rats, however this effect did not differ based on the prenatal MA exposure. In contrast, prenatal MA exposure induced rather tolerance to cocaine than sensitization after the conditioning in the CPP. MDMA and THC did not induce significant effects. Even though the present data did not fully confirmed our hypotheses, future studies are planned to test the drug-seeking behavior also in self-administration test.

  2. Intense interval training in healthy older adults increases skeletal muscle [(3)H]ouabain-binding site content and elevates Na(+),K(+)-ATPase α2 isoform abundance in Type II fibers.

    PubMed

    Wyckelsma, Victoria L; Levinger, Itamar; Murphy, Robyn M; Petersen, Aaron C; Perry, Ben D; Hedges, Christopher P; Anderson, Mitchell J; McKenna, Michael J

    2017-04-01

    Young adults typically adapt to intense exercise training with an increased skeletal muscle Na(+),K(+)-ATPase (NKA) content, concomitant with reduced extracellular potassium concentration [K(+)] during exercise and enhanced exercise performance. Whether these changes with longitudinal training occur in older adults is unknown and was investigated here. Fifteen older adults (69.4 ± 3.5 years, mean ± SD) were randomized to either 12 weeks of intense interval training (4 × 4 min at 90-95% peak heart rate), 3 days/week (IIT, n = 8); or no exercise controls (n = 7). Before and after training, participants completed an incremental cycle ergometer exercise test until a rating of perceived exertion of 17 (very hard) on a 20-point scale was attained, with measures of antecubital venous [K(+)]v Participants underwent a resting muscle biopsy prior to and at 48-72 h following the final training session. After IIT, the peak exercise work rate (25%), oxygen uptake (16%) and heart rate (6%) were increased (P < 0.05). After IIT, the peak exercise plasma [K(+)]v tended to rise (P = 0.07), while the rise in plasma [K(+)]v relative to work performed (nmol.L(-1)J(-1)) was unchanged. Muscle NKA content increased by 11% after IIT (P < 0.05). Single fiber measurements, increased in NKA α2 isoform in Type II fibers after IIT (30%, P < 0.05), with no changes to the other isoforms in single fibers or homogenate. Thus, intense exercise training in older adults induced an upregulation of muscle NKA, with a fiber-specific increase in NKA α2 abundance in Type II fibers, coincident with increased muscle NKA content and enhanced exercise performance.

  3. Memory and comprehension for health information among older adults: distinguishing the effects of domain-general and domain-specific knowledge.

    PubMed

    Chin, Jessie; Payne, Brennan; Gao, Xuefei; Conner-Garcia, Thembi; Graumlich, James F; Murray, Michael D; Morrow, Daniel G; Stine-Morrow, Elizabeth A L

    2015-01-01

    While there is evidence that knowledge influences understanding of health information, less is known about the processing mechanisms underlying this effect and its impact on memory. We used the moving window paradigm to examine how older adults varying in domain-general crystallised ability (verbal ability) and health knowledge allocate attention to understand health and domain-general texts. Participants (n = 107, age: 60-88 years) read and recalled single sentences about hypertension and about non-health topics. Mixed-effects modelling of word-by-word reading times suggested that domain-general crystallised ability increased conceptual integration regardless of text domain, while health knowledge selectively increased resource allocation to conceptual integration at clause boundaries in health texts. These patterns of attentional allocation were related to subsequent recall performance. Although older adults with lower levels of crystallised ability were less likely to engage in integrative processing, when they did, this strategy had a compensatory effect in improving recall. These findings suggest that semantic integration during reading is an important comprehension process that supports the construction of the memory representation and is engendered by knowledge. Implications of the findings for theories of text processing and memory as well as for designing patient education materials are discussed.

  4. Typologies of substance use and illegal behaviors: A comparison of emerging adults with histories of foster care and the general population

    PubMed Central

    Snyder, Susan M.; Medeiros, Rose Anne

    2016-01-01

    This study used latent class analysis (LCA) to explore whether patterns of substance use and illegal behaviors among emerging adults, 18 to 28 years old, differ depending on whether they have a prior history in foster care. The study sample, consisting of 316 respondents who had previously been in foster care and 14,301 respondents without a foster care history, was drawn from the third wave of the National Longitudinal Study of Adolescent Health. A multiple-group LCA compared former foster youth to their peers in the general population. The following four classes were identified: illegal behaviors, substance use, illegal behaviors with problematic substance use and normative behaviors. Most of the differences between the groups were not statistically significant. However, within the illegal behavior class former foster youth were less likely to have bought, sold, or held stolen goods; injured someone in a fight so that she or he needed medical attention; to have sold drugs; and to have been drunk at school or work. Additionally, in the illegal behaviors with problematic substance use class emerging adults in the general population were more likely to have used cocaine. Within the normative behaviors class, former foster youth were more likely to be current smokers, and to have injured someone in a fight so that he or she required medical attention. Within the substance use class, emerging adults from the general population were more likely to have taken place in a fight where one group fought another. Additional statistically significant, but very small differences were also identified. PMID:27546938

  5. Working Memory Capacity and Psychotic-Like Experiences in a General Population Sample of Adolescents and Young Adults

    PubMed Central

    Ziermans, Tim B.

    2013-01-01

    Working memory (WM) impairment is a common feature in individuals with schizophrenia and high-risk for psychosis and a promising target for early intervention strategies. However, it is unclear to what extent WM impairment parallels specific behavioral symptoms along the psychosis continuum. To address this issue, the current study investigated the relation of WM capacity with psychotic-like experiences (PLEs) in a large Swedish population sample (N = 1012) of adolescents and young adults (M = 24.4 years, range 12–35). WM was assessed with two online computer tasks: a task where participants had to identify and remember the location of an odd shape and a task of remembering and following instructions. PLE scores were derived from a translated symptom questionnaire (Community Assessment of Psychic Experiences), which includes positive, negative, and depressive symptom scales. Positive and negative symptom scales were further subdivided into symptom clusters based on factor analyses. The results showed that low WM capacity was modestly associated with increased reports of bizarre experiences (BE) and depressive symptoms, after controlling for age, gender, and global symptom scores. Interestingly, when analyses were repeated for separate age groups, low WM was exclusively associated with a higher frequency of BE for young adults (20–27 years) and with depressive symptoms for older adults (28–35 years). These findings suggest that specific PLEs can be indicative of reduced WM capacity in early adulthood, which in turn may reflect an increased risk for psychosis and a greater need for targeted intervention. In contrast, during adolescence individual differences in cognitive development may influence the strength of the relationships and thereby mask potential vulnerabilities for psychopathology. PMID:24348432

  6. Stroke awareness in the general population: knowledge of stroke risk factors and warning signs in older adults

    PubMed Central

    Hickey, Anne; O'Hanlon, Ann; McGee, Hannah; Donnellan, Claire; Shelley, Emer; Horgan, Frances; O'Neill, Desmond

    2009-01-01

    Background Stroke is a leading cause of death and functional impairment. While older people are particularly vulnerable to stroke, research suggests that they have the poorest awareness of stroke warning signs and risk factors. This study examined knowledge of stroke warning signs and risk factors among community-dwelling older adults. Methods Randomly selected community-dwelling older people (aged 65+) in Ireland (n = 2,033; 68% response rate). Participants completed home interviews. Questions assessed knowledge of stroke warning signs and risk factors, and personal risk factors for stroke. Results Of the overall sample, 6% had previously experienced a stroke or transient ischaemic attack. When asked to identify stroke risk factors from a provided list, less than half of the overall sample identified established risk factors (e.g., smoking, hypercholesterolaemia), hypertension being the only exception (identified by 74%). Similarly, less than half identified established warning signs (e.g., weakness, headache), with slurred speech (54%) as the exception. Overall, there were considerable gaps in awareness with poorest levels evident in those with primary level education only and in those living in Northern Ireland (compared with Republic of Ireland). Conclusion Knowledge deficits in this study suggest that most of the common early symptoms or signs of stroke were recognized as such by less than half of the older adults surveyed. As such, many older adults may not recognise early symptoms of stroke in themselves or others. Thus, they may lose vital time in presenting for medical attention. Lack of public awareness about stroke warning signs and risk factors must be addressed as one important contribution to reducing mortality and morbidity from stroke. PMID:19656359

  7. On the plasticity of semantic generalizations: Children and adults modify their verb lexicalization biases in response to changing input

    PubMed Central

    Shafto, Carissa L.; Havasi, Catherine; Snedeker, Jesse

    2014-01-01

    Languages differ in how they package the components of an event into words to form sentences. For example, while some languages typically encode the manner of motion in the verb (e.g., running), others more often use verbs that encode the path (e.g., ascending). Prior research has demonstrated that children and adults have lexicalization biases; i.e. they assume that novel motion verbs will reflect the dominant pattern of their own language. These experiments explored the plasticity of these biases. In Experiments 1 and 2 we taught English-speaking adults motion verbs, varying the proportion of manner and path verbs in the training set; their interpretation of subsequent verbs closely reflected the probabilistic variation in the input. In Experiments 3 and 4, five-year-old children also systematically shifted their lexicalization biases to reflect the verbs that they were taught. We conclude that lexicalization biases are adaptive inferences about verb meaning that are updated on the basis of experience. PMID:24001149

  8. Parent Inclusion in Early Intensive Behavioral Intervention: The Influence of Parental Stress, Parent Treatment Fidelity and Parent-Mediated Generalization of Behavior Targets on Child Outcomes

    ERIC Educational Resources Information Center

    Strauss, Kristin; Vicari, Stefano; Valeri, Giovanni; D'Elia, Lidia; Arima, Serena; Fava, Leonardo

    2012-01-01

    Although early intensive behavior interventions have been efficient in producing positive behavior outcome in young children with Autism Spectrum Disorder, there is a considerable variety in the children's progress. Research has suggested that parental and treatment factors are likely to affect children's response to treatment. The purpose of the…

  9. Multiple roads lead to Rome: combined high-intensity aerobic and strength training vs. gross motor activities leads to equivalent improvement in executive functions in a cohort of healthy older adults.

    PubMed

    Berryman, Nicolas; Bherer, Louis; Nadeau, Sylvie; Lauzière, Séléna; Lehr, Lora; Bobeuf, Florian; Lussier, Maxime; Kergoat, Marie Jeanne; Vu, Thien Tuong Minh; Bosquet, Laurent

    2014-01-01

    The effects of physical activity on cognition in older adults have been extensively investigated in the last decade. Different interventions such as aerobic, strength, and gross motor training programs have resulted in improvements in cognitive functions. However, the mechanisms underlying the relationship between physical activity and cognition are still poorly understood. Recently, it was shown that acute bouts of exercise resulted in reduced executive control at higher relative exercise intensities. Considering that aging is characterized by a reduction in potential energy ([Formula: see text] max - energy cost of walking), which leads to higher relative walking intensity for the same absolute speed, it could be argued that any intervention aimed at reducing the relative intensity of the locomotive task would improve executive control while walking. The objective of the present study was to determine the effects of a short-term (8 weeks) high-intensity strength and aerobic training program on executive functions (single and dual task) in a cohort of healthy older adults. Fifty-one participants were included and 47 (age, 70.7 ± 5.6) completed the study which compared the effects of three interventions: lower body strength + aerobic training (LBS-A), upper body strength + aerobic training (UBS-A), and gross motor activities (GMA). Training sessions were held 3 times every week. Both physical fitness (aerobic, neuromuscular, and body composition) and cognitive functions (RNG) during a dual task were assessed before and after the intervention. Even though the LBS-A and UBS-A interventions increased potential energy to a higher level (Effect size: LBS-A-moderate, UBS-A-small, GMA-trivial), all groups showed equivalent improvement in cognitive function, with inhibition being more sensitive to the intervention. These findings suggest that different exercise programs targeting physical fitness and/or gross motor skills may lead to equivalent improvement in

  10. Experiences of Parents and General Practitioners with End-of-Life Care in Adolescents and Young Adults with Cancer.

    PubMed

    Kaal, Suzanne E J; Kuijken, Noortje M J; Verhagen, Constant A H H V M; Jansen, Rosemarie; Servaes, Petra; van der Graaf, Winette T A

    2016-03-01

    This study aims to analyze the experiences of Dutch bereaved parents and general practitioners (GPs) with palliative care of AYAs (18-35 years) in the terminal stage. Fifteen parents and nine GPs involved with nine deceased AYAs filled out questionnaires and were interviewed by telephone, respectively. In general, the parents were satisfied with the emotional care they themselves received and the medical care that their child received. The GPs were very satisfied with the cooperation with the palliative team. Gaps are present in the areas of symptom control, communication between hospital professionals and parents, aftercare, and transition between hospital and GP.

  11. [Vaccination--General concepts. Systematic vaccination schedules for the child and adult in Spain. Impact of vaccination programs].

    PubMed

    Arrazola Martínez, M Pilar; de Juanes Pardo, José Ramón; García de Codes Ilario, Aurelia

    2015-01-01

    One area of major importance in promoting health is the prevention of infectious diseases through vaccination. Vaccine is any preparation intended to generate immunity against a disease by stimulating the production of antibodies. There are two basic types: live attenuated and inactivated, with different characteristics that determine their use. The main properties of a vaccine are safety and protective efficacy. The vaccines can be administered based on individualized directions depending on various factors (personal, environmental…), or systematically as part of the immunization schedules. In Spain, the first childhood immunization schedule was implemented in 1975. The Autonomous Communities are currently responsible for establishing vaccine recommendations. The incidence of vaccine-preventable diseases and vaccination coverage are essential criteria for the evaluation of vaccination programs. In Spain the incidence of vaccine-preventable diseases is low. Vaccination coverage is high in childhood, but in adolescents, adults and groups at risk it is not always appropriate.

  12. The Rate of Age-Related Olfactory Decline Among the General Population of Older U.S. Adults

    PubMed Central

    Wroblewski, Kristen E.; Kern, David W.; Schumm, L. Philip; McClintock, Martha K.

    2015-01-01

    Background. Age-related olfactory loss (presbyosmia) is a prevalent sensory impairment with a large public health impact. In cross-sectional analyses, we found striking health disparities in olfactory function among older U.S. adults. Here, we report a 5-year follow-up to determine the magnitude of within-person olfactory decline. Methods. The National Social Life, Health, and Aging Project (NSHAP) interviewed a probability sample of home-dwelling older U.S. adults (57–85 years) in 2005–2006 (Wave 1) and reinterviewed them in 2010–2011 (Wave 2), assessing demographics, social life, and health, including olfaction. Odor identification was measured with a 5-item version of the Sniffin’ Sticks (0–5 correct). Fourteen hundred and thirty-six respondents provided olfaction data in both waves. Multivariate linear and logistic regression were used to model the association between change in olfactory performance and demographic, health, and psychosocial factors. Results. Odor identification declined most rapidly among older individuals (0.25 additional errors per 5 years for each decade of age, p < .001) and in men (0.17 additional errors per 5 years compared to women, p = .005). Among those with perfect scores in Wave 1, African Americans declined more rapidly than Whites (p = .04). Neither socioeconomic status, health conditions, cognition, mental health, alcohol use nor smoking was associated with change in olfaction (p > .05, all). Conclusions. The rate of olfactory decline increases with age and is greater among men than women despite adjusting for differences in psychosocial and health conditions, indicating physiologic factors as drivers. African Americans are more likely to experience initial olfactory decline, consistent with an earlier onset of aging among this subgroup. PMID:26253908

  13. Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study

    PubMed Central

    2013-01-01

    Background Insulin resistance has been associated with metabolic and hemodynamic alterations and higher cardio metabolic risk. There is great variability in the threshold homeostasis model assessment of insulin resistance (HOMA-IR) levels to define insulin resistance. The purpose of this study was to describe the influence of age and gender in the estimation of HOMA-IR optimal cut-off values to identify subjects with higher cardio metabolic risk in a general adult population. Methods It included 2459 adults (range 20–92 years, 58.4% women) in a random Spanish population sample. As an accurate indicator of cardio metabolic risk, Metabolic Syndrome (MetS), both by International Diabetes Federation criteria and by Adult Treatment Panel III criteria, were used. The effect of age was analyzed in individuals with and without diabetes mellitus separately. ROC regression methodology was used to evaluate the effect of age on HOMA-IR performance in classifying cardio metabolic risk. Results In Spanish population the threshold value of HOMA-IR drops from 3.46 using 90th percentile criteria to 2.05 taking into account of MetS components. In non-diabetic women, but no in men, we found a significant non-linear effect of age on the accuracy of HOMA-IR. In non-diabetic men, the cut-off values were 1.85. All values are between 70th-75th percentiles of HOMA-IR levels in adult Spanish population. Conclusions The consideration of the cardio metabolic risk to establish the cut-off points of HOMA-IR, to define insulin resistance instead of using a percentile of the population distribution, would increase its clinical utility in identifying those patients in whom the presence of multiple metabolic risk factors imparts an increased metabolic and cardiovascular risk. The threshold levels must be modified by age in non-diabetic women. PMID:24131857

  14. Generalized Anxiety Disorder: A Comparison of Symptom Change in Adults Receiving Cognitive-Behavioral Therapy or Applied Relaxation

    ERIC Educational Resources Information Center

    Donegan, Eleanor; Dugas, Michel J.

    2012-01-01

    Objective: Generalized anxiety disorder (GAD) is characterized by excessive worry and somatic symptoms of anxiety (e.g., restlessness, muscle tension). Several psychological treatments lead to significant reductions in GAD symptoms by posttreatment. However, little is known about how GAD symptoms change over time. Our main goal was to examine how…

  15. On the consideration of scaling properties of extreme rainfall in Madrid (Spain) for developing a generalized intensity-duration-frequency equation and assessing probable maximum precipitation estimates

    NASA Astrophysics Data System (ADS)

    Casas-Castillo, M. Carmen; Rodríguez-Solà, Raúl; Navarro, Xavier; Russo, Beniamino; Lastra, Antonio; González, Paula; Redaño, Angel

    2016-11-01

    The fractal behavior of extreme rainfall intensities registered between 1940 and 2012 by the Retiro Observatory of Madrid (Spain) has been examined, and a simple scaling regime ranging from 25 min to 3 days of duration has been identified. Thus, an intensity-duration-frequency (IDF) master equation of the location has been constructed in terms of the simple scaling formulation. The scaling behavior of probable maximum precipitation (PMP) for durations between 5 min and 24 h has also been verified. For the statistical estimation of the PMP, an envelope curve of the frequency factor (k m ) based on a total of 10,194 station-years of annual maximum rainfall from 258 stations in Spain has been developed. This curve could be useful to estimate suitable values of PMP at any point of the Iberian Peninsula from basic statistical parameters (mean and standard deviation) of its rainfall series.

  16. High curability via intensive reinduction chemotherapy and stem cell transplantation in young adults with relapsed acute lymphoblastic leukemia in Sweden 2003–2007

    PubMed Central

    Kozlowski, Piotr; Åström, Maria; Ahlberg, Lucia; Bernell, Per; Hulegårdh, Erik; Hägglund, Hans; Karlsson, Karin; Markuszewska-Kuczymska, Alicja; Tomaszewska-Toporska, Beata; Smedmyr, Bengt; Hallböök, Helene

    2012-01-01

    Background A minority of patients with adult acute lymphoblastic leukemia who relapse are rescued. The aim of this population-based study was to assess the results of reinduction treatment and allogeneic stem cell transplantation in patients in second complete remission. Design and Methods Between 2003–2007, 76 adults (<66 years) with relapsed acute lymphoblastic leukemia (Burkitt’s leukemia excluded) were prospectively reported to The Swedish Adult Acute Leukemia Registry and later evaluated. Results Reinduction with: (i) mitoxantrone, etoposide, and cytarabine (MEA); (ii) fludarabine, cytarabine, pegylated-asparaginase plus granulocyte colony-stimulating factor (FLAG-Asp); and (iii) cytarabine, betamethasone, cyclophosphamide, daunorubicin, and vincristine (ABCDV) resulted in complete remission in 6/9 (67%), 10/16 (63%) and 9/21 (43%) of the patients, respectively. Allogeneic stem cell transplantation was performed during second complete remission in 29 patients. Multivariate analysis regarding overall survival after relapse revealed that age over 35 years at diagnosis and relapse within 18 months were negative prognostic factors. Overall survival rates at 3 and 5 years were 22% (95% CI: 13–32) and 15% (95% CI: 7–24). Of 19 patients less than 35 years at diagnosis who underwent allogeneic stem cell transplantation in second remission, ten (53%) are still alive at a median of 5.5 years (range, 4.2–8.3) after relapse, whereas all patients over 35 years old at diagnosis have died. Conclusions Allogeneic stem cell transplantation remains the treatment of choice for young adults with relapsed acute lymphoblastic leukemia. Both (i) mitoxantrone, etoposide, and cytarabine and (ii) fludarabine, cytarabine, pegylated-asparaginase plus granulocyte colony-stimulating factor seem effective as reinduction treatments and should be further evaluated. New salvage strategies are needed, especially for patients over 35 years old at diagnosis. PMID:22511497

  17. Gender differences in general mental health, smoking, drinking and chronic diseases in older adults in Jilin province, China.

    PubMed

    Wang, Shibin; Ungvari, Gabor S; Forester, Brent P; Chiu, Helen F K; Wu, Yanhua; Kou, Changgui; Fu, Yingli; Qi, Yue; Liu, Yawen; Tao, Yuchun; Yu, Yaqin; Li, Bo; Xiang, Yu-Tao

    2017-05-01

    There is little information on gender differences in general mental health, smoking, drinking and chronic diseases in Chinese elderly. We examined the gender differences in general mental health, smoking, drinking and a number of chronic diseases in a large Chinese old population. Multistage stratified cluster sampling was used in this cross-sectional study. A total of 4115 people (2198 women; 1917 men) aged between 60 and 79 years were included and their general mental health, smoking, drinking and chronic diseases were recorded with standardized assessment tools. Multivariate analyses revealed that women were less likely to be current smokers and frequent drinkers, but had higher prevalence of poor mental health compared with their male counterparts. In addition, the prevalence rate of chronic diseases and multi-morbidities were higher in women than that in men (both p values <0.05). Health professionals and policy makers need to pay special attention to the common chronic diseases and poor mental health in older women and higher prevalence of smoking and drinking in men.

  18. Estimated nutrient intakes from food generally do not meet dietary reference intakes among adult members of Pacific Northwest tribal nations.

    PubMed

    Fialkowski, Marie K; McCrory, Megan A; Roberts, Sparkle M; Tracy, J Kathleen; Grattan, Lynn M; Boushey, Carol J

    2010-05-01

    Diet is influential in the etiology of chronic diseases in many populations including Native Americans. The objective of this report is to present the first comprehensive dietary survey, to our knowledge, of a representative sample of nonpregnant adults from Pacific Northwest tribal nations participating in the Communities Advancing the Studies of Tribal Nations Across the Lifespan (CoASTAL) cohort. Only participants who completed 1-4 d of dietary records and had weights and heights measured in the laboratory were eligible for this analysis (n = 418). Mean nutrient intakes were stratified by gender for the total sample, those with plausibly reported energy intakes (rEI), and those with implausibly rEI. Estimates of nutrient intakes were compared with Dietary Reference Intakes (DRI). Nutrient estimates from NHANES 2001-2002 were used as a reference. Among both men and women, total fat contributed 34-37% of energy intake and saturated fat contributed 11-12% of energy intake. Daily cholesterol intakes ranged from 262 to 442 mg. A majority of men and women were not meeting recommendations for vitamins A, C, and E, magnesium, and sodium. For a majority of the nutrients examined, plausibility resulted in higher mean estimates. The CoASTAL cohort nutrient profile is similar to NHANES 2001-2002, with a majority of DRI recommendations not being met. Adequate dietary intake information may be more important for this population, because Native Americans experience a disproportionate burden for diseases.

  19. Telephone-Delivered Cognitive Behavioral Therapy and Telephone-Delivered Nondirective Supportive Therapy for Rural Older Adults With Generalized Anxiety Disorder

    PubMed Central

    Brenes, Gretchen A.; Danhauer, Suzanne C.; Lyles, Mary F.; Hogan, Patricia E.; Miller, Michael E.

    2016-01-01

    IMPORTANCE Generalized anxiety disorder (GAD) is common in older adults; however, access to treatment may be limited, particularly in rural areas. OBJECTIVE To examine the effects of telephone-delivered cognitive behavioral therapy (CBT) compared with telephone-delivered nondirective supportive therapy (NST) in rural older adults with GAD. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial in the participants’ homes of 141 adults aged 60 years and older with a principal or coprincipal diagnosis of GAD who were recruited between January 27, 2011, and October 22, 2013. INTERVENTIONS Telephone-delivered CBT consisted of as many as 11 sessions (9 were required) focused on recognition of anxiety symptoms, relaxation, cognitive restructuring, the use of coping statements, problem solving, worry control, behavioral activation, exposure therapy, and relapse prevention, with optional chapters on sleep and pain. Telephone-delivered NST consisted of 10 sessions focused on providing a supportive atmosphere in which participants could share and discuss their feelings and did not provide any direct suggestions for coping. MAIN OUTCOMES AND MEASURES Primary outcomes included interviewer-rated anxiety severity (Hamilton Anxiety Rating Scale) and self-reported worry severity (Penn State Worry Questionnaire–Abbreviated) measured at baseline, 2 months’ follow-up, and 4 months’ follow-up. Mood-specific secondary outcomes included self-reported GAD symptoms (GAD Scale 7 Item) measured at baseline and 4 months’ follow-up and depressive symptoms (Beck Depression Inventory) measured at baseline, 2 months’ follow-up, and 4 months’ follow-up. Among the 141 participants, 70 were randomized to receive CBT and 71 to receive NST. RESULTS At 4 months’ follow-up, there was a significantly greater decline in worry severity among participants in the telephone-delivered CBT group (difference in improvement, −4.07; 95%CI, −6.26 to −1.87; P = .004) but no significant

  20. Adjustments of pulmonary O2 uptake and muscle deoxygenation during ramp incremental exercise and constant-load moderate-intensity exercise in young and older adults

    PubMed Central

    Gravelle, Braden M. R.; Murias, Juan M.; Spencer, Matthew D.; Paterson, Donald H.

    2012-01-01

    The matching of muscle O2 delivery to O2 utilization can be inferred from the adjustments in muscle deoxygenation (Δ[HHb]) and pulmonary O2 uptake (V̇o2p). This study examined the adjustments of V̇o2p and Δ[HHb] during ramp incremental (RI) and constant-load (CL) exercise in adult males. Ten young adults (YA; age: 25 ± 5 yr) and nine older adults (OA; age: 70 ± 3 yr) completed two RI tests and six CL step transitions to a work rate (WR) corresponding to 1) 80% of the estimated lactate threshold (same relative WR) and 2) 50 W (same absolute WR). V̇o2p was measured breath by breath, and Δ[HHb] of the vastus lateralis was measured using near-infrared spectroscopy. Δ[HHb]-WR profiles were normalized from baseline (0%) to peak Δ[HHb] (100%) and fit using a sigmoid function. The sigmoid slope (d) was greater (P < 0.05) in OA (0.027 ± 0.01%/W) compared with YA (0.017 ± 0.01%/W), and the c/d value (a value corresponding to 50% of the amplitude) was smaller (P < 0.05) for OA (133 ± 40 W) than for YA (195 ± 51 W). No age-related differences in the sigmoid parameters were reported when WR was expressed as a percentage of peak WR. V̇o2p kinetics compared with Δ[HHb] kinetics for the 50-W transition were similar between YA and OA; however, Δ[HHb] kinetics during the transition to 80% of the lactate threshold were faster than V̇o2p kinetics in both groups. The greater reliance on O2 extraction displayed in OA during RI exercise suggests a lower O2 delivery-to-O2 utilization relationship at a given absolute WR compared with YA. PMID:22961268

  1. Entrance surface dose and image quality: comparison of adult chest and abdominal X-ray examinations in general practitioner clinics, public and private hospitals in Malaysia.

    PubMed

    Hambali, Ahmad Shariff; Ng, Kwan-Hoong; Abdullah, Basri Johan Jeet; Wang, Hwee-Beng; Jamal, Noriah; Spelic, David C; Suleiman, Orhan H

    2009-01-01

    This study was undertaken to compare the entrance surface dose (ESD) and image quality of adult chest and abdominal X-ray examinations conducted at general practitioner (GP) clinics, and public and private hospitals in Malaysia. The surveyed facilities were randomly selected within a given category (28 GP clinics, 20 public hospitals and 15 private hospitals). Only departmental X-ray units were involved in the survey. Chest examinations were done at all facilities, while only hospitals performed abdominal examinations. This study used the x-ray attenuation phantoms and protocols developed for the Nationwide Evaluation of X-ray Trends (NEXT) survey program in the United States. The ESD was calculated from measurements of exposure and clinical geometry. An image quality test tool was used to evaluate the low-contrast detectability and high-contrast detail performance under typical clinical conditions. The median ESD value for the adult chest X-ray examination was the highest (0.25 mGy) at GP clinics, followed by private hospitals (0.22 mGy) and public hospitals (0.17 mGy). The median ESD for the adult abdominal X-ray examination at public hospitals (3.35 mGy) was higher than that for private hospitals (2.81 mGy). Results of image quality assessment for the chest X-ray examination show that all facility types have a similar median spatial resolution and low-contrast detectability. For the abdominal X-ray examination, public hospitals have a similar median spatial resolution but larger low-contrast detectability compared with private hospitals. The results of this survey clearly show that there is room for further improvement in performing chest and abdominal X-ray examinations in Malaysia.

  2. Features of Age-Related Macular Degeneration in the General Adults and Their Dependency on Age, Sex, and Smoking: Results from the German KORA Study

    PubMed Central

    Brandl, Caroline; Breinlich, Valentin; Stark, Klaus J.; Enzinger, Sabrina; Aßenmacher, Matthias; Olden, Matthias; Grassmann, Felix; Graw, Jochen; Heier, Margit; Peters, Annette; Helbig, Horst; Küchenhoff, Helmut; Weber, Bernhard H. F.; Heid, Iris M.

    2016-01-01

    Age-related macular degeneration (AMD) is a vision impairing disease of the central retina characterized by early and late forms in individuals older than 50 years of age. However, there is little knowledge to what extent also younger adults are affected. We have thus set out to estimate the prevalence of early AMD features and late AMD in a general adult population by acquiring color fundus images in 2,840 individuals aged 25 to 74 years of the Cooperative Health Research in the Region of Augsburg project (KORA) in South Germany. Among the 2,546 participants with gradable images for each eye, 10.9% (n = 277) had early AMD features (applying the 9-step Age-Related Eye Disease Study Severity Scale), 0.2% (n = 6) had late AMD. Prevalence increased with age, reaching 26.3% for early AMD features and 1.9% for late AMD at the age 70+. However, signs of early AMD were found in subjects as young as 25 years, with the risk for early AMD features increasing linearly by years of age in men, and, less consistent with a linear increase, in women. Risk for early AMD features increased linearly by pack years of smoking in men, not in women, nor was there any association with other lifestyle or metabolic factors. By providing much sought-after prevalence estimates for AMD from Central Europe, our data underscores a substantial proportion of the adult population with signs of early AMD, including individuals younger than 50 years. This supports the notion that early AMD features in the young might be under-acknowledged. PMID:27893849

  3. Assessment of a web-based Guided Self-Determination intervention for adults with type 2 diabetes in general practice: a study protocol

    PubMed Central

    Karlsen, Bjørg; Oftedal, Bjørg; Stangeland Lie, Silje; Rokne, Berit; Peyrot, Mark; Zoffmann, Vibeke; Graue, Marit

    2016-01-01

    Introduction Self-management is deemed the cornerstone in overall diabetes management. Web-based self-management interventions have potential to support adults with type 2 diabetes (T2DM) in managing their disease. Owing to somewhat ambiguous results of such interventions, interventions should be theory-based and incorporate well-defined counselling methods and techniques for behavioural change. This study is designed to assess the effectiveness of a theory-driven web-based Guided Self-Determination (GSD) intervention among adults with T2DM in general practice to improve diabetes self-management behaviours and glycosylated haemoglobin (HbA1c). Methods and analysis A complex intervention design based on the framework of the UK Medical Research Council is employed as a guide for developing the intervention, assessing its feasibility and evaluating its effectiveness. The study consists of three phases: (1) the modelling phase adapting the original GSD programme for adults with T2DM, using a qualitative design, (2) feasibility assessment of the adapted intervention on the web, employing qualitative and quantitative methods and (3) evaluating the effectiveness of the intervention on diabetes self-management behaviours and HbA1c, using a quasi-experimental design. The first phase, which is completed, and the second phase, which is underway, will provide important information about the development of the intervention and its acceptability, whereas the third phase will assess the effectiveness of this systematically developed intervention. Ethics and dissemination The Norwegian Regional Committee for Medical and Health Research Ethics (REK west number 2015/60) has approved the study design. Patients recruited in the different phases will fill out an informed consent form prior to inclusion and will be guaranteed anonymity and the right to withdraw from the study at any time. The results of the study will be published in peer-reviewed journals, electronically and in print

  4. Heterogeneous responses of personalised high intensity interval training on type 2 diabetes mellitus and cardiovascular disease risk in young healthy adults.

    PubMed

    Higgins, Timothy P; Baker, Matthew D; Evans, Shelley-Ann; Adams, Rachel A; Cobbold, Christian

    2015-01-01

    Hypertension, decreased glucose tolerance, adverse lipid profiles and low physical activity levels are associated with increased type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) risk. High intensity interval training (HIIT), a low volume, reduced time, high intensity programme, may be a useful alternative to current government guidelines which specify a minimum of 150 minutes of physical activity per week. We describe a personalised programme of high intensity exercise which provides significant improvements in CVD risk markers. Healthy volunteers undertook 6 weeks of HIIT. T2DM and CVD risk predictors including glucose tolerance, VO2max, blood pressure (BP), and lipids were measured before and after HIIT. HIIT training was associated with beneficial changes in a range of predictors of blood flow and cardiovascular risk. There was a heterogeneous response to HIIT, with some subjects responding with favourable changes and others being non-responders to HIIT. In responders, HIIT was associated with a statistically significant (p = 0.023) increase in VO2max, from 45.4 (38.4,52.5) to 56.9 (51.2,65.7) (median (interquartile range)(ml/min/kg)). In responders HIIT resulted in a decrease in systolic BP from 127 (126,129) to 116 (106,122) (mmHg) with p = 0.026 and a decrease is diastolic blood pressure from 72 (69,74) to 57 (56,66) with p = 0.026. There was also some evidence of a beneficial change in blood lipid and glucose concentrations with HIIT. In conclusion, personalised HIIT has potential as an intervention to improve blood flow and cardiovascular health.

  5. Screening instruments for a population of older adults: The 10-item Kessler Psychological Distress Scale (K10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7).

    PubMed

    Vasiliadis, Helen-Maria; Chudzinski, Veronica; Gontijo-Guerra, Samantha; Préville, Michel

    2015-07-30

    Screening tools that appropriately detect older adults' mental disorders are of great public health importance. The present study aimed to establish cutoff scores for the 10-item Kessler Psychological Distress (K10) and the 7-item Generalized Anxiety Disorder (GAD-7) scales when screening for depression and anxiety. We used data from participants (n = 1811) in the Enquête sur la Santé des Aînés-Service study. Depression and anxiety were measured using DSM-V and DSM-IV criteria. Receiver operating characteristic (ROC) curve analysis provided an area under the curve (AUC) of 0.767 and 0.833 for minor and for major depression when using K10. A cutoff of 19 was found to balance sensitivity (0.794) and specificity (0.664) for minor depression, whereas a cutoff of 23 was found to balance sensitivity (0.692) and specificity (0.811) for major depression. When screening for an anxiety with GAD-7, ROC analysis yielded an AUC of 0.695; a cutoff of 5 was found to balance sensitivity (0.709) and specificity (0.568). No significant differences were found between subgroups of age and gender. Both K10 and GAD-7 were able to discriminate between cases and non-cases when screening for depression and anxiety in an older adult population of primary care service users.

  6. Obese children, adults and senior citizens in the eyes of the general public: results of a representative study on stigma and causation of obesity.

    PubMed

    Sikorski, Claudia; Luppa, Melanie; Brähler, Elmar; König, Hans-Helmut; Riedel-Heller, Steffi G

    2012-01-01

    Obese individuals are blamed for their excess weight based on causal attribution to the individual. It is unclear whether obese individuals of different age groups and gender are faced with the same amount of stigmatization. This information is important in order to identify groups of individuals at risk for higher stigmatization and discrimination. A telephone interview was conducted in a representative sample of 3,003 participants. Experimental manipulation was realized by vignettes describing obese and normal-weight children, adults and senior citizens. Stigmatizing attitudes were measured by semantic differential. Causal attribution was assessed. Internal factors were rated with highest agreement rates as a cause for the vignette's obesity. Lack of activity behavior and eating too much are the most supported causes. Importance of causes differed for the different vignettes. For the child, external causes were considered more important. The overweight vignette was rated consistently more negatively. Higher educational attainment and personal obesity were associated with lower stigmatizing attitudes. The vignette of the obese child was rated more negatively compared to that of an adult or senior citizen. Obesity is seen as a controllable condition, but for children external factors are seen as well. Despite this finding, they are faced with higher stigmatizing attitudes in the general public, contradicting attribution theory assumptions. Internal and external attribution were found to be inter-correlated. Obese children are the population most at risk for being confronted with stigmatization, making them a target point in stigma-reduction campaigns.

  7. Obese Children, Adults and Senior Citizens in the Eyes of the General Public: Results of a Representative Study on Stigma and Causation of Obesity

    PubMed Central

    Sikorski, Claudia; Luppa, Melanie; Brähler, Elmar; König, Hans-Helmut; Riedel-Heller, Steffi G.

    2012-01-01

    Obese individuals are blamed for their excess weight based on causal attribution to the individual. It is unclear whether obese individuals of different age groups and gender are faced with the same amount of stigmatization. This information is important in order to identify groups of individuals at risk for higher stigmatization and discrimination. A telephone interview was conducted in a representative sample of 3,003 participants. Experimental manipulation was realized by vignettes describing obese and normal-weight children, adults and senior citizens. Stigmatizing attitudes were measured by semantic differential. Causal attribution was assessed. Internal factors were rated with highest agreement rates as a cause for the vignette's obesity. Lack of activity behavior and eating too much are the most supported causes. Importance of causes differed for the different vignettes. For the child, external causes were considered more important. The overweight vignette was rated consistently more negatively. Higher educational attainment and personal obesity were associated with lower stigmatizing attitudes. The vignette of the obese child was rated more negatively compared to that of an adult or senior citizen. Obesity is seen as a controllable condition, but for children external factors are seen as well. Despite this finding, they are faced with higher stigmatizing attitudes in the general public, contradicting attribution theory assumptions. Internal and external attribution were found to be inter-correlated. Obese children are the population most at risk for being confronted with stigmatization, making them a target point in stigma-reduction campaigns. PMID:23071664

  8. Associations of objectively measured moderate-to-vigorous-intensity physical activity and sedentary time with all-cause mortality in a population of adults at high risk of type 2 diabetes mellitus.

    PubMed

    Bakrania, Kishan; Edwardson, Charlotte L; Khunti, Kamlesh; Henson, Joseph; Stamatakis, Emmanuel; Hamer, Mark; Davies, Melanie J; Yates, Thomas

    2017-03-01

    The relationships of physical activity and sedentary time with all-cause mortality in those at high risk of type 2 diabetes mellitus (T2DM) are unexplored. To address this gap in knowledge, we examined the associations of objectively measured moderate-to-vigorous-intensity physical activity (MVPA) and sedentary time with all-cause mortality in a population of adults at high risk of T2DM. In 2010-2011, 712 adults (Leicestershire, U.K.), identified as being at high risk of T2DM, consented to be followed up for mortality. MVPA and sedentary time were assessed by accelerometer; those with valid data (≥ 10 hours of wear-time/day with ≥ 4 days of data) were included. Cox proportional hazards regression models, adjusted for potential confounders, were used to investigate the independent associations of MVPA and sedentary time with all-cause mortality. 683 participants (250 females (36.6%)) were included and during a mean follow-up period of 5.7 years, 26 deaths were registered. Every 10% increase in MVPA time/day was associated with a 5% lower risk of all-cause mortality [Hazard Ratio (HR): 0.95 (95% Confidence Interval (95% CI): 0.91, 0.98); p = 0.004]; indicating that for the average adult in this cohort undertaking approximately 27.5 minutes of MVPA/day, this benefit would be associated with only 2.75 additional minutes of MVPA/day. Conversely, sedentary time showed no association with all-cause mortality [HR (every 10-minute increase in sedentary time/day): 0.99 (95% CI: 0.95, 1.03); p = 0.589]. These data support the importance of MVPA in adults at high risk of T2DM. The association between sedentary time and mortality in this population needs further investigation.

  9. Parent inclusion in Early Intensive Behavioral Intervention: the influence of parental stress, parent treatment fidelity and parent-mediated generalization of behavior targets on child outcomes.

    PubMed

    Strauss, Kristin; Vicari, Stefano; Valeri, Giovanni; D'Elia, Lidia; Arima, Serena; Fava, Leonardo

    2012-01-01

    Although early intensive behavior interventions have been efficient in producing positive behavior outcome in young children with Autism Spectrum Disorder, there is a considerable variety in the children's progress. Research has suggested that parental and treatment factors are likely to affect children's response to treatment. The purpose of the current study was to examine the interrelating factors that impact children's progress, highlighting the influence of parent inclusion in treatment provision captured by parental stress, how faithfully the parents followed the treatment protocols and the intensity of treatment provided at home. Twenty-four children received cross-setting staff- and parent-mediated EIBI, including continuous parent training and supervision. A comparison group of 20 children received eclectic intervention. Standardized tests were carried out by independent examiners at intake and after six months. The intervention group outperformed the eclectic group in measures of autism severity, developmental and language skills. Parent training and constant parent-mediated treatment provision led to reduced challenging behaviors from the children, increased treatment fidelity and child direct behavior change as measured by performance in correct responding on behavior targets. Variables of treatment progress and potential predictors of child outcome were analyzed in detail and mapped with regard to their relationships drawn from multiple regression analysis. Particularly, the study highlights an association between parental stress and staff treatment fidelity that interferes with decision making in treatment planning and consequently with positive behavior outcome. Such results provide important scientific and clinical information on parental and treatment factors likely to affect a child's response to treatment.

  10. The Geography of Diabetes among the General Adults Aged 35 Years and Older in Bangladesh: Recent Evidence from a Cross-Sectional Survey

    PubMed Central

    Khan, Md. Mobarak Hossain; Gruebner, Oliver; Kraemer, Alexander

    2014-01-01

    Objective To report geographical variations of sex-specific diabetes by place of residence (large cities/city corporations, small towns/other urban areas, rural areas) and region of residence (divided into seven divisions) among general adults (35+ years of age) in Bangladesh. Methods The recent cross-sectional data, extracted from the nationally representative Bangladesh Demographic and Health Survey 2011, was used. A total of 3,720 men and 3,823 women aged 35+ years, who participated in the fasting blood sugar testing, were analysed. Any person with either fasting plasma glucose level (mmol/L) ≥7.0 or taking medication for diabetes was considered as a person with diabetes. Results The prevalence of diabetes was 10.6% in men and 11.3% in women. Bivariable analyses indicated significant variations of diabetes by both geographical variables. The prevalence was highest in city corporations (men 18.0%, women 22.3%), followed by small towns (men 13.6%, women 15.2%) and rural areas (men 9.3%, women 9.5%). Regional disparities in diabetes prevalence were also remarkable, with the highest prevalence in Chittagong division and lowest prevalence in Khulna division. Multivariable logistic regression analyses provided mixed patterns of geographical disparities (depending on the adjusted variables). Some other independent risk factors for diabetes were advancing age, higher level of education and wealth, having TV (a proxy indicator of physical activity), overweight/obesity and hypertension. Conclusions Over 10% of the general adults aged 35 years and older were having diabetes. Most of the persons with diabetes were unaware of this before testing fasting plasma glucose level. Although significant disparities in diabetes prevalence by geographical variables were observed, such disparities are very much influenced by the adjusted variables. Finally, we underscore the necessities of area-specific strategies including early diagnosis and health education programmes for changing

  11. 20 CFR 663.220 - Who may receive intensive services?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) ADULT AND DISLOCATED WORKER ACTIVITIES UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Intensive Services § 663.220 Who may receive intensive services? There are two categories of adults and dislocated workers who may receive intensive services: (a) Adults and dislocated workers who are unemployed,...

  12. 20 CFR 663.220 - Who may receive intensive services?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...) ADULT AND DISLOCATED WORKER ACTIVITIES UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Intensive Services § 663.220 Who may receive intensive services? There are two categories of adults and dislocated workers who may receive intensive services: (a) Adults and dislocated workers who are unemployed,...

  13. The general practitioner's role in promoting physical activity to older adults: a review based on program theory.

    PubMed

    Hinrichs, Timo; Brach, Michael

    2012-02-01

    Positive influences of physical activity both on many chronic diseases and on preservation of mobility are well documented. But chronically ill or mobility restricted elderly living in their own homes are difficult to reach for interventions. The general practitioner's (GP) surgery offers one of the few opportunities to give advice for physical activity to those people. We used program theory to sound out knowledge on GP-centered physical activity counseling. The "conceptual theory" (evidence for training effects in old age) and the "implementation theory" (unique position of the GP) were reviewed narratively. The "action theory" (effects of GP counseling) was reviewed systematically. According to program theory, appropriate MeSH (Medical subject headings) concepts were Aged OR Aged, 80 and over (Target group), Physicians, Family OR Primary Health Care (Implementation/Setting), Counseling OR Patient Education as Topic OR Disease Management OR Health promotion (Intervention), Exercise OR Motor Activity OR Physical Fitness OR Sports (Determinants). The resulting six review papers (Pubmed, 2000-2009) were presented using the STARLITE mnemonic. Authors agree, that the GP plays a central role in the promotion of physical activity to elderly people, but there is conflicting evidence concerning counseling effectiveness. Utilizing behavioral change strategies and the collaboration between GPs and specialised professions are recommended and currently under research.

  14. Effects of a High-Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia

    PubMed Central

    Toots, Annika; Littbrand, Håkan; Lindelöf, Nina; Wiklund, Robert; Holmberg, Henrik; Nordström, Peter; Lundin-Olsson, Lillemor; Gustafson, Yngve; Rosendahl, Erik

    2016-01-01

    Objectives To investigate the effects of a high-intensity functional exercise program on independence in activities of  daily living (ADLs) and balance in older people with dementia and whether exercise effects differed between dementia types. Design Cluster-randomized controlled trial: Umeå Dementia and Exercise (UMDEX) study. Setting Residential care facilities, Umeå, Sweden. Participants Individuals aged 65 and older with a dementia diagnosis, a Mini-Mental State Examination score of 10 or greater, and dependence in ADLs (N = 186). Intervention Ninety-three participants each were allocated to the high-intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity. Measurements Blinded assessors measured ADL independence using the Functional Independence Measure (FIM) and Barthel Index (BI) and balance using the Berg Balance Scale (BBS) at baseline and 4 (directly after intervention completion) and 7 months. Results Linear mixed models showed no between-group effect on ADL independence at 4 (FIM=1.3, 95% confidence interval (CI)=−1.6–4.3; BI=0.6, 95% CI=−0.2–1.4) or 7 (FIM=0.8, 95% CI=−2.2–3.8; BI=0.6, 95% CI=−0.3–1.4) months. A significant between-group effect on balance favoring exercise was observed at 4 months (BBS=4.2, 95% CI=1.8–6.6). In interaction analyses, exercise effects differed significantly between dementia types. Positive between-group exercise effects were found in participants with non-Alzheimer's dementia according to the FIM at 7 months and BI and BBS at 4 and 7 months. Conclusion In older people with mild to moderate dementia living in residential care facilities, a 4-month high-intensity functional exercise program appears to slow decline in ADL independence and improve balance, albeit only in participants with non-Alzheimer's dementia. PMID:26782852

  15. Lu AA21004, a multimodal psychotropic agent, in the prevention of relapse in adult patients with generalized anxiety disorder.

    PubMed

    Baldwin, David S; Loft, Henrik; Florea, Ioana

    2012-07-01

    The purpose of this study was to investigate the long-term maintenance of the efficacy of Lu AA21004 5 or 10 mg/day in the prevention of relapse in patients with generalized anxiety disorder (GAD). Patients (n = 687) with a primary diagnosis of GAD (DSM-IV criteria) and a baseline Hamilton Anxiety (HAM-A) total score of at least 20 underwent a 20-week, open-label Lu AA21004 treatment. In all, 459 patients responded and were randomized to 24-56 weeks of a double-blind treatment with Lu AA21004 (n = 229) or placebo (n = 230). The predefined primary efficacy endpoint was time to relapse (HAM-A total score ≥ 15) using a Cox model; the key secondary efficacy endpoint under multiplicity control was time to relapse for patients responding to treatment for at least 12 weeks. The primary analysis showed a statistically significant effect of Lu AA21004 relative to the placebo on the time to relapse of GAD, with a hazard ratio of 2.71 (P < 0.001). There was a statistically significant effect of Lu AA21004 in the stable responders (hazard ratio = 3.06, P < 0.001). Lu AA21004 was well tolerated, with withdrawal rates due to adverse events of 9% (open-label) and 3% (placebo) and 4% (Lu AA21004) in the double-blind period. In this study, Lu AA21004 5 or 10 mg/day was efficacious in preventing relapse and was well tolerated in the maintenance treatment of GAD.

  16. First results about recovery of walking function in patients with intensive care unit-acquired muscle weakness from the General Weakness Syndrome Therapy (GymNAST) cohort study

    PubMed Central

    Mehrholz, Jan; Mückel, Simone; Oehmichen, Frank; Pohl, Marcus

    2015-01-01

    Objectives To describe the time course of recovery of walking function and other activities of daily living in patients with intensive care unit (ICU)-acquired muscle weakness. Design This is a cohort study. Participants We included critically ill patients with ICU-acquired muscle weakness. Setting Post-acute ICU and rehabilitation units in Germany. Measures We measured walking function, muscle strength, activities in daily living, motor and cognitive function. Results We recruited 150 patients (30% female) who fulfilled our inclusion and exclusion criteria. The primary outcome recovery of walking function was achieved after a median of 28.5 days (IQR=45) after rehabilitation onset and after a median of 81.5 days (IQR=64) after onset of illness. Our final multivariate model for recovery of walking function included two clinical variables from baseline: the Functional Status Score ICU (adjusted HR=1.07 (95% CI 1.03 to 1.12) and the ability to reach forward in cm (adjusted HR=1.02 (95% CI 1.00 to 1.04). All secondary outcomes but not pain improved significantly in the first 8 weeks after study onset. Conclusions We found good recovery of walking function for most patients and described the recovery of walking function of people with ICU-acquired muscle weakness. Trials registrations number Sächsische Landesärztekammer EK-BR-32/13-1; DRKS00007181, German Register of Clinical Trials. PMID:26700274

  17. Development of review criteria for assessing the quality of management of stable angina, adult asthma, and non-insulin dependent diabetes mellitus in general practice

    PubMed Central

    Campbell, S. M.; Roland, M. O.; Shekelle, P. G.; Cantrill, J. A.; Buetow, S. A.; Cragg, D. K.

    1999-01-01

    OBJECTIVE: To develop review criteria to assess the quality of care for three major chronic diseases: adult asthma, stable angina, and non- insulin dependent diabetes mellitus. SUBJECTS AND METHODS: Modified panel process based upon the RAND/UCLA (University College of Los Angeles) appropriateness method. Three multiprofessional panels made up of general practitioners, hospital specialists, and practice nurses. RESULTS: The RAND/UCLA appropriateness method of augmenting evidence with expert opinion was used to develop criteria for the care of the three conditions. Of those aspects of care which were rated as necessary by the panels, only 26% (16% asthma, 10% non-insulin dependent diabetes, 40% angina) were subsequently rated by the panels as being based on strong scientific evidence. CONCLUSION: The results show the importance of a systematic approach to combining evidence with expert opinion to develop review criteria for assessing the quality of three chronic diseases in general practice. The evidence base for the criteria was often incomplete, and explicit methods need to be used to combine evidence with expert opinion where evidence is not available. PMID:10557672

  18. Does Training and Support of General Practitioners in Intensive Treatment of People with Screen-Detected Diabetes Improve Medication, Morbidity and Mortality in People with Clinically-Diagnosed Diabetes? Investigation of a Spill-Over Effect in a Cluster RCT

    PubMed Central

    Skriver, Mette V.; Griffin, Simon J.; Simmons, Rebecca K.; Witte, Daniel R.; Dalsgaard, Else-Marie; Lauritzen, Torsten; Sandbæk, Annelli

    2017-01-01

    Introduction Very few studies have examined the potential spill-over effect of a trial intervention in general practice. We investigated whether training and support of general practitioners in the intensive treatment of people with screen-detected diabetes improved rates of redeemed medication, morbidity and mortality in people with clinically-diagnosed diabetes. Methods This is a secondary, post-hoc, register-based analysis linked to a cluster randomised trial. In the ADDITION-Denmark trial, 175 general practices were cluster randomised (i) to routine care, or (ii) to receive training and support in intensive multifactorial treatment of individuals with screen-detected diabetes (2001 to 2009). Using national registers we identified all individuals who were diagnosed with clinically incident diabetes in the same practices over the same time period. (Patients participating in the ADDITION trial were excluded). We compared rates of redeemed medication, a cardiovascular composite endpoint, and all-cause mortality between the routine care and intensive treatment groups. Results In total, 4,107 individuals were diagnosed with clinically incident diabetes in ADDITION-Denmark practices between 2001 and 2009 (2,051 in the routine care group and 2,056 in the intensive treatment group). There were large and significant increases in the proportion of patients redeeming cardio-protective medication in both treatment groups during follow-up. After a median of seven years of follow-up, there was no difference in the incidence of a composite cardiovascular endpoint (HR 1.15, 95% CI 0.95 to 1.38) or all-cause mortality between the two groups (HR 1.08, 95% CI 0.94 to 1.23). Discussion There was no evidence of a spill-over effect from an intervention promoting intensive treatment of people with screen-detected diabetes to those with clinically-diagnosed diabetes. Overall, the proportion of patients redeeming cardio-protective medication during follow-up was similar in both groups

  19. Prior heavy exercise elevates pyruvate dehydrogenase activity and speeds O2 uptake kinetics during subsequent moderate-intensity exercise in healthy young adults

    PubMed Central

    Gurd, B J; Peters, S J; Heigenhauser, G J F; LeBlanc, P J; Doherty, T J; Paterson, D H; Kowalchuk, J M

    2006-01-01

    The adaptation of pulmonary oxygen uptake V˙O2 during the transition to moderate-intensity exercise (Mod) is faster following a prior bout of heavy-intensity exercise. In the present study we examined the activation of pyruvate dehydrogenase (PDHa) during Mod both with and without prior heavy-intensity exercise. Subjects (n = 9) performed a Mod1–heavy-intensity–Mod2 exercise protocol preceded by 20 W baseline. Breath-by-breath V˙O2 kinetics and near-infrared spectroscopy-derived muscle oxygenation were measured continuously, and muscle biopsy samples were taken at specific times during the transition to Mod. In Mod1, PDHa increased from baseline (1.08 ± 0.2 mmol min−1 (kg wet wt)−1) to 30 s (2.05 ± 0.2 mmol min−1 (kg wet wt)−1), with no additional change at 6 min exercise (2.07 ± 0.3 mmol min−1 (kg wet wt)−1). In Mod2, PDHa was already elevated at baseline (1.88 ± 0.3 mmol min−1 (kg wet wt)−1) and was greater than in Mod1, and did not change at 30 s (1.96 ± 0.2 mmol min−1 (kg wet wt)−1) but increased at 6 min exercise (2.70 ± 0.3 mmol min−1 (kg wet wt)−1). The time constant of V˙O2 was lower in Mod2 (19 ± 2 s) than Mod1 (24 ± 3 s). Phosphocreatine (PCr) breakdown from baseline to 30 s was greater (P < 0.05) in Mod1 (13.6 ± 6.7 mmol (kg dry wt)−1) than Mod2 (6.5 ± 6.2 mmol (kg dry wt)−1) but total PCr breakdown was similar between conditions (Mod1, 14.8 ± 7.4 mmol (kg dry wt)−1; Mod2, 20.1 ± 8.0 mmol (kg dry wt)−1). Both oxyhaemoglobin and total haemoglobin were elevated prior to and throughout Mod2 compared with Mod1. In conclusion, the greater PDHa at baseline prior to Mod2 compared with Mod1 may have contributed in part to the faster V˙O2 kinetics in Mod2. That oxyhaemoglobin and total haemoglobin were elevated prior to Mod2 suggests that greater muscle perfusion may also have contributed to the observed faster V˙O2 kinetics. These findings are consistent with metabolic inertia, via delayed activation of PDH

  20. Initial fluconazole prophylaxis may not be required in adults with acute leukemia or myelodysplastic/myeloproliferative disorders after reduced intensity conditioning peripheral blood stem cell allogeneic transplantation.

    PubMed

    Brissot, Eolia; Cahu, Xavier; Guillaume, Thierry; Delaunay, Jacques; Ayari, Sameh; Peterlin, Pierre; Le Bourgeois, Amandine; Harousseau, Jean-Luc; Milpied, Noel; Bene, Marie-Christine; Moreau, Philippe; Mohty, Mohamad; Chevallier, Patrice

    2015-04-01

    In the myeloablative transplant setting, the early use of fluconazole prophylaxis provides a benefit in overall survival. Recent changes in transplantation practices, including the use of peripheral blood stem cells (PBSC) and/or reduced intensity conditioning (RIC) regimen may have favorably impacted the epidemiology of invasive fungal infections (IFI) after allogeneic stem cell transplantation (allo-SCT). Yet, the impact of removing fluconazole prophylaxis after RIC PBSC allotransplant is ill known. Here, a retrospective analysis was performed comparing patients who received fluconazole as antifungal prophylaxis (n = 53) or not (n = 56) after allo-SCT for acute leukemia or myelodysplastic/myeloproliferative syndrome. Sixteen IFI were documented (14 %) at a median time of 103 days after transplantation, including eight before day +100, at a similar rate, whether the patients received fluconazole prophylaxis (13 %) or not (16 %). IFI were due mainly to Aspergillus species (87 %), and only two Candida-related IFI (13 %) were documented in the non-fluconazole group before day +100. The incidences of IFI (overall, before or after day +100) as well as 3-year overall and disease-free survival, non-relapse mortality, or acute and chronic graft-versus-host disease (GVHD) were similar between both groups. In conclusion, this study suggests that fluconazole may not be required at the initial phase of RIC allo-SCT using PBSC. This result has to be confirmed prospectively while Aspergillus prophylaxis should be discussed in this particular setting.

  1. Screening for Intestinal Colonization with Vancomycin Resistant Enterococci and Associated Risk Factors among Patients Admitted to an Adult Intensive Care Unit of a Large Teaching Hospital

    PubMed Central

    Amberpet, Rajesh; Parija, Subhash Chandra; Thabah, Molly Mary

    2016-01-01

    Introduction Gut colonization with Vancomycin Resistant Enterococci (VRE) increases the risk of acquiring infection during hospital stay. Patients admitted in the ICU’s are the major reservoirs for VRE colonization due to higher antibiotic pressure. Aim To determine the rate of VRE colonization among patients admitted in the Medical Intensive Care Unit (MICU) and to assess the various risk factors which are associated with VRE colonization. Materials and Methods This was a prospective study carried out over a period of 18 months from September 2013 to February 2015 in the Jawaharlal Institute of Post graduate Medical Education and Research (JIPMER), Pondicherry, South India. After 48 hours of ICU admission rectal swabs were collected from a total of 302 patients, admitted in MICU. The samples were inoculated on to Bile Esculin Sodium Azide agar with 6mg/L of vancomycin. Vancomycin resistance was confirmed by determination of Minimum Inhibitory Concentration (MIC) by agar dilution method. Isolates were identified up to species level by standard biochemical tests. Vancomycin resistance genes such as van A, van B and van C, were detected by Polymerase Chain Reaction (PCR). Risk factors were assessed by multivariate logistic regression analysis. Results The rates of VRE colonization in patients admitted to MICU was 29%. Majority of the isolates were Enterococcus faecium (77.2 %) followed by Enterococcus faecalis (23.8%). All the VRE isolates were positive for van A gene. Increased duration of hospital stay, younger age, consumption of ceftriaxone and vancomycin were found to be significantly associated with VRE colonization in MICU. Among VRE colonized patients, six (4.5%) acquired VRE infection. Conclusion The rates of VRE colonization in our ICU were similar to other hospitals worldwide. Educating health care workers on the importance of adherence to hand hygiene is essential to bring down VRE colonization rates. PMID:27790430

  2. Low 25(OH) Vitamin D3 Levels Are Associated with Adverse Outcome in Newly-Diagnosed Intensively-Treated Adult Acute Myeloid Leukemia Patients

    PubMed Central

    Lee, Hun Ju; Muindi, Josephia R.; Tan, Wei; Hu, Qiang; Wang, Dan; Liu, Song; Wilding, Gregory E.; Ford, Laurie A.; Sait, Sheila N.J.; Block, Annemarie W.; Adjei, Araba A.; Barcos, Maurice; Griffiths, Elizabeth A; Thompson, James E.; Wang, Eunice S.; Johnson, Candace S; Trump, Donald L.; Wetzler, Meir

    2013-01-01

    Background Several studies suggest that low 25(OH) vitamin D3 levels may be prognostic in some malignancies, but no studies have evaluated their impact on treatment outcome in acute myeloid leukemia (AML). Methods VD levels were evaluated in 97 consecutive newly diagnosed, intensively-treated AML patients. MicroRNA-expression profiles and single nucleotide polymorphisms (SNPs) in the 25(OH) vitamin D3 pathway genes were evaluated and correlated with 25(OH) vitamin D3 levels and treatment outcome. Results Thirty-four (35%) patients had normal 25(OH) vitamin D3 levels (32–100 ng/ml), 34 (35%) insufficient (20–31.9 ng/ml) and 29 (30%) deficient levels (<20 ng/ml). Insufficient/deficient 25(OH) vitamin D3 levels were associated with worse relapse-free survival (RFS) compared to normal vitamin D3 levels. In multivariate analyses, deficient 25(OH) vitamin D3, smoking, European LeukemiaNet Genetic Groups and white blood cell count retained their statistical significance for RFS. A number of microRNAs and SNPs were found to be associated with 25(OH) vitamin D3 level, although none remained significant after multiple test corrections; one 25(OH) vitamin D3 receptor SNP, rs10783219, was associated with lower complete remission rate (p=0.0442), shorter RFS (p=0.0058) and overall survival (p=0.0011). Conclusions It remains to be determined what role microRNA and SNP profiles play in contributing to low 25(OH) vitamin D3 level and/or outcome and whether supplementation will improve AML outcome. PMID:24166051

  3. Validation of the German Diabetes Risk Score among the general adult population: findings from the German Health Interview and Examination Surveys

    PubMed Central

    Paprott, Rebecca; Mühlenbruch, Kristin; Mensink, Gert B M; Thiele, Silke; Schulze, Matthias B; Scheidt-Nave, Christa; Heidemann, Christin

    2016-01-01

    Objective To evaluate the German Diabetes Risk Score (GDRS) among the general adult German population for prediction of incident type 2 diabetes and detection of prevalent undiagnosed diabetes. Methods The longitudinal sample for prediction of incident diagnosed type 2 diabetes included 3625 persons who participated both in the examination survey in 1997–1999 and the examination survey in 2008–2011. Incident diagnosed type 2 diabetes was defined as first-time physician diagnosis or antidiabetic medication during 5 years of follow-up excluding potential incident type 1 and gestational diabetes. The cross-sectional sample for detection of prevalent undiagnosed diabetes included 6048 participants without diagnosed diabetes of the examination survey in 2008–2011. Prevalent undiagnosed diabetes was defined as glycated haemoglobin ≥6.5% (48 mmol/mol). We assessed discrimination as area under the receiver operating characteristic curve (ROC-AUC (95% CI)) and calibration through calibration plots. Results In longitudinal analyses, 82 subjects with incident diagnosed type 2 diabetes were identified after 5 years of follow-up. For prediction of incident diagnosed diabetes, the GDRS yielded an ROC-AUC of 0.87 (0.83 to 0.90). Calibration plots indicated excellent prediction for low diabetes risk and overestimation for intermediate and high diabetes risk. When considering the entire follow-up period of 11.9 years (ROC-AUC: 0.84 (0.82 to 0.86)) and including incident undiagnosed diabetes (ROC-AUC: 0.81 (0.78 to 0.84)), discrimination decreased somewhat. A previously simplified paper version of the GDRS yielded a similar predictive ability (ROC-AUC: 0.86 (0.82 to 0.89)). In cross-sectional analyses, 128 subjects with undiagnosed diabetes were identified. For detection of prevalent undiagnosed diabetes, the ROC-AUC was 0.84 (0.81 to 0.86). Again, the simplified version yielded a similar result (ROC-AUC: 0.83 (0.80 to 0.86)). Conclusions The GDRS might be applied

  4. Validation of components of the water cycle in the ECHAM4 general circulation model based on the Newtonian relaxation technique: a case study of an intense winter cyclone

    NASA Astrophysics Data System (ADS)

    Bauer, Hans-Stefan; Wulfmeyer, Volker

    2009-07-01

    The representation of a simulated synoptic-scale weather system is compared with observations. To force the model to the observed state, the so-called Newtonian relaxation technique (nudging) is applied to relax vorticity, divergence, temperature, and the logarithm of surface pressure to the European Centre for Medium-Range Weather Forecasts (ECMWF) reanalysis fields. The development of an extraordinary strong cyclone along the East Coast of the USA during 12-14 March 1993 was chosen as the case study. The synoptic-scale features were well represented in the model simulation. However, systematic differences to observations of the International Satellite Cloud Climatology Project (ISCCP) occurred. The model underestimated clouds in lower and middle levels of the troposphere. Low-level clouds were mainly underestimated behind the cold front of the developing cyclone, while the underestimation of mid-level clouds seems to be a more general feature. The reason for the latter is the fact that the relative humidity has to exceed a critical threshold before clouds can develop. In contrast, thin upper-level cirrus clouds in pre-frontal regions were systematically overestimated by the model. Therefore, we investigated the effects of changed physical parameterizations with two sensitivity studies. In the PCI experiment, the standard cloud scheme operated in ECHAM4 was replaced by a more sophisticated one which defines separate prognostic equations for cloud liquid water and cloud ice. The second experiment, RHCRIT, changed the profile of the critical relative humidity threshold for the development of clouds in the standard scheme. Both experiments showed positive changes in the representation of clouds during the development of the cyclone as compared to the ISCCP. PCI clearly reduced the upper-level cloud amounts by intensifying the precipitation flux in the middle troposphere. The changed condensation threshold in the RHCRIT experiment led to a sharper represented cold

  5. Rich Environments for Adult Learners

    ERIC Educational Resources Information Center

    Bentham, Renee

    2008-01-01

    Unaware of the messages a bare adult learning environment sends and its effect on adult learners, a trainer attends an intensive Reggio Emilia course and learns that the physical environment is the "third teacher"--for adults as well as for children. Using principles of Reggio, she offers suggestions for enhancing adult learning spaces and…

  6. Current sources of lead exposure and their relative contributions to the blood lead levels in the general adult population of Northern France: The IMEPOGE Study, 2008-2010.

    PubMed

    Tagne-Fotso, Romuald; Leroyer, Ariane; Howsam, Mike; Dehon, Betty; Richeval, Camille; Nisse, Catherine

    2016-01-01

    There is justification for limiting lead (Pb) exposure as much as possible, given its impact on health at low concentrations. Consequently, the aim of this study was to measure blood lead levels (BLL) and examine exposure factors related to BLL variations in the general adult population of northern France, a current and past industrial area. Two thousand inhabitants of northern France, aged between 20 and 59 years, were recruited using the quota method with caution. Blood lead levels were quantified by inductively coupled plasma-mass spectroscopy (ICP-MS), and variation factors were studied separately in men and women using multivariate stepwise linear and logistic regression models. The geometric mean of the BLL was 18.8 μg/L (95% confidence interval [CI]: 18.3-19.3). Occupational factors affected BLL only in men and represented 14% of total explained variance of BLL. External occupational factors significantly increasing mean levels of BLL were tobacco, consumption of some beverages (wine, coffee, tea, and/or tap water), raw vegetables, housing characteristics (built prior to 1948, Pb piping in the home) and do-it-yourself or leisure activities (paint stripping or rifle shooting). Consumption habits accounted together for 25% and 18% of the total explained variance, respectively, in men and women. Industrial environment did not significantly contribute to BLL variations. Blood lead levels observed in the general population of this industrial part of France did not appear to be excessively elevated compared to values found internationally. Nonetheless, these BLL remain a public health issue in regard to nonthreshold toxicity attributed to Pb.

  7. Contemporary use of antibiotics in 1089 adults presenting with acute lower respiratory tract illness in general practice in the U.K.: implications for developing management guidelines.

    PubMed

    Macfarlane, J; Lewis, S A; Macfarlane, R; Holmes, W

    1997-08-01

    Respiratory symptoms are the most common cause of general practitioner (GP) consultation, and hospital-based specialists are often called on to provide management guidelines, particularly in the area of antibiotic prescribing. The present authors have assessed factors associated with antibiotic use by 115 GPs when managing 1089 adults with an acute lower respiratory tract illness, including cough. They prescribed antibiotics to three-quarters of patients, but felt antibiotics to be definitely indicated in less than one-third of these cases and not needed in one-fifth. Univariate analysis revealed that antibiotics were prescribed more frequently by older GPs for older patients in the presence of underlying disease, discoloured sputum, shortness of breath, wheeze, fever, signs on chest examination, and 'other factors'. Multivariate logistic regression confirmed an independent effect for all these findings except for the presence of underlying disease, shortness of breath and wheeze. 'Other factors' included patient 'pressure' and social factors, and GP work pressure or prior experience with the patient. These factors were an important influence on prescribing, especially if the GP felt an antibiotic was not indicated. Amoxycillin was the first choice (58% of total) except where the patient had recently received antibiotics for the same illness. Broader spectrum antibiotics were used more commonly in patients with chronic lung disease, discoloured sputum, chest signs on examination and where the GP felt antibiotics were indicated. However, these antibiotics were also prescribed to 14% of previously well patients. General practitioners used a wide variety of terms to describe the illness with little consistency or structure. The decision concerning the use and choice of antibiotics and the confidence with which the GP makes that decision is a complex interaction between patient, doctor and disease, being affected not only by clinical features but also by the social and

  8. Confirmation of the factorial structure of the Japanese short version of the TEMPS-A in psychiatric patients and general adults

    PubMed Central

    Nakato, Yasuya; Inoue, Takeshi; Nakagawa, Shin; Kitaichi, Yuji; Kameyama, Rie; Wakatsuki, Yumi; Kitagawa, Kan; Omiya, Yuki; Kusumi, Ichiro

    2016-01-01

    Background The Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) is a 110-item questionnaire that assesses five affective temperaments. However, a valid shortened version is desired for large-scale investigations to enhance the compliance of respondents. Methods A confirmatory factor analysis was conducted among 320 psychiatric patients and 61 general adults. The participants completed the Japanese 39-item short version of the TEMPS-A, and a portion of the participants completed the 110-item version. An exploratory factor analysis with the principal factor method and varimax rotation was conducted to identify a more suitable model of the short version of the TEMPS-A. Results The confirmatory factor analysis revealed that the 39-item version exhibited a poor model fit. However, we found that the 18-item version exhibited a firm five-factor structure based on the exploratory factor analysis, and this model exhibited an acceptable model fit. It had good or acceptable internal consistency (Cronbach’s αs: 0.672–0.819). Limitations The majority of the subjects in the present study were patients, and the temperament data may have been affected by psychiatric symptoms. Conclusion A firm five-factor structure was not found in the 39-item short version of the Japanese TEMPS-A. Therefore, an 18-item version was proposed. This new 18-item version of the TEMPS-A might be useful for clinical applications and large-scale investigations. PMID:27601911

  9. Triple Comorbid Trajectories of Tobacco, Alcohol, and Marijuana Use as Predictors of Antisocial Personality Disorder and Generalized Anxiety Disorder Among Urban Adults

    PubMed Central

    Brook, Judith S.; Lee, Jung Yeon; Rubenstone, Elizabeth; Brook, David W.; Finch, Stephen J.

    2014-01-01

    Objectives. We modeled triple trajectories of tobacco, alcohol, and marijuana use from adolescence to adulthood as predictors of antisocial personality disorder (ASPD) and generalized anxiety disorder (GAD). Methods. We assessed urban African American and Puerto Rican participants (n = 816) in the Harlem Longitudinal Development Study, a psychosocial investigation, at 4 time waves (mean ages = 19, 24, 29, and 32 years). We used Mplus to obtain the 3 variable trajectories of tobacco, alcohol, and marijuana use from time 2 to time 5 and then conducted logistic regression analyses. Results. A 5-trajectory group model, ranging from the use of all 3 substances (23%) to a nonuse group (9%), best fit the data. Membership in the trajectory group that used all 3 substances was associated with an increased likelihood of both ASPD (adjusted odds ratio [AOR] = 6.83; 95% CI = 1.14, 40.74; P < .05) and GAD (AOR = 4.35; 95% CI = 1.63, 11.63; P < .001) in adulthood, as compared with the nonuse group, with control for earlier proxies of these conditions. Conclusions. Adults with comorbid tobacco, alcohol, and marijuana use should be evaluated for use of other substances and for ASPD, GAD, and other psychiatric disorders. Treatment programs should address the use of all 3 substances to decrease the likelihood of comorbid psychopathology. PMID:24922120

  10. Industrial and Practical Arts, Vocational Education, and General Adult Education, Leflore County School District, Mississippi. Reports of Consultants and Advisory Specialists under Planning Grant, Title III, Elementary and Secondary Education Act of 1965.

    ERIC Educational Resources Information Center

    Roberts, Roy W.; Hunt, Elizabeth E.

    Descriptions of vocational, practical arts, and general adult education programs for an exemplary school curriculum, grades K-12 in Leflore County, Mississippi, are given in this 1969 document. Suggestions include development of an area vocational-technical school designed to supply partially the anticipated manpower needs of this rural county. It…

  11. Point prevalence and epidemiological characteristics of chronic cough in the general adult population: The Korean National Health and Nutrition Examination Survey 2010-2012.

    PubMed

    Kang, Min-Gyu; Song, Woo-Jung; Kim, Hyun-Jung; Won, Ha-Kyeong; Sohn, Kyoung-Hee; Kang, Sung-Yoon; Jo, Eun-Jung; Kim, Min-Hye; Kim, Sae-Hoon; Kim, Sang-Heon; Park, Heung-Woo; Chang, Yoon-Seok; Lee, Byung-Jae; Morice, Alyn H; Cho, Sang-Heon

    2017-03-01

    Cough is frequently self-limiting, but may persist longer in certain individuals. Most of previous studies on the epidemiology of chronic cough have only measured period prevalence, and thus have afforded limited information on the burden and natural course. We aimed to investigate the epidemiology of chronic cough by using a point prevalence measure in a large-scale general population.We analyzed cross-sectional data collected from 18,071 adults who participated in the Korean National Health and Nutrition Examination Survey 2010-2012. Presence and duration of current cough was ascertained by structured questionnaires, and cough was classified into acute (<3 weeks), subacute (3-8 weeks), or chronic cough (≥8 weeks). Demographic and clinical parameters were examined in relation to chronic cough.The point prevalences of acute, subacute, and chronic cough were 2.5 ± 0.2%, 0.8 ± 0.1% and 2.6 ± 0.2%, respectively. The proportion of current cough showed a steep decrease after 1 week of duration. However, 2 peaks in the prevalence of current cough were revealed; cough durations of less than 1 week and longer than 1 year were most common (31.1% and 27.7% of current cough, respectively). Subacute and chronic cough were more prevalent in the elderly (≥65 years); the positive associations with older age were independent of other confounders, including current smoking and comorbidities.This is the first report on the epidemiology of cough using a point prevalence measure in a nationally representative population sample. Our findings indicate a high burden of chronic cough among adults with current cough in the community. The dual-peak of cough duration suggested that the pathophysiology of acute and chronic cough may differ. The preponderance of elderly people in the prevalence of chronic cough warrants further investigation. In addition, more sophistication and validation of tools to define chronic cough will help our understanding of the epidemiology.

  12. Design and Participant Characteristics for a Randomized Effectiveness Trial of an Intensive Lifestyle Intervention to Reduce Cardiovascular Risk in Adults with Type 2 Diabetes: The I-D-HEALTH Study

    PubMed Central

    Liss, David T.; Finch, Emily A.; Gregory, Dyanna L.; Cooper, Andrew; Ackermann, Ronald T.

    2016-01-01

    Intervening in Diabetes with Healthy Eating, Activity and Linkages To Healthcare (I-D-HEALTH) is a community-based randomized trial evaluating the effectiveness of a group-based adaption of the Look AHEAD intensive lifestyle intervention. Most potentially eligible patients were identified through electronic medical record queries or referral to a diabetes resource hub. Trial enrollees had a usual source of primary care, elevated body mass index (BMI) and type 2 diabetes. I-D-HEALTH participants were randomized to either standard care alone or standard care plus free-of-charge access to a group-based lifestyle intervention (GLI) offered by the YMCA. GLI participation was encouraged, but not required, for the latter group. The primary outcome is percent weight change over 6, 12 and 24 months. Secondary outcomes include direct intervention costs and direct medical and non-medical expenditures, as well as changes in systolic blood pressure, hemoglobin A1c and cholesterol. Among 331 I-D-HEALTH participants, 167 were randomized to standard care and 164 to GLI. The mean age (± standard deviation) in each group was 57.1 years (±12.2) and 57.6 years (±10.5), respectively. Mean BMI was 34.9 kg/m2 (±7.3) among standard care participants and 36.2 kg/m2 (±7.8) among GLI participants. In both groups, approximately one third of participants were non-Hispanic Whites. We detected no significant differences between groups in mean systolic blood pressure, hemoglobin A1c or total cholesterol (P>0.05 for all characteristics above). The I-D-HEALTH study enrolled a diverse sample of adults with diabetes and offers a unique opportunity to evaluate the effectiveness of offering a community-based intensive lifestyle intervention. PMID:26611433

  13. Adult Education and the Elderly. Case Studies from Latin America, Africa, Asia and Europe. Background Materials. The Literacy Debate. General Discussion. Literacy and Women. Literacy and Health-Programmes. Adult Education and Development. Number 24.

    ERIC Educational Resources Information Center

    Adult Education and Development, 1985

    1985-01-01

    This journal issue contains 18 solicited articles on two major topics: adult education and the elderly, and the literacy debate. The articles on adult education and the elderly include "A Ripe Old Age," republished from a newsletter of the British aid organization OXFAM; "Special Programme for Retirees: A Model Project in Cali, Colombia," by…

  14. Baby, you light-up my face: culture-general physiological responses to infants and culture-specific cognitive judgements of adults.

    PubMed

    Esposito, Gianluca; Nakazawa, Jun; Ogawa, Shota; Stival, Rita; Kawashima, Akiko; Putnick, Diane L; Bornstein, Marc H

    2014-01-01

    Infants universally elicit in adults a set of solicitous behaviors that are evolutionarily important for the survival of the species. However, exposure, experience, and prejudice appear to govern adults' social choice and ingroup attitudes towards other adults. In the current study, physiological arousal and behavioral judgments were assessed while adults processed unfamiliar infant and adult faces of ingroup vs. outgroup members in two contrasting cultures, Japan and Italy. Physiological arousal was investigated using the novel technique of infrared thermography and behavioral judgments using ratings. We uncovered a dissociation between physiological and behavioral responses. At the physiological level, both Japanese and Italian adults showed significant activation (increase of facial temperature) for both ingroup and outgroup infant faces. At the behavioral level, both Japanese and Italian adults showed significant preferences for ingroup adults. Arousal responses to infants appear to be mediated by the autonomic nervous system and are not dependent on direct caregiving exposure, but behavioral responses appear to be mediated by higher-order cognitive processing based on social acceptance and cultural exposure.

  15. The effects of multivitamin supplementation on mood and general well-being in healthy young adults. A laboratory and at-home mobile phone assessment.

    PubMed

    Pipingas, A; Camfield, D A; Stough, C; Cox, K H M; Fogg, E; Tiplady, B; Sarris, J; White, D J; Sali, A; Wetherell, M A; Scholey, A B

    2013-10-01

    Previous research has suggested that multivitamin (MV) supplementation may be associated with beneficial effects for mood and general well-being, although treatment durations have typically been less than 90 days, samples have often been restricted to males only and acute effects have not been adequately differentiated from chronic effects. In the current study a MV supplement containing high levels of B-vitamins was administered daily to 138 healthy young adult participants between the ages of 20 and 50 years over a 16-week period. Chronic mood measures (GHQ-28, POMS, Chalder fatigue, PILL, Bond-Lader and custom visual analogue scales) were administered pre-dose at baseline, 8- and 16-weeks. Changes in Bond-Lader and VAS in response to a multi-tasking framework (MTF) were also assessed at 8- and 16-weeks. For a subset of participants, at-home mobile-phone assessments of mood were assessed on a weekly basis using Bond-Lader and VAS. No significant treatment effects were found for any chronic laboratory mood measures. In response to the MTF, a significant treatment x time interaction was found for STAI-S, with a trend towards a greater increase in stress ratings for male participants in the MV group at 16 weeks. However, this finding may have been attributable to a larger proportion of students in the male MV group. In contrast, at-home mobile-phone assessments, where assessments were conducted post-dose, revealed significantly reduced stress, physical fatigue and anxiety in the MV group in comparison to placebo across a number of time points. Further research using both acute and chronic dosing regimens are required in order to properly differentiate these effects.

  16. Sequential myeloablative autologous stem cell transplantation and reduced intensity allogeneic hematopoietic cell transplantation is safe and feasible in children, adolescents and young adults with poor-risk refractory or recurrent Hodgkin and non-Hodgkin lymphoma.

    PubMed

    Satwani, P; Jin, Z; Martin, P L; Bhatia, M; Garvin, J H; George, D; Chaudhury, S; Talano, J; Morris, E; Harrison, L; Sosna, J; Peterson, M; Militano, O; Foley, S; Kurtzberg, J; Cairo, M S

    2015-02-01

    The outcome of children, adolescents and young adults (CAYA) with poor-risk recurrent/refractory lymphoma is dismal (⩽30%). To overcome this poor prognosis, we designed an approach to maximize an allogeneic graft vs lymphoma effect in the setting of low disease burden. We conducted a multi-center prospective study of myeloablative conditioning (MAC) and autologous stem cell transplantation (AutoSCT), followed by a reduced intensity conditioning (RIC) and allogeneic hematopoietic cell transplantation (AlloHCT) in CAYA, with poor-risk refractory or recurrent lymphoma. Conditioning for MAC AutoSCT consisted of carmustine/etoposide/cyclophosphamide, RIC consisted of busulfan/fludarabine. Thirty patients, 16 Hodgkin lymphoma (HL) and 14 non-Hodgkin lymphoma (NHL), with a median age of 16 years and median follow-up of 5years, were enrolled. Twenty-three patients completed both MAC AutoSCT and RIC AlloHCT. Allogeneic donor sources included unrelated cord blood (n=9), unrelated donor (n=8) and matched siblings (n=6). The incidence of transplant-related mortality following RIC AlloHCT was only 12%. In patients with HL and NHL, 10 year EFS was 59.8% and 70% (P=0.613), respectively. In summary, this approach is safe, and long-term EFS with this approach is encouraging considering the poor-risk patient characteristics and the use of unrelated donors for RIC AlloHCT in the majority of cases.

  17. Adult Education in Sweden.

    ERIC Educational Resources Information Center

    Miller, Harry; And Others

    Folk high schools, study circles, labor market training, union education, and municipal adult schools are the major providers of adult education in Sweden. For the most part, these programs are financed by the government and are tuition free. Folk high schools, which are the oldest type, were founded to provide young adults with a general civic…

  18. Adult Education in Greece

    ERIC Educational Resources Information Center

    Kokkos, Alexios

    2008-01-01

    The central aim of this article is to analyse the current situation of adult education in Greece. The article focuses on the following points: (a) the degree of participation in programmes of continuing professional training and general adult education courses, (b) the quality and the outcomes of the adult education provision in Greece, and (c)…

  19. Associations of moderate-to-vigorous-intensity physical activity and body mass index with glycated haemoglobin within the general population: a cross-sectional analysis of the 2008 Health Survey for England

    PubMed Central

    Bakrania, Kishan; Yates, Thomas; Edwardson, Charlotte L; Bodicoat, Danielle H; Esliger, Dale W; Gill, Jason M R; Kazi, Aadil; Velayudhan, Latha; Sinclair, Alan J; Sattar, Naveed; Biddle, Stuart J H; Hamer, Mark; Davies, Melanie J; Khunti, Kamlesh

    2017-01-01

    Objectives To investigate the associations of objectively measured moderate-to-vigorous-intensity physical activity (MVPA) and body mass index (BMI) with glycated haemoglobin (HbA1c) in a national sample of English adults. Methods The 2008 Health Survey for England data were used with 1109 participants aged ≥18 providing complete data. MVPA time was assessed using an accelerometer. Weighted linear regression models, adjusted for several confounders, quantified the associations between continuous measures of MVPA and BMI with HbA1c. Interaction analyses were implemented to observe whether the association of MVPA with HbA1c was modified by BMI or vice versa. Further weighted linear regression models examined the differences in HbA1c across four mutually exclusive categories of MVPA and BMI: (1) ‘physically active and non-obese’, (2) ‘physically active and obese’, (3) ‘physically inactive and non-obese’ and (4) ‘physically inactive and obese’. ‘Physically active’ was defined as: ≥150 min/week of MVPA. ‘Obese’ was defined as: BMI ≥30.0 kg/m2. A wide range of sensitivity analyses were also implemented. Results Every 30 min/day increment in MVPA was associated with a 0.7 mmol/mol (0.07% (p<0.001)) lower HbA1c level. Each 1 kg/m2 increment in BMI was associated with a 0.2 mmol/mol (0.02% (p<0.001)) higher HbA1c level. The association of MVPA with HbA1c was stronger in obese individuals (−1.5 mmol/mol (−0.13% (p<0.001))) than non-obese individuals (−0.7 mmol/mol (−0.06% (p<0.001))); p=0.004 for interaction. The association of BMI with HbA1c remained stable across MVPA categories. Compared with individuals categorised as ‘physically inactive and obese’, only those categorised as ‘physically active and obese’ or ‘physically active and non-obese’ had lower HbA1c levels by 2.1 mmol/mol (0.19% (p=0.005)) and 3.5 mmol/mol (0.32% (p<0.001)), respectively. Sensitivity analyses indicated robustness and stability

  20. Personality and Biography: Proceedings of the Sixth International Conference on the History of Adult Education. Volume I: General, Comparative, and Synthetic Studies.

    ERIC Educational Resources Information Center

    Friedenthal-Haase, Martha, Ed.

    This volume includes the following papers: "Foreword: The Standing International Conference on the History of Adult Education (AE)" (Franz Poeggeler); "Editor's Introduction: Perspectives on the Sixth International Conference on the History of AE" (Martha Friedenthal-Haase); two special addresses by Joerg Prinzhausen and Ursula…

  1. A General Practice-Based Prevalence Study of Epilepsy among Adults with Intellectual Disabilities and of Its Association with Psychiatric Disorder, Behaviour Disturbance and Carer Stress

    ERIC Educational Resources Information Center

    Matthews, T.; Weston, N.; Baxter, H.; Felce, D.; Kerr, M.

    2008-01-01

    Background: Although the elevated occurrence of epilepsy in people with intellectual disabilities (ID) is well recognized, the nature of seizures and their association with psychopathology and carer strain are less clearly understood. The aims were to determine the prevalence and features of epilepsy in a community-based population of adults with…

  2. Effect of the Web-Based Intervention MyPlan 1.0 on Self-Reported Fruit and Vegetable Intake in Adults Who Visit General Practice: A Quasi-Experimental Trial

    PubMed Central

    Crombez, Geert; Van der Mispel, Celien; Verloigne, Maite; Van Stappen, Vicky; De Bourdeaudhuij, Ilse

    2016-01-01

    Background Web-based interventions typically have small intervention effects on adults’ health behavior because they primarily target processes leading to an intention to change leaving individuals in an intention-behavior gap, they often occur without contact with health care providers, and a limited amount of feedback is provided only at the beginning of these interventions, but not further on in the behavior change process. Therefore, we developed a Web-based intervention (“MyPlan 1.0”) to promote healthy behavior in adults. The intervention was based on a self-regulation perspective that also targets postintentional processes and guides individuals during all phases of behavior change. Objective The study investigated the effectiveness of MyPlan1.0 on fruit and vegetable intake of Flemish adults visiting general practice (3 groups: control group, intervention group recruited by researchers, and intervention group recruited and guided by general practitioners [GPs]). Second, it examined whether there was a larger intervention effect for the intervention group guided by GPs compared to the intervention group recruited by researchers. Methods Adults (≥18 years) were recruited in 19 Flemish general practices. In each general practice, patients were systematically allocated by a researcher either for the intervention group (researchers’ intervention group) or the waiting-list control group that received general advice. In a third group, the GP recruited adults for the intervention (GPs intervention group). The two intervention groups filled in evaluation questionnaires and received MyPlan 1.0 for a behavior of choice (fruit, vegetable, or physical activity). The waiting-list control group filled in the evaluation questionnaires and received only general information. Self-reported fruit and vegetable intake were assessed at baseline (T0), 1 week (T1), and 1 month (T2) postbaseline. Three-level (general practice, adults, time) linear regression models were

  3. Impacts of macroalgal spores on the dynamics of adult macroalgae in a eutrophic estuary: high versus low hydrodynamic seasons and long-term simulations for global warming scenarios.

    PubMed

    Martins, Irene; Marcotegui, Aránzazu; Marques, João Carlos

    2008-05-01

    A model describing macroalgal early life stages and adult dynamics was used to quantify the effects of non-adult forms on the productivity of adult macroalgae in a eutrophic estuary. Predictions indicate that during years with mild winters and low rainfall, spring blooms will occur at the expense of the growth and reproduction of overwintering adults and without the contribution of the spore bank. In these circumstances, there is a positive correlation between the intensity of the blooms and the biomass of overwintering adults until a maximum threshold value. On the contrary, in years with high rainfall and low or inexistent biomass of overwintering adults, the onset of adult's growth depends on the biomass of viable dormant spores, the growing season occurs later and adult productivity is very limited. Long-term predictions for climate change scenarios suggest that, in general, global warming will have adverse affects on Ulva intestinalis productivity, with the adults being more affected than the early life stages.

  4. Idaho Habitat/Natural Production Monitoring, Part II: Intensive Monitoring Subproject : Annual Progress Report 1990.

    SciTech Connect

    Kiefer, Russell B.; Forster, Katharine A.

    1992-04-01

    Project 83-7 was established under the Northeast Power Planning Council's 1982 Fish and Wildlife Program, Measure 704 (d) (1) to monitor natural production of anadromous fish, evaluate Bonneville Power Administration habitat improvement project, and develop a credit record for off-site mitigation projects in Idaho. Project 83-7 is divided into two sub-projects: general and intensive monitoring. Results of the intensive monitoring sub-project are reported here. Results from the general monitoring sub-project will be reported in a separate document. The purpose of this intensive monitoring project is to determine the number of returning chinook and steelhead adults necessary to achieve optimal smolt production, and develop mitigation accounting based on increases in smolt production. Two locations are being intensively studied to meet these objectives. Information from this research will be applied to parr monitoring streams statewide to develop escapement objectives and determine success of habitat enhancement projects. Field work began in 1987 in upper Salmon River and Crooked River (South Fork Clearwater River tributary). Methods include using weirs to trap adults, conducting ground and aerial redd counts, snorkeling to estimate parr populations, PIT-tagging juveniles to determine parr-tosmolt survival, trapping fall and spring downstream emigrants with scoop traps, and outplanting adults to determine juvenile carrying capacity. PIT tags also provide a wide range of other information such as migration timing, effects of flow and passage conditions on smolt survival, other factors affecting smolt survival, and growth.

  5. Helical Tomotherapy vs. Intensity-Modulated Proton Therapy for Whole Pelvis Irradiation in High-Risk Prostate Cancer Patients: Dosimetric, Normal Tissue Complication Probability, and Generalized Equivalent Uniform Dose Analysis

    SciTech Connect

    Widesott, Lamberto; Pierelli, Alessio; Fiorino, Claudio; Lomax, Antony J.; Amichetti, Maurizio; Cozzarini, Cesare; Soukup, Martin; Schneider, Ralf; Hug, Eugen; Di Muzio, Nadia; Calandrino, Riccardo; Schwarz, Marco

    2011-08-01

    Purpose: To compare intensity-modulated proton therapy (IMPT) and helical tomotherapy (HT) treatment plans for high-risk prostate cancer (HRPCa) patients. Methods and Materials: The plans of 8 patients with HRPCa treated with HT were compared with IMPT plans with two quasilateral fields set up (-100{sup o}; 100{sup o}) and optimized with the Hyperion treatment planning system. Both techniques were optimized to simultaneously deliver 74.2 Gy/Gy relative biologic effectiveness (RBE) in 28 fractions on planning target volumes (PTVs)3-4 (P + proximal seminal vesicles), 65.5 Gy/Gy(RBE) on PTV2 (distal seminal vesicles and rectum/prostate overlapping), and 51.8 Gy/Gy(RBE) to PTV1 (pelvic lymph nodes). Normal tissue calculation probability (NTCP) calculations were performed for the rectum, and generalized equivalent uniform dose (gEUD) was estimated for the bowel cavity, penile bulb and bladder. Results: A slightly better PTV coverage and homogeneity of target dose distribution with IMPT was found: the percentage of PTV volume receiving {>=}95% of the prescribed dose (V{sub 95%}) was on average >97% in HT and >99% in IMPT. The conformity indexes were significantly lower for protons than for photons, and there was a statistically significant reduction of the IMPT dosimetric parameters, up to 50 Gy/Gy(RBE) for the rectum and bowel and 60 Gy/Gy(RBE) for the bladder. The NTCP values for the rectum were higher in HT for all the sets of parameters, but the gain was small and in only a few cases statistically significant. Conclusions: Comparable PTV coverage was observed. Based on NTCP calculation, IMPT is expected to allow a small reduction in rectal toxicity, and a significant dosimetric gain with IMPT, both in medium-dose and in low-dose range in all OARs, was observed.

  6. Systematic review and meta-analysis: the effects of fermented milk with Bifidobacterium lactis CNCM I-2494 and lactic acid bacteria on gastrointestinal discomfort in the general adult population

    PubMed Central

    Eales, Jacqui; Gibson, Peter; Whorwell, Peter; Kellow, John; Yellowlees, Ann; Perry, Richard H. J.; Edwards, Mary; King, Sarah; Wood, Hannah; Glanville, Julie

    2016-01-01

    Background: It has been suggested that probiotics may improve gastrointestinal discomfort. Not all probiotics exhibit the same effects and consequently meta-analyses on probiotics should be confined to well-defined strains or strain combinations. The aim of this study was to evaluate the effectiveness of a probiotic fermented milk (PFM) that includes Bifidobacterium lactis (B. lactis) CNCM I-2494 and lactic acid bacteria on gastrointestinal discomfort in the general adult population. Methods: Double-blind randomized controlled trials in the general adult population comparing PFM with a control dairy product for at least 4 weeks were searched from multiple literature databases (up to February 2015). Meta-analyses using random-effects models, with individual participant data were undertaken to calculate an odds ratio (OR) or standard mean difference (SMD), with a 95% confidence interval (CI). Results: The search strategy identified 12,439 documents. Overall, three trials with a total of 598 adults (female = 96.5%) met the inclusion criteria. Consumption of the PFM product was associated with a significant improvement in overall gastrointestinal discomfort compared with the control product (OR = 1.48; 95% CI 1.07–2.05), with a number needed to treat (NNT) of 10.24 (95% CI 5.64–55.93). PFM was also superior to the control in reducing digestive symptoms, as measured using a composite score (SMD = −0.21; 95% CI −0.37 to −0.05). Sensitivity analyses produced similar results, and the heterogeneity between studies was minimal. Conclusions: This meta-analysis shows that the consumption of PFM with B. lactis CNCM I-2494 and lactic acid bacteria is associated with a modest but consistent and significant improvement of outcomes related to gastrointestinal discomfort in healthy adults. PMID:28286561

  7. The development of pediatric anesthesia and intensive care in Scandinavia.

    PubMed

    Nilsson, Krister; Ekström-Jodal, Barbro; Meretoja, Olli; Valentin, Niels; Wagner, Kari

    2015-05-01

    The initiation and development of pediatric anesthesia and intensive care have much in common in the Scandinavian countries. The five countries had to initiate close relations and cooperation in all medical disciplines. The pediatric anesthesia subspecialty took its first steps after the Second World War. Relations for training and exchange of experiences between Scandinavian countries with centers in Europe and the USA were a prerequisite for development. Specialized pediatric practice was not a full-time position until during the 1950s, when the first pediatric anesthesia positions were created. Scandinavian anesthesia developed slowly. In contrast, Scandinavia pioneered both adult and certainly pediatric intensive care. The pioneers were heavily involved in the teaching and training of anesthetists and nurses. This was necessary to manage the rapidly increasing work. The polio epidemics during the 1950s initiated a combination of clinical development and technical innovations. Blood gas analyses technology and interpretation in combination with improved positive pressure ventilators were developed in Scandinavia contributing to general and pediatric anesthesia and intensive care practice. Scandinavian specialist training and accreditation includes both anesthesia and intensive care. Although pediatric anesthesia/intensive care is not a separate specialty, an 'informal accreditation' for a specialist position is obtained after training. The pleasure of working in a relatively small group of devoted colleagues and staff has persisted from the pioneering years. It is still one of the most inspiring and pleasant gifts for those working in this demanding specialty.

  8. Cerebrovascular complications in pediatric intensive care unit

    PubMed Central

    Sachdev, Anil; Sharma, Rachna; Gupta, Dhiren

    2010-01-01

    Cerebrovascular complications are being frequently recognized in the pediatric intensive care unit in the recent few years. The epidemiology and risk factors for pediatric stroke are different from that of the adults. The incidence of ischemic stroke is almost slightly more than that of hemorrhagic stroke. The list of diagnostic causes is increasing with the availability of newer imaging modalities and laboratory tests. The diagnostic work up depends on the age of the child and the rapidity of presentation. Magnetic resonance imaging, computerized tomography and arteriography and venography are the mainstay of diagnosis and to differentiate between ischemic and hemorrhagic events. Very sophisticated molecular diagnostic tests are required in a very few patients. There are very few pediatric studies on the management of stroke. General supportive management is as important as the specific treatment. Most of the treatment guidelines and suggestions are extrapolated from the adult studies. Few guidelines are available for the use of anticoagulants and thrombolytic agents in pediatric patients. So, our objective was to review the available literature on the childhood stroke and to provide an insight into the subject for the pediatricians and critical care providers. PMID:21253346

  9. Data-Intensive Benchmarking Suite

    SciTech Connect

    2008-11-26

    The Data-Intensive Benchmark Suite is a set of programs written for the study of data-or storage-intensive science and engineering problems, The benchmark sets cover: general graph searching (basic and Hadoop Map/Reduce breadth-first search), genome sequence searching, HTTP request classification (basic and Hadoop Map/Reduce), low-level data communication, and storage device micro-beachmarking

  10. The Association Between Blood Mercury Levels and Risk for Overweight in a General Adult Population: Results from the Korean National Health and Nutrition Examination Survey.

    PubMed

    Lee, Seunghyun; Yoon, Jin-Ha; Won, Jong-Uk; Lee, Wanhyung; Lee, June-Hee; Seok, Hongdeok; Kim, Yeong-Kwang; Kim, Chi-Nyon; Roh, Jaehoon

    2016-06-01

    The primary objective of this study was to estimate the association between blood mercury levels and overweight in Korean adults. We analyzed cross-sectional data from 9228 participants (4283 men and 4945 women) who completed the Korean National Health and Nutrition Examination Survey (KNHANES), 2007-2013. The population was divided into two groups according to the body mass index (BMI) and waist circumference (WC). Blood mercury levels were analyzed using a gold amalgam method with a DMA-80 instrument, categorized into quartiles, and stratified by sex. After adjusting for all covariates, blood mercury was significantly associated with overweight in all subjects. According to the BMI criteria, the adjusted odds ratio of being in the highest blood mercury quartile was 1.75 (95 % confidence interval [CI], 1.53-2.01) overall, 2.09 (95 % CI, 1.71-2.55) in men, and 1.58 (95 % CI, 1.32-1.89) in women. According to the WC criteria, the adjusted odds ratio of being in the highest blood mercury quartile was 1.85 (95 % CI, 1.49-2.30) in men and 1.96 (95 % CI, 1.62-2.36) in women compared to the lowest quartile. Additionally, a trend in overweight across increasing blood mercury levels was observed by the p for trend test in the multiple diagnostic criteria.

  11. Filling service gaps: Providing intensive treatment services for offenders.

    PubMed

    Young, Douglas W; Farrell, Jill L; Henderson, Craig E; Taxman, Faye S

    2009-08-01

    Consistent with the few studies that have previously examined treatment prevalence and access in the adult and juvenile justice systems, the recent National Criminal Justice Treatment Practices (NCJTP) survey indicated that there is a particular need to expand intensive treatment modalities for offenders in both institutional and community corrections settings. Applying multilevel modeling techniques to NCJTP survey data, this study explores conditions and factors that may underlie the wide variation among states in the provision of intensive treatment for offenders. Results indicate that states' overall rates of substance abuse and dependence, funding resources, and the state governor's political party affiliation were significantly associated with intensive treatment provision. Numerous factors that have been implicated in recent studies of evidence-based practice adoption, including state agency executives' views regarding rehabilitation, agency culture and climate, and other state-level measures (e.g., household income, crime rates, expenditures on treatment for the general population) were not associated with treatment provision. Future research should examine further variations in offenders' service needs, the role of legislators' political affiliations, and how other factors may interact with administrator characteristics in the adoption and expansion of intensive treatment services for offenders.

  12. Adult Learning. ARIS Information Sheet.

    ERIC Educational Resources Information Center

    National Languages and Literacy Inst. of Australia, Melbourne. Adult Education Resource and Information Service.

    This information sheet provides a summary of general observations regarding adult learners. Adults from different walks of life may seek out learning at different times in their lives, for different reasons, and for vastly different purposes. Adult learning groups may include students of different ages, cultures, and educational and socioeconomic…

  13. The relation of respiratory symptoms and ventilatory function to moderate occupational exposure in a general population. Results from the French PAARC study of 16,000 adults.

    PubMed

    Krzyzanowski, M; Kauffmann, F

    1988-06-01

    Data from the French PAARC (Pollution Atmosphérique et Affections Respiratoires Chroniques) study were used to assess the effect of a priori moderate occupational exposure to dust, gases or chemical fumes on the prevalence of respiratory symptoms and ventilatory function. In this community-based population, without households 'headed' by manual workers, 34% of the 8692 men and 23% of the 7772 women, 25-59 years of age, ever occupationally active, reported some exposure. The studied relationships were adjusted for age, height, smoking habits, socio-occupational class, education and air pollution by logistic or linear regression methods. For men and women, some 50% increase (p less than 0.01) in chronic cough, chronic bronchitis, dyspnoea grade 2 and wheezing prevalence was observed in the exposed group compared to the never exposed, with the strongest association for wheezing. FEV1 and FEF25-75% were not associated with occupational exposure. Among men, FEV1/FVC and FEF25-75%/FVC were significantly lower (p less than 0.001 and p less than 0.05) among the exposed compared to never exposed, but FVC was significantly greater (p less than 0.05). Among women, occupational exposure was significantly related to a lower FEV1/FVC in the subgroup with a history of asthma or wheezing. Results suggest that occupational exposures of relatively low intensity, encountered in the non-industrial work places may constitute a non-negligible risk for respiratory health.

  14. TRENDS IN ADULT READING.

    ERIC Educational Resources Information Center

    MILLER, JUSTIN H.

    TRENDS EVIDENT IN ADULT READING DURING THE 1960'S IN THE AREAS OF ADMINISTRATION, PROGRAMS, TEACHING, TECHNIQUES, RESEARCH PROJECTS, AND METHODS OF PROMOTION OF READING PROGRAMS ARE DISCUSSED. TWO INSTANCES OF COMMERCIAL EXPLOITATION BASED ON INTENSE AND OFTEN FALLACIOUS ADVERTISING AND ON PUBLIC IGNORANCE ARE CITED. A POSITIVE TREND IN THE AREA…

  15. Complete resolution of chronic pericardial effusion with an intensive course of inhaled iloprost in an adult patient with unrepaired ventricular septal defect, and life-threatening severe pulmonary arterial hypertension.

    PubMed

    Alzahrani, Ahmed M; Alqahtani, Abdullah S; Alnajashi, Khalid S; Idrees, Majdy M

    2014-10-01

    A 38-year-old male was diagnosed with unrepaired ventricular septal defect associated with severe pulmonary arterial hypertension, cyanosis, and significant exercise intolerance. His echocardiogram showed right ventricular dysfunction and moderate pericardial effusion with no signs of cardiac tamponade. He was treated with an intensive course of inhaled iloprost and sildenafil. He showed a dramatic clinical response; his saturation went up from 60% on admission to 90% on minimal oxygen with significant improvement in his symptoms and signs of heart failure and total resolution of pericardial effusion. On follow up 3 and 6 weeks later, he was stable and could walk 360 meters in a 6 minutes walk test with disappearance of pericardial effusion. With unavailability of intravenous prostacyclin, we have shown in this case that intensive administration of inhaled iloprost could be used intensively as a rescue therapy in severe cases of pulmonary arterial hypertension with excellent results. 

  16. The influence of general identity disturbance on reports of lifetime substance use disorders and related outcomes among sexual minority adults with a history of substance use.

    PubMed

    Talley, Amelia E; Tomko, Rachel L; Littlefield, Andrew K; Trull, Timothy J; Sher, Kenneth J

    2011-09-01

    Previous research has shown that sexual minority (i.e., nonheterosexual) individuals report increased problematic substance use involvement, compared with their sexual majority counterparts. We hypothesize that feelings of an unstable sense of self (i.e., identity disturbance) may potentially drive problematic substance use. The purpose of the current study is to examine identity disturbance among sexual minorities as a potential explanatory mechanism of increased sexual minority lifetime rates of substance dependence. Measures of identity disturbance and three indicators of sexual orientation from lifetime female (n = 16,629) and male (n = 13,553) alcohol/illicit drug users in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were examined. Findings generally showed that the increased prevalence of alcohol dependence, illicit drug dependence, and combined alcohol/illicit drug dependence as well as a younger age of alcohol use initiation among sexual minority women was associated with elevated levels of identity disturbance. The results were consistent with a mediational role for identity disturbance in explaining the association between sexual minority status and substance dependence and were generally replicated among male sexual minority respondents. The current research suggests that identity disturbance, a predictor of substance use, may contribute to heightened risk for substance dependence among certain subgroups of sexual minority individuals.

  17. Predictors of Upper-Extremity Physical Function in Older Adults

    PubMed Central

    Hermanussen, Hugo H.; Menendez, Mariano E.; Chen, Neal C.; Ring, David; Vranceanu, Ana-Maria

    2016-01-01

    Background: Little is known about the influence of habitual participation in physical exercise and diet on upper-extremity physical function in older adults. To assess the relationship of general physical exercise and diet to upper-extremity physical function and pain intensity in older adults. Methods: A cohort of 111 patients 50 or older completed a sociodemographic survey, the Rapid Assessment of Physical Activity (RAPA), an 11-point ordinal pain intensity scale, a Mediterranean diet questionnaire, and three Patient- Reported Outcomes Measurement Information System (PROMIS) based questionnaires: Pain Interference to measure inability to engage in activities due to pain, Upper-Extremity Physical Function, and Depression. Multivariable linear regression modeling was used to characterize the association of physical activity, diet, depression, and pain interference to pain intensity and upper-extremity function. Results: Higher general physical activity was associated with higher PROMIS Upper-Extremity Physical Function and lower pain intensity in bivariate analyses. Adherence to the Mediterranean diet did not correlate with PROMIS Upper-Extremity Physical Function or pain intensity in bivariate analysis. In multivariable analyses factors associated with higher PROMIS Upper-Extremity Physical Function were male sex, non-traumatic diagnosis and PROMIS Pain Interference, with the latter accounting for most of the observed variability (37%). Factors associated with greater pain intensity in multivariable analyses included fewer years of education and higher PROMIS Pain Interference. Conclusions: General physical activity and diet do not seem to be as strongly or directly associated with upper-extremity physical function as pain interference. PMID:27847850

  18. Vitamin A concentrations in liver determined by isotope dilution assay with tetradeuterated vitamin A and by biopsy in generally healthy adult humans

    SciTech Connect

    Furr, H.C.; Amedee-Manesme, O.; Clifford, A.J.; Bergen, H.R. 3d.; Jones, A.D.; Anderson, D.P.; Olson, J.A.

    1989-04-01

    The vitamin A status in 11 generally healthy surgical patients was estimated by measuring the dilution of a 45-mg oral dose of tetradeuterated retinyl acetate (99% pure). After purification of retinol by high-performance liquid chromatography, the ratio of /sup 2/H/sub 4/-retinol:/sup 1/H-retinol in plasma was measured by gas chromatography-mass spectrometry. On the basis of the observed ratios of (/sup 2/H/sub 4/)retinol:(/sup 1/H)retinol over 19-47 d, the total body reserves and liver concentrations of vitamin A were calculated. Liver biopsy samples taken at surgery were directly analyzed for vitamin A. The correlation coefficient between calculated and measured liver vitamin A concentrations for 10 of the subjects was 0.88, and the Spearman's rank correlation coefficient was 0.95 (p less than 0.002). Thus, total body reserves of vitamin A in humans can be estimated validly in the marginal and satisfactory ranges by a benign, relatively noninvasive procedure.

  19. Sleep and Sleep Disorders in Rare Hereditary Diseases: A Reminder for the Pediatrician, Pediatric and Adult Neurologist, General Practitioner, and Sleep Specialist

    PubMed Central

    Gadoth, Natan; Oksenberg, Arie

    2014-01-01

    Although sleep abnormalities in general and sleep-related breathing disorders (SBD) in particular are quite common in healthy children; their presence is notably under-recognized. Impaired sleep is a frequent problem in subjects with inborn errors of metabolism as well as in a variety of genetic disorders; however, they are commonly either missed or underestimated. Moreover, the complex clinical presentation and the frequently life-threatening symptoms are so overwhelming that sleep and its quality may be easily dismissed. Even centers, which specialize in rare genetic-metabolic disorders, are expected to see only few patients with a particular syndrome, a fact that significantly contributes to the under-diagnosis and treatment of impaired sleep in this particular population. Many of those patients suffer from reduced life quality associated with a variable degree of cognitive impairment, which may be worsened by poor sleep and abnormal ventilation during sleep, abnormalities which can be alleviated by proper treatment. Even when such problems are detected, there is a paucity of publications on sleep and breathing characteristics of such patients that the treating physician can refer to. In the present paper, we provide an overview of sleep and breathing characteristics in a number of rare genetic–metabolic disorders with the hope that it will serve as a reminder for the medical professional to look for possible impaired sleep and SBD in their patients and when present to apply the appropriate evaluation and treatment options. PMID:25101051

  20. Measuring autistic traits in the general population: a systematic review of the Autism-Spectrum Quotient (AQ) in a nonclinical population sample of 6,900 typical adult males and females.

    PubMed

    Ruzich, Emily; Allison, Carrie; Smith, Paula; Watson, Peter; Auyeung, Bonnie; Ring, Howard; Baron-Cohen, Simon

    2015-01-01

    The Autism-Spectrum Quotient (AQ) is a self-report measure of autistic traits. It is frequently cited in diverse fields and has been administered to adults of at least average intelligence with autism and to nonclinical controls, as well as to clinical control groups such as those with schizophrenia, prosopagnosia, anorexia, and depression. However, there has been no empirical systematic review of the AQ since its inception in 2001. The present study reports a comprehensive systematic review of the literature to estimate a reliable mean AQ score in individuals without a diagnosis of an autism spectrum condition (ASC), in order to establish a reference norm for future studies. A systematic search of computerized databases was performed to identify studies that administered the AQ to nonclinical participant samples representing the adult male and female general population. Inclusion was based on a set of formalized criteria that evaluated the quality of the study, the usage of the AQ, and the population being assessed. After selection, 73 articles, detailing 6,934 nonclinical participants, as well as 1,963 matched clinical cases of ASC (from available cohorts within each individual study), were analyzed. Mean AQ score for the nonclinical population was 16.94 (95% CI 11.6, 20.0), while mean AQ score for the clinical population with ASC was found to be 35.19 (95% CI 27.6, 41.1). In addition, in the nonclinical population, a sex difference in autistic traits was found, although no sex difference in AQ score was seen in the clinical ASC population. These findings have implications for the study of autistic traits in the general population. Here, we confirm previous norms with more rigorous data and for the first time establish average AQ scores based on a systematic review, for populations of adult males and females with and without ASC. Finally, we advise future researchers to avoid risk of bias by carefully considering the recruitment strategy for both clinical and

  1. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation

    PubMed Central

    van Gaalen, Johanna L; van Bodegom-Vos, Leti; Bakker, Moira J; Snoeck-Stroband, Jiska B; Sont, Jacob K

    2016-01-01

    Objectives The aim of this study was to explore barriers among patients, general practitioners (GPs) and practice nurses to implement internet-based self-management support as provided by PatientCoach for asthma in primary care. Setting Primary care within South Holland, the Netherlands. Participants Twenty-two patients (12 women, mean age 38 years), 21 GPs (6 women, mean age 52 years) and 13 practice nurses (all women, mean age 41 years). Design A qualitative study using focus groups and interviews. Outcomes Barriers as perceived by patients, GPs and practice nurses to implementation of PatientCoach. Methods 10 focus groups and 12 interviews were held to collect data: 4 patient focus groups, 4 GP focus groups, 2 practice nurse focus group, 2 patient interviews, 5 GP interviews and 5 practice nurse interviews. A prototype of PatientCoach that included modules for coaching, personalised information, asthma self-monitoring, medication treatment plan, feedback, e-consultations and a forum was demonstrated. A semistructured topic guide was used. Directed content analysis was used to analyse data. Reported barriers were classified according to a framework by Grol and Wensing. Results A variety of barriers emerged among all participant groups. Barriers identified among patients include a lack of a patient–professional partnership in using PatientCoach and a lack of perceived benefit in improving asthma symptoms. Barriers identified among GPs include a low sense of urgency towards asthma care and current work routines. Practice nurses identified a low level of structured asthma care and a lack of support by colleagues as barriers. Among all participant groups, insufficient ease of use of PatientCoach, lack of financial arrangements and patient characteristics such as a lack of asthma symptoms were reported as barriers. Conclusions We identified a variety of barriers to implementation of PatientCoach. An effective implementation strategy for internet-based self

  2. Atlas-guided volumetric diffuse optical tomography enhanced by generalized linear model analysis to image risk decision-making responses in young adults

    PubMed Central

    Lin, Zi-Jing; Li, Lin; Cazzell, Mary; Liu, Hanli

    2014-01-01

    Diffuse optical tomography (DOT) is a variant of functional near infrared spectroscopy and has the capability of mapping or reconstructing three dimensional (3D) hemodynamic changes due to brain activity. Common methods used in DOT image analysis to define brain activation have limitations because the selection of activation period is relatively subjective. General linear model (GLM)-based analysis can overcome this limitation. In this study, we combine the atlas-guided 3D DOT image reconstruction with GLM-based analysis (i.e., voxel-wise GLM analysis) to investigate the brain activity that is associated with risk decision-making processes. Risk decision-making is an important cognitive process and thus is an essential topic in the field of neuroscience. The Balloon Analog Risk Task (BART) is a valid experimental model and has been commonly used to assess human risk-taking actions and tendencies while facing risks. We have used the BART paradigm with a blocked design to investigate brain activations in the prefrontal and frontal cortical areas during decision-making from 37 human participants (22 males and 15 females). Voxel-wise GLM analysis was performed after a human brain atlas template and a depth compensation algorithm were combined to form atlas-guided DOT images. In this work, we wish to demonstrate the excellence of using voxel-wise GLM analysis with DOT to image and study cognitive functions in response to risk decision-making. Results have shown significant hemodynamic changes in the dorsal lateral prefrontal cortex (DLPFC) during the active-choice mode and a different activation pattern between genders; these findings correlate well with published literature in functional magnetic resonance imaging (fMRI) and fNIRS studies. PMID:24619964

  3. Prevalence of acute post-operative pain in patients in adult age-group undergoing inpatient abdominal surgery and correlation of intensity of pain and satisfaction with analgesic management: A cross-sectional single institute-based study

    PubMed Central

    Singh, Prashant Kumar; Saikia, Priyam; Lahakar, Mangala

    2016-01-01

    Background and Aims: Considering the paucity of regional data, this study was designed to investigate the prevalence of post-operative pain and determine if there exists any correlation between the intensity of post-operative pain and patient's level of satisfaction with their pain management after inpatient abdominal surgery at an academic tertiary care government centre. Methods: Pain intensity was measured in 120 patients with numeric rating scale at the fifth post-operative hour, second and third post-operative day. A questionnaire was used to measure the level of satisfaction with nurse's and doctor's response to their pain and overall pain management. Results: The prevalence of post-operative pain was 84.17%, 92.5% and 96.66% at the fifth post-operative hour, second and third post-operative day, respectively. Less number of patients experienced severe intensity pain on the third post-operative day (P = 0.00046), whereas the number of patients experiencing mild pain increased (P < 0.000) compared to the fifth post-operative hour. The number of patients with complete analgesia decreased on the third post-operative day (P = 0.001 compared to fifth post-operative day). The Spearman correlation coefficient between pain score on the third post-operative day and level of satisfaction with nurse's response, doctor's response to pain and the overall pain management was − 0.0218 (P = 0.8107), 0.1307 (P = 0.1553) and 0.0743 (P = 0.4195), respectively. Conclusion: There is a high prevalence of acute post-operative pain in patients undergoing inpatient abdominal surgery at our institute. There is a weak correlation between the intensity of pain and level of satisfaction with pain management. PMID:27761037

  4. 14 CFR 27.1389 - Position light distribution and intensities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Position light distribution and intensities... light distribution and intensities. (a) General. the intensities prescribed in this section must be provided by new equipment with light covers and color filters in place. Intensities must be determined...

  5. 14 CFR 29.1389 - Position light distribution and intensities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Position light distribution and intensities... Position light distribution and intensities. (a) General. The intensities prescribed in this section must be provided by new equipment with light covers and color filters in place. Intensities must...

  6. 14 CFR 27.1389 - Position light distribution and intensities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Position light distribution and intensities... light distribution and intensities. (a) General. the intensities prescribed in this section must be provided by new equipment with light covers and color filters in place. Intensities must be determined...

  7. 14 CFR 29.1389 - Position light distribution and intensities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Position light distribution and intensities... Position light distribution and intensities. (a) General. The intensities prescribed in this section must be provided by new equipment with light covers and color filters in place. Intensities must...

  8. 14 CFR 27.1389 - Position light distribution and intensities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Position light distribution and intensities... light distribution and intensities. (a) General. the intensities prescribed in this section must be provided by new equipment with light covers and color filters in place. Intensities must be determined...

  9. 14 CFR 29.1389 - Position light distribution and intensities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Position light distribution and intensities... Position light distribution and intensities. (a) General. The intensities prescribed in this section must be provided by new equipment with light covers and color filters in place. Intensities must...

  10. 14 CFR 29.1389 - Position light distribution and intensities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Position light distribution and intensities... Position light distribution and intensities. (a) General. The intensities prescribed in this section must be provided by new equipment with light covers and color filters in place. Intensities must...

  11. 14 CFR 29.1389 - Position light distribution and intensities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Position light distribution and intensities... Position light distribution and intensities. (a) General. The intensities prescribed in this section must be provided by new equipment with light covers and color filters in place. Intensities must...

  12. 14 CFR 27.1389 - Position light distribution and intensities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Position light distribution and intensities... light distribution and intensities. (a) General. the intensities prescribed in this section must be provided by new equipment with light covers and color filters in place. Intensities must be determined...

  13. 14 CFR 27.1389 - Position light distribution and intensities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Position light distribution and intensities... light distribution and intensities. (a) General. the intensities prescribed in this section must be provided by new equipment with light covers and color filters in place. Intensities must be determined...

  14. Children visiting adults in ITU-what support is available? A descriptive survey.

    PubMed

    Vint, Pauline E

    2005-01-01

    Traditionally, children appear to have been discouraged from visiting in adult intensive therapy units. Various reasons have been given, mostly unsubstantiated by research. There is minimal information specifically related to this topic, but all studies (and related studies) reviewed propose visiting as a method to help children cope with critical illness in an adult family member. This postal survey offers a general perspective of how units have responded to the nursing literature and previous recommendations to date. This appears to have been the first national study specifically exploring the support for children visiting (or who may wish to visit) a critically ill adult in an intensive therapy unit. This study highlights (perhaps for the first time) not only the lack of policy and staff education but also the lack of available information for visitors, regarding visits by children so that they can make informed choices together.

  15. Retrospective analysis of outcomes from two intensive comprehensive aphasia programs.

    PubMed

    Persad, Carol; Wozniak, Linda; Kostopoulos, Ellina

    2013-01-01

    Positive outcomes from intensive therapy for individuals with aphasia have been reported in the literature. Little is known about the characteristics of individuals who attend intensive comprehensive aphasia programs (ICAPs) and what factors may predict who makes clinically significant changes when attending such programs. Demographic data on participants from 6 ICAPs showed that individuals who attend these programs spanned the entire age range (from adolescence to late adulthood), but they generally tended to be middle-aged and predominantly male. Analysis of outcome data from 2 of these ICAPs found that age and gender were not significant predictors of improved outcome on measures of language ability or functional communication. However, time post onset was related to clinical improvement in functional communication as measured by the Communication Activities of Daily Living, second edition (CADL-2). In addition, for one sample, initial severity of aphasia was related to outcome on the Western Aphasia Battery-Revised, such that individuals with more severe aphasia tended to show greater recovery compared to those with mild aphasia. Initial severity of aphasia also was highly correlated with changes in CADL-2 scores. These results suggest that adults of all ages with aphasia in either the acute or chronic phase of recovery can continue to show positive improvements in language ability and functional communication with intensive treatment.

  16. Energy density of the diets of Japanese adults in relation to food and nutrient intake and general and abdominal obesity: a cross-sectional analysis from the 2012 National Health and Nutrition Survey, Japan.

    PubMed

    Murakami, Kentaro; Livingstone, M Barbara E; Okubo, Hitomi; Sasaki, Satoshi

    2017-01-01

    The associations of dietary energy density with dietary intake and obesity have been largely unexplored in non-Western populations. The present cross-sectional study examined the associations using data from the 2012 National Health and Nutrition Survey, Japan. Dietary intake was assessed using a 1-d semi-weighed dietary record in 15 618 Japanese adults aged ≥20 years. Mean dietary energy density (calculated on the basis of foods only) was 5·98 (sd 1·20) kJ/g in men and 5·72 (sd 1·16) kJ/g in women. Dietary energy density was positively associated with intakes of bread, noodles (only men), meat, fats and oils, and sugar and confectionery but inversely with intakes of white rice (only men), potatoes, pulses, vegetables, fruits, and fish and shellfish. For nutrient intake, dietary energy density was positively associated with total fat and SFA but inversely associated with all other nutrients examined such as protein, carbohydrate, alcohol (only women), dietary fibre, and several vitamins and minerals, including Na. After adjustment for potential confounding factors, dietary energy density was positively associated with abdominal obesity (waist circumference ≥80 cm) in women (adjusted prevalence ratio between the extreme tertiles 1·07; 95 % CI 1·02, 1·12; P for trend=0·003). Dietary energy density was also positively but non-significantly associated with general obesity (BMI≥25 kg/m2) in women (P for trend=0·08). There were no such associations in men. In conclusion, lower energy density of the diets of Japanese adults was associated with favourable food and nutrient intake patterns, except for higher Na, and, in only women, a lower prevalence of abdominal obesity.

  17. Youth and young adult physical activity and body composition of young adult women: findings from the dietary intervention study in children.

    PubMed

    Hodge, Melissa G; Hovinga, Mary; Shepherd, John A; Egleston, Brian; Gabriel, Kelley; Van Horn, Linda; Robson, Alan; Snetselaar, Linda; Stevens, Victor K; Jung, Seungyoun; Dorgan, Joanne

    2015-02-01

    This study prospectively investigates associations between youth moderate-to-vigorous-intensity physical activity (MVPA) and body composition in young adult women using data from the Dietary Intervention Study in Children (DISC) and the DISC06 Follow-Up Study. MVPA was assessed by questionnaire on 5 occasions between the ages 8 and 18 years and at age 25-29 years in 215 DISC female participants. Using whole body dual-energy x-ray absorptiometry (DXA), overall adiposity and body fat distribution were assessed at age 25-29 years by percent body fat (%fat) and android-to-gynoid (A:G) fat ratio, respectively. Linear mixed effects models and generalized linear latent and mixed models were used to assess associations of youth MVPA with both outcomes. Young adult MVPA, adjusted for other young adult characteristics, was significantly inversely associated with young adult %fat (%fat decreased from 37.4% in the lowest MVPA quartile to 32.8% in the highest (p-trend = 0.02)). Adjusted for youth and young adult characteristics including young adult MVPA, youth MVPA also was significantly inversely associated with young adult %fat (β=-0.40 per 10 MET-hrs/wk, p = .02) . No significant associations between MVPA and A:G fat ratio were observed. Results suggest that youth and young adult MVPA are important independent predictors of adiposity in young women.

  18. Hazards from High Intensity Lamps and Arcs

    NASA Technical Reports Server (NTRS)

    Sliney, D. H.

    1970-01-01

    The principal occupational health problem generally associated with high intensity arc lamps results from exposure of the eye and skin to ultraviolet radiation. Occasionally, the chorioretinal burns are of concern. The eye is generally more susceptible than the skin to injury from high intensity optical radiation sources whether ultraviolet, visible or infrared. Recent developments in technology have shown that some high intensity optical radiation sources which have output parameters greatly different from those encountered in the natural environment present a serious chorioretinal burn hazard.

  19. Polymyositis - adult

    MedlinePlus

    ... rash is a sign of a similar condition, dermatomyositis . Common symptoms include: Muscle weakness in the shoulders ... in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial. ...

  20. Facts about Meningococcal Disease for Adults

    MedlinePlus

    ... will have serious permanent disabilities like brain damage, hearing loss, and limb amputations. FACT: While some adults are at increased risk and need vaccination, adolescents and young adults generally have a higher risk ...

  1. Treatment Options for Adult Primary Liver Cancer

    MedlinePlus

    ... Cancer Prevention Liver Cancer Screening Research Adult Primary Liver Cancer Treatment (PDQ®)–Patient Version General Information About Adult Primary Liver Cancer Go to Health Professional Version Key Points ...

  2. Treatment Option Overview (Adult Primary Liver Cancer)

    MedlinePlus

    ... Cancer Prevention Liver Cancer Screening Research Adult Primary Liver Cancer Treatment (PDQ®)–Patient Version General Information About Adult Primary Liver Cancer Go to Health Professional Version Key Points ...

  3. Stages of Adult Primary Liver Cancer

    MedlinePlus

    ... Cancer Prevention Liver Cancer Screening Research Adult Primary Liver Cancer Treatment (PDQ®)–Patient Version General Information About Adult Primary Liver Cancer Go to Health Professional Version Key Points ...

  4. General Information about Adult Hodgkin Lymphoma

    MedlinePlus

    ... Hodgkin lymphoma include swollen lymph nodes, fever, night sweats, and weight loss. These and other signs and ... groin. Fever for no known reason. Drenching night sweats. Weight loss for no known reason. Itchy skin. ...

  5. General Information about Adult Soft Tissue Sarcoma

    MedlinePlus

    ... superficial (in subcutaneous tissue with no spread into connective tissue or muscle below) or deep (in the muscle ... superficial (in subcutaneous tissue with no spread into connective tissue or muscle below) or deep (in the muscle ...

  6. General Information about Adult Acute Myeloid Leukemia

    MedlinePlus

    ... the past. Being exposed to radiation from an atomic bomb or to the chemical benzene . Having a ... chemicals to look for certain changes in the structure or function of genes. This test is used ...

  7. Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using National Cholesterol Education Program-Adult Treatment Panel III criteria in Botswana

    PubMed Central

    Omech, Bernard; Tshikuka, Jose-Gaby; Mwita, Julius C; Tsima, Billy; Nkomazana, Oathokwa; Amone-P’Olak, Kennedy

    2016-01-01

    Background Low- and middle-income countries, including Botswana, are facing rising prevalence of obesity and obesity-related cardiometabolic complications. Very little information is known about clustering of cardiovascular risk factors in the outpatient setting during routine visits. We aimed to assess the prevalence and identify the determinants of metabolic syndrome among the general outpatients’ attendances in Botswana. Methods A cross-sectional study was conducted from August to October 2014 involving outpatients aged ≥20 years without diagnosis of diabetes mellitus. A precoded questionnaire was used to collect data on participants’ sociodemographics, risk factors, and anthropometric indices. Fasting blood samples were drawn and analyzed for glucose and lipid profile. Metabolic syndrome was assessed using National Cholesterol Education Program-Adult Treatment Panel III criteria. Results In total, 291 participants were analyzed, of whom 216 (74.2%) were females. The mean age of the total population was 50.1 (±11) years. The overall prevalence of metabolic syndrome was 27.1% (n=79), with no significant difference between the sexes (female =29.6%, males =20%, P=0.11). A triad of central obesity, low high-density lipoprotein-cholesterol, and elevated blood pressure constituted the largest proportion (38 [13.1%]) of cases of metabolic syndrome, followed by a combination of low high-density lipoprotein, elevated triglycerides, central obesity, and elevated blood pressure, with 17 (5.8%) cases. Independent determinants of metabolic syndrome were antihypertensive use and increased waist circumference. Conclusion Metabolic syndrome is highly prevalent in the general medical outpatients clinics. Proactive approaches are needed to screen and manage cases targeting its most important predictors. PMID:27616893

  8. Insulin therapy in the pediatric intensive care unit

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Hyperglycemia is a major risk factor for increased morbidity and mortality in the intensive care unit. Insulin therapy has emerged in adult intensive care units, and several pediatric studies are currently being conducted. This review discusses hyperglycemia and the effects of insulin on metabolic a...

  9. 20 CFR 663.210 - How are intensive services delivered?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false How are intensive services delivered? 663.210 Section 663.210 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) ADULT AND DISLOCATED WORKER ACTIVITIES UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Intensive...

  10. 20 CFR 663.210 - How are intensive services delivered?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false How are intensive services delivered? 663.210 Section 663.210 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) ADULT AND DISLOCATED WORKER ACTIVITIES UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Intensive...

  11. 20 CFR 663.220 - Who may receive intensive services?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... One-Stop operator to be in need of more intensive services to obtain employment; and (b) Adults and dislocated workers who are employed, have received at least one core service, and are determined by a One-Stop operator to be in need of intensive services to obtain or retain employment that leads to...

  12. [Summary of the Consensus for management of community acquired pneumonia in adults].

    PubMed

    2005-08-01

    This is an update of the Consensus for treatment of community acquired pneumonia in adults, prepared by the Chilean Society of Respiratory Diseases and the Chilean Society of Infectious Diseases. These norms were prepared by thirty specialists in respiratory diseases, internal medicine, infectious diseases, microbiology, intensive medicine and radiology. The purpose of the document is to norm the management of immunocompetent adults with community acquired pneumonia, by the public and private health systems of our country. The complete document will be published in June, in the respective journals of the Societies of Respiratory and Infectious Diseases. This is a summary to obtain a better diffusion of these norms among internists and general practitioners.

  13. Young Adults' Implicit and Explicit Attitudes towards the Sexuality of Older Adults.

    PubMed

    Thompson, Ashley E; O'Sullivan, Lucia F; Byers, E Sandra; Shaughnessy, Krystelle

    2014-09-01

    Sexual interest and capacity can extend far into later life and result in many positive health outcomes. Yet there is little support for sexual expression in later life, particularly among young adults. This study assessed and compared young adults' explicit and implicit attitudes towards older adult sexuality. A sample of 120 participants (18-24 years; 58% female) completed a self-report (explicit) measure and a series of Implicit Association Tests capturing attitudes towards sexuality among older adults. Despite reporting positive explicit attitudes, young people revealed an implicit bias against the sexual lives of older adults. In particular, young adults demonstrated implicit biases favouring general, as compared to sexual, activities and young adults as compared to older adults. Moreover, the bias favouring general activities was amplified with regard to older adults as compared to younger adults. Our findings challenge the validity of research relying on self-reports of attitudes about older adult sexuality.

  14. Serum Folate, Vitamin B-12, Vitamin A, γ-Tocopherol, α-Tocopherol, and Carotenoids Do Not Modify Associations between Cadmium Exposure and Leukocyte Telomere Length in the General US Adult Population.

    PubMed

    Nomura, Sarah Jo; Robien, Kim; Zota, Ami R

    2017-03-08

    Background: Leukocyte telomere length (LTL) is a biomarker of the aging process and is associated with the risk of chronic disease. Higher exposure to cadmium may be associated with shorter LTL, and adequate nutrient concentrations may be associated with longer LTL; however, the potential interaction between metals and nutrients on LTL has yet to be examined.Objectives: The objective of this study was to evaluate whether serum concentrations of vitamins and carotenoids were associated with LTL, and whether they modified the association between blood cadmium and LTL in the US NHANES (1999-2002).Methods: We evaluated cross-sectional associations between LTL and serum concentrations of vitamin A, γ-tocopherol, α-tocopherol, folate, and vitamin B-12 (1999-2002; n = 7458) and α-carotene, β-carotene, β-cryptoxanthin, lutein + zeaxanthin, and lycopene (2001-2002; n = 4018) in a nationally representative sample of US adults (≥20 y of age) with the use of multivariable linear regression. We further investigated whether vitamin and carotenoid concentrations modified associations between blood cadmium and LTL with models stratified by serum nutrient concentrations and the inclusion of an interaction term.Results: Blood cadmium was inversely associated with LTL (percentage of LTL difference per 1 μg/L = -3.74; 95% CI: -5.35, -2.10). Serum vitamin A was positively associated (percentage of LTL difference per 1 μg/L = 4.01; 95% CI: 0.26, 7.90) and γ-tocopherol was inversely associated (percentage of LTL difference per 1 μg/dL = -2.49; 95% CI: -4.21, -0.73) with LTL. Serum folate (P-trend = 0.06) and α-tocopherol (P-trend = 0.10) were marginally positively associated with LTL, whereas vitamin B-12 (P-trend = 0.78) was not associated with LTL. Serum carotenoids were generally positively associated with LTL. Serum vitamin and carotenoid concentrations did not modify blood cadmium and LTL associations (P-interaction > 0.10).Conclusions: Results from this cross

  15. Effect of day-case unilateral cochlear implantation in adults on general and disease-specific quality of life, postoperative complications and hearing results, tinnitus, vertigo and cost-effectiveness: protocol for a randomised controlled trial

    PubMed Central

    Derks, Laura S M; Wegner, Inge; Smit, Adriana L; Thomeer, Hans G X M; Topsakal, Vedat; Grolman, Wilko

    2016-01-01

    Introduction Cochlear implantation is an increasingly common procedure in the treatment of severe to profound sensorineural hearing loss (SNHL) in children and adults. It is often performed as a day-case procedure. The major drive towards day-case surgery has been from a logistical, economical and societal perspective, but we also speculate that the patient's quality of life (QoL) is at least equal to inpatient surgery if not increased as a result of rapid discharge and rehabilitation. Even though cochlear implantation seems well suited to a day-case approach and this even seems to be common practice in some countries, evidence is scarce and of low quality to guide us towards the preferred treatment option. Methods and analysis A single-centre, non-blinded, randomised, controlled trial was designed to (primarily) investigate the effect on general QoL of day-case cochlear implantation compared to inpatient cochlear implantation and (secondarily) the effect of both methods on (subjective) hearing improvement, disease-specific QoL, tinnitus, vertigo and cost-effectiveness. 30 adult patients with severe to profound bilateral postlingual SNHL who are eligible for unilateral cochlear implantation will be randomly assigned to either the day-case or inpatient treatment group. The outcome measures will be assessed using auditory evaluations, questionnaires (preoperatively, at 1-week, 3-week, 3-month and 1-year follow-up) and costs diaries (weekly during the first month postoperatively, after which once in a month until 1-year follow-up). Preoperative and postoperative outcomes will be compared. The difference in costs and benefit will be represented using the incremental cost utility/effectiveness ratio. The analyses will be carried out on an intention-to-treat basis. Ethics and dissemination This research protocol was approved by the Institutional Review Board of the UMC Utrecht (NL45590.041.13; V.5, November 2015). The trial results will be disseminated through peer

  16. Is parenteral phosphate replacement in the intensive care unit safe?

    PubMed

    Agarwal, Banwari; Walecka, Agnieszka; Shaw, Steve; Davenport, Andrew

    2014-02-01

    Hypophosphatemia is well recognized in the intensive care setting, associated with refeeding and continuous forms of renal replacement therapy (CCRT). However, it is unclear as to when and how to administer intravenous phosphate supplementation in the general intensive care setting. There have been recent concerns regarding phosphate administration and development of acute kidney injury. We therefore audited our practice of parenteral phosphate administration. We prospectively audited parenteral phosphate administration (20 mmol) in 58 adult patients in a general intensive care unit in a University tertiary referral center. Fifty-eight patients were audited; mean age 57.2 ± 2.0 years, 70.7% male. The median duration of the infusion was 310 min (228-417), and 50% of the patients were on CRRT. 63.8% of patients were hypophosphatemic (<0.87 mmol/L) prior to the phosphate infusion, and serum phosphate increased from 0.79 ± 0.02 to 1.07 ± 0.03 mmol/L, P < 0.001. Two patients became hyperphosphatemic (>1.45 mmol/L). There was no correlation between the change in serum phosphate and the pre-infusion phosphate. Although there were no significant changes in serum urea, creatinine or other electrolytes, arterial ionized calcium fell from 1.15 ± 0.01 to 1.13 ± 0.01 mmol/L, P < 0.01. Although infusion of 20 mmol phosphate did not appear to adversely affect renal function and corrected hypophosphatemia in 67.7% of cases, we found that around 33% of patients who were given parenteral phosphate were not hypophosphatemic, and that the fall in ionized calcium raises the possibility of the formation of calcium-phosphate complexes and potential for soft tissue calcium deposition.

  17. Sequential chemotherapy followed by reduced-intensity conditioning and allogeneic haematopoietic stem cell transplantation in adult patients with relapse or refractory acute myeloid leukaemia: a survey from the Acute Leukaemia Working Party of EBMT.

    PubMed

    Ringdén, Olle; Labopin, Myriam; Schmid, Christoph; Sadeghi, Behnam; Polge, Emmanuelle; Tischer, Johanna; Ganser, Arnold; Michallet, Mauricette; Kanz, Lothar; Schwerdtfeger, Rainer; Nagler, Arnon; Mohty, Mohamad

    2017-02-01

    This study analysed the outcome of 267 patients with relapse/refractory acute myeloid leukaemia (AML) who received sequential chemotherapy including fludarabine, cytarabine and amsacrine followed by reduced-intensity conditioning (RIC) and allogeneic haematopoietic stem cell transplantation (HSCT). The transplants in 77 patients were from matched sibling donors (MSDs) and those in 190 patients were from matched unrelated donors. Most patients (94·3%) were given anti-T-cell antibodies. The incidence of acute graft-versus-host disease (GVHD) of grades II-IV was 32·1% and that of chronic GVHD was 30·2%. The 3-year probability of non-relapse mortality (NRM) was 25·9%, that of relapse was 48·5%, that of GVHD-free and relapse-free survival (GRFS) was 17·8% and that of leukaemia-free survival (LFS) was 25·6%. In multivariate analysis, unrelated donor recipients more frequently had acute GVHD of grades II-IV [hazard ratio (HR) = 1·98, P = 0·017] and suffered less relapses (HR = 0·62, P = 0·01) than MSD recipients. Treatment with anti-T-cell antibodies reduced NRM (HR = 0·35, P = 0·01) and improved survival (HR = 0·49, P = 0·01), GRFS (HR = 0·37, P = 0·0004) and LFS (HR = 0·46, P = 0·005). Thus, sequential chemotherapy followed by RIC HSCT and use of anti-T-cell antibodies seems promising in patients with refractory AML.

  18. Intensive Care, Intense Conflict: A Balanced Approach.

    PubMed

    Paquette, Erin Talati; Kolaitis, Irini N

    2015-01-01

    Caring for a child in a pediatric intensive care unit is emotionally and physically challenging and often leads to conflict. Skilled mediators may not always be available to aid in conflict resolution. Careproviders at all levels of training are responsible for managing difficult conversations with families and can often prevent escalation of conflict. Bioethics mediators have acknowledged the important contribution of mediation training in improving clinicians' skills in conflict management. Familiarizing careproviders with basic mediation techniques is an important step towards preventing escalation of conflict. While training in effective communication is crucial, a sense of fairness and justice that may only come with the introduction of a skilled, neutral third party is equally important. For intense conflict, we advocate for early recognition, comfort, and preparedness through training of clinicians in de-escalation and optimal communication, along with the use of more formally trained third-party mediators, as required.

  19. Placing Advocacy at the Heart of Adult Education

    ERIC Educational Resources Information Center

    Taylor, Jackie

    2016-01-01

    Adult educators know that adults and families change their lives through adult education. Adult education also positively impacts a host of social and economic issues. Yet this fact is largely unknown or misunderstood by the general public. Resources have become increasingly scarce, while at the same time adult educators are asked to do more with…

  20. Perceived Stress among Deaf Adults

    ERIC Educational Resources Information Center

    Jones, Elaine G.; Ouellette, Sue E.; Kang, Youngmi

    2006-01-01

    The Present Article describes the effectiveness of stress management classes in decreasing perceived stress among Deaf adults. Deaf adults may experience unique stressors, in addition to circumstances associated with increased stress in the general population. The Perceived Stress Scale (S. Cohen, Kamarck, & Mermelstein, 1983) was used as a…

  1. Adult Functional Competency: A Summary.

    ERIC Educational Resources Information Center

    Texas Univ., Austin. Div. of Extension.

    The Adult Performance Level (APL) project summary specifies the competencies which are functional to economic and educational success in society and describes devices developed for assessing those competencies. The APL theory of functional competency identifies adult needs in general knowledge areas (consumer economics, occupational knowledge,…

  2. Light intensity compressor

    DOEpatents

    Rushford, Michael C.

    1990-01-01

    In a system for recording images having vastly differing light intensities over the face of the image, a light intensity compressor is provided that utilizes the properties of twisted nematic liquid crystals to compress the image intensity. A photoconductor or photodiode material that is responsive to the wavelength of radiation being recorded is placed adjacent a layer of twisted nematic liquid crystal material. An electric potential applied to a pair of electrodes that are disposed outside of the liquid crystal/photoconductor arrangement to provide an electric field in the vicinity of the liquid crystal material. The electrodes are substantially transparent to the form of radiation being recorded. A pair of crossed polarizers are provided on opposite sides of the liquid crystal. The front polarizer linearly polarizes the light, while the back polarizer cooperates with the front polarizer and the liquid crystal material to compress the intensity of a viewed scene. Light incident upon the intensity compressor activates the photoconductor in proportion to the intensity of the light, thereby varying the field applied to the liquid crystal. The increased field causes the liquid crystal to have less of a twisting effect on the incident linearly polarized light, which will cause an increased percentage of the light to be absorbed by the back polarizer. The intensity of an image may be compressed by forming an image on the light intensity compressor.

  3. Light intensity compressor

    DOEpatents

    Rushford, Michael C.

    1990-02-06

    In a system for recording images having vastly differing light intensities over the face of the image, a light intensity compressor is provided that utilizes the properties of twisted nematic liquid crystals to compress the image intensity. A photoconductor or photodiode material that is responsive to the wavelength of radiation being recorded is placed adjacent a layer of twisted nematic liquid crystal material. An electric potential applied to a pair of electrodes that are disposed outside of the liquid crystal/photoconductor arrangement to provide an electric field in the vicinity of the liquid crystal material. The electrodes are substantially transparent to the form of radiation being recorded. A pair of crossed polarizers are provided on opposite sides of the liquid crystal. The front polarizer linearly polarizes the light, while the back polarizer cooperates with the front polarizer and the liquid crystal material to compress the intensity of a viewed scene. Light incident upon the intensity compressor activates the photoconductor in proportion to the intensity of the light, thereby varying the field applied to the liquid crystal. The increased field causes the liquid crystal to have less of a twisting effect on the incident linearly polarized light, which will cause an increased percentage of the light to be absorbed by the back polarizer. The intensity of an image may be compressed by forming an image on the light intensity compressor.

  4. Pediatric intensive care.

    PubMed

    Macintire, D K

    1999-07-01

    To provide optimal care, a veterinarian in a pediatric intensive care situation for a puppy or kitten should be familiar with normal and abnormal vital signs, nursing care and monitoring considerations, and probable diseases. This article is a brief discussion of the pediatric intensive care commonly required to treat puppies or kittens in emergency situations and for canine parvovirus type 2 enteritis.

  5. Adult outcomes of preterm children.

    PubMed

    Hack, Maureen

    2009-10-01

    The survivors of the initial years of neonatal intensive care of preterm infants reached adulthood during the last decade. Reports of their adult outcomes examined have included neurodevelopmental, behavioral and health outcomes as well as social functioning and reproduction. Despite statistically significant differences between preterm young adults and controls in most outcomes studied, the majority of preterm survivors do well and live fairly normal lives. The two major predictors of adult outcomes are lower gestational age that reflect perinatal injury and family sociodemographic status which reflects both genetic and environmental effects.

  6. A Morphometric Study of Antral G-Cell Density in a Sample of Adult General Population: Comparison of Three Different Methods and Correlation with Patient Demography, Helicobacter pylori Infection, Histomorphology and Circulating Gastrin Levels

    PubMed Central

    Petersson, Fredrik; Borch, Kurt; Rehfeld, Jens F; Franzén, Lennart E

    2009-01-01

    Helicobacter pylori infection has been linked to hypergastrinemia and either decreased or normal G-cell content in the antral mucosa. To clarify this controversial issue, we quantitatively determined antral G-cell content on the same biopsy specimens with three different methods and examined whether these methods are intercorrelated and the relation of these methods to plasma gastrin concentrations, demography, the occurrence of H. pylori infection and chronic gastritis. Gastric antral mucosal biopsy sections from 273 adults (188 with and 85 without H pylori infection) from a general population sample were examined immunohistochemically for G-cells using cell counting, stereology (point counting) and computerized image analysis. Gastritis was scored according to the updated Sydney system. Basal plasma gastrin concentrations were measured by radioimmunoassay. The three methods for G-cell quantification were poorly correlated and the results showed no correlation with basal plasma gastrin concentrations. The antral G-cell density and scores for H. pylori colonization were positively related to age. Neither the scores for chronic inflammation, nor the scores for inflammatory activity, atrophy or intestinal metaplasia were consistently related to the antral G-cell content. In conclusion, the results of three techniques for G-cell quantification in the gastric antral mucosa were poorly intercorrelated and none of the methods correlated with plasma gastrin concentrations. Age and scores for H pylori colonization seem to be determinants of the G-cell density. That common morphometric techniques correlate poorly is of utmost importance to bear in mind when quantitative morphological studies are planned, compared or interpreted. PMID:19079618

  7. Planning the acoustic environment of a neonatal intensive care unit.

    PubMed

    Philbin, M Kathleen

    2004-06-01

    This article addresses general principles of designing a quiet neonatal intensive care unit (NICU) and describes basic aspects of room acoustics as these apply to the NICU. Recommended acoustical criteria for walls, background noise, vibration, and reverberation are included as appendices. Crowding in open, multiple-bed NICUs is the major factor in designs that inevitably produce noisy nurseries with limited space for parents. Quiet infant spaces with appropriate sound sources rely on isolation of the infant from facility and operational noise sources (eg, adult work spaces, supply delivery, and travel paths) and extended contact with family members.However, crowding has been an important influence on the clinical practice and social context of neonatology. It allows clinicians to rely on wide visual and auditory access to many patients for monitoring their well-being. It also allows immediate social contact with other adults, both staff and families. Giving up this wide access and relying on other forms of communication in order to provide for increased quiet and privacy for staff, infants, and parents is a challenge for some design teams. Studies of the effects of various nursery designs on infants, parents, clinicians, and the delivery of services are proposed as a means of advancing the field of design.

  8. Intensity Biased PSP Measurement

    NASA Technical Reports Server (NTRS)

    Subramanian, Chelakara S.; Amer, Tahani R.; Oglesby, Donald M.; Burkett, Cecil G., Jr.

    2000-01-01

    The current pressure sensitive paint (PSP) technique assumes a linear relationship (Stern-Volmer Equation) between intensity ratio (I(sub o)/I) and pressure ratio (P/P(sub o)) over a wide range of pressures (vacuum to ambient or higher). Although this may be valid for some PSPs, in most PSPs the relationship is nonlinear, particularly at low pressures (less than 0.2 psia when the oxygen level is low). This non-linearity can be attributed to variations in the oxygen quenching (de-activation) rates (which otherwise is assumed constant) at these pressures. Other studies suggest that some paints also have non-linear calibrations at high pressures; because of heterogeneous (non-uniform) oxygen diffusion and quenching. Moreover, pressure sensitive paints require correction for the output intensity due to light intensity variation, paint coating variation, model dynamics, wind-off reference pressure variation, and temperature sensitivity. Therefore to minimize the measurement uncertainties due to these causes, an insitu intensity correction method was developed. A non-oxygen quenched paint (which provides a constant intensity at all pressures, called non-pressure sensitive paint, NPSP) was used for the reference intensity (I(sub NPSP) with respect to which all the PSP intensities (I) were measured. The results of this study show that in order to fully reap the benefits of this technique, a totally oxygen impermeable NPSP must be available.

  9. Intensity Biased PSP Measurement

    NASA Technical Reports Server (NTRS)

    Subramanian, Chelakara S.; Amer, Tahani R.; Oglesby, Donald M.; Burkett, Cecil G., Jr.

    2000-01-01

    The current pressure sensitive paint (PSP) technique assumes a linear relationship (Stern-Volmer Equation) between intensity ratio (I(sub 0)/I) and pressure ratio (P/P(sub 0)) over a wide range of pressures (vacuum to ambient or higher). Although this may be valid for some PSPs, in most PSPs the relationship is nonlinear, particularly at low pressures (less than 0.2 psia when the oxygen level is low). This non-linearity can be attributed to variations in the oxygen quenching (de-activation) rates (which otherwise is assumed constant) at these pressures. Other studies suggest that some paints also have non-linear calibrations at high pressures; because of heterogeneous (non-uniform) oxygen diffusion and c quenching. Moreover, pressure sensitive paints require correction for the output intensity due to light intensity variation, paint coating variation, model dynamics, wind-off reference pressure variation, and temperature sensitivity. Therefore to minimize the measurement uncertainties due to these causes, an in- situ intensity correction method was developed. A non-oxygen quenched paint (which provides a constant intensity at all pressures, called non-pressure sensitive paint, NPSP) was used for the reference intensity (I(sub NPSP)) with respect to which all the PSP intensities (I) were measured. The results of this study show that in order to fully reap the benefits of this technique, a totally oxygen impermeable NPSP must be available.

  10. General Anesthesia

    MedlinePlus

    General anesthesia Overview By Mayo Clinic Staff Under general anesthesia, you are completely unconscious and unable to feel pain during medical procedures. General anesthesia usually uses a combination of intravenous drugs and ...

  11. Are Older Adults Physically Active Enough – A Matter of Assessment Method? The Generation 100 Study

    PubMed Central

    Zisko, Nina; Ingebrigtsen, Jan Erik; Wisløff, Ulrik; Stensvold, Dorthe

    2016-01-01

    Introduction Physical activity (PA) is beneficial for general health. As a result, adults around the world are recommended to undertake regular PA of either absolute or relative intensity. Traditionally, adherence to PA recommendation is assessed by accelerometers that record absolute intensity thresholds. Since ageing often results in a decrease in cardiorespiratory fitness (CRF), older adults (aged > 65 years) might be more susceptible to not meeting the PA recommendation when measured in absolute terms. The aim of the present study was to compare the adherence to the PA recommendation using both absolute and relative thresholds. Additionally, we aimed to report the reference values for overall PA in a large sample of Norwegian older adults. Methods PA was assessed for 7 days using the Actigraph GT3X+ accelerometer in 1219 older adults (624 females) aged 70–77 years. Overall PA was measured as counts per minute (CPM) and steps. Absolute and relative moderate-to-vigorous PA (MVPA) thresholds were applied to quantify adherence to PA recommendation. The relative MVPA thresholds were developed specifically for the Generation 100 population sample. CRF was directly measured as peak oxygen uptake (VO2peak). Results Proportions meeting PA recommendation were 29% and 71% when utilizing absolute and relative MVPA, respectively. More females met the relative PA recommendation compared to males. Overall PA was higher among the youngest age group. Older adults with medium- and high levels of CRF were more physically active, compared to those with the lowest levels of CRF. Conclusion This is the first study to compare adherence to PA recommendation, using absolute and relative intensity thresholds among older adults. The present study clearly illustrates the consequences of using different methodological approaches to surveillance of PA across age, gender and CRF in a population of older adults. PMID:27893785

  12. [Orthodontic treatment for adults].

    PubMed

    Kuitert, R B

    2000-04-01

    The number of adults undergoing orthodontic treatment has increased strongly and the average age that adult patients undergo orthodontic treatment increased steadily although 3/4 is still younger than 27 years. In adults the facial skeletal pattern can only be changed in a very confined way, consequently in case of an abnormal skeletal pattern one has to choose between a combined orthodontic-surgical approach (which is the case in 18% of the patients) and a compromised orthodontic treatment, if necessary combined with other disciplines. It is still controversial whether tooth movement in adults is slower and more difficult than in adolescents. The same holds true for the risk for loss of periodontal support, for root resorption, for gnathologic problems and for relapse. As related to these variables there appears to be a large individual variation. Many adults show one or more problems in their dentition that may influence their orthodontic treatment. About 60% of the adult patients need a multidisciplinary approach. The development of implantology and of bone regeneration and bone grafting has lead to more combined treatments. The risks of such complex treatment plans are generally larger than those for more simple kinds of treatment. A very careful treatment planning and good communication between the different specialists is essential. Moreover the treatment plan with all its (dis)advantages has to be extensively discussed with the patient.

  13. High solar intensity radiometer

    NASA Technical Reports Server (NTRS)

    Jack, J. R.; Spisz, E. W.

    1972-01-01

    Silicon solar cells are used to measure visible radiant energy and radiation intensities to 20 solar constants. Future investigations are planned for up to 100 solar constants. Radiometer is small, rugged, accurate and inexpensive.

  14. [Intensive medicine in Spain].

    PubMed

    2011-03-01

    Intensive care medicine is a medical specialty that was officially established in our country in 1978, with a 5-year training program including two years of common core training followed by three years of specific training in an intensive care unit accredited for training. During this 32-year period, intensive care medicine has carried out an intense and varied activity, which has allowed its positioning as an attractive and with future specialty in the hospital setting. This document summarizes the history of the specialty, its current situation, the key role played in the programs of organ donation and transplantation of the National Transplant Organization (after more than 20 years of mutual collaboration), its training activities with the development of the National Plan of Cardiopulmonary Resuscitation, with a trajectory of more than 25 years, its interest in providing care based on quality and safety programs for the severely ill patient. It also describes the development of reference registries due to the need for reliable data on the care process for the most prevalent diseases, such as ischemic heart disease or ICU-acquired infections, based on long-term experience (more than 15 years), which results in the availability of epidemiological information and characteristics of care that may affect the practical patient's care. Moreover, features of its scientific society (SEMICYUC) are reported, an organization that agglutinates the interests of more than 280 ICUs and more than 2700 intensivists, with reference to the journal Medicina Intensiva, the official journal of the society and the Panamerican and Iberian Federation of Critical Medicine and Intensive Care Societies. Medicina Intensiva is indexed in the Thompson Reuters products of Science Citation Index Expanded (Scisearch(®)) and Journal Citation Reports, Science Edition. The important contribution of the Spanish intensive care medicine to the scientific community is also analyzed, and in relation to

  15. High intensity neutrino beams

    SciTech Connect

    Ichikawa, A. K.

    2015-07-15

    High-intensity proton accelerator complex enabled long baseline neutrino oscillation experiments with a precisely controlled neutrino beam. The beam power so far achieved is a few hundred kW with enourmorous efforts of accelerator physicists and engineers. However, to fully understand the lepton mixing structure, MW-class accelerators are desired. We describe the current intensity-frontier high-energy proton accelerators, their plans to go beyond and technical challenges in the neutrino beamline facilities.

  16. Impact of Evaluation Anxiety on Adult Learning.

    ERIC Educational Resources Information Center

    Sogunro, Olusegun A.

    1998-01-01

    Evaluation anxiety can have a significant impact on adult learning, and it is a generally inescapable part of teaching-learning transactions. Too much evaluation anxiety can be devastating. This paper examines the effects of evaluation anxiety on adult learning, discussing the causes, the control measures, and the implications for adult educators.…

  17. Physical Criteria for Adult Learning Environments.

    ERIC Educational Resources Information Center

    White, Sally

    The development of learning environments especially for adults has been neglected and research in planning such environments is fragmented and minimal. There is general agreement that facilities for adults should have an aura of adulthood to contribute to an adult's feeling of ease, confidence, and capability; that they should be flexible in room…

  18. How Should We Fund Adult Learning?

    ERIC Educational Resources Information Center

    McNair, Stephen

    2009-01-01

    Adult learning happens in many places and forms, and is paid for by a complex mix of public, employer and private funds. National Institute of Adult Continuing Education's recent survey of public attitudes to paying for lifelong learning shows clearly that people have not convinced the general public that adult learning deserves more public…

  19. Maine Adult Education Director's Handbook, 2004.

    ERIC Educational Resources Information Center

    Maine Department of Education, 2004

    2004-01-01

    The Maine Adult Education Directors' Handbook offers a basic overview of the Adult and Community Education system in Maine. The information is general and intended to provide a background to the person initially becoming involved in adult education--director, teacher, school board member, advisory council member or superintendent. The Handbook is…

  20. Speaking-Related Dyspnea in Healthy Adults

    ERIC Educational Resources Information Center

    Hoit, Jeannette D.; Lansing, Robert W.; Perona, Kristen E.

    2007-01-01

    Purpose: To reveal the qualities and intensity of speaking-related dyspnea in healthy adults under conditions of high ventilatory drive, in which the behavioral and metabolic control of breathing must compete. Method: Eleven adults read aloud while breathing different levels of inspired carbon dioxide (CO[subscript 2]). After the highest level,…

  1. Adult Seborrheic Dermatitis

    PubMed Central

    2011-01-01

    Seborrheic dermatitis is a common chronic-recurrent inflammatory disorder that most commonly affects adults; however, a more transient infantile form also occurs. The definitive cause of seborrheic dermatitis is unknown. However, proliferation of Malassezia species has been described as a contributing factor. The adult form of seborrheic dermatitis affects up to approximately five percent of the general population. The disorder commonly affects the scalp, face, and periauricular region, with the central chest, axillae, and genital region also involved in some cases. Pruritus is not always present and is relatively common, especially with scalp disease. A variety of treatments are available including topical corticosteroids, topical antifungal agents, topical calcineurin inhibitors, and more recently, a nonsteroidal “device ”cream. This article reviews the practical topical management of seborrheic dermatitis in the United States, focusing on the adult population. PMID:21607192