Urban-rural status affects associations between domains of environmental quality and adverse birth outcomes

EPA Science Inventory

The relationship between environmental conditions and human health varies by environmental domain and urbanicity. To account for multiple ambient environmental conditions, we constructed an Environmental Quality Index (EQI) for health research. We used U.S. county level data rep...

Urban-rural differences in environmental quality and associations with adverse birth outcomes

EPA Science Inventory

Exposures affecting human health differ across environmental media and level of urbanicity. To address this, we constructed an Environmental Quality Index (EQI) with data representing five domains (air, water, land, built, sociodemographic) for each United States (U.S.) county. F...

Energy, Weatherization and Indoor Air Quality

EPA Pesticide Factsheets

Climate change presents many challenges, including the production of severe weather events. These events and efforts to minimize their effects through weatherization can adversely affect indoor environments.

49 CFR 266.19 - Environmental impact.

Code of Federal Regulations, 2011 CFR

2011-10-01

... adverse impact in any natural, cultural, recreational, or scenic environment(s) in which the action takes... affect the quality of the human environment. The finding of no significant impact shall include a... the impact upon the quality of the human environment. FRA recommends that prior to submitting the...

Quality of Institutional Care and Early Childhood Development

ERIC Educational Resources Information Center

Oliveira, Paula Salgado; Fearon, R. M. Pasco; Belsky, Jay; Fachada, Inês; Soares, Isabel

2015-01-01

Institutional rearing adversely affects children's development, but the extent to which specific characteristics of the institutional context and the quality of care provided contribute to problematic development remains unclear. In this study, 72 preschoolers institutionalised for at least 6 months were evaluated by their caregiver using the…

Domains of environmental quality are differentially associated with adverse birth outcomes by levels of urban-rural status

EPA Science Inventory

Human health is affected by exposures operating from multiple domains across level of urbanicity. To accommodate this, we constructed an environmental quality index(EQI) using data from five domains (air, water, land, built, sociodemographic) for each United States (U.S.) county;...

Developmental Constraints in a Wild Primate

PubMed Central

Lea, Amanda J.; Altmann, Jeanne; Alberts, Susan C.; Tung, Jenny

2015-01-01

Early-life experiences can dramatically affect adult traits. However, the evolutionary origins of such early-life effects are debated. The predictive adaptive response hypothesis argues that adverse early environments prompt adaptive phenotypic adjustments that prepare animals for similar challenges in adulthood. In contrast, the developmental constraints hypothesis argues that early adversity is generally costly. To differentiate between these hypotheses, we studied two sets of wild female baboons: those born during low-rainfall, low-quality years and those born during normal-rainfall, high-quality years. For each female, we measured fertility-related fitness components during years in adulthood that matched and mismatched her early conditions. We found support for the developmental constraints hypothesis: females born in low-quality environments showed greater decreases in fertility during drought years than females born in high-quality environments, even though drought years matched the early conditions of females born in low-quality environments. Additionally, we found that females born in low-quality years to high-status mothers did not experience reduced fertility during drought years. These results indicate that early ecological adversity did not prepare individuals to cope with ecological challenges in later life. Instead, individuals that experienced at least one high-quality early environment—either ecological or social—were more resilient to ecological stress in later life. Together, these data suggest that early adversity carries lifelong costs, which is consistent with the developmental constraints hypothesis. PMID:25996865

Adapting Buildings for Indoor Air Quality in a Changing Climate

EPA Pesticide Factsheets

Climate change presents many challenges, including the production of severe weather events. These events and efforts to minimize their effects through weatherization can adversely affect indoor environments.

Marital quality, health, and aging: gender equity?

PubMed

Umberson, Debra; Williams, Kristi

2005-10-01

Recent research shows that poor marital quality adversely affects trajectories of physical health over time and that these adverse effects are similar for men and women. These studies test the possibility of gender differences in vulnerability to poor marital quality, but they fail to take into account possible gender differences in exposure to poor marital quality. We present longitudinal evidence to show that although the impact of marital quality on physical health trajectories may be similar for married men and women, generally lower levels of marital quality experienced by women may translate into a sustained disadvantage for the health of married women over the life course. These findings frame the call for renewed theoretical work on gender and marriage that takes into account both gender similarity in response to marital quality as well as gender differences in the experience of marriage over the life course.

Marital Quality, Health, and Aging: Gender Equity?

PubMed Central

Umberson, Debra; Williams, Kristi

2011-01-01

Recent research shows that poor marital quality adversely affects trajectories of physical health over time and that these adverse effects are similar for men and women. These studies test the possibility of gender differences in vulnerability to poor marital quality, but they fail to take into account possible gender differences in exposure to poor marital quality. We present longitudinal evidence to show that although the impact of marital quality on physical health trajectories may be similar for married men and women, generally lower levels of marital quality experienced by women may translate into a sustained disadvantage for the health of married women over the life course. These findings frame the call for renewed theoretical work on gender and marriage that takes into account both gender similarity in response to marital quality as well as gender differences in the experience of marriage over the life course. PMID:16251580

A 2-1-1 research collaboration: participant accrual and service quality indicators.

PubMed

Eddens, Katherine S; Alcaraz, Kassandra I; Kreuter, Matthew W; Rath, Suchitra; Greer, Regina

2012-12-01

In times of crises, 2-1-1 serves as a lifeline in many ways. These crises often cause a spike in call volume that can challenge 2-1-1's ability to meet its service quality standards. For researchers gathering data through 2-1-1s, a sudden increase in call volume might reduce accrual as 2-1-1 has less time to administer study protocols. Research activities imbedded in 2-1-1 systems may affect directly 2-1-1 service quality indicators. Using data from a 2-1-1 research collaboration, this paper examines the impact of crises on call volume to 2-1-1, how call volume affects research participant accrual through 2-1-1, and how research recruitment efforts affect 2-1-1 service quality indicators. t-tests were used to examine the effect of call volume on research participant accrual. Linear and logistic regressions were used to examine the effect of research participant accrual on 2-1-1 service quality indicators. Data were collected June 2010-December 2011; data were analyzed in 2012. Findings from this collaboration suggest that crises causing spikes in call volume adversely affect 2-1-1 service quality indicators as well as accrual of research participants. Administering a brief (2-3 minute) health risk assessment did not affect service quality negatively, but administering a longer (15-18 minute) survey had a modest adverse effect on these indicators. In 2-1-1 research collaborations, both partners need to understand the dynamic relationship among call volume, research accrual, and service quality and adjust expectations accordingly. If research goals include administering a longer survey, increased staffing of 2-1-1 call centers may be needed to avoid compromising service quality. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Tsunamis: Water Quality

MedlinePlus

... viruses, parasites) and chemicals that can adversely affect human health. The sea salts associated with saltwater flooding of ... 232-6348 Email CDC-INFO U.S. Department of Health & Human Services HHS/Open USA.gov Top

Profilograph specification study.

DOT National Transportation Integrated Search

2010-10-01

Pavement smoothness is probably the single most important indicator of pavement performance according to the traveling public. Rough or uneven pavements adversely affect driver safety, ride quality, fuel efficiency, and vehicle wear and tear. Rough p...

Effect of Myopathies on Meat Quality and Protein Characteristics of Broiler Breast Meat.

USDA-ARS?s Scientific Manuscript database

The wooden breast (WB) and white striping (WS) conditions are abnormalities that occur in the breast muscles of modern broilers. Although WB and WS are known to adversely affect meat quality, the underlying effect of these conditions on muscle proteins are not well understood. The objective of this ...

Effects of fire retardant on water quality

Treesearch

Logan A. Norris; Warren L. Webb

1989-01-01

Ammonium-based fire retardants are important in managing wildfires, but their use can adversely affect water quality. Their entry, fate, and impact were studied in five forest streams. Initial retardant concentrations in water approached levels which could damage fish, but no distressed fish were found. Concentrations decreased sharply with time after application and...

43 CFR 2653.5 - Cemetery sites and historical places.

Code of Federal Regulations, 2014 CFR

2014-10-01

... eligibility of properties as historical places, the quality of significance in Native history or culture shall... Management, and other affected Federal agencies, of such error. The applicant shall have 60 days from receipt... with 43 CFR part 4, subpart E. Any agency adversely affected by the certification of BIA or the...

43 CFR 2653.5 - Cemetery sites and historical places.

Code of Federal Regulations, 2012 CFR

2012-10-01

... eligibility of properties as historical places, the quality of significance in Native history or culture shall... Management, and other affected Federal agencies, of such error. The applicant shall have 60 days from receipt... with 43 CFR part 4, subpart E. Any agency adversely affected by the certification of BIA or the...

43 CFR 2653.5 - Cemetery sites and historical places.

Code of Federal Regulations, 2013 CFR

2013-10-01

... eligibility of properties as historical places, the quality of significance in Native history or culture shall... Management, and other affected Federal agencies, of such error. The applicant shall have 60 days from receipt... with 43 CFR part 4, subpart E. Any agency adversely affected by the certification of BIA or the...

Exercise for patients with major depression: a systematic review with meta-analysis and trial sequential analysis

PubMed Central

Speyer, Helene; Gluud, Christian; Nordentoft, Merete

2017-01-01

Objectives To assess the benefits and harms of exercise in patients with depression. Design Systematic review Data sources Bibliographical databases were searched until 20 June 2017. Eligibility criteria and outcomes Eligible trials were randomised clinical trials assessing the effect of exercise in participants diagnosed with depression. Primary outcomes were depression severity, lack of remission and serious adverse events (eg, suicide) assessed at the end of the intervention. Secondary outcomes were quality of life and adverse events such as injuries, as well as assessment of depression severity and lack of remission during follow-up after the intervention. Results Thirty-five trials enrolling 2498 participants were included. The effect of exercise versus control on depression severity was −0.66 standardised mean difference (SMD) (95% CI −0.86 to −0.46; p<0.001; grading of recommendations assessment, development and evaluation (GRADE): very low quality). Restricting this analysis to the four trials that seemed less affected of bias, the effect vanished into −0.11 SMD (−0.41 to 0.18; p=0.45; GRADE: low quality). Exercise decreased the relative risk of no remission to 0.78 (0.68 to 0.90; p<0.001; GRADE: very low quality). Restricting this analysis to the two trials that seemed less affected of bias, the effect vanished into 0.95 (0.74 to 1.23; p=0.78). Trial sequential analysis excluded random error when all trials were analysed, but not if focusing on trials less affected of bias. Subgroup analyses found that trial size and intervention duration were inversely associated with effect size for both depression severity and lack of remission. There was no significant effect of exercise on secondary outcomes. Conclusions Trials with less risk of bias suggested no antidepressant effects of exercise and there were no significant effects of exercise on quality of life, depression severity or lack of remission during follow-up. Data for serious adverse events and adverse events were scarce not allowing conclusions for these outcomes. Systematic review registration The protocol was published in the journal Systematic Reviews: 2015; 4:40. PMID:28928174

The Impact of Adverse Child and Adult Experiences on Recovery from Serious Mental Illness

PubMed Central

Stumbo, Scott P.; Yarborough, Bobbi Jo H.; Paulson, Robert I.; Green, Carla A.

2015-01-01

Objective To compare effects of adverse childhood experiences and adverse adult experiences on recovery from serious mental illnesses. Methods As part of a mixed-methods study of recovery from serious mental illnesses, we interviewed and administered questionnaires to 177 members of a not-for-profit health plan over a two-year period. Participants had a diagnosis of bipolar disorder, affective psychosis, schizophrenia or schizoaffective disorder. Data for analyses came from standardized self-reported measures; outcomes included recovery, functioning, quality of life, and psychiatric symptoms. Adverse events in childhood and adulthood were evaluated as predictors. Results Child and adult exposures to adverse experiences were high, at 91% and 82% respectively. Cumulative lifetime exposure to adverse experiences (childhood plus adult experiences) was 94%. In linear regression analyses, adverse adult experiences were more important predictors of outcomes than adverse childhood experiences. Adult experiences were associated with lower recovery scores, quality of life, mental and physical functioning, social functioning, and greater psychiatric symptoms. Emotional neglect in adulthood was associated with lower recovery scores. Conclusions and Implications for Practice Early and repeated exposure to adverse events was common in this sample of people with serious mental illnesses. Adverse adult experiences were stronger predictors of worse functioning and lower recovery levels than were childhood experiences. Focusing clinical attention on adult experiences of adverse or traumatic events may result in greater benefit than focusing on childhood experiences alone. PMID:26053533

You make me sick: marital quality and health over the life course.

PubMed

Umberson, Debra; Williams, Kristi; Powers, Daniel A; Liu, Hui; Needham, Belinda

2006-03-01

We work from a life course perspective and identify several reasons to expect age and gender differences in the link between marital quality and health. We present growth curve evidence from a national longitudinal survey to show that marital strain accelerates the typical decline in self-rated health that occurs over time and that this adverse effect is greater at older ages. These findings fit with recent theoretical work on cumulative adversity in that marital strain seems to have a cumulative effect on health over time-an effect that produces increasing vulnerability to marital strain with age. Contrary to expectations, marital quality seems to affect the health of men and women in similar ways across the life course.

36 CFR 51.87 - Does the concessioner have an unconditional right to receive the Director's approval of an...

Code of Federal Regulations, 2010 CFR

2010-07-01

... affect adversely the quality of facilities and services provided by the concessioner, or result in a need for increased rates and charges to the public to maintain the quality of concession facilities and... construction of capital improvements under the applicable concession contract in the applicable park area or to...

76 FR 45397 - Export Inspection and Weighing Waiver for High Quality Specialty Grain Transported in Containers

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-29

... compared to an average $0.34 per metric ton for traditional grain exports. On December 13, 2005, GIPSA... mandatory inspection and weighing requirements of the USGSA that would adversely affect the marketing system... established the waiver to facilitate the marketing of high quality specialty grain by eliminating the burden...

Minimizing AED adverse effects: improving quality of life in the interictal state in epilepsy care.

PubMed

St Louis, Erik K; Louis, Erik K

2009-06-01

The goals of epilepsy therapy are to achieve seizure freedom while minimizing adverse effects of treatment. However, producing seizure-freedom is often overemphasized, at the expense of inducing adverse effects of treatment. All antiepileptic drugs (AEDs) have the potential to cause dose-related, "neurotoxic" adverse effects (i.e., drowsiness, fatigue, dizziness, blurry vision, and incoordination). Such adverse effects are common, especially when initiating AED therapy and with polytherapy. Dose-related adverse effects may be obviated in most patients by dose reduction of monotherapy, reduction or elimination of polytherapy, or substituting for a better tolerated AED. Additionally, all older and several newer AEDs have idiosyncratic adverse effects which usually require withdrawal in an affected patient, including serious rash (i.e., Stevens-Johnson Syndrome, toxic epidermal necrolysis), hematologic dyscrasias, hepatotoxicity, teratogenesis in women of child bearing potential, bone density loss, neuropathy, and severe gingival hyperplasia. Unfortunately, occurrence of idiosyncratic AED adverse effects cannot be predicted or, in most cases, prevented in susceptible patients. This article reviews a practical approach for the definition and identification of adverse effects of epilepsy therapies, and reviews the literature demonstrating that adverse effects result in detrimental quality of life in epilepsy patients. Strategies for minimizing AED adverse effects by reduction or elimination of AED polytherapy, appropriately employing drug-sparing therapies, and optimally administering AEDs are outlined, including tenets of AED selection, titration, therapeutic AED laboratory monitoring, and avoidance of chronic idiosyncratic adverse effects.

45 CFR 73.735-301 - Courtesy and consideration for others.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... Employees must recognize that inattention to matters of common courtesy can adversely affect the quality of... courtesy be shown in day-by-day interaction with co-workers. Employees shall be polite to and considerate...

Association between quality of life and self-stigma, insight, and adverse effects of medication in patients with depressive disorders.

PubMed

Yen, Cheng-Fang; Chen, Cheng-Chung; Lee, Yu; Tang, Tze-Chun; Ko, Chih-Hung; Yen, Ju-Yu

2009-01-01

The aims of this study were to examine whether different domains of quality of life (QOL) are differently affected by depressive disorders by comparing QOL of subjects with and without depressive disorders, and to examine the association of QOL with self-stigma, insight and adverse effects of medication among subjects with depressive disorders. The QOL on the four domains of the WHOQOL-BREF Taiwan version were compared between the 229 subjects with depressive disorders and 106 control subjects. Among the depressive subjects, the association between the four QOL domains and subjects' self-stigma, insight, and adverse effects of medication were examined using multiple regression analyses by controlling for the influence of depression, socio-demographic and clinical characteristics and family function. Depressive subjects had poorer QOL on the physical, psychological and social relationship domains than the non-depressive control group. The depressive subjects who had more severe self-stigma had poorer QOL on all four domains. The depressive subjects who perceived more severe adverse effects from medication had poorer QOL on the physical, psychological and environmental domains. However, insight was not associated with any domain of QOL in patients with depressive disorders. The results of this study demonstrate that different domains of QOL are differently affected by depressive disorders, and that clinicians must consider the negative influences of self-stigma and adverse effects from medication on QOL of subjects with depressive disorders.

The impact of adverse child and adult experiences on recovery from serious mental illness.

PubMed

Stumbo, Scott P; Yarborough, Bobbi Jo H; Paulson, Robert I; Green, Carla A

2015-12-01

The purpose of this study was to compare effects of adverse childhood experiences and adverse adult experiences on recovery from serious mental illnesses. As part of a mixed-methods study of recovery from serious mental illnesses, we interviewed and administered questionnaires to 177 members of a not-for-profit health plan over a 2-year period. Participants had a diagnosis of bipolar disorder, affective psychosis, schizophrenia, or schizoaffective disorder. Data for analyses came from standardized self-reported measures; outcomes included recovery, functioning, quality of life, and psychiatric symptoms. Adverse events in childhood and adulthood were evaluated as predictors. Child and adult exposures to adverse experiences were high, at 91% and 82%, respectively. Cumulative lifetime exposure to adverse experiences (childhood plus adult experiences) was 94%. In linear regression analyses, adverse adult experiences were more important predictors of outcomes than adverse childhood experiences. Adult experiences were associated with lower recovery scores, quality of life, mental and physical functioning and social functioning and greater psychiatric symptoms. Emotional neglect in adulthood was associated with lower recovery scores. Early and repeated exposure to adverse events was common in this sample of people with serious mental illnesses. Adverse adult experiences were stronger predictors of worse functioning and lower recovery levels than were childhood experiences. Focusing clinical attention on adult experiences of adverse or traumatic events may result in greater benefit than focusing on childhood experiences alone. (c) 2015 APA, all rights reserved).

Intensive management influence on Douglas-fir stem form, branch characteristics, and simulated product recovery

Treesearch

A.R. Weiskittel; R.A. Monserud; R. Rose; E.C. Turnblom; Douglas A. Maguire

2006-01-01

Intensive management may adversely affect lumber yield and quality by increasing knot size and creating a more conical stem form with a greater average rate of taper. This study was initiated to examine the impact of management on simulated lumber yield and quality. Stem diameter and branch size and location of 223 Pseudotsuga menziesii (Mirb.)...

49 CFR 195.230 - Welds: Repair or removal of defects.

Code of Federal Regulations, 2012 CFR

2012-10-01

... adversely affect the quality of the weld repair. After repair, the segment of the weld that was repaired... welding procedure used to make the original weld are met upon completion of the final weld repair. [Amdt...

49 CFR 195.230 - Welds: Repair or removal of defects.

Code of Federal Regulations, 2014 CFR

2014-10-01

... adversely affect the quality of the weld repair. After repair, the segment of the weld that was repaired... welding procedure used to make the original weld are met upon completion of the final weld repair. [Amdt...

49 CFR 195.230 - Welds: Repair or removal of defects.

Code of Federal Regulations, 2011 CFR

2011-10-01

... adversely affect the quality of the weld repair. After repair, the segment of the weld that was repaired... welding procedure used to make the original weld are met upon completion of the final weld repair. [Amdt...

49 CFR 195.230 - Welds: Repair or removal of defects.

Code of Federal Regulations, 2013 CFR

2013-10-01

... adversely affect the quality of the weld repair. After repair, the segment of the weld that was repaired... welding procedure used to make the original weld are met upon completion of the final weld repair. [Amdt...

49 CFR 195.230 - Welds: Repair or removal of defects.

Code of Federal Regulations, 2010 CFR

2010-10-01

... adversely affect the quality of the weld repair. After repair, the segment of the weld that was repaired... welding procedure used to make the original weld are met upon completion of the final weld repair. [Amdt...

0-6638: performance testing of coagulants to reduce stormwater runoff turbidity : [project summary].

DOT National Transportation Integrated Search

2013-08-01

During the last two decades, policy makers have : increasingly recognized that water quality is : adversely affected by sediment-laden : stormwater discharge from construction sites. : On December 1, 2009, the U.S. Environmental : Protection Agency (...

77 FR 58301 - Final Requirements-Race to the Top-Early Learning Challenge; Phase 2

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-20

... career advancement. Core Area B addresses the importance of a high-quality plan for rating and monitoring... adversely affect a sector of the economy, productivity, competition, jobs, the environment, public health or...

A Qualitative Study on the Interconnected Nature of HIV, Water, and Family.

PubMed

Ramirez-Ortiz, Daisy; Zolnikov, Tara Rava

2017-03-01

Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) and poor access to water are two primary global health issues. Poor access to water may significantly affect families infected with HIV and result in adverse social and health consequences. A qualitative study used semi-structured interviews to understand health and social outcomes of families after the implementation of water interventions in rural Kenya. One major sub-theme emerged during this research, which included the effects of water on an HIV-affected family. Prior to the water interventions, common adverse health effects from lack of nutrition, water, and poor hygiene were experienced. After receiving access to water, nutrition and hygiene were improved and additional time was gained and used to reinforce relationships and spread awareness about HIV/AIDS. This study provides need-based evidence for access to safe drinking water in order to decrease adverse health outcomes and improve the quality of life for HIV-affected individuals.

The Midwest Stream Quality Assessment—Influences of human activities on streams

USGS Publications Warehouse

Van Metre, Peter C.; Mahler, Barbara J.; Carlisle, Daren M.; Coles, James F.

2018-04-16

Healthy streams and the fish and other organisms that live in them contribute to our quality of life. Extensive modification of the landscape in the Midwestern United States, however, has profoundly affected the condition of streams. Row crops and pavement have replaced grasslands and woodlands, streams have been straightened, and wetlands and fields have been drained. Runoff from agricultural and urban land brings sediment and chemicals to streams. What is the chemical, physical, and biological condition of Midwestern streams? Which physical and chemical stressors are adversely affecting biological communities, what are their origins, and how might we lessen or avoid their adverse effects?In 2013, the U.S. Geological Survey (USGS) conducted the Midwest Stream Quality Assessment to evaluate how human activities affect the biological condition of Midwestern streams. In collaboration with the U.S. Environmental Protection Agency National Rivers and Streams Assessment, the USGS sampled 100 streams, chosen to be representative of the different types of watersheds in the region. Biological condition was evaluated based on the number and diversity of fish, algae, and invertebrates in the streams. Changes to the physical habitat and chemical characteristics of the streams—“stressors”—were assessed, and their relation to landscape factors and biological condition was explored by using mathematical models. The data and models help us to better understand how the human activities on the landscape are affecting streams in the region.

Final Supplemental Environmental Assessment: Falcon I Launch Vehicle Program from SLC-4W Vandenberg Air Force Base, California

DTIC Science & Technology

2005-09-06

affected surface water, 3) adversely affected groundwater quantity or quality, or 4) caused a need that exceeded the existing potable supply or...goby is from Tillas Slough (mouth of the Smith River) in Del Norte County, south to Colonel Louis D. Van Mullem, Jr. (1-8-96-F/C-29) 5 Agua Hedionda

Environmental forensic research for emerging contaminants in complex environmental matrices

EPA Science Inventory

The United States Environmental Protection Agency has established criteria to address many of the significant traditional pollutants demonstrated to have adverse affects on environmental quality. However, new chemicals are being created almost daily, and these new chemicals, as ...

Consequences of violence across the lifespan: Mental health and sleep quality in pregnant women.

PubMed

Miller-Graff, Laura E; Cheng, Philip

2017-09-01

Research has demonstrated that exposure to violence and adversity has negative effects on both mental health and biobehavioral outcomes, such as sleep health. Research examining the relationship between past and recent violence exposure and mental health suggests that the effects of childhood adversity are especially pernicious, but to date, no studies have attempted to disentangle the direct, indirect and relative effects of past year versus childhood exposure to violence and adversity on sleep. The objective of the current study was to examine the direct effects of adverse childhood experiences (ACEs) and past year intimate partner violence (IPV) on different aspects of sleep health in pregnant women. A sample of high-risk pregnant women (n = 101) were interviewed. Mediation analysis with bias-corrected, bootstrapped confidence intervals was used to evaluate direct and indirect effects. Findings indicated that while ACEs had significant direct effects on mental health, past year IPV had stronger effects on sleep quality, latency, and efficiency. ACEs did, however, indirectly affect subjective sleep quality via past year psychological IPV. These findings suggest that sleep disturbance may be a regulatory stress response that is most clearly linked to past year violence and trauma. That is, though long-term sleep disturbance may be evident following childhood adversity, it is likely that this relationship is better explained by the role of childhood adversity in predicting adulthood revictimization or due to long-term mental health difficulties associated with early trauma. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Exercise for patients with major depression: a systematic review with meta-analysis and trial sequential analysis.

PubMed

Krogh, Jesper; Hjorthøj, Carsten; Speyer, Helene; Gluud, Christian; Nordentoft, Merete

2017-09-18

To assess the benefits and harms of exercise in patients with depression. Systematic review DATA SOURCES: Bibliographical databases were searched until 20 June 2017. Eligible trials were randomised clinical trials assessing the effect of exercise in participants diagnosed with depression. Primary outcomes were depression severity, lack of remission and serious adverse events (eg, suicide) assessed at the end of the intervention. Secondary outcomes were quality of life and adverse events such as injuries, as well as assessment of depression severity and lack of remission during follow-up after the intervention. Thirty-five trials enrolling 2498 participants were included. The effect of exercise versus control on depression severity was -0.66 standardised mean difference (SMD) (95% CI -0.86 to -0.46; p<0.001; grading of recommendations assessment, development and evaluation (GRADE): very low quality). Restricting this analysis to the four trials that seemed less affected of bias, the effect vanished into -0.11 SMD (-0.41 to 0.18; p=0.45; GRADE: low quality). Exercise decreased the relative risk of no remission to 0.78 (0.68 to 0.90; p<0.001; GRADE: very low quality). Restricting this analysis to the two trials that seemed less affected of bias, the effect vanished into 0.95 (0.74 to 1.23; p=0.78). Trial sequential analysis excluded random error when all trials were analysed, but not if focusing on trials less affected of bias. Subgroup analyses found that trial size and intervention duration were inversely associated with effect size for both depression severity and lack of remission. There was no significant effect of exercise on secondary outcomes. Trials with less risk of bias suggested no antidepressant effects of exercise and there were no significant effects of exercise on quality of life, depression severity or lack of remission during follow-up. Data for serious adverse events and adverse events were scarce not allowing conclusions for these outcomes. The protocol was published in the journal Systematic Reviews : 2015; 4:40. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Drinking water for dairy cattle: always a benefit or a microbiological risk?

PubMed

Van Eenige, M J E M; Counotte, G H M; Noordhuizen, J P T M

2013-02-01

Drinking water can be considered an essential nutrient for dairy cattle. However, because it comes from different sources, its chemical and microbiological quality does not always reach accepted standards. Moreover, water quality is not routinely assessed on dairy farms. The microecology of drinking water sources and distribution systems is rather complex and still not fully understood. Water quality is adversely affected by the formation of biofilms in distribution systems, which form a persistent reservoir for potentially pathogenic bacteria. Saprophytic microorganisms associated with such biofilms interact with organic and inorganic matter in water, with pathogens, and even with each other. In addition, the presence of biofilms in water distribution systems makes cleaning and disinfection difficult and sometimes impossible. This article describes the complex dynamics of microorganisms in water distribution systems. Water quality is diminished primarily as a result of faecal contamination and rarely as a result of putrefaction in water distribution systems. The design of such systems (with/ without anti-backflow valves and pressure) and the materials used (polyethylene enhances biofilm; stainless steel does not) affect the quality of water they provide. The best option is an open, funnel-shaped galvanized drinking trough, possibly with a pressure system, air inlet, and anti-backflow valves. A poor microbiological quality of drinking water may adversely affect feed intake, and herd health and productivity. In turn, public health may be affected because cattle can become a reservoir of microorganisms hazardous to humans, such as some strains of E. coli, Yersinia enterocolitica, and Campylobacter jejuni. A better understanding of the biological processes in water sources and distribution systems and of the viability of microorganisms in these systems may contribute to better advice on herd health and productivity at a farm level. Certain on-farm risk factors for water quality have been identified. A practical approach will facilitate the control and management of these risks, and thereby improve herd health and productivity.

Birth outcome racial disparities: A result of intersecting social and environmental factors.

PubMed

Burris, Heather H; Hacker, Michele R

2017-10-01

Adverse birth outcomes such as preterm birth, low-birth weight, and infant mortality continue to disproportionately affect black and poor infants in the United States. Improvements in healthcare quality and access have not eliminated these disparities. The objective of this review was to consider societal factors, including suboptimal education, income inequality, and residential segregation, that together lead to toxic environmental exposures and psychosocial stress. Many toxic chemicals, as well as psychosocial stress, contribute to the risk of adverse birth outcomes and black women often are more highly exposed than white women. The extent to which environmental exposures combine with stress and culminate in racial disparities in birth outcomes has not been quantified but is likely substantial. Primary prevention of adverse birth outcomes and elimination of disparities will require a societal approach to improve education quality, income equity, and neighborhoods. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors affecting quality of life in adults with epilepsy in Taiwan: A cross-sectional, correlational study.

PubMed

Chen, Hsiu-Fang; Tsai, Yun-Fang; Hsi, Mo-Song; Chen, Jui-Chen

2016-05-01

The purpose of this study was to assess eight factors considered important for quality of life in persons with epilepsy in order to determine which of these components affect quality of life in adults with epilepsy in Taiwan. A cross-sectional, correlational study using structured questionnaires assessed 260 patients with epilepsy purposively sampled from a medical center in Northern Taiwan. Health-related quality of life (HRQoL) was evaluated with the Quality of Life in Epilepsy-31 (QOLIE-31) questionnaire. Data also included personal and health-related characteristics, knowledge of epilepsy, efficacy in the self-management of epilepsy, and social support. Scores for the QOLIE-31 were correlated with the following factors: (1) demographic characteristics of age, gender, and income; (2) sleep quality; (3) symptoms of anxiety and depression; (4) epilepsy-specific variables: seizure frequency; types, number, and frequency of antiepileptic drugs (AEDs); and adverse events of AEDs; and (5) social support. Stepwise regression analysis showed that seven factors were predictive for quality of life: anxiety, depression, adverse events of AEDs, social support, seizure frequency of at least once in three months, household income of NT$ 40,001-100,000, and male gender. These factors accounted for 58.2% of the variance of quality of life. Our study assessed multiple factors in an examination of relationships and predictive factors for quality of life in adults with epilepsy in Taiwan. Knowledge of these contributing factors can assist health-care providers when evaluating patients with epilepsy to help target interventions for improving quality of life. Copyright © 2016 Elsevier Inc. All rights reserved.

Parental childhood adversity, depressive symptoms, and parenting quality: Effects on toddler self-regulation in Child Welfare Services-involved families

PubMed Central

Spieker, Susan J.; Oxford, Monica L.; Fleming, Charles B.; Lohr, Mary Jane

2018-01-01

Parents who are child welfare services-involved (CWSI) often have a history of childhood adversity and depressive symptoms. Both affect parenting quality, which in turn influences child adaptive functioning. We tested a model of the relations between parental depression and child regulatory outcomes first proposed by Lyons-Ruth and colleagues (2002). We hypothesized that both parental depression and parenting quality mediate the effects of parental early adversity on offspring regulatory outcomes. Participants were 123 CWSI parents and their toddlers who were assessed three times over a period of six months. At T1, parents reported on their childhood adversity and current depressive symptoms. At T2, parents’ sensitivity to their child’s distress and non-distress cues were rated from a videotaped teaching task. At T3, observers rated children’s emotional regulation, orientation/engagement, and secure base behavior. The results of a path model partly supported hypotheses. Parent childhood adversity was associated with current depressive symptoms, which in turn was related to parent sensitivity to child distress but not non-distress. Sensitivity to distress also predicted secure base behavior. Depression directly predicted orientation/engagement, also predicted by sensitivity to non-distress. Sensitivity to distress predicted emotion regulation and orientation/engagement. Results are discussed in terms of intervention approaches for CWSI families. PMID:29266280

PARENTAL CHILDHOOD ADVERSITY, DEPRESSIVE SYMPTOMS, AND PARENTING QUALITY: EFFECTS ON TODDLER SELF-REGULATION IN CHILD WELFARE SERVICES INVOLVED FAMILIES.

PubMed

Spieker, Susan J; Oxford, Monica L; Fleming, Charles B; Lohr, Mary Jane

2018-01-01

Parents who are involved with child welfare services (CWSI) often have a history of childhood adversity and depressive symptoms. Both affect parenting quality, which in turn influences child adaptive functioning. We tested a model of the relations between parental depression and child regulatory outcomes first proposed by K. Lyons-Ruth, R. Wolfe, A. Lyubchik, and R. Steingard (2002). We hypothesized that both parental depression and parenting quality mediate the effects of parental early adversity on offspring regulatory outcomes. Participants were 123 CWSI parents and their toddlers assessed three times over a period of 6 months. At Time 1, parents reported on their childhood adversity and current depressive symptoms. At Time 2, parents' sensitivity to their child's distress and nondistress cues was rated from a videotaped teaching task. At Time 3, observers rated children's emotional regulation, orientation/engagement, and secure base behavior. The results of a path model partly supported the hypotheses. Parent childhood adversity was associated with current depressive symptoms, which in turn related to parent sensitivity to child distress, but not nondistress. Sensitivity to distress also predicted secure base behavior. Depression directly predicted orientation/engagement, also predicted by sensitivity to nondistress. Sensitivity to distress predicted emotion regulation and orientation/engagement. Results are discussed in terms of intervention approaches for CWSI families. © 2017 Michigan Association for Infant Mental Health.

Dietary supplements and disease prevention — a global overview

USDA-ARS?s Scientific Manuscript database

Dietary supplements are widely used and offer the potential to improve health if appropriately targeted to those in need. Inadequate nutrition and micronutrient deficiencies are prevalent conditions that adversely affect global health. Although improvements in diet quality are essential to address t...

The effect of financial pressure on the quality of care in hospitals.

PubMed

Shen, Yu-Chu

2003-03-01

This paper examines the effect of financial pressure on hospital quality, using health outcomes after treatment for acute myocardial infarction (AMI) as quality indicators. The financial pressure variables are: fiscal pressure from the Prospective Payment System (PPS) for inpatient care, and changes in health maintenance organization (HMO) penetration at the county level. The study shows that both types of financial pressures adversely affect short-term health outcomes, but do not affect patient survival beyond 1 year after patients' hospital admissions. Furthermore, the impact of HMO penetration appears to differ from that of Medicare payment changes for certain hospitals because HMO penetration encourages price competition. Copyright 2003 Elsevier Science B.V.

Nurse specialty subcultures and patient outcomes in acute care hospitals: A multiple-group structural equation modeling.

PubMed

Mallidou, Anastasia A; Cummings, Greta G; Estabrooks, Carole A; Giovannetti, Phyllis B

2011-01-01

Hospital organizational culture is widely held to matter to the delivery of services, their effectiveness, and system performance in general. However, little empirical evidence exists to support that culture affects provider and patient outcomes; even less evidence exists to support how this occurs. To explore causal relationships and mechanisms between nursing specialty subcultures and selected patient outcomes (i.e., quality of care, adverse patient events). Martin's differentiation perspective of culture (nested subcultures within organizations) was used as a theoretical framework to develop and test a model. Hospital nurse subcultures were identified as being reflected in formal practices (i.e., satisfactory salary, continuing education, quality assurance program, preceptorship), informal practices (i.e., autonomy, control over practice, nurse-physician relationships), and content themes (i.e., emotional exhaustion). A series of structural equation models were assessed using LISREL on a large nurse survey database representing four specialties (i.e., medical, surgical, intensive care, emergency) in acute care hospitals in Alberta, Canada. Nursing specialty subcultures differentially influenced patient outcomes. Specifically, quality of care (a) was affected by nurses' control over practice, (b) was better in intensive care than in medical specialty, and (c) was related to lower adverse patient events; nurses in intensive care and emergency specialties reported fewer adverse events than did their counterparts in medical specialties. Understanding the meaning of subcultures in clinical settings would influence nurses and administrators efforts to implement clinical change and affect outcomes. More research is needed on nested subcultures within healthcare organizations for better understanding differentiated subspecialty effects on complexity of care and outcomes in hospitals. Copyright © 2010 Elsevier Ltd. All rights reserved.

Effect of crude protein concentration and dietary electrolyte balance on litter quality, foot pad dermatitis, growth performance and processing yields in two medium heavy turkey hybrids.

PubMed

Veldkamp, T; Hocking, P M; Vinco, L J

2017-10-01

1. An experiment was conducted to investigate the effect of crude protein (CP) concentration and dietary electrolyte balance (DEB) on growth performance, processing yields, litter quality and foot pad dermatitis (FPD) in male turkeys from two commercial hybrids. Soya bean meal was replaced by vegetable protein sources selected for lower K concentrations to lower DEB in order to improve litter quality and subsequent quality of foot pads. 2. Effects of CP on litter friability and wetness were not consistent during the production period. FPD in turkeys fed on diets with low CP was significantly lower than FPD in turkeys fed on diets with high CP until 84 d. Growth performance was adversely affected at low CP. Processing yields were not affected by CP. 3. Litter was significantly dryer in pens of turkeys fed on diets with low DEB than in pens of turkeys fed on diets with high DEB. FPD in turkeys fed on diets with low DEB was significantly lower than in turkeys fed on diets with high DEB. Growth performance and processing yields were adversely affected at low DEB. 4. FPD in turkey hybrid A was higher than in turkey hybrid B at 28 d of age. Thereafter, no differences in FPD between turkey hybrids were observed. Growth performance and processing yields were not affected by turkey hybrid. 5. Overall, a significant interaction effect of CP × DEB was observed for FCR: in turkeys fed on the high DEB treatment, FCR of turkeys fed on the high CP diets was lower than FCR of turkeys fed on the low CP (LCP) diets whereas on the low DEB treatment, FCR was not affected by CP treatment. 6. It was concluded that litter quality can be improved and FPD may be decreased in turkeys fed on diets containing lower CP and DEB levels.

Adverse effect versus quality control of the Fuenzalida-Palacios antirabies vaccine.

PubMed

Nogueira, Y L

1998-01-01

We evaluated the components of the Fuenzalida-Palacios antirabies vaccine, which is till used in most developing countries in human immunization for treatment and prophylaxis. This vaccine is prepared from newborn mouse brains at 1% concentration. Even though the vaccine is considered to have a low myelin content, it is not fully free of myelin or of other undesirable components that might trigger adverse effects after vaccination. The most severe effect is a post-vaccination neuroparalytic accident associated with Guillain-Barré syndrome. In the present study we demonstrate how the vaccines produced and distributed by different laboratories show different component patterns with different degrees of impurity and with varying protein concentrations, indicating that production processes can vary from one laboratory to another. These differences, which could be resolved using a better quality control process, may affect and impair immunization, with consequent risks and adverse effects after vaccination. We used crossed immunoelectrophoresis to evaluate and demonstrate the possibility of quality control in vaccine production, reducing the risk factors possibly involved in these immunizing products.

Flight test and analyses of the B-1 structural mode control system at supersonic flight conditions

NASA Technical Reports Server (NTRS)

Wykes, J. H.; Kelpl, M. J.; Brosnan, M. J.

1983-01-01

A practical structural mode control system (SMCS) that could be turned on at takeoff and be left on for the entire flight was demonstrated. The SMCS appears to be more effective in damping the key fuselage bending modes at supersonic speeds than at the design point of Mach 0.85 (for fixed gains). The SMCS has an adverse effect on high frequency symmetric modes; however, this adverse effect did not make the system unstable and does not appear to affect ride quality performance. The vertical ride quality analyses indicate that the basic configuration without active systems is satisfactory for long term exposure. If clear air turbulence were to be encountered, indications are that the SMCS would be very effective in reducing the adverse accelerations. On the other hand, lateral ride quality analyses indicate that the aircraft with the SMCS on does not quite meet the long term exposure criteria, but would be satisfactory for shot term exposure at altitude. Again, the lateral SMCS was shown to be very effective in reducing peak lateral accelerations.

Potential Adverse Effects of Violent Video Gaming: Interpersonal- Affective Traits Are Rather Impaired Than Disinhibition in Young Adults.

PubMed

Kimmig, Ann-Christin S; Andringa, Gerda; Derntl, Birgit

2018-01-01

The increasing trend of mass shootings, which were associated with excessive use of violent video games, fueled the debate of possible effects violent video games may have on adolescents and young adults. The aim of this study was to investigate the possible link between violent video gaming effects and the disposition of adverse behavior traits such as interpersonal-affective deficits and disinhibition. Data of 167 young adults, collected by an online questionnaire battery, were analyzed for lifetime video game exposure differences (i.e., non-gamers, non-violent video gamers, stopped violent video game users, and ongoing violent video game users) as well as for recent exposure effects on adverse behavior traits (Levenson's Psychopathy Scale), while controlling for other potentially confounding lifestyle factors. While interpersonal-affective deficits were significantly higher in participants with ongoing violent video game exposure compared to non-gamers and non-violent video gamers, disinhibition was significantly higher in both - stopped and ongoing - violent video game exposure groups compared to non-gamers. Recent violent video game exposure was a stronger predictor for interpersonal-affective deficits, but was also significant for disinhibition. Considering that we observed small to medium effects in a sample of young adults with little to moderate use of violent video games highlights the importance of further investigating the potential adverse effects of violent video games on quality of social relationships.

GUIDANCE MANUAL FOR IMPLEMENTING MUNICIPAL STORM WATER MANAGEMENT PROGRAMS; PLANNING AND ADMINISTRATION

EPA Science Inventory

Urbanization and industrial activities around the country have significantly altered the natural landscape of our Nation's watersheds. This, in turn, has adversely affected both the quantity and the quality of storm water runoff and has contributed to the chemical, physical, and...

The health impacts and economic value of wildland fire episodes in the U.S.: 2008-2012

EPA Science Inventory

Introduction: Wildland fires degrade regional air quality and adversely affect human health. A growing body of epidemiology literature report increased rates of emergency department, hospital admission and premature deaths from wildfire smoke exposure. Objective: Our research a...

MORPHOLOGICAL, MINERALOGICAL, AND CHEMICAL CHARACTERIZATION OF THREE IRON TUBERCLES FROM AN IRON PIPE

EPA Science Inventory

Water utilities adjust water quality treatment procedures to minimize corrosion and to remain in compliance with local, state, and federal regulations. Some treatment changes though can adversely affect tubercle stability and cause red water and/or other related problems. Therefo...

Effects of carbohydrase enzyme supplementation on performance, eggshell quality, and bone parameters of laying hens fed on maize- and wheat-based diets.

PubMed

Olgun, Osman; Altay, Y; Yildiz, Alp O

2018-04-01

1. This study was conducted to determine the effects of enzyme supplementation of maize/wheat-based diets on the performance, egg quality, and serum and bone parameters of laying hens. 2. During the 12-week experimental period, a total of 72 laying hens aged 52 weeks were randomly distributed among 6 experimental groups. Each experimental group contained 4 replicates, each with three birds. The experiment was a randomised design consisting of a 3 × 2 factorial arrangement, with three levels of wheat substitution and two levels of enzyme (xylanase: 1500.00 U/kg, β-glucanase: 100 000 U/kg, cellulase: 1 000 000 U/kg, α-amylase: 160 000 U/kg) inclusion in the diet. Wheat replaced 0, 50, or 100% of maize with or without 1.0 g/kg enzyme supplementation in iso-nitrogenous and iso-caloric experimental diets. 3. Body weight, egg production, egg weight, egg mass, eggshell thickness, and the feed conversion ratio were adversely affected by the wheat-based diet. The eggshell quality parameters decreased with enzyme supplementation to the diet. 4. Wheat-based diets adversely affected calcium and phosphorus concentrations in the tibia, but the addition of the enzymes to the wheat-based diet prevented the negative effects of wheat-based diets on tibia mineralisation in laying hens. The wheat-based diets tended to reduce plasma mineral contents, and the addition of enzymes tended to affect plasma minerals and biomechanical properties of the tibia positively in laying hens. 5. These results indicate that wheat-based diets in aged laying hens adversely affected the mineral metabolism compared with maize-based diets, and the negative effects of wheat on bone mineralisation can be prevented by enzyme supplementation to the diets in laying hens.

Early life adversity and telomere length: a meta-analysis.

PubMed

Ridout, K K; Levandowski, M; Ridout, S J; Gantz, L; Goonan, K; Palermo, D; Price, L H; Tyrka, A R

2018-04-01

Early adversity, in the form of abuse, neglect, socioeconomic status and other adverse experiences, is associated with poor physical and mental health outcomes. To understand the biologic mechanisms underlying these associations, studies have evaluated the relationship between early adversity and telomere length, a marker of cellular senescence. Such results have varied in regard to the size and significance of this relationship. Using meta-analytic techniques, we aimed to clarify the relationship between early adversity and telomere length while exploring factors affecting the association, including adversity type, timing and study design. A comprehensive search in July 2016 of PubMed/MEDLINE, PsycINFO and Web of Science identified 2462 studies. Multiple reviewers appraised studies for inclusion or exclusion using a priori criteria; 3.9% met inclusion criteria. Data were extracted into a structured form; the Newcastle-Ottawa Scale assessed study quality, validity and bias. Forty-one studies (N=30 773) met inclusion criteria. Early adversity and telomere length were significantly associated (Cohen's d effect size=-0.35; 95% CI, -0.46 to -0.24; P<0.0001). Sensitivity analyses revealed no outlier effects. Adversity type and timing significantly impacted the association with telomere length (P<0.0001 and P=0.0025, respectively). Subgroup and meta-regression analyses revealed that medication use, medical or psychiatric conditions, case-control vs longitudinal study design, methodological factors, age and smoking significantly affected the relationship. Comprehensive evaluations of adversity demonstrated more extensive telomere length changes. These results suggest that early adversity may have long-lasting physiological consequences contributing to disease risk and biological aging.

A review of preserved and preservative-free prostaglandin analogues for the treatment of open-angle glaucoma and ocular hypertension.

PubMed

Hommer, A

2010-06-01

Glaucoma affects an increasing number of people worldwide and is the second leading cause of blindness. The aim of antiglaucoma therapy is to maintain a patient's visual function and quality of life. Prostaglandin analogues are first-line topical antiglaucoma therapy. They are effective at lowering intraocular pressure (IOP) and are generally well tolerated, with fewer systemic adverse events compared with the other classes. However, the use of prostaglandin analogues can be associated with ocular adverse effects, such as stinging/burning sensation, dry eyes, iris and periocular hyperpigmentation, and eye lash growth, which can affect patient compliance. Preservatives used in antiglaucoma preparations can have dose-dependent toxic effects, which contribute to adverse effects. The development of preservative-free preparations may reduce such adverse effects and therefore improve patient compliance. Tafluprost is a prostaglandin analogue in a preservative-free formulation that was recently approved for the reduction of elevated IOP in open-angle glaucoma and ocular hypertension. Copyright 2010 Prous Science, S.A.U. or its licensors. All rights reserved.

Potential Conflicting Interests for Surgeons in End-of-Life Care.

PubMed

Golden, Adam G; Silverman, Michael A; Heller, Andrew; Loyal, Michael; Cendan, Juan

2015-11-01

Thirty-day mortality represents a variable that is commonly used to measure the quality of surgical care. The definition of 30-day mortality and the application of a risk adjustment to its measurement may vary among different organizations comparing physician quality. In the midst of this confusion, conflicting interests arise for surgeons who must weigh the potential benefit of surgical interventions to individual patients versus the potential loss of access by future patients should 30-day mortality ratings be adversely affected. Similarly, surgeons may become adversely impacted by the lack of compensation from avoiding "high-risk" cases, but might face a more severe financial impact if they have a higher mortality rating compared to their peers. © The Author(s) 2014.

Combining genomic approaches to understand genetic control of aflatoxin contamination in peanut

USDA-ARS?s Scientific Manuscript database

Aflatoxin contamination in peanut is more prevalent under rainfed conditions making produce unfit for human and animal consumption, affecting the international trade adversely. Although the losses in yield and quality due to aflatoxin contamination is higher than realized, there are limited resistan...

The Green Obligation

ERIC Educational Resources Information Center

Adams, Cameron

2007-01-01

As the green movement grows, studies provide conclusive evidence about the benefits of environmentally conscious practices indoors and outdoors. Schools are no exception. Many of these studies demonstrate how poor indoor air quality (IAQ) in schools adversely affects many of the nation's 55 million students with health problems such as asthma and…

Environmental Monitoring and Modeling Needs in the 21st Century

EPA Science Inventory

It is well-known that adverse weather conditions and high levels of air pollutants affect human health and the environment. Over the past four decades, there has been a significant increase in the number of locations where air quality and meteorological observations are taken. ...

Preliminary field trash studies using near-infrared spectroscopy

USDA-ARS?s Scientific Manuscript database

Cotton is a cash crop that is important in the world market. Development of instrumental techniques to measure cotton quality parameters which are accurate, precise, and fast would be beneficial. Cotton trash (leaf, etc.) and field trash (plastic bags, etc.) comingled with lint adversely affects th...

The importance of physical activity and sleep for affect on stressful days: Two intensive longitudinal studies.

PubMed

Flueckiger, Lavinia; Lieb, Roselind; Meyer, Andrea H; Witthauer, Cornelia; Mata, Jutta

2016-06-01

We investigated the potential stress-buffering effect of 3 health behaviors-physical activity, sleep quality, and snacking-on affect in the context of everyday life in young adults. In 2 intensive longitudinal studies with up to 65 assessment days over an entire academic year, students (Study 1, N = 292; Study 2, N = 304) reported stress intensity, sleep quality, physical activity, snacking, and positive and negative affect. Data were analyzed using multilevel regression analyses. Stress and positive affect were negatively associated; stress and negative affect were positively associated. The more physically active than usual a person was on a given day, the weaker the association between stress and positive affect (Study 1) and negative affect (Studies 1 and 2). The better than usual a person's sleep quality had been during the previous night, the weaker the association between stress and positive affect (Studies 1 and 2) and negative affect (Study 2). The association between daily stress and positive or negative affect did not differ as a function of daily snacking (Studies 1 and 2). On stressful days, increasing physical activity or ensuring high sleep quality may buffer adverse effects of stress on affect in young adults. These findings suggest potential targets for health-promotion and stress-prevention programs, which could help reduce the negative impact of stress in young adults. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Semen quality and insulin-like factor 3: Associations with urinary and seminal levels of phthalate metabolites in adult males.

PubMed

Chang, Wei-Hsiang; Wu, Meng-Hsing; Pan, Hsien-An; Guo, Pao-Lin; Lee, Ching-Chang

2017-04-01

Certain phthalates have adverse effects on male reproductive functions in animals, and potentially affect human testicular function and spermatogenesis, but little is known about the active mechanisms. We measured the urinary and seminal phthalate metabolites and explored their associations on insulin-like factor 3 (INSL3) and semen quality. Urine, blood, and semen samples were collected from the male partners of subfertile (n = 253) and fertile (n = 37) couples in a reproductive center in southern Taiwan. INSL3, reproductive hormones, semen-quality, and 11 phthalate metabolites in urine and semen were measured. There were significant correlations in the distribution pattern of metabolites, such as the relative contribution of low or high molecular weight phthalate metabolites. The significantly monotonic trends in semen volume, sperm concentration and motility were associated with increasing quartiles of INSL3 (all p-trend < 0.001). In adjusted regression models, increases in urinary phthalate metabolites levels were adversely associated with sperm concentration (monobenzyl phthalate [MBzP], mono-2-ethylhexyl phthalate [MEHP] and MEHP%), motility (MBzP and MEHP) and INSL3 (MBzP, MEHP and MEHP%) (all p < 0.01). Higher seminal phthalate metabolite levels were associated with decreases in sperm concentration (MEHP and mono-2-ethyl-5-hydroxyhexyl phthalate), motility (mono-ethyl phthalate [MEP] and di-(2-ethylhexyl) phthalate [DEHP] metabolites), normal morphology (MEP), and INSL3 (monomethyl phthalate and MEP) (all p < 0.05). Our data suggest that INSL3 secretion, reproductive hormone balance, and sperm production and quality might be simultaneously adversely affected for individuals excreting increasing levels of phthalates metabolites (especially di-ethyl phthalate, butylbenzyl phthalate, and DEHP) in urine and semen samples. Copyright © 2017 Elsevier Ltd. All rights reserved.

Reciprocal associations between adolescents' night-time sleep and daytime affect and the role of gender and depressive symptoms.

PubMed

van Zundert, Rinka M P; van Roekel, Eeske; Engels, Rutger C M E; Scholte, Ron H J

2015-02-01

During adolescence, students not only obtain less sleep and sleep of poorer quality but also experience increases in negative affect, decreases in positive affect, and increases in depressive symptoms. Given that sleep and affect may both influence one another, a disruption of either one of the two may trigger a downward spiral where poor sleep and affective dysfunctioning continue to negatively influence each other. As a result, the present study aims to examine the bidirectional daily associations between adolescents' nighttime sleep (sleep quality and disturbance) and daytime affect as well as the moderational effects of participants' gender and depressive symptoms. To this end, we conducted hierarchical linear regression modelling in a sample of 286 13-16 year-old non-disordered adolescents (59% female) who completed 9 randomly sampled assessments per day as well as a standard morning and evening assessment for a period of 6 days. Results indicate that sleep disturbance was not associated with positive and negative affect, whereas sleep quality was. Poorer sleep quality predicted more negative and less positive affect the next day, and also was predicted by higher levels of negative and lower levels of positive affect the day before. Girls and participants higher in depressive symptoms seemed to experience stronger adverse effects of poor sleep quality on their negative affect than boys and participants low in depressive symptoms. Additionally, the positive association between positive affect and next day's positive affect was weaker for those who scored higher on depressive symptoms. These findings suggest that improving sleep quality and improving daily affect are both useful strategies to create upward spirals of adolescent well-being that might be needed particularly for girls and adolescents with elevated symptoms of depression.

49 CFR 192.245 - Repair or removal of defects.

Code of Federal Regulations, 2013 CFR

2013-10-01

... NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Welding of Steel in Pipelines § 192... be preheated if conditions exist which would adversely affect the quality of the weld repair. After... minimum mechanical properties specified for the welding procedure used to make the original weld are met...

49 CFR 192.245 - Repair or removal of defects.

Code of Federal Regulations, 2011 CFR

2011-10-01

... NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Welding of Steel in Pipelines § 192... be preheated if conditions exist which would adversely affect the quality of the weld repair. After... minimum mechanical properties specified for the welding procedure used to make the original weld are met...

49 CFR 192.245 - Repair or removal of defects.

Code of Federal Regulations, 2014 CFR

2014-10-01

... NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Welding of Steel in Pipelines § 192... be preheated if conditions exist which would adversely affect the quality of the weld repair. After... minimum mechanical properties specified for the welding procedure used to make the original weld are met...

49 CFR 192.245 - Repair or removal of defects.

Code of Federal Regulations, 2012 CFR

2012-10-01

... NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Welding of Steel in Pipelines § 192... be preheated if conditions exist which would adversely affect the quality of the weld repair. After... minimum mechanical properties specified for the welding procedure used to make the original weld are met...

49 CFR 192.245 - Repair or removal of defects.

Code of Federal Regulations, 2010 CFR

2010-10-01

... NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Welding of Steel in Pipelines § 192... be preheated if conditions exist which would adversely affect the quality of the weld repair. After... minimum mechanical properties specified for the welding procedure used to make the original weld are met...

Future riverine nitrogen export to US coastal regions: Prospects for improving water quality amid population growth.

EPA Science Inventory

Excess nitrogen (N) in the environment degrades ecosystems and adversely affects human health. Here we examine predictions of contemporary (2000) and future (2030) coastal N loading in the continental US by the Nutrient Export from WaterSheds (NEWS) model. Future scenarios were b...

Complexity Science and the Dynamics of Climate and Communication: Reducing Nursing Home Turnover

ERIC Educational Resources Information Center

Anderson, Ruth A.; Corazzini, Kirsten N.; McDaniel, Reuben R., Jr.

2004-01-01

Purpose: Turnover in nursing homes is a widespread problem adversely affecting care quality. Using complexity theory, we tested the effect of administrative climate, communication patterns, and the interaction between the two on turnover, controlling for facility context. Design and Methods: Perceptions of administrative climate and communication…

Improved egg crack detection algorithm for modified pressure imaging system

USDA-ARS?s Scientific Manuscript database

Shell eggs with microcracks are often undetected during egg grading processes. In the past, a modified pressure imaging system was developed to detect eggs with microcracks without adversely affecting the quality of normal intact eggs. The basic idea of the modified pressure imaging system was to ap...

7 CFR 58.101 - Meaning of words.

Code of Federal Regulations, 2010 CFR

2010-01-01

... provided the product is tested and meets the quality requirements for No. 2 milk.) (e) Sanitizing treatment... considered safe for product production. Such treatment shall not adversely affect the equipment, the milk or the milk product, or the health of consumers. Sanitizing solutions shall comply with 21 CFR 178.1010...

Herbicide-resistant weeds threaten soil conservation gains: finding a balance for soil and farm sustainability

USDA-ARS?s Scientific Manuscript database

Tillage has been an integral part of agriculture since the dawn of civilization. Growers and scientists have long recognized both beneficial and detrimental aspects to tillage. There is no question that most tillage promotes soil loss, adversely affects surface water quality and negatively impacts...

Application of the WEPS and SWEEP models to non-agricultural disturbed lands

USDA-ARS?s Scientific Manuscript database

Wind erosion not only affects agricultural productivity but also soil, air, and water quality. Dust and specifically particulate matter = 10 µm (PM-10) has adverse effects on respiratory health and also reduces visibility along roadways, resulting in auto accidents. The Wind Erosion Prediction Syste...

Implementation of Programmatic Quality and the Impact on Safety

NASA Astrophysics Data System (ADS)

Huls, Dale T.; Meehan, Kevin M.

2005-12-01

The implementation of an inadequate programmatic quality assurance discipline has the potential to adversely affect safety and mission success. This is best demonstrated in the lessons provided by the Apollo 1 Apollo 13 Challenger, and Columbia accidents; NASA Safety and Mission Assurance (S&MA) benchmarking exchanges; and conclusions reached by the Shuttle Return-to-Flight Task Group established following the Columbia Shuttle accident. Examples from the ISS Program demonstrate continuing issues with programmatic quality. Failure to adequately address programmatic quality assurance issues has a real potential to lead to continued inefficiency, increases in program costs, and additional catastrophic accidents.

Ureteral Stents: Impact on Quality of Life.

PubMed

Ucuzal, Meral; Serçe, Perihan

Ureteral stents have an indispensable place in urology, and indications for their use are increasing. However, stents can affect their users' quality of life negatively because of complications and adverse effects. This descriptive research aimed to determine the effect of ureteral stenting on quality of life. The study sample consisted of 75 patients. Data were collected using a questionnaire form, the SF-36 Quality of Life Scale, and the International Prostate Symptom Score. Patients were interviewed twice (before stenting and 1 month after stenting). The data were analyzed with descriptive statistics methods. This research determined that patients with ureteral stents had increased lower urinary tract symptoms and significantly reduced quality of life.

Potential Adverse Effects of Violent Video Gaming: Interpersonal- Affective Traits Are Rather Impaired Than Disinhibition in Young Adults

PubMed Central

Kimmig, Ann-Christin S.; Andringa, Gerda; Derntl, Birgit

2018-01-01

The increasing trend of mass shootings, which were associated with excessive use of violent video games, fueled the debate of possible effects violent video games may have on adolescents and young adults. The aim of this study was to investigate the possible link between violent video gaming effects and the disposition of adverse behavior traits such as interpersonal-affective deficits and disinhibition. Data of 167 young adults, collected by an online questionnaire battery, were analyzed for lifetime video game exposure differences (i.e., non-gamers, non-violent video gamers, stopped violent video game users, and ongoing violent video game users) as well as for recent exposure effects on adverse behavior traits (Levenson’s Psychopathy Scale), while controlling for other potentially confounding lifestyle factors. While interpersonal-affective deficits were significantly higher in participants with ongoing violent video game exposure compared to non-gamers and non-violent video gamers, disinhibition was significantly higher in both – stopped and ongoing – violent video game exposure groups compared to non-gamers. Recent violent video game exposure was a stronger predictor for interpersonal-affective deficits, but was also significant for disinhibition. Considering that we observed small to medium effects in a sample of young adults with little to moderate use of violent video games highlights the importance of further investigating the potential adverse effects of violent video games on quality of social relationships. PMID:29867689

Clinical roundtable monograph. New alternatives in CLL therapy: managing adverse events.

PubMed

Chanan-Khan, Asher; Kipps, Thomas; Stilgenbauer, Stephan

2010-08-01

Chronic lymphocytic leukemia (CLL) is a B-cell leukemia mainly affecting older adults. Historically, CLL has been regarded as an incurable disease, and treatment has been confined to cytotoxic chemotherapy regimens. However, prognosis for patients treated with these agents remained poor, prompting the development of new, targeted agents. The introduction of rituximab, a CD20-targeted monoclonal antibody, revolutionized the treatment for this disease. Rituximab in combination with fludarabine improved response rates and length of progression-free survival. The success of rituximab in this setting has prompted the development of many more investigational agents for CLL, including other antibody agents. However, as with any medication, the potential benefit achieved with CLL therapies is mitigated by the safety risk for the patient. These agents have been associated with adverse events such as immunosuppression, reactivation of cytomegalovirus, and infusion-related reactions that can occur with antibody administration. Adverse events can greatly affect the patient’s quality of life and ability to tolerate therapy. Management of adverse events is a critical component of the overall treatment strategy for CLL, particularly in elderly patients. In this clinical roundtable monograph, 3 expert physicians discuss the latest clinical studies evaluating the treatment of CLL, focusing on the adverse events associated with each agent and the potential interventions that can be used to manage their occurrence.

Rotation of Boar Semen Doses During Storage Affects Sperm Quality.

PubMed

Schulze, M; Rüdiger, K; Waberski, D

2015-08-01

It is common practice to rotate boar semen doses during storage for prevention of sperm sedimentation. In this study, the effect of rotation of boar semen doses during storage on sperm quality was investigated. Manual turning twice daily and automatic rotation five times per hour resulted in the following effects: alkalinization of the BTS-extender, loss of membrane integrity at day 3, and loss of motility and changes in sperm kinematics during a thermoresistance test at day 5. Using a pH-stabilized variant of BTS extender, sperm motility and velocity decreased in continuously rotated samples, whereas membrane integrity and mitochondrial activity remain unaffected. It is concluded that rotation of semen samples adversely affects sperm quality and, therefore, should no longer be recommended for AI practice. © 2015 Blackwell Verlag GmbH.

Clinical and economic impact of an antibiotics stewardship programme in a regional hospital in Hong Kong.

PubMed

Ng, C K; Wu, T C; Chan, W M J; Leung, Y S W; Li, C K P; Tsang, D N C; Leung, G M

2008-10-01

Inappropriate use of antibiotics is one of the important factors attributing to emergence of drug-resistant pathogens. Infection with multidrug-resistant pathogens adversely affects quality of medical care. Queen Elizabeth Hospital, an 1800-bed acute service hospital in Hong Kong. Antibiotics are commonly prescribed for treating acute infections. Reduce inappropriate prescription of broad-spectrum antibiotics and overall antibiotic prescription through implementation of a multidisciplinary antibiotics stewardship programme (ASP). A multidisciplinary programme involving policy and guideline formulation, education and feedback, monthly antibiotic consumption and cost monitoring, antimicrobial susceptibility pattern reporting and concurrent feedbacks for commonly prescribed broad-spectrum antibiotics was implemented in 2004. Predefined logistics to prescribe "restricted" antibiotics were formulated and implemented with collaborative efforts from clinical and non-clinical departments. The programme was supported by management at department and hospital levels. Broad-spectrum antibiotics were prescribed inappropriately in 28.9% (n = 192) clinical scenarios. The ASP reduced the restricted and total antibiotic consumption as well as the antibiotics-related costs. Predefined clinical outcomes were not adversely affected. Economic analysis suggested that the extra human cost in running ASP could be offset by savings from antibiotic expenditure. It is cost-effective to implement a multidisciplinary ASP in acute service hospitals as the programme reduces antibiotic consumption and results in overall cost savings. The quality of medical care is not jeopardized as the important clinical outcomes are not adversely affected. The generalisability and sustainability of ASPs in other clinical contexts warrant further studies to ensure the continuous success of this programme.

Evaluating bone quality in patients with chronic kidney disease

PubMed Central

Malluche, Hartmut H.; Porter, Daniel S.; Pienkowski, David

2013-01-01

Bone of normal quality and quantity can successfully endure physiologically imposed mechanical loads. Chronic kidney disease–mineral and bone disorder (CKD–MBD) adversely affects bone quality through alterations in bone turnover and mineralization, whereas bone quantity is affected through changes in bone volume. Changes in bone quality can be associated with altered bone material, structure, or microdamage, which can result in an elevated rate of fracture in patients with CKD–MBD. Fractures cannot always be explained by reduced bone quantity and, therefore, bone quality should be assessed with a variety of techniques from the macro-organ level to the nanoscale level. In this Review, we demonstrate the importance of evaluating bone from multiple perspectives and hierarchical levels to understand CKD–MBD-related abnormalities in bone quality. Understanding the relationships between variations in material, structure, microdamage, and mechanical properties of bone in patients with CKD–MBD should aid in the development of new modalities to prevent, or treat, these abnormalities. PMID:24100399

Assessment of water quality in canals of eastern Broward County, Florida, 1969-74

USGS Publications Warehouse

Waller, Bradley G.; Miller, Wesley L.

1982-01-01

An intensive water-quality monitoring program was started in 1969 to determine the effects of man-induced contaminants on the water quality in the primary canal system of eastern Broward County, Florida. This report covers the first 6 years of the program and provides a data base that can be used to compare future changes in water-quality conditions. Most data indicate that beyond the small seasonal fluctuation in constituent level, the greatest adverse effect on the quality of water is caused by discharge of sewage and treated sewage effluent to the canals. The areas affected by sewage have greater concentrations of macronutrients, trace metals, and pesticides than unaffected areas. Major-ion concentrations were affected only by season and local lithology. Over the 6-year study a gradual decrease in macronutrient concentration and an increase in dissolved oxygen have occurred. This improvement in water quality is attributed to a decrease of sewage discharge into canals and better treatment of sewage effluents. (USGS)

Future riverine nitrogen export to US coastal regions: Prospects for improving water quality considering population growth

EPA Science Inventory

Excess nitrogen (N) in the environment degrades ecosystems and adversely affects human health. Here we examine predictions of contemporary (2000) and future (2030) coastal N loading in the continental US by the Nutrient Export from WaterSheds (NEWS) model. Future output is from s...

Motion compensated image processing and optimal parameters for egg crack detection using modified pressure

USDA-ARS?s Scientific Manuscript database

Shell eggs with microcracks are often undetected during egg grading processes. In the past, a modified pressure imaging system was developed to detect eggs with microcracks without adversely affecting the quality of normal intact eggs. The basic idea of the modified pressure imaging system was to ap...

The Relationship between the Severity of Eating Problems and Intellectual Developmental Deficit Level

ERIC Educational Resources Information Center

Gal, Eynat; Hardal-Nasser, Reem; Engel-Yeger, Batya

2011-01-01

Nutrition, essential in the daily living functions promoting life quality of persons with intellectual developmental deficits (IDD), is adversely affected by the highly prevalent eating problems in these persons. The current study explores the characteristics of eating problems in population of children with intellectual developmental disorders.…

THE USE OF GEOMORPHOLOGY AND STREAM STABILITY IN THE ASSESSMENT OF THE RISK OF STREAM IMPAIRMENT FROM SEDIMENT

EPA Science Inventory

The evaluation of the current condition is critical to the management of streams impaired by sediment and other non-point source stressors, which adversely affect both physical habitat and water quality. Several rating and classification systems based on geomorphic data exist for...

From Standards to Compliance, to Good Services, to Quality Lives: Is This How It Works?

ERIC Educational Resources Information Center

Shea, John R.

1992-01-01

Licensing and certification regulations for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) can adversely affect individuals, distort the allocation of scarce resources, and encourage community residences to become small institutions. A case study of one home in northern California illustrates poor program evaluation and the need…

21 CFR 212.20 - What activities must I perform to ensure drug quality?

Code of Federal Regulations, 2014 CFR

2014-04-01

... operations. You must oversee production operations to ensure that each PET drug meets the requirements of the... of a PET drug. (c) Specifications and processes. You must approve or reject, before implementation..., and purity of a PET drug. You must demonstrate that any change does not adversely affect the identity...

21 CFR 212.20 - What activities must I perform to ensure drug quality?

Code of Federal Regulations, 2012 CFR

2012-04-01

... operations. You must oversee production operations to ensure that each PET drug meets the requirements of the... of a PET drug. (c) Specifications and processes. You must approve or reject, before implementation..., and purity of a PET drug. You must demonstrate that any change does not adversely affect the identity...

21 CFR 212.20 - What activities must I perform to ensure drug quality?

Code of Federal Regulations, 2013 CFR

2013-04-01

... operations. You must oversee production operations to ensure that each PET drug meets the requirements of the... of a PET drug. (c) Specifications and processes. You must approve or reject, before implementation..., and purity of a PET drug. You must demonstrate that any change does not adversely affect the identity...

Stress in Academe--A Cross-Cultural Comparison between Israeli and American Academicians.

ERIC Educational Resources Information Center

Perlberg, Arye; Keinan, Giora

The effects of stress on the physical and psychological well-being of people in different professions and occupations have become a focal interest of researchers and clinicians. There is growing evidence that stress adversely affects the performance, productivity, job satisfaction, health, and the general quality of life of professionals and of…

Motivational Strategies for Young Professionals in the Human Services.

ERIC Educational Resources Information Center

Cherniss, Cary

Many of the caring and socializing functions formerly provided by primary groups, such as the family or church, now are assumed by formal institutions. The quality of life in our society increasingly has been influenced by human service professionals. Motivational problems for these professionals can adversely affect their performance and can…

The Introductory Psychology Textbook Market: Perceptions of Authors and Editors.

ERIC Educational Resources Information Center

Griggs, Richard A.; Jackson, Sherri L.

1989-01-01

Surveys psychology textbook authors and editors on their perceptions of the introductory psychology textbook market. Finds that the textbook market is divided into three levels according to quality, and that authors and editors are not familiar with most textbooks. Notes that the growth of used book companies has adversely affected the market.…

A COLLABORATIVE EFFORT TO COLLECT BIOLOGICAL, CHEMICAL AND GEOLOGICAL DATA TO QUANTIFY THE INTERRELATIONSHIPS WHICH INFLUENCE STREAM IMPAIRMENT

EPA Science Inventory

The evaluation of the current condition is critical to the management of streams impaired by sediment and other non-point source stressors, which adversely affect both physical habitat and water quality. Impairment is generally assigned based on biological criteria, which are der...

STATUS OF ENDOCRINE DISRUPTOR SCREENING AND TESTING ACTIVITIES IN THE US: IMPLEMENTATION OF THE EDSTAC RECOMMENDATIONS

EPA Science Inventory

The last two decades have witnessed a growing concern for chemicals that have the potential to adversely affect the normal functioning of the endocrine system. In 1996, the US Congress passed the Food Quality Protection Act (FQPA) that mandated the US Environmental Protection Ag...

VAM under Scrutiny: Teacher Evaluation Litigation in the States

ERIC Educational Resources Information Center

Hazi, Helen M.

2017-01-01

As teacher quality is judged and tenured teachers are rated ineffective, educators are challenging teacher evaluation systems in the courts as they adversely affect their employment. Teachers have lost jobs, pay, tenure, and career advancement. This article reports on these cases, providing an interpretation in light of court cases about teacher…

Analysis of metal artifact reduction tools for dental hardware in CT scans of the oral cavity: kVp, iterative reconstruction, dual-energy CT, metal artifact reduction software: does it make a difference?

PubMed

De Crop, An; Casselman, Jan; Van Hoof, Tom; Dierens, Melissa; Vereecke, Elke; Bossu, Nicolas; Pamplona, Jaime; D'Herde, Katharina; Thierens, Hubert; Bacher, Klaus

2015-08-01

Metal artifacts may negatively affect radiologic assessment in the oral cavity. The aim of this study was to evaluate different metal artifact reduction techniques for metal artifacts induced by dental hardware in CT scans of the oral cavity. Clinical image quality was assessed using a Thiel-embalmed cadaver. A Catphan phantom and a polymethylmethacrylate (PMMA) phantom were used to evaluate physical-technical image quality parameters such as artifact area, artifact index (AI), and contrast detail (IQFinv). Metal cylinders were inserted in each phantom to create metal artifacts. CT images of both phantoms and the Thiel-embalmed cadaver were acquired on a multislice CT scanner using 80, 100, 120, and 140 kVp; model-based iterative reconstruction (Veo); and synthesized monochromatic keV images with and without metal artifact reduction software (MARs). Four radiologists assessed the clinical image quality, using an image criteria score (ICS). Significant influence of increasing kVp and the use of Veo was found on clinical image quality (p = 0.007 and p = 0.014, respectively). Application of MARs resulted in a smaller artifact area (p < 0.05). However, MARs reconstructed images resulted in lower ICS. Of all investigated techniques, Veo shows to be most promising, with a significant improvement of both the clinical and physical-technical image quality without adversely affecting contrast detail. MARs reconstruction in CT images of the oral cavity to reduce dental hardware metallic artifacts is not sufficient and may even adversely influence the image quality.

Effects of Compensation Methods and Physician Group Structure on Physicians' Perceived Incentives to Alter Services to Patients

PubMed Central

Reschovsky, James D; Hadley, J ack; Landon, Bruce E

2006-01-01

Objective To examine how health plan payment, group ownership, compensation methods, and other practice management tools affect physician perceptions of whether their overall financial incentives tilt toward increasing or decreasing services to patients. Data Source Nationally representative data on physicians are from the 2000–2001 Community Tracking Study Physician Survey (N = 12,406). Study Design Ordered and multinomial logistic regression were used to explore how physician, group, and market characteristics are associated with physician reports of whether overall financial incentives are to increase services, decrease services, or neither. Principal Findings Seven percent of physicians report financial incentives are to reduce services to patients, whereas 23 percent report incentives to increase services. Reported incentives to reduce services were associated with reports of lower ability to provide quality care. Group revenue in the form of capitation was associated with incentives to reduce services whereas practice ownership and variable compensation and bonuses for employee physicians were mostly associated with incentives to increase services to patients. Full ownership of groups, productivity incentives, and perceived competitive markets for patients were associated with incentives to both increase and reduce services. Conclusions Practice ownership and the ways physicians are compensated affect their perceived incentives to increase or decrease services to patients. In the latter case, this adversely affects perceived quality of care and satisfaction, although incentives to increase services may also have adverse implications for quality, cost, and insurance coverage. PMID:16899003

A model for predicting daily peak visitation and implications for recreation management and water quality: evidence from two rivers in Puerto Rico.

PubMed

Santiago, Luis E; Gonzalez-Caban, Armando; Loomis, John

2008-06-01

Visitor use surveys and water quality data indicates that high visitor use levels of two rivers in Puerto Rico does not appear to adversely affect several water quality parameters. Optimum visitor use to maximize visitor defined satisfaction is a more constraining limit on visitor use than water quality. Our multiple regression analysis suggests that visitor use of about 150 visitors per day yields the highest level of visitor reported satisfaction, a level that does not appear to affect turbidity of the river. This high level of visitor use may be related to the gregarious nature of Puerto Ricans and their tolerance for crowding on this densely populated island. The daily peak visitation model indicates that regulating the number of parking spaces may be the most effective way to keep visitor use within the social carrying capacity.

Psychiatric Symptoms and Quality of Life in Military Personnel Deployed Abroad.

PubMed

Oznur, Taner; Akarsu, Suleyman; Erdem, Murat; Durusu, Murat; Toygar, Mehmet; Poyrazoglu, Yavuz; Kaldirim, Umit; Eryilmaz, Mehmet; Ozmenler, Kamil Nahit

2015-01-01

Military personnel deployed abroad could be exposed to more risk factors that adversely affect quality of life. In this study, we examined psychiatric symptoms and quality of life in Turkish Armed Forces deployed to Afghanistan. A total of 289 Turkish military personnel working in Afghanistan enrolled in this study. They completed two surveys containing questions about socio-demographic characteristics. Data were collected and analyzed from 258 of the participants. The general symptom scores (GSI) were above 1 in 20.8 Percent (n=54) of the participants. The lowest SF-36 scores by the sub-groups were mental health (59.14 ± 18.56) and vitality (59.25 ± 21.17). The highest score was in the physical function subscale (84.42 ± 19.53). All Quality of Life Questionnaire Short Form (SF-36)subscale scores were lower in the GSI above 1 group than the GSI below 1 group. In the GSI above 1 group: education level and depression affected SF-36 physical functioning; paranoid ideation and somatization affected SF-36 role limitations due to physical health; age and somatization affected SF-36 pain; age affected SF-36 general health; phobic anxiety affected SF-36 vitality; age, tenure of occupation, tenure abroad; and phobic anxiety affected SF-36 mental health. The negative effects of psychiatric symptoms on the quality of life were similar to those in the general population and in specific disease groups. These results should be considered when evaluating the mental health of military personnel deployed abroad.

[Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses].

PubMed

Citolino, Clairton Marcos Filho; Santos, Eduesley Santana; Silva, Rita de Cassia Gengo E; Nogueira, Lilia de Souza

2015-12-01

To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR) in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. The majority of nurses reported that the high number of professionals in the scenario (75.5%), the lack of harmony (77.6%) or stress of any member of staff (67.3%), lack of material and/or equipment failure (57.1%), lack of familiarity with the emergency trolleys (98.0%) and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1%) are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.

75 FR 9619 - South Carolina Electric & Gas Company; Virgil C. Summer Nuclear Station; Environmental Assessment...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-03

... significantly affect plant safety and would not have a significant adverse effect on the probability of an... effluents. No changes to the National Pollution Discharge Elimination System permit are needed. No effects... Magnuson-Steven's Act are expected. There are no impacts to the air or ambient air quality. There are no...

Using Video Prompting to Teach Leisure Skills to Students with Significant Disabilities

ERIC Educational Resources Information Center

Cannella-Malone, Helen I.; Miller, Olivia; Schaefer, John M.; Jimenez, Eliseo D.; Page, E. Justin; Sabielny, Linsey M.

2016-01-01

Recreational activities are an important part of anyone's quality of life, owing to the various benefits of participation (e.g., social, physical). For individuals with significant disabilities, engagement in leisure skills continues to be a low priority in many schools, which can adversely affect the level of school and community membership. This…

Hillslope erosion rates in the oak savannas of the southwestern borderlands region

Treesearch

Aaron T. Kauffman; Cody L. Stropki; Peter F. Ffolliott; Gerald J. Gottfried; Daniel G. Neary

2007-01-01

Hillslope soil erosion on watershed landscapes can lower the productivity of upland sites and adversely impact water quality and downstream (off-site) areas. It is not surprising, therefore, that excessive soil erosion and the consequent sedimentation can represent significant costs to the land and people that are affected. The first known estimates of hillslope soil...

The Efficacy of Asthma Case Management in an Urban School District in Reducing School Absences and Hospitalizations for Asthma

ERIC Educational Resources Information Center

Levy, Marian; Heffner, Brenda; Stewart, Tara; Beeman, Gail

2006-01-01

Pediatric asthma rates are reaching epidemic proportions, adversely affecting children's quality of life, educational potential, and health care costs, especially those in the inner city. This study evaluated the effectiveness of a school-based asthma case management (CM) approach with medically undeserved inner-city children attending Memphis…

[Emotional distress and quality of life in people with diabetes and their families].

PubMed

Beléndez Vázquez, Marina; Lorente Armendáriz, Iñaki; Maderuelo Labrador, Mercedes

2015-01-01

The daily experience of living with diabetes can adversely affect the quality of life of people with diabetes and their families. We present the results for Spain of the DAWN2 study related to quality of life and wellbeing of patients and their families. The DAWN2 study is an observational, cross-sectional study. In the present study, we used the Spanish sample of patients (N=502) and their relatives (N=123). A total of 13.9% of patients were at risk of possible depression while 50.0% of people with diabetes and 45.5% of family members reported a high level of diabetes-related emotional stress. People with diabetes experience high levels of stress and the psychosocial impact of diabetes also affects family members. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

The animal fat paradox and meat quality.

PubMed

Webb, E C; O'Neill, H A

2008-09-01

The purpose of this paper is to address some of the paradoxical issues and perceptions regarding animal fats and the related effects on meat quality and consumer perceptions. Meat scientists have been studying carcass characteristics for many years and although the factors that influence the accumulation, distribution and composition of carcass fat in livestock have been extensively researched, the role, value and perceptions of animal fats in meat quality differ significantly in importance between producers, abattoirs, butchers, retailers and consumers. Fat and long-chain fatty acids, whether in adipose tissue or muscle, contribute to important aspects of meat quality and are central to the nutritional and sensory values of meat. In this review the nutritional value of fat, as well as the importance of fat in terms of carcass and meat quality will be highlighted. The 'quality' of meat depends greatly on the socio-demographic backgrounds of the consumer. The aim is to focus on the global importance of fat in the carcass to the producer, processor and consumer. There is currently no clear cut definition for fat quality because the acceptability and perceived quality of fat varies significantly in terms of quantity, colour, consistency and chemical composition in different species of livestock around the world. The association between animal fats and human health is critical and recommendations by health professionals range from excluding fats altogether to a moderate consumption of fats due to their essential role in the body. Recently the emphasis has shifted away from fat quantity to fat quality. Despite these recommendations and years of bad publicity in terms of the adverse affects of animal fats in human health, the livestock industry seems reluctant to shift its focus to fat quality rather than quantity. This approach may adversely affect future meat consumption by consumers who are becoming increasingly critical about the food they eat.

The application of high-pressure treatment in the reduction of salt levels in reduced-phosphate breakfast sausages.

PubMed

O'Flynn, Claire C; Cruz-Romero, Malco C; Troy, Declan; Mullen, Anne M; Kerry, Joe P

2014-03-01

This study investigated the effects of high pressure (HP) treatment of pork meat before manufacturing sausages with reduced salt levels and compared them to sausages manufactured with untreated meat (control sausages). A 2×5 factorial design was set up incorporating two pressure levels (0 or 150 MPa) and five salt levels (0.5, 1.0, 1.5, 2.0 and 2.5%). Most quality attributes were affected when salt levels were reduced below 1.5%. Fat loss (FL) was (P<0.05) affected by salt level; samples with <1.5% salt had the highest FL. HP treatment increased emulsion stability and reduced cook loss (CL) compared to control sausages. Increased CL was observed when salt was reduced below 2.0%. Salt reduction below 1.5% adversely affected colour, sensory and texture attributes. Independent of salt, HP treatment affected adversely juiciness and cohesiveness while adhesiveness was improved. Overall, there is potential to manufacture sausages maintaining organoleptic and functional properties traditionally associated with sausages using HP treated meat. Copyright © 2013 Elsevier Ltd. All rights reserved.

Development of risk-based air quality management strategies under impacts of climate change.

PubMed

Liao, Kuo-Jen; Amar, Praveen; Tagaris, Efthimios; Russell, Armistead G

2012-05-01

Climate change is forecast to adversely affect air quality through perturbations in meteorological conditions, photochemical reactions, and precursor emissions. To protect the environment and human health from air pollution, there is an increasing recognition of the necessity of developing effective air quality management strategies under the impacts of climate change. This paper presents a framework for developing risk-based air quality management strategies that can help policy makers improve their decision-making processes in response to current and future climate change about 30-50 years from now. Development of air quality management strategies under the impacts of climate change is fundamentally a risk assessment and risk management process involving four steps: (1) assessment of the impacts of climate change and associated uncertainties; (2) determination of air quality targets; (3) selections of potential air quality management options; and (4) identification of preferred air quality management strategies that minimize control costs, maximize benefits, or limit the adverse effects of climate change on air quality when considering the scarcity of resources. The main challenge relates to the level of uncertainties associated with climate change forecasts and advancements in future control measures, since they will significantly affect the risk assessment results and development of effective air quality management plans. The concept presented in this paper can help decision makers make appropriate responses to climate change, since it provides an integrated approach for climate risk assessment and management when developing air quality management strategies. Development of climate-responsive air quality management strategies is fundamentally a risk assessment and risk management process. The risk assessment process includes quantification of climate change impacts on air quality and associated uncertainties. Risk management for air quality under the impacts of climate change includes determination of air quality targets, selections of potential management options, and identification of effective air quality management strategies through decision-making models. The risk-based decision-making framework can also be applied to develop climate-responsive management strategies for the other environmental dimensions and assess costs and benefits of future environmental management policies.

A perinatal care quality and safety initiative: are there financial rewards for improved quality?

PubMed

Kozhimannil, Katy B; Sommerness, Samantha A; Rauk, Phillip; Gams, Rebecca; Hirt, Charles; Davis, Stanley; Miller, Kristi K; Landers, Daniel V

2013-08-01

Although costs of providing care may decrease with hospital initiatives to improve obstetric and neonatal outcomes, the accompanying reduced adverse outcomes may negatively affect hospital revenues. In 2008 a Minnesota-based hospital system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which used evidence-based care bundles to guide management of obstetric services. A pre-post analysis of financial impacts of ZBI was conducted by using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009-2011) the initiative. For the Fairview Health Services hospitals, after adjusting for relevant covariates, implementation of ZBI was associated with a mean 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (adjusted odds ratio [AOR] = 0.89, p = .076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008. Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering improved quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize QI. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost.

Otorhinolaryngological Toxicities of New Drugs in Oncology.

PubMed

Hartl, Dana M; Morel, Daphné; Saavedra, Erika; Massard, Christophe; Rinaldo, Alessandra; Saba, Nabil F; Ferlito, Alfio; Soria, Jean-Charles

2017-04-01

Many new or relatively new cancer drugs-personalized anticancer agents-have been approved for use in various clinical settings in oncology or are still under evaluation in clinical trials. Targeted therapies as well as new immune checkpoint blockers have toxicity profiles that differ from conventional cytotoxic chemotherapy, and many can cause adverse effects that affect the mouth and pharynx, the nasal cavities, and the larynx. This review aims to provide an overview of current knowledge concerning these side effects and contemporary management. Adverse effects of the mouth/pharynx, nasal cavities, larynx, and cochlear-vestibular system are generally low grade (according to the Common Terminology Criteria for Adverse Events) and generally present non-life-threatening symptoms. However, the impact on patients' quality of life could be important. The incidence and severity vary according to the drug, its target(s), and dose, but there are currently no known predictive factors, and each patient has an individual toxicity profile. Management guidelines are based on expert opinion. These ear, nose, and throat adverse effects are not frequently mentioned in the literature because of the often non-specific nature of the symptoms and their mildness, but also the absence of specific treatment. These symptoms can contribute to decreased quality of life and lead to drug compliance issues if not diagnosed and managed appropriately.

Mode of treatment affects quality of life in head and neck cancer survivors: Implications for holistic care.

PubMed

Bower, Wendy Fiona; Vlantis, Alexander Christopher; Chung, Tiffany M L; Van Hasselt, C Andrew

2010-10-01

As adverse effects of live-saving treatment are unavoidable surgeons have a duty to address physical changes and quality of life issues that matter to head and neck (H&N) cancer patients. We propose a tailored holistic care package. This study compared the quality of life of H&N cancer survivors managed with different approaches in the follow-up phase after initial treatment and identified factors adversely impacting quality of life parameters. H&N cancer patients studied: 1) surgery only, 2) radiotherapy only, 3) surgery and radiotherapy, and 4) any combination of surgery, chemotherapy or radiotherapy. Patients unable to communicate in Cantonese, with thyroid cancer or end-of-life disease were excluded. EORTC QLQ-H&N35 Cantonese version was administered at least 1 year after initial H&N cancer treatment. Quality of life impairment was worse in all of the domains for combination therapy versus monotherapy patients. Scores between surgery or radiotherapy-only patients were not significantly different. Radiotherapy preceding surgery impacted significantly more on speech than surgery before the radiotherapy. Patients with advanced disease had more impairment of quality of life in each domain than patients with early disease. Coughing, eating problems, sticky saliva, and difficulties with social contact were all significant predictors of problems associated with a dry mouth.

Impact and implications of disruptive behavior in the perioperative arena.

PubMed

Rosenstein, Alan H; O'Daniel, Michelle

2006-07-01

There is a growing concern about the role of human factor issues and their effect on patient safety and clinical outcomes of care. Problems with disruptive behaviors negatively affect communication flow and team dynamics, which can lead to adverse events and poor quality outcomes. A 25-question survey tool was used to assess the status and significance of disruptive behaviors around perioperative services in a large metropolitan academic medical center. Results were analyzed and compared with those from a national databank to identify areas of concern and opportunities for improvement. Disruptive behaviors were a common occurrence in the perioperative setting. These types of behaviors were most prevalent in attending surgeons. Disruptive behaviors increased levels of stress and frustration, which impaired concentration, impeded communication flow, and adversely affected staff relationships and team collaboration. These events were perceived to increase the likelihood of medical errors and adverse events and to compromise patient safety and quality of care. Disruptive behaviors in the perioperative arena have a significant impact on team dynamics and communication flow, which can have a negative impact on patient care. Organizations need to recognize the prevalence and significance of disruptive behaviors and develop policies and processes to address the issue. Key areas of focus include recognition and awareness, organizational and cultural commitment, implementation of appropriate codes of behavior policies and procedures, and provision of education and training programs to discuss contributing factors and tools to build effective communication and team collaboration skills.

Biogeochemical cycling and chemical fluxes in a managed northern forested wetland, Michigan, USA

Treesearch

James McLaughlin; Emily Calhoon; Margaret Gale; Martin Jurgensen; Carl Trettin

2011-01-01

Forest harvesting and subsequent regeneration treatments may cause changes in soil and solution chemistry that adversely affect forest productivity and environmental quality. The objective of this study was to assess soil carbon (C), nitrogen (N), and base cation pools and fluxes, and to construct a hydrogen ion (H+) mass balance to identify major processes controlling...

Interactions of woody biofuel feedstock production systems with water resources: Considerations for sustainability

Treesearch

Carl C. Trettin; Devendra Amatya; Mark Coleman

2008-01-01

Water resources are important for the production of woody biofuel feedstocks. It is necessary to ensure that production systems do not adversely affect the quantity or quality of surface and ground water. The effects of woody biomass plantations on water resources are largely dependent on the prior land use and the management regime. Experience from both irrigated and...

Interactions of woody biofuel feedstock production systems with water resources: considerations for sustainability

Treesearch

Carl C. Trettin; Devendra Amatya; Mark Coleman

2008-01-01

Water resources are important for the production of woody biofuel feedstocks. It is necessary to ensure that production systems do not adversely affect the quantity or quality of surface and ground water. The effects of woody biomass plantations on water resources are largely dependent on the prior land use and the management regime. Experience from both irrigated and...

The Effect of an Educational Program for Persons with Macular Degeneration: A Pilot Study

ERIC Educational Resources Information Center

Smith, Theresa Marie; Thomas, Kimberly; Dow, Katherine

2009-01-01

Macular degeneration is the leading cause of vision loss in the United States for persons aged 60 and older. Compared to individuals without disabilities, individuals with low vision demonstrate a 15% to 30% higher dependence on others to perform activities of daily living. In addition, low vision can adversely affect a person's quality of life.…

Treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): an overview of systematic reviews.

PubMed

Oaklander, Anne Louise; Lunn, Michael Pt; Hughes, Richard Ac; van Schaik, Ivo N; Frost, Chris; Chalk, Colin H

2017-01-13

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronic progressive or relapsing and remitting disease that usually causes weakness and sensory loss. The symptoms are due to autoimmune inflammation of peripheral nerves. CIPD affects about 2 to 3 per 100,000 of the population. More than half of affected people cannot walk unaided when symptoms are at their worst. CIDP usually responds to treatments that reduce inflammation, but there is disagreement about which treatment is most effective. To summarise the evidence from Cochrane systematic reviews (CSRs) and non-Cochrane systematic reviews of any treatment for CIDP and to compare the effects of treatments. We considered all systematic reviews of randomised controlled trials (RCTs) of any treatment for any form of CIDP. We reported their primary outcomes, giving priority to change in disability after 12 months.Two overview authors independently identified published systematic reviews for inclusion and collected data. We reported the quality of evidence using GRADE criteria. Two other review authors independently checked review selection, data extraction and quality assessments.On 31 October 2016, we searched the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects (in theCochrane Library), MEDLINE, Embase, and CINAHL Plus for systematic reviews of CIDP. We supplemented the RCTs in the existing CSRs by searching on the same date for RCTs of any treatment of CIDP (including treatment of fatigue or pain in CIDP), in the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL Plus. Five CSRs met our inclusion criteria. We identified 23 randomised trials, of which 15 had been included in these CSRs. We were unable to compare treatments as originally planned, because outcomes and outcome intervals differed. CorticosteroidsIt is uncertain whether daily oral prednisone improved impairment compared to no treatment because the quality of the evidence was very low (1 trial, 28 participants). According to moderate-quality evidence (1 trial, 41 participants), six months' treatment with high-dose monthly oral dexamethasone did not improve disability more than daily oral prednisolone. Observational studies tell us that prolonged use of corticosteroids sometimes causes serious side-effects. Plasma exchangeAccording to moderate-quality evidence (2 trials, 59 participants), twice-weekly plasma exchange produced more short-term improvement in disability than sham exchange. In the largest observational study, 3.9% of plasma exchange procedures had complications. Intravenous immunoglobulinAccording to high-quality evidence (5 trials, 269 participants), intravenous immunoglobulin (IVIg) produced more short-term improvement than placebo. Adverse events were more common with IVIg than placebo (high-quality evidence), but serious adverse events were not (moderate-quality evidence, 3 trials, 315 participants). One trial with 19 participants provided moderate-quality evidence of little or no difference in short-term improvement of impairment with plasma exchange in comparison to IVIg. There was little or no difference in short-term improvement of disability with IVIg in comparison to oral prednisolone (moderate-quality evidence; 1 trial, 29 participants) or intravenous methylprednisolone (high-quality evidence; 1 trial, 45 participants). One unpublished randomised open trial with 35 participants found little or no difference in disability after three months of IVIg compared to oral prednisone; this trial has not yet been included in a CSR. We know from observational studies that serious adverse events related to IVIg do occur. Other immunomodulatory treatmentsIt is uncertain whether the addition of azathioprine (2 mg/kg) to prednisone improved impairment in comparison to prednisone alone, as the quality of the evidence is very low (1 trial, 27 participants). Observational studies show that adverse effects truncate treatment in 10% of people.According to low-quality evidence (1 trial, 60 participants), compared to placebo, methotrexate 15 mg/kg did not allow more participants to reduce corticosteroid or IVIg doses by 20%. Serious adverse events were no more common with methotrexate than with placebo, but observational studies show that methotrexate can cause teratogenicity, abnormal liver function, and pulmonary fibrosis.According to moderate-quality evidence (2 trials, 77 participants), interferon beta-1a (IFN beta-1a) in comparison to placebo, did not allow more people to withdraw from IVIg. According to moderate-quality evidence, serious adverse events were no more common with IFN beta-1a than with placebo.We know of no other completed trials of immunosuppressant or immunomodulatory agents for CIDP. Other treatmentsWe identified no trials of treatments for fatigue or pain in CIDP. Adverse effectsNot all trials routinely collected adverse event data; when they did, the quality of evidence was variable. Adverse effects in the short, medium, and long term occur with all interventions. We are not able to make reliable comparisons of adverse events between the interventions included in CSRs. We cannot be certain based on available evidence whether daily oral prednisone improves impairment compared to no treatment. However, corticosteroids are commonly used, based on widespread availability, low cost, very low-quality evidence from observational studies, and clinical experience. The weakness of the evidence does not necessarily mean that corticosteroids are ineffective. High-dose monthly oral dexamethasone for six months is probably no more or less effective than daily oral prednisolone. Plasma exchange produces short-term improvement in impairment as determined by neurological examination, and probably produces short-term improvement in disability. IVIg produces more short-term improvement in disability than placebo and more adverse events, although serious side effects are probably no more common than with placebo. There is no clear difference in short-term improvement in impairment with IVIg when compared with intravenous methylprednisolone and probably no improvement when compared with either oral prednisolone or plasma exchange. According to observational studies, adverse events related to difficult venous access, use of citrate, and haemodynamic changes occur in 3% to17% of plasma exchange procedures.It is uncertain whether azathioprine is of benefit as the quality of evidence is very low. Methotrexate may not be of benefit and IFN beta-1a is probably not of benefit.We need further research to identify predictors of response to different treatments and to compare their long-term benefits, safety and cost-effectiveness. There is a need for more randomised trials of immunosuppressive and immunomodulatory agents, routes of administration, and treatments for symptoms of CIDP.

Confidential Clinician-reported Surveillance of Adverse Events Among Medical Inpatients

PubMed Central

Weingart, Saul N; Ship, Amy N; Aronson, Mark D

2000-01-01

BACKGROUND Although iatrogenic injury poses a significant risk to hospitalized patients, detection of adverse events (AEs) is costly and difficult. METHODS The authors developed a confidential reporting method for detecting AEs on a medicine unit of a teaching hospital. Adverse events were defined as patient injuries. Potential adverse events (PAEs) represented errors that could have, but did not result in harm. Investigators interviewed house officers during morning rounds and by e-mail, asking them to identify obstacles to high quality care and iatrogenic injuries. They compared house officer reports with hospital incident reports and patients' medical records. A multivariate regression model identified correlates of reporting. RESULTS One hundred ten events occurred, affecting 84 patients. Queries by e-mail (incidence rate ratio [IRR ]=0.16; 95% confidence interval [95% CI], 0.05 to 0.49) and on days when house officers rotated to a new service (IRR =0.12; 95% CI, 0.02 to 0.91) resulted in fewer reports. The most commonly reported process of care problems were inadequate evaluation of the patient (16.4%), failure to monitor or follow up (12.7%), and failure of the laboratory to perform a test (12.7%). Respondents identified 29 (26.4%) AEs, 52 (47.3%) PAEs, and 29 (26.4%) other house officer-identified quality problems. An AE occurred in 2.6% of admissions. The hospital incident reporting system detected only one house officer-reported event. Chart review corroborated 72.9% of events. CONCLUSIONS House officers detect many AEs among inpatients. Confidential peer interviews of front-line providers is a promising method for identifying medical errors and substandard quality. PMID:10940133

Burnout, depression and anxiety in preclinical medical students: a cross-sectional survey.

PubMed

van Venrooij, Lennard T; Barnhoorn, Pieter C; Giltay, Erik J; van Noorden, Martijn S

2015-11-10

The purpose of this study was to assess the prevalences and correlates of adverse affective states (burnout-, depression- and anxiety-related symptoms) among preclinical medical students. Self-report questionnaires were sent to all preclinical medical students of Leiden University Medical Center (n=1311). Burnout-related symptoms were measured using the Maslach Burnout Inventory-General Survey (MBI-GS), depression and anxiety-related symptoms and vitality using the Symptom Questionnaire-48 (SQ-48). Furthermore, duration of sleep, quality of life (SF-36), need for recovery, happiness and dispositional optimism were assessed and analysed in relation to affective symptoms using regression analysis. Among the 433 responders (response rate=33.0%), prevalences of self-reported burnout-, depression- and anxiety-related symptoms were 46.0% (n=199), 27.0% (n=117) and 29.1% (n=126), respectively. Independent correlates for burnout-related symptoms were <6 h sleep per night (p=0.02), low happiness (p<0.001) and a high need for recovery (p<0.001). Independent correlates for both depression- and anxiety-related symptoms were low optimism (p<0.001; p<0.001, respectively), low happiness (p<0.001; p=0.001, respectively) and a high need for recovery (p=0.03; p<0.001, respectively). Prevalences for adverse affective states were high among preclinical medical students and mainly associated with personality trait-related factors and need for recovery, rather than work-related factors. These findings suggest that being a medical student increases one's risk to adverse affective states, and should inspire preventative initiatives.

CIRSE Guidelines on Percutaneous Vertebral Augmentation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tsoumakidou, Georgia, E-mail: gtsoumakidou@yahoo.com; Too, Chow Wei, E-mail: spyder55@gmail.com; Koch, Guillaume, E-mail: guillaume.koch@gmail.com

Vertebral compression fracture (VCF) is an important cause of severe debilitating back pain, adversely affecting quality of life, physical function, psychosocial performance, mental health and survival. Different vertebral augmentation procedures (VAPs) are used in order to consolidate the VCFs, relief pain,and whenever posible achieve vertebral body height restoration. In the present review we give the indications, contraindications, safety profile and outcomes of the existing percutaneous VAPs.

Quality of Care and the Burden of Two Cultures: When the World of the Nurse's Aide Enters the World of the Nursing Home.

ERIC Educational Resources Information Center

Tellis-Nayak, V.; Tellis-Nayak, Mary

1989-01-01

Used ethnographic data to examine personal and work worlds of nurse's aides. Concludes that, because nursing home's institutional culture often adds to adversity of their personal life, nurse's aides move between the two milieus in self-perpetuating negative cycle, carrying to bedside of elderly residents the affective and psychological burden…

Medical marijuana in neurology.

PubMed

Benbadis, Selim R; Sanchez-Ramos, Juan; Bozorg, Ali; Giarratano, Melissa; Kalidas, Kavita; Katzin, Lara; Robertson, Derrick; Vu, Tuan; Smith, Amanda; Zesiewicz, Theresa

2014-12-01

Constituents of the Cannabis plant, cannabinoids, may be of therapeutic value in neurologic diseases. The most abundant cannabinoids are Δ(9)-tetrahydrocannabinol, which possesses psychoactive properties, and cannabidiol, which has no intrinsic psychoactive effects, but exhibits neuroprotective properties in preclinical studies. A small number of high-quality clinical trials support the safety and efficacy of cannabinoids for treatment of spasticity of multiple sclerosis, pain refractory to opioids, glaucoma, nausea and vomiting. Lower level clinical evidence indicates that cannabinoids may be useful for dystonia, tics, tremors, epilepsy, migraine and weight loss. Data are also limited in regards to adverse events and safety. Common nonspecific adverse events are similar to those of other CNS 'depressants' and include weakness, mood changes and dizziness. Cannabinoids can have cardiovascular adverse events and, when smoked chronically, may affect pulmonary function. Fatalities are rare even with recreational use. There is a concern about psychological dependence, but physical dependence is less well documented. Cannabis preparations may presently offer an option for compassionate use in severe neurologic diseases, but at this point, only when standard-of-care therapy is ineffective. As more high-quality clinical data are gathered, the therapeutic application of cannabinoids will likely expand.

Mining-Related Sediment and Soil Contamination in a Large Superfund Site: Characterization, Habitat Implications, and Remediation.

PubMed

Juracek, K E; Drake, K D

2016-10-01

Historical mining activity (1850-1970) in the now inactive Tri-State Mining District provided an ongoing source of lead and zinc to the environment including the US Environmental Protection Agency Superfund site located in Cherokee County, southeast Kansas, USA. The resultant contamination adversely affected biota and caused human health problems and risks. Remediation in the Superfund site requires an understanding of the magnitude and extent of contamination. To provide some of the required information, a series of sediment and soil investigations were conducted in and near the Superfund site to characterize lead and zinc contamination in the aquatic and floodplain environments along the main-stem Spring River and its major tributaries. In the Superfund site, the most pronounced lead and zinc contamination, with concentrations that far exceed sediment quality guidelines associated with potential adverse biological effects, was measured for streambed sediments and floodplain soils located within or downstream from the most intensive mining-affected areas. Tributary streambeds and floodplains in affected areas are heavily contaminated with some sites having lead and zinc concentrations that are an order of magnitude (or more) greater than the sediment quality guidelines. For the main-stem Spring River, the streambed is contaminated but the floodplain is mostly uncontaminated. Measured lead and zinc concentrations in streambed sediments, lakebed sediments, and floodplain soils documented a persistence of the post-mining contamination on a decadal timescale. These results provide a basis for the prioritization, development, and implementation of plans to remediate contamination in the affected aquatic and floodplain environments within the Superfund site.

Mining-Related Sediment and Soil Contamination in a Large Superfund Site: Characterization, Habitat Implications, and Remediation

NASA Astrophysics Data System (ADS)

Juracek, K. E.; Drake, K. D.

2016-10-01

Historical mining activity (1850-1970) in the now inactive Tri-State Mining District provided an ongoing source of lead and zinc to the environment including the US Environmental Protection Agency Superfund site located in Cherokee County, southeast Kansas, USA. The resultant contamination adversely affected biota and caused human health problems and risks. Remediation in the Superfund site requires an understanding of the magnitude and extent of contamination. To provide some of the required information, a series of sediment and soil investigations were conducted in and near the Superfund site to characterize lead and zinc contamination in the aquatic and floodplain environments along the main-stem Spring River and its major tributaries. In the Superfund site, the most pronounced lead and zinc contamination, with concentrations that far exceed sediment quality guidelines associated with potential adverse biological effects, was measured for streambed sediments and floodplain soils located within or downstream from the most intensive mining-affected areas. Tributary streambeds and floodplains in affected areas are heavily contaminated with some sites having lead and zinc concentrations that are an order of magnitude (or more) greater than the sediment quality guidelines. For the main-stem Spring River, the streambed is contaminated but the floodplain is mostly uncontaminated. Measured lead and zinc concentrations in streambed sediments, lakebed sediments, and floodplain soils documented a persistence of the post-mining contamination on a decadal timescale. These results provide a basis for the prioritization, development, and implementation of plans to remediate contamination in the affected aquatic and floodplain environments within the Superfund site.

Mining-related sediment and soil contamination in a large Superfund site: Characterization, habitat implications, and remediation

USGS Publications Warehouse

Juracek, Kyle E.; Drake, K. D.

2016-01-01

Historical mining activity (1850–1970) in the now inactive Tri-State Mining District provided an ongoing source of lead and zinc to the environment including the US Environmental Protection Agency Superfund site located in Cherokee County, southeast Kansas, USA. The resultant contamination adversely affected biota and caused human health problems and risks. Remediation in the Superfund site requires an understanding of the magnitude and extent of contamination. To provide some of the required information, a series of sediment and soil investigations were conducted in and near the Superfund site to characterize lead and zinc contamination in the aquatic and floodplain environments along the main-stem Spring River and its major tributaries. In the Superfund site, the most pronounced lead and zinc contamination, with concentrations that far exceed sediment quality guidelines associated with potential adverse biological effects, was measured for streambed sediments and floodplain soils located within or downstream from the most intensive mining-affected areas. Tributary streambeds and floodplains in affected areas are heavily contaminated with some sites having lead and zinc concentrations that are an order of magnitude (or more) greater than the sediment quality guidelines. For the main-stem Spring River, the streambed is contaminated but the floodplain is mostly uncontaminated. Measured lead and zinc concentrations in streambed sediments, lakebed sediments, and floodplain soils documented a persistence of the post-mining contamination on a decadal timescale. These results provide a basis for the prioritization, development, and implementation of plans to remediate contamination in the affected aquatic and floodplain environments within the Superfund site.

How does obesity affect fertility in men - and what are the treatment options?

PubMed

Stokes, Victoria J; Anderson, Richard A; George, Jyothis T

2015-05-01

Adiposity is associated with reduced fertility in men. The aetiology is multifactorial, with obese men at greater risk of suffering from impaired spermatogenesis, reduced circulating testosterone levels, erectile dysfunction and poor libido. The diagnosis and treatment of reduced fertility observed in obese men therefore requires insight into the underlying pathology, which has hormonal, mechanical and psychosocial aspects. This article summarises the current epidemiological, experimental and clinical trial evidence from the perspective of a practicing clinician. The following conclusions and recommendations can be drawn: Obesity is associated with low serum testosterone concentrations, but treatment with exogenous testosterone is likely to adversely impact on fertility. It is important to discuss this with men prior to initiation of testosterone therapy. Obesity adversely affects sperm concentration and may affect sperm quality. However, whether or not weight loss will correct these factors remain to be established. Oestrogen receptor modulators (and aromatase inhibitors) are unlicensed in the treatment for male hypogonadism and/or infertility. These treatments should hence be considered experimental approach until ongoing clinical trials report their outcomes. © 2014 John Wiley & Sons Ltd.

Associations of semen quality with non-essential heavy metals in blood and seminal fluid: data from the Environment and Male Infertility (EMI) study in Lebanon.

PubMed

Sukhn, Carol; Awwad, Johnny; Ghantous, Akram; Zaatari, Ghazi

2018-06-21

Human exposure to environmental pollutants is widespread. It was suggested that exposure to non-essential heavy metals may adversely affect semen development in men. To evaluate associations between non-essential heavy metals in blood and seminal fluid and semen quality parameters in men. Male partners of heterosexual couples were included. The following elements were measured in blood and seminal fluid: lead (Pb), cadmium (Cd), arsenic (As), barium (Ba), mercury (Hg), and uranium (U) using ion-coupled plasma-mass spectrometry. The fertility clinic at the American University of Beirut Medical Center. Semen quality parameters (volume, concentration, total count, progressive motility, viability, and normal morphology). We found that participants with low-quality semen had significantly higher Cd and Ba concentrations in the seminal fluid than participants with normal-quality semen. We also observed significant associations between low sperm viability and higher blood Cd and Ba, as well as higher seminal Pb, Cd, Ba, and U. Furthermore, U concentrations in the seminal fluid were associated with increased odds ratios for below-reference progressive sperm motility and normal morphology. Environmental exposures to Pb, Cd, Ba, and U appear to adversely influence sperm development in men. In non-occupationally exposed men, measurements of heavy metals in the seminal fluid may be more predictive of below-reference sperm quality parameters than in blood.

Appetite and adverse effects associated with radiation therapy in patients with head and neck cancer.

PubMed

Ogama, Norimasa; Suzuki, Sumie; Umeshita, Koji; Kobayashi, Tamami; Kaneko, Shoko; Kato, Sakiko; Shimizu, Yasuko

2010-02-01

The relationship between radiation treatment and adverse effects resulting in changes in appetite was studied in patients with head and neck (H&N) cancer. Path analysis was used to evaluate the following factors in 117 patients receiving radiation therapy for H&N cancer: daily fluctuations in saliva production, analgesic use, frequency of oral care, subject characteristics, and appetite. At 20 Gy of radiation, appetite was affected by Brinkman index value, age, and sensitivity to taste (R2=0.48, p<0.001); at 30 Gy of radiation, appetite was affected by frequency of oral care, xerostomia symptoms, age, sensitivity to taste, and oral mucositis (R2=0.52, p<0.001); and at 50 Gy of radiation, appetite was affected by low saliva production in the morning, frequency of oral care, xerostomia symptoms, sensitivity to taste, analgesic use, and oral mucositis (R2=0.62, p<0.001). The results of this study suggest that care taken to avoid a decrease in appetite due to adverse effects of radiation therapy should differ according to the dosage and schedule of radiation therapy. These findings represent important data for health care professionals to understand and support appropriate dietary intake and improved quality of life for H&N cancer patients receiving radiation therapy. Copyright 2009 Elsevier Ltd. All rights reserved.

Adverse selection and supply-side factors in the enrollment in community-based health insurance in Northwest Ethiopia: A mixed methodology.

PubMed

Atafu, Asmamaw; Kwon, Soonman

2018-05-20

Since 2010, the Ethiopian government introduced different measures to implement community-based health insurance (CBHI) schemes to improve access to health service and reduce the catastrophic effect of health care costs. The aim of this study was to examine the determinants of enrollment in CBHI in Northwest Ethiopia. In this study, we utilized a mix of quantitative (multivariate logistic regression applied to population survey linked with health facility survey) and qualitative (focus group discussion and in-depth interview) methods to better understand the factors that affect CBHI enrollment. The study revealed important factors, such as household, informal association, and health facility, as barriers to CBHI enrollment. Age and educational status, self-rated health status, perceived quality of health services, knowledge, and information (awareness) about CBHI were among the characteristics of individual household head, affecting enrollment. Household size and participation in an informal association, such as local credit associations, were also positively associated with CBHI enrollment. Additionally, health facility factors like unavailability of laboratory tests were the main factor that hinders CBHI enrollment. This study showed a possibility of adverse selection in CBHI enrollment. Additionally, perceived quality of health services, knowledge, and information (awareness) are positively associated with CBHI enrollment. Therefore, policy interventions to mitigate adverse selection as well as provision of social marketing activities are crucial to increase enrollment in CBHI. Furthermore, policy interventions that enhance the capacity of health facilities and schemes to provide the promised services are necessary. Copyright © 2018 John Wiley & Sons, Ltd.

Assessing Impacts on Unplanned Hospitalisations of Care Quality and Access Using a Structural Equation Method: With a Case Study of Diabetes

PubMed Central

Congdon, Peter

2016-01-01

Background: Enhanced quality of care and improved access are central to effective primary care management of long term conditions. However, research evidence is inconclusive in establishing a link between quality of primary care, or access, and adverse outcomes, such as unplanned hospitalisation. Methods: This paper proposes a structural equation model for quality and access as latent variables affecting adverse outcomes, such as unplanned hospitalisations. In a case study application, quality of care (QOC) is defined in relation to diabetes, and the aim is to assess impacts of care quality and access on unplanned hospital admissions for diabetes, while allowing also for socio-economic deprivation, diabetes morbidity, and supply effects. The study involves 90 general practitioner (GP) practices in two London Clinical Commissioning Groups, using clinical quality of care indicators, and patient survey data on perceived access. Results: As a single predictor, quality of care has a significant negative impact on emergency admissions, and this significant effect remains when socio-economic deprivation and morbidity are allowed. In a full structural equation model including access, the probability that QOC negatively impacts on unplanned admissions exceeds 0.9. Furthermore, poor access is linked to deprivation, diminished QOC, and larger list sizes. Conclusions: Using a Bayesian inference methodology, the evidence from the analysis is weighted towards negative impacts of higher primary care quality and improved access on unplanned admissions. The methodology of the paper is potentially applicable to other long term conditions, and relevant when care quality and access cannot be measured directly and are better regarded as latent variables. PMID:27598184

Assessing Impacts on Unplanned Hospitalisations of Care Quality and Access Using a Structural Equation Method: With a Case Study of Diabetes.

PubMed

Congdon, Peter

2016-09-01

Enhanced quality of care and improved access are central to effective primary care management of long term conditions. However, research evidence is inconclusive in establishing a link between quality of primary care, or access, and adverse outcomes, such as unplanned hospitalisation. This paper proposes a structural equation model for quality and access as latent variables affecting adverse outcomes, such as unplanned hospitalisations. In a case study application, quality of care (QOC) is defined in relation to diabetes, and the aim is to assess impacts of care quality and access on unplanned hospital admissions for diabetes, while allowing also for socio-economic deprivation, diabetes morbidity, and supply effects. The study involves 90 general practitioner (GP) practices in two London Clinical Commissioning Groups, using clinical quality of care indicators, and patient survey data on perceived access. As a single predictor, quality of care has a significant negative impact on emergency admissions, and this significant effect remains when socio-economic deprivation and morbidity are allowed. In a full structural equation model including access, the probability that QOC negatively impacts on unplanned admissions exceeds 0.9. Furthermore, poor access is linked to deprivation, diminished QOC, and larger list sizes. Using a Bayesian inference methodology, the evidence from the analysis is weighted towards negative impacts of higher primary care quality and improved access on unplanned admissions. The methodology of the paper is potentially applicable to other long term conditions, and relevant when care quality and access cannot be measured directly and are better regarded as latent variables.

40 CFR 125.85 - May alternative requirements be authorized?

Code of Federal Regulations, 2011 CFR

2011-07-01

... requirement at issue or would result in significant adverse impacts on local air quality, significant adverse impacts on local water resources other than impingement or entrainment, or significant adverse impacts on... the wholly out of proportion cost or the significant adverse impacts on local air quality, significant...

40 CFR 125.85 - May alternative requirements be authorized?

Code of Federal Regulations, 2010 CFR

2010-07-01

... requirement at issue or would result in significant adverse impacts on local air quality, significant adverse impacts on local water resources other than impingement or entrainment, or significant adverse impacts on... the wholly out of proportion cost or the significant adverse impacts on local air quality, significant...

Pathways between childhood/adolescent adversity, adolescent socioeconomic status, and long-term cardiovascular disease risk in young adulthood.

PubMed

Doom, Jenalee R; Mason, Susan M; Suglia, Shakira F; Clark, Cari Jo

2017-09-01

The current study investigated mediators between childhood/adolescent adversities (e.g., dating violence, maltreatment, homelessness, and parental death), low socioeconomic status (SES) during adolescence, and cardiovascular disease (CVD) risk in young adulthood. The purpose of these analyses was to understand whether SES during adolescence and childhood/adolescent adversities affect CVD risk through similar pathways, including maternal relationship quality, health behaviors, financial stress, medical/dental care, educational attainment, sleep problems, and depressive symptoms. Using the National Longitudinal Study of Adolescent to Adult Health (N = 14,493), which has followed US adolescents (Wave 1; M = 15.9 years) through early adulthood (Wave 4; M = 28.9 years), associations were examined between childhood/adolescent adversity and SES to 30-year CVD risk in young adulthood. The outcome was a Framingham-based prediction model of CVD risk that included age, sex, body mass index, smoking, systolic blood pressure, diabetes, and antihypertensive medication use at Wave 4. Path analysis was used to examine paths through the adolescent maternal relationship to young adult mediators of CVD risk. Childhood/adolescent adversity significantly predicted greater adult CVD risk through the following pathways: maternal relationship, health behaviors, financial stress, lack of medical/dental care, and educational attainment; but not through depressive symptoms or sleep problems. Lower SES during adolescence significantly predicted greater adult CVD risk through the following pathways: health behaviors, financial stress, lack of medical/dental care, and educational attainment, but not maternal relationship, depressive symptoms, or sleep problems. Childhood/adolescent adversities and SES affected CVD risk in young adulthood through both similar and unique pathways that may inform interventions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Health Monitoring and Management for Manufacturing Workers in Adverse Working Conditions.

PubMed

Xu, Xiaoya; Zhong, Miao; Wan, Jiafu; Yi, Minglun; Gao, Tiancheng

2016-10-01

In adverse working conditions, environmental parameters such as metallic dust, noise, and environmental temperature, directly affect the health condition of manufacturing workers. It is therefore important to implement health monitoring and management based on important physiological parameters (e.g., heart rate, blood pressure, and body temperature). In recent years, new technologies, such as body area networks, cloud computing, and smart clothing, have allowed the improvement of the quality of services. In this article, we first give five-layer architecture for health monitoring and management of manufacturing workers. Then, we analyze the system implementation process, including environmental data processing, physical condition monitoring and system services and management, and present the corresponding algorithms. Finally, we carry out an evaluation and analysis from the perspective of insurance and compensation for manufacturing workers in adverse working conditions. The proposed scheme will contribute to the improvement of workplace conditions, realize health monitoring and management, and protect the interests of manufacturing workers.

Anti-epileptic drugs in pediatric traumatic brain injury.

PubMed

Tanaka, Tomoko; Litofsky, N Scott

2016-10-01

Pediatric post-traumatic epilepsy incidence varies depending on reporting mechanism and injury severity; anti-epileptic drug (AEDs) use also varies with lack of quality evidence-based data. Adverse AED effects are not negligible; some may negatively affect functional outcome. This review focuses on clarifying available data. This review discusses seizures associated with traumatic brain injury in children, including seizure incidence, relationship to severity of injury, potential detrimental effects of seizures, potential benefits of AED, adverse effects of AED, new developments in preventing epileptogenesis, and suggested recommendations for patient management. English language papers were identified from PubMed using search terms including but not excluding the following: adverse drug effects, anti-epileptic drugs, children, electroencephalogram, epilepsy, epileptogenesis, head injury, levetiracetam, pediatrics, phenytoin, post-traumatic epilepsy, prevention, prophylaxis, seizures, and traumatic brain injury. Expert commentary: Identification of high-risk patients for post-traumatic seizures is a key goal. Levetiracetam may prevent epileptogenesis, as may other developments.

Resiliency in the Face of Adversity: A Short Longitudinal Test of the Trait Hypothesis.

PubMed

Karaırmak, Özlem; Figley, Charles

2017-01-01

Resilience represents coping with adversity and is in line with a more positive paradigm for viewing responses to adversity. Most research has focused on resilience as coping-a state-based response to adversity. However, a competing hypothesis views resilience or resiliency as a trait that exists across time and types of adversity. We tested undergraduates enrolled in social work classes at a large southern university at two time periods during a single semester using measures of adversity, positive and negative affect, and trait-based resiliency. Consistent with the trait-based resiliency, and in contrast to state-based resilience, resiliency scores were not strongly correlated with adversity at both testing points but were with positive affect, and resiliency scores remained the same over time despite adversity variations. There was no gender or ethnic group difference in resilience scores. Black/African Americans reported significantly less negative affect and more positive affect than White/Caucasians.

Adverse events and the relation with quality of life in adults with intellectual disability and challenging behaviour using psychotropic drugs.

PubMed

Scheifes, Arlette; Walraven, Sanne; Stolker, Joost Jan; Nijman, Henk L I; Egberts, Toine C G; Heerdink, Eibert R

2016-01-01

Psychotropic drugs are prescribed to approximately 30-40% of adults with intellectual disability (ID) and challenging behaviour, despite the limited evidence of effectiveness and the potential of adverse events. To assess the prevalence of adverse events in association with psychotropic drug use in adults with ID and challenging behaviour and to examine the relation of these adverse events with the person's quality of life. The presence of adverse events was measured with a questionnaire that had to be filled in by the physicians of the participants. Movement disorders were measured separately with a standardised protocol. The strength of the association between adverse events and Intellectual Disability Quality of Life-16 (IDQOL-16), and daily functioning was investigated using linear regression analyses, taking into account the severity of disease (CGI-S) as potential confounder. Virtually all of 103 adults with ID and challenging behaviour had at least one adverse event (84.4%) and almost half had ≥3 adverse events (45.6%) across different subclasses. Using psychotropic drugs increased the prevalence of adverse events significantly. Respectively 13% of the patients without psychotropic drugs and 61% of the patients with ≥2 psychotropic drugs had ≥3 adverse events. Having adverse events had a significantly negative influence on the quality of life. A large majority of all patients had at least one adverse event associated with psychotropic drug use. More attention is needed for these adverse events and their negative influence on the quality of life of these patients, taking into account the lack of evidence of effectiveness of psychotropic drugs for challenging behaviour. Copyright © 2015. Published by Elsevier Ltd.

A web-based incident reporting system: a two years' experience in an Italian research and teaching hospital.

PubMed

Bodina, A; Demarchi, A; Castaldi, S

2014-01-01

A web-based incident reporting system (IRS) is a tool allowing healthcare workers to voluntary and anonymously report adverse events/near misses. In 2010, this system was introduced in a research and teaching hospital in metropolitan area in the North part of Italy, in order to detect errors and to learn from failures in care delivery. The aim of this paper is to assess whether and how IRS has proved to be a valuable tool to manage clinical risk and improve healthcare quality. Adverse events are reported anonymously by staff members with the use of an online template form available in the hospital intranet. We retrospectively reviewed the recorded data for each incident/near miss reported between January 2011 and December 2012. The number of reported incidents/near misses was 521 in 2011 and 442 in 2012. In the two years the admissions were 36.974 and 36.107 respectively. We noticed that nursing staff made more use of IRS and that reported errors were basically related to prescription and administration of medications. Much international literature reports that adverse events and near misses are 10% of admissions. Our data are far from that number, thus meaning that a failure in reporting adverse events exists. This consideration, together with the high number of near misses in comparison with occurred errors, leads us to speculate that adverse events with serious consequences for patients are marginally reported. Probably the lack of a strong leadership considering IRS as an instrument for improving quality and operators' reluctance to overcome the culture of blame may negatively affect IRS.

A clinical data validated mathematical model of prostate cancer growth under intermittent androgen suppression therapy

NASA Astrophysics Data System (ADS)

Portz, Travis; Kuang, Yang; Nagy, John D.

2012-03-01

Prostate cancer is commonly treated by a form of hormone therapy called androgen suppression. This form of treatment, while successful at reducing the cancer cell population, adversely affects quality of life and typically leads to a recurrence of the cancer in an androgen-independent form. Intermittent androgen suppression aims to alleviate some of these adverse affects by cycling the patient on and off treatment. Clinical studies have suggested that intermittent therapy is capable of maintaining androgen dependence over multiple treatment cycles while increasing quality of life during off-treatment periods. This paper presents a mathematical model of prostate cancer to study the dynamics of androgen suppression therapy and the production of prostate-specific antigen (PSA), a clinical marker for prostate cancer. Preliminary models were based on the assumption of an androgen-independent (AI) cell population with constant net growth rate. These models gave poor accuracy when fitting clinical data during simulation. The final model presented hypothesizes an AI population with increased sensitivity to low levels of androgen. It also hypothesizes that PSA production is heavily dependent on androgen. The high level of accuracy in fitting clinical data with this model appears to confirm these hypotheses, which are also consistent with biological evidence.

Subjective sleep disturbance in Chinese adults with epilepsy: Associations with affective symptoms.

PubMed

Shen, Yeru; Zhang, Mengmeng; Wang, Yu; Wang, Lanlan; Xu, Xiangjun; Xiao, Gairong; Chen, Jing; Zhang, Ting; Zhou, Nong

2017-09-01

As well as being a very common neurological disease worldwide, epilepsy significantly impairs patients' emotional, behavioral, and cognitive functioning. Sleep disturbances are the most frequent complaint in patients with epilepsy. The present study assesses the impact of a range of affective symptoms on subjective sleep quality and sleep disturbances in Chinese adults with epilepsy. Adults with epilepsy who visited our epilepsy clinic from July 2015 to March 2016 were enrolled in our study. Both patients and healthy controls completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Mini-mental State Examination (MMSE). Subjective sleep quality and sleep disturbances were examined with regard to self-reported symptoms of depression and anxiety, seizure-related factors, and demographic factors. The PSQI scores and ISI scores of patients were significantly higher (indicating lower quality sleep and more serious insomnia) than those of the control group. Symptoms associated with depression and anxiety were independently related to impaired subjective sleep quality and insomnia. Affective symptoms explained more of the variance in PSQI scores and ISI scores than did seizure-related or demographic variables. In addition, these variables also seemed to be less powerful contributing factors to subjective sleep quality and insomnia than affective symptoms, several seizure-related factors, such as seizure control, partial seizures and duration of epilepsy, which are also significantly associated with subjective sleep quality and insomnia. In addition, use of lamotrigine (LTG) was also associated with insomnia and use of clonazepam (CZP) and phenobarbital (PB) with daytime sleepiness in patients with epilepsy. Chinese adults with epilepsy have poorer self-reported subjective sleep quality and a higher prevalence of insomnia than the control group. Depressive- and anxiety-related symptoms independently exert an adverse effect on the subjective sleep quality and insomnia of patients. In addition, seizure control, partial seizures, and the duration of epilepsy affect the quality of sleep and insomnia in patients, but seem less powerful predictors of sleep quality and insomnia than affective symptoms. Early identification and treatment of affective symptoms is of great importance in improving the sleep quality and insomnia of patients with epilepsy. Copyright © 2017 Elsevier B.V. All rights reserved.

Proposed work plan for the study of hydrologic effects of ground-water development in the Wet Mountain Valley, Colorado

USGS Publications Warehouse

Robson, S.G.

1985-01-01

Large-scale development of groundwater resources in the Wet Mountain Valley, Colorado, could adversely affect other water rights in the valley or in the Arkansas River Basin. Such infringement on senior water rights could severely limit development of additional water supplies in the valley. A work plan is presented for a study that is intended to define the hydrologic system in the valley better, and to determine the extent that the quantity and chemical quality of both surface and groundwater in the valley might be affected by proposed development. (USGS)

[Hypothyroidism during pregnancy risks the child's neurocognitive development. New guidelines and remaining knowledge gaps].

PubMed

Skalkidou, Alkistis; Bixo, Marie; Sköldebrand Sparre, Ann-Charlotte; Strandell, Annika; Lindén Hirschberg, Angelica; Filipsson Nyström, Helena

2016-02-05

Thyroid abnormalities are common during pregnancy and can affect pregnancy outcome. In 2012, the working group for endocrinology was assigned by SFOG to develop evidence based guidelines for their management. There is high quality evidence that untreated clinical hypothyroidism increases the risk of pregnancy and fetal complications. Subclinical hypothyroidism is associated with pregnancy complications. The presence of TPO-antibodies is linked to miscarriage and premature birth. It is uncertain whether subclinical hypothyroidism/maternal TPO-antibodies adversely affect the child's neurocognitive development. Reference intervals for TSH among pregnant women in Sweden need to be established.

Within-Hospital Variation in 30-Day Adverse Events: Implications for Measuring Quality.

PubMed

Burke, Robert E; Glorioso, Thomas; Barón, Anna K; Kaboli, Peter J; Ho, P Michael

Novel measures of hospital quality are needed. Because quality improvement efforts seek to reduce variability in processes and outcomes, hospitals with higher variability in adverse events may be delivering poorer quality care. We sought to evaluate whether within-hospital variability in adverse events after a procedure might function as a quality metric that is correlated with facility-level mortality rates. We analyzed all percutaneous coronary interventions (PCIs) performed in the Veterans Health Administration (VHA) system from 2007 to 2013 to evaluate the correlation between within-hospital variability in 30-day postdischarge adverse events (readmission, emergency department visit, and repeat revascularization), and facility-level mortality rates, after adjustment for patient demographics, comorbidities, PCI indication, and PCI urgency. The study cohort included 47,567 patients at 48 VHA hospitals. The overall 30-day adverse event rate was 22.0% and 1-year mortality rate was 4.9%. The most variable sites had relative changes of 20% in 30-day rates of adverse events period-to-period. However, within-hospital variability in 30-day events was not correlated with 1-year mortality rates (correlation coefficient = .06; p = .66). Thus, measuring within-hospital variability in postdischarge adverse events may not improve identification of low-performing hospitals. Evaluation in other conditions, populations, and in relationship with other quality metrics may reveal stronger correlations with care quality.

Multidimensional Measurement of Household Water Poverty in a Mumbai Slum: Looking Beyond Water Quality.

PubMed

Subbaraman, Ramnath; Nolan, Laura; Sawant, Kiran; Shitole, Shrutika; Shitole, Tejal; Nanarkar, Mahesh; Patil-Deshmukh, Anita; Bloom, David E

2015-01-01

A focus on bacterial contamination has limited many studies of water service delivery in slums, with diarrheal illness being the presumed outcome of interest. We conducted a mixed methods study in a slum of 12,000 people in Mumbai, India to measure deficiencies in a broader array of water service delivery indicators and their adverse life impacts on the slum's residents. Six focus group discussions and 40 individual qualitative interviews were conducted using purposeful sampling. Quantitative data on water indicators-quantity, access, price, reliability, and equity-were collected via a structured survey of 521 households selected using population-based random sampling. In addition to negatively affecting health, the qualitative findings reveal that water service delivery failures have a constellation of other adverse life impacts-on household economy, employment, education, quality of life, social cohesion, and people's sense of political inclusion. In a multivariate logistic regression analysis, price of water is the factor most strongly associated with use of inadequate water quantity (≤20 liters per capita per day). Water service delivery failures and their adverse impacts vary based on whether households fetch water or have informal water vendors deliver it to their homes. Deficiencies in water service delivery are associated with many non-health-related adverse impacts on slum households. Failure to evaluate non-health outcomes may underestimate the deprivation resulting from inadequate water service delivery. Based on these findings, we outline a multidimensional definition of household "water poverty" that encourages policymakers and researchers to look beyond evaluation of water quality and health. Use of multidimensional water metrics by governments, slum communities, and researchers may help to ensure that water supplies are designed to advance a broad array of health, economic, and social outcomes for the urban poor.

Multidimensional Measurement of Household Water Poverty in a Mumbai Slum: Looking Beyond Water Quality

PubMed Central

Subbaraman, Ramnath; Nolan, Laura; Sawant, Kiran; Shitole, Shrutika; Shitole, Tejal; Nanarkar, Mahesh; Patil-Deshmukh, Anita; Bloom, David E.

2015-01-01

Objective A focus on bacterial contamination has limited many studies of water service delivery in slums, with diarrheal illness being the presumed outcome of interest. We conducted a mixed methods study in a slum of 12,000 people in Mumbai, India to measure deficiencies in a broader array of water service delivery indicators and their adverse life impacts on the slum’s residents. Methods Six focus group discussions and 40 individual qualitative interviews were conducted using purposeful sampling. Quantitative data on water indicators—quantity, access, price, reliability, and equity—were collected via a structured survey of 521 households selected using population-based random sampling. Results In addition to negatively affecting health, the qualitative findings reveal that water service delivery failures have a constellation of other adverse life impacts—on household economy, employment, education, quality of life, social cohesion, and people’s sense of political inclusion. In a multivariate logistic regression analysis, price of water is the factor most strongly associated with use of inadequate water quantity (≤20 liters per capita per day). Water service delivery failures and their adverse impacts vary based on whether households fetch water or have informal water vendors deliver it to their homes. Conclusions Deficiencies in water service delivery are associated with many non-health-related adverse impacts on slum households. Failure to evaluate non-health outcomes may underestimate the deprivation resulting from inadequate water service delivery. Based on these findings, we outline a multidimensional definition of household “water poverty” that encourages policymakers and researchers to look beyond evaluation of water quality and health. Use of multidimensional water metrics by governments, slum communities, and researchers may help to ensure that water supplies are designed to advance a broad array of health, economic, and social outcomes for the urban poor. PMID:26196295

Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience.

PubMed

Bethell, Christina D; Newacheck, Paul; Hawes, Eva; Halfon, Neal

2014-12-01

The ongoing longitudinal Adverse Childhood Experiences Study of adults has found significant associations between chronic conditions; quality of life and life expectancy in adulthood; and the trauma and stress associated with adverse childhood experiences, including physical or emotional abuse or neglect, deprivation, or exposure to violence. Less is known about the population-based epidemiology of adverse childhood experiences among US children. Using the 2011-12 National Survey of Children's Health, we assessed the prevalence of adverse childhood experiences and associations between them and factors affecting children's development and lifelong health. After we adjusted for confounding factors, we found lower rates of school engagement and higher rates of chronic disease among children with adverse childhood experiences. Our findings suggest that building resilience-defined in the survey as "staying calm and in control when faced with a challenge," for children ages 6-17-can ameliorate the negative impact of adverse childhood experiences. We found higher rates of school engagement among children with adverse childhood experiences who demonstrated resilience, as well as higher rates of resilience among children with such experiences who received care in a family-centered medical home. We recommend a coordinated effort to fill knowledge gaps and translate existing knowledge about adverse childhood experiences and resilience into national, state, and local policies, with a focus on addressing childhood trauma in health systems as they evolve during ongoing reform. Project HOPE—The People-to-People Health Foundation, Inc.

Changes in sleep quality and levels of psychological distress during the adaptation to university: The role of childhood adversity.

PubMed

John-Henderson, Neha A; Williams, Sarah E; Brindle, Ryan C; Ginty, Annie T

2018-05-25

Stress-related sleep disturbances are common, and poor sleep quality can negatively affect health. Previous work indicates that early-life adversity is associated with compromised sleep quality later in life, but it is unknown whether it predicts greater declines in sleep quality during stressful life transitions. We propose and test a conceptual model whereby individuals who reported experiencing greater levels of child maltreatment would experience greater psychological distress during a stressful life transition, which in turn would contribute to greater declines in sleep quality, relative to their quality of sleep before the stressful transition. Controlling for potential confounding variables (e.g., age, gender), structural equation modelling demonstrated that psychological distress experienced during a stressful transition (i.e., beginning life at university) mediated the relationship between childhood emotional neglect and changes in sleep quality. The hypothesized model demonstrated a good overall fit to the data, χ 2 (15) = 17.69, p = .279, CFI = .99, TLI = .97, SRMR = .04, RMSEA = .04 (90% CI <0.001-0.09). Emotional neglect (β = .22) was positively associated with psychological distress which in turn was positively associated with poor sleep quality (β = .31) during a stressful transition. Future research should aim to understand the specific stressors in the university environment that are most challenging to individuals who faced early-life emotional maltreatment. These findings will help inform interventions to facilitate adaptation to a new environment and improve sleep quality for these university students. © 2018 The British Psychological Society.

Environmental Assessment Facility Renovation / New Construction and Operation of Marine Corps Units (MAG-42, HMLA-773 and MALS-42) Relocated from Naval Air Station Atlanta to Robins Air Force Base

DTIC Science & Technology

2007-08-16

activities within the area do not significantly adversely or significantly positively impact storm water quality . The Proposed Construction Area does...adversely impact storm water quality . Existing buildings receive limited runoff from the adjacent area to the west; however, no indications of adverse... water quality . Existing buildings receive limited runoff from the adjacent area to the north and west; however, no indications of adverse environmental

Effects of mining-associated lead and zinc soil contamination on native floristic quality.

PubMed

Struckhoff, Matthew A; Stroh, Esther D; Grabner, Keith W

2013-04-15

We assessed the quality of plant communities across a range of lead (Pb) and zinc (Zn) soil concentrations at a variety of sites associated with Pb mining in southeast Missouri, USA. In a novel application, two standard floristic quality measures, Mean Coefficient of Conservatism (Mean C) and Floristic Quality Index (FQI), were examined in relation to concentrations of Pb and Zn, soil nutrients, and other soil characteristics. Nonmetric Multidimensional Scaling and Regression Tree Analyses identified soil Pb and Zn concentrations as primary explanatory variables for plant community composition and indicated negative relationships between soil metals concentrations and both Mean C and FQI. Univariate regression also demonstrated significant negative relationships between metals concentrations and floristic quality. The negative effects of metals in native soils with otherwise relatively undisturbed conditions indicate that elevated soil metals concentrations adversely affect native floristic quality where no other human disturbance is evident. Published by Elsevier Ltd.

Effects of mining-associated lead and zinc soil contamination on native floristic quality

USGS Publications Warehouse

Struckhoff, Matthew A.; Stroh, Esther D.; Grabner, Keith W.

2013-01-01

We assessed the quality of plant communities across a range of lead (Pb) and zinc (Zn) soil concentrations at a variety of sites associated with Pb mining in southeast Missouri, USA. In a novel application, two standard floristic quality measures, Mean Coefficient of Conservatism (Mean C) and Floristic Quality Index (FQI), were examined in relation to concentrations of Pb and Zn, soil nutrients, and other soil characteristics. Nonmetric Multidimensional Scaling and Regression Tree Analyses identified soil Pb and Zn concentrations as primary explanatory variables for plant community composition and indicated negative relationships between soil metals concentrations and both Mean C and FQI. Univariate regression also demonstrated significant negative relationships between metals concentrations and floristic quality. The negative effects of metals in native soils with otherwise relatively undisturbed conditions indicate that elevated soil metals concentrations adversely affect native floristic quality where no other human disturbance is evident.

Invited article: Managing disruptive physician behavior: impact on staff relationships and patient care.

PubMed

Rosenstein, Alan H; O'Daniel, Michelle

2008-04-22

Disruptive behavior can have a significant impact on care delivery, which can adversely affect patient safety and quality outcomes of care. Disruptive behavior occurs across all disciplines but is of particular concern when it involves physicians and nurses who have primary responsibility for patient care. There is a higher frequency of disruptive behavior in neurologists compared to most other nonsurgical specialties. Disruptive behavior causes stress, anxiety, frustration, and anger, which can impede communication and collaboration, which can result in avoidable medical errors, adverse events, and other compromises in quality care. Health care organizations need to be aware of the significance of disruptive behaviors and develop appropriate policies, standards, and procedures to effectively deal with this serious issue and reinforce appropriate standards of behavior. Having a better understanding of what contributes to, incites, or provokes disruptive behaviors will help organizations provide appropriate educational and training programs that can lessen the likelihood of occurrence and improve the overall effectiveness of communication among the health care team.

Effect of noise on tasks in operating theatres: a survey of the perceptions of healthcare staff.

PubMed

Padmakumar, A D; Cohen, O; Churton, A; Groves, J B; Mitchell, D A; Brennan, P A

2017-02-01

Noise in the operating theatre has an adverse impact on healthcare professionals, both physically and psychologically. It can be distracting, make communication difficult, and contribute to a perceived increase in stress. Staff in theatre must deliver high quality care, and overlook noise as a potentially damaging influence. The aim of this survey was to obtain further information about the perspective of healthcare professionals on how noise can affect their practice and whether it affects their work in theatre. We distributed six closed-ended questions in the form of a Survey Monkey ® questionnaire to about 50 hospitals across the UK and target groups such as medical students, the Leeds Advanced Trauma Life Support faculty group, the Court of Examiners of the Royal College of Surgeons of England, and surgical trainees sitting the Member of the Royal College of Surgeons examination. We received 519 responses of which 415 respondents (83%) thought that noise contributed to human errors. A total of 282 participants (57%) thought that the theatre was the noisiest area within the theatre suite. Both communication among staff (n=400, 80%) and concentration (n=384, 77%) were thought to be adversely affected by noise. However, 385 (78%) did not feel that music adversely affected their performance. The results provide insights into the interplay of noise and its effect on people. Although the role of music remains contentious, our results suggest that it might have a calming influence. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Improvement of efficiency of oil extraction from wild apricot kernels by using enzymes.

PubMed

Bisht, Tejpal Singh; Sharma, Satish Kumar; Sati, Ramesh Chandra; Rao, Virendra Kumar; Yadav, Vijay Kumar; Dixit, Anil Kumar; Sharma, Ashok Kumar; Chopra, Chandra Shekhar

2015-03-01

An experiment was conducted to evaluate and standardize the protocol for enhancing recovery of oil and quality from cold pressed wild apricot kernels by using various enzymes. Wild apricot kernels were ground into powder in a grinder. Different lots of 3 kg powdered kernel were prepared and treated with different concentrations of enzyme solutions viz. Pectazyme (Pectinase), Mashzyme (Cellulase) and Pectazyme + Mashzyme. Kernel powder mixed with enzyme solutions were kept for 2 h at 50(±2) °C temperature for enzymatic treatment before its use for oil extraction through oil expeller. Results indicate that use of enzymes resulted in enhancement of oil recovery by 9.00-14.22 %. Maximum oil recovery was observed at 0.3-0.4 % enzyme concentration for both the enzymes individually, as well as in combination. All the three enzymatic treatments resulted in increasing oil yield. However, with 0.3 % (Pectazyme + Mashzyme) combination, maximum oil recovery of 47.33 % could be observed against were 33.11 % in control. The oil content left (wasted) in the cake and residue were reduced from 11.67 and 11.60 % to 7.31 and 2.72 % respectively, thus showing a high increase in efficiency of oil recovery from wild apricot kernels. Quality characteristics indicate that the oil quality was not adversely affected by enzymatic treatment. It was concluded treatment of powdered wild apricot kernels with 0.3 % (Pectazyme + Mashzyme) combination was highly effective in increasing oil recovery by 14.22 % without adversely affecting the quality and thus may be commercially used by the industry for reducing wastage of highly precious oil in the cake.

Management of common adverse effects in the era of highly active antiretroviral therapy in south east Ethiopia

PubMed Central

Abdella, Sadikalmahdi Hussen; Wabe, Nasir Tajure; Yesuf, Elias Ali

2011-01-01

Background: The combination of antiretroviral therapy is the corner stone of management of patients with human immune deficiency virus infection. Although antiretroviral therapy can reduce viral load to undetectable level, improve the immunity and prolong survival of patients, antiretroviral drugs are associated with many adverse effects that may be severe and affect patient adherence and quality of life. Aims: The aim of this study was to assess management strategies under taken in patient's experienced common adverse effects of highly active antiretroviral therapy in Goba Hospital antiretroviral clinic. Patients and Methods: A cross sectional study of patient record chart of patients who had follow-up during data collection period was done followed by patient interview. Data was filled on well structured questionnaire and analyzed using SPSS for window version 16.0. Results: The common adverse effects were Rash (48.8%), Peripheral neuropathy (36.9%) and Anemia (20.24%). The rate of management was 39.3%. Pyridoxine (36.8%) was commonly prescribed drug for management of Peripheral neuropathy. Chlorphenarimine gel and Iron gluconate were common drugs for management of Rash and Anemia respectively. Use of traditional healers (57.7%) was leading reason for non-management. Conclusion: Rate of management for common adverse effect is low. Education should be given on adverse effects for patients. PMID:22361495

20 CFR 617.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... to apply for TAA. (c) Adversely affected worker means an individual who, because of lack of work in adversely affected employment: (1) Has been totally or partially separated from such employment; or (2) Has been totally separated from employment with the firm in a subdivision of which such adversely affected...

47 CFR 73.4157 - Network signals which adversely affect affiliate broadcast service.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 4 2011-10-01 2011-10-01 false Network signals which adversely affect affiliate broadcast service. 73.4157 Section 73.4157 Telecommunication FEDERAL COMMUNICATIONS COMMISSION....4157 Network signals which adversely affect affiliate broadcast service. See Public Notice, FCC 79-387...

47 CFR 73.4157 - Network signals which adversely affect affiliate broadcast service.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 4 2010-10-01 2010-10-01 false Network signals which adversely affect affiliate broadcast service. 73.4157 Section 73.4157 Telecommunication FEDERAL COMMUNICATIONS COMMISSION....4157 Network signals which adversely affect affiliate broadcast service. See Public Notice, FCC 79-387...

A Review on the Effect of Traditional Chinese Medicine Against Anthracycline-Induced Cardiac Toxicity

PubMed Central

Yang, Xinyu; Liu, Nian; Li, Xinye; Yang, Yihan; Wang, Xiaofeng; Li, Linling; Jiang, Le; Gao, Yonghong; Tang, Hebin; Tang, Yong; Xing, Yanwei; Shang, Hongcai

2018-01-01

Anthracyclines are effective agents generally used to treat solid-tumor and hematologic malignancies. The use of anthracyclines for over 40 years has improved cancer survival statistics. Nevertheless, the clinical utility of anthracyclines is limited by its dose-dependent cardiotoxicity that adversely affects 10–30% of patients. Anthracycline-induced cardiotoxicity may be classified as acute/subacute or chronic/late toxicity and leads to devastating adverse effects resulting in poor quality of life, morbidity, and premature mortality. Traditional Chinese medicine has a history of over 2,000 years, involving both unique theories and substantial experience. Several studies have investigated the potential of natural products to decrease the cardiotoxic effects of chemotherapeutic agents on healthy cells, without negatively affecting their antineoplastic activity. This article discusses the mechanism of anthracycline-induced cardiotoxicity, and summarizes traditional Chinese medicine treatment for anthracycline-induced heart failure (HF), cardiac arrhythmia, cardiomyopathy, and myocardial ischemia in recent years, in order to provide a reference for the clinical prevention and treatment of cardiac toxicity. PMID:29867456

Racism and Health I: Pathways and Scientific Evidence.

PubMed

Williams, David R; Mohammed, Selina A

2013-08-01

This article reviews the scientific research that indicates that despite marked declines in public support for negative racial attitudes in the United States, racism, in its multiple forms, remains embedded in American society. The focus of the article is on the review of empirical research that suggests that racism adversely affects the health of non-dominant racial populations in multiple ways. First, institutional racism developed policies and procedures that have reduced access to housing, neighborhood and educational quality, employment opportunities and other desirable resources in society. Second, cultural racism, at the societal and individual level, negatively affects economic status and health by creating a policy environment hostile to egalitarian policies, triggering negative stereotypes and discrimination that are pathogenic and fostering health damaging psychological responses such as stereotype threat and internalized racism. Finally, a large and growing body of evidence indicates that experiences of racial discrimination are an important type of psychosocial stressor that can lead to adverse changes in health status and altered behavioural patterns that increase health risks.

Racism and Health I: Pathways and Scientific Evidence

PubMed Central

Williams, David R.; Mohammed, Selina A.

2013-01-01

This article reviews the scientific research that indicates that despite marked declines in public support for negative racial attitudes in the United States, racism, in its multiple forms, remains embedded in American society. The focus of the article is on the review of empirical research that suggests that racism adversely affects the health of non-dominant racial populations in multiple ways. First, institutional racism developed policies and procedures that have reduced access to housing, neighborhood and educational quality, employment opportunities and other desirable resources in society. Second, cultural racism, at the societal and individual level, negatively affects economic status and health by creating a policy environment hostile to egalitarian policies, triggering negative stereotypes and discrimination that are pathogenic and fostering health damaging psychological responses such as stereotype threat and internalized racism. Finally, a large and growing body of evidence indicates that experiences of racial discrimination are an important type of psychosocial stressor that can lead to adverse changes in health status and altered behavioural patterns that increase health risks. PMID:24347666

Affective forecasting: an unrecognized challenge in making serious health decisions.

PubMed

Halpern, Jodi; Arnold, Robert M

2008-10-01

Patients facing medical decisions that will impact quality of life make assumptions about how they will adjust emotionally to living with health declines and disability. Despite abundant research on decision-making, we have no direct research on how accurately patients envision their future well-being and how this influences their decisions. Outside medicine, psychological research on "affective forecasting" consistently shows that people poorly predict their future ability to adapt to adversity. This finding is important for medicine, since many serious health decisions hinge on quality-of-life judgments. We describe three specific mechanisms for affective forecasting errors that may influence health decisions: focalism, in which people focus more on what will change than on what will stay the same; immune neglect, in which they fail to envision how their own coping skills will lessen their unhappiness; and failure to predict adaptation, in which people fail to envision shifts in what they value. We discuss emotional and social factors that interact with these cognitive biases. We describe how caregivers can recognize these biases in the clinical setting and suggest interventions to help patients recognize and address affective forecasting errors.

Nitrous oxide for the management of labor pain: a systematic review.

PubMed

Likis, Frances E; Andrews, Jeffrey C; Collins, Michelle R; Lewis, Rashonda M; Seroogy, Jeffrey J; Starr, Sarah A; Walden, Rachel R; McPheeters, Melissa L

2014-01-01

We systematically reviewed evidence addressing the effectiveness of nitrous oxide for the management of labor pain, the influence of nitrous oxide on women's satisfaction with their birth experience and labor pain management, and adverse effects associated with nitrous oxide for labor pain management. We searched the MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for articles published in English. The study population included pregnant women in labor intending a vaginal birth, birth attendees or health care providers who may be exposed to nitrous oxide during labor, and the fetus/neonate. We identified a total of 58 publications, representing 59 distinct study populations: 2 studies were of good quality, 11 fair, and 46 poor. Inhalation of nitrous oxide provided less effective pain relief than epidural analgesia, but the quality of studies was predominately poor. The heterogeneous outcomes used to assess women's satisfaction with their birth experience and labor pain management made synthesis of studies difficult. Most maternal adverse effects reported in the literature were unpleasant side effects that affect tolerability, such as nausea, vomiting, dizziness, and drowsiness. Apgar scores in newborns whose mothers used nitrous oxide were not significantly different from those of newborns whose mothers used other labor pain management methods or no analgesia. Evidence about occupational harms and exposure was limited. The literature addressing nitrous oxide for the management of labor pain includes few studies of good or fair quality. Further research is needed across all of the areas examined: effectiveness, satisfaction, and adverse effects.

Obesity and reproductive function: a review of the evidence.

PubMed

Klenov, Violet E; Jungheim, Emily S

2014-12-01

Over the last decade, the evidence linking obesity to impaired reproductive function has grown. In this article, we review this evidence and discuss the underlying pathophysiology. Obese women are less likely than normal-weight women to achieve pregnancy. Female obesity adversely affects reproductive function through alterations in the hypothalamic-pituitary-ovarian axis, oocyte quality, and endometrial receptivity. It is unclear which mechanism contributes the most to subfecundity, and it is likely a cumulative process. Emerging data highlight the contribution of male obesity to impaired reproductive function and that couple obesity has synergistic adverse effects. Once pregnant, obese women are at higher risk for adverse pregnancy outcomes. Weight loss improves reproductive potential in obese patients. As obese women surpass 35 years of age, age may be more important than body mass index in determining reproductive potential. Obstetrician gynecologists need to be aware of the negative impact of obesity on reproductive function so that they appropriately counsel their patients. Further work is needed to clarify the underlying pathophysiology responsible for adverse effects of obesity on reproduction so that novel treatment approaches may be developed.

Juvenile wood effect in red alder : analysis of physical and mechanical data to delineate juvenile and mature wood zones

Treesearch

Joel W. Evans; John F. Senft; David W. Green

2000-01-01

The objective of this study was to investigate the influence of juvenile wood on the mechanical and physical properties of red alder. Tree growth in the first 10 to 20 years, usually referred to as juvenile wood, often influences wood quality by adversely affecting mechanical strength properties. Strength can be reduced up to 50 percent by the presence of juvenile wood...

Comparing Alternatives For Replacing Harmful Chemicals

NASA Technical Reports Server (NTRS)

Cruit, W.; Schutzenhofer, S.; Goldberg, B.; Everhart, K.

1995-01-01

Methodology developed to provide guidance for replacement of industrial chemicals that must be phased out by law because they are toxic and/or affect environment adversely. Chemicals and processes ranked numerically. Applies mostly to chemicals contributing to depletion of ozone in upper atmosphere; some other harmful chemicals included. Quality function deployment matrix format provides convenient way to compare alternative processes and chemicals. Overall rating at bottom of each process-and-chemical column indicates relative advantage.

Soil and solid poultry waste nutrient management and water quality.

PubMed

Chapman, S L

1996-07-01

Concerns about the impacts of nitrogen, phosphorus, and pathogens on surface and ground water quality has forced the poultry industry to implement voluntary waste management guidelines for use by growers. In some states, animal waste guidelines are being enforced by regulatory agencies. Strategies that growers may use to properly dispose of poultry waste include: 1) local land application as a fertilizer; 2) offsite marketing for use as a fertilizer or soil amendment, feed additive, or energy source; and 3) chemical additives that will immobilize nitrogen and phosphorus in the manure or litter. If properly followed, these and other innovative strategies should be adequate to protect surface and ground water quality without adversely affecting the economics of poultry production.

Improving the quality of mass produced maps

USGS Publications Warehouse

Simley, J.

2001-01-01

Quality is critical in cartography because key decisions are often made based on the information the map communicates. The mass production of digital cartographic information to support geographic information science has now added a new dimension to the problem of cartographic quality, as problems once limited to small volumes can now proliferate in mass production programs. These problems can also affect the economics of map production by diverting a sizeable portion of production cost to pay for rework on maps with poor quality. Such problems are common to general industry-in response, the quality engineering profession has developed a number of successful methods to overcome these problems. Two important methods are the reduction of error through statistical analysis and addressing the quality environment in which people work. Once initial and obvious quality problems have been solved, outside influences periodically appear that cause adverse variations in quality and consequently increase production costs. Such errors can be difficult to detect before the customer is affected. However, a number of statistical techniques can be employed to detect variation so that the problem is eliminated before significant damage is caused. Additionally, the environment in which the workforce operates must be conductive to quality. Managers have a powerful responsibility to create this environment. Two sets of guidelines, known as Deming's Fourteen Points and ISO-9000, provide models for this environment.

[Evaluation of reporting quality of RCT on nephrotoxicity of Tripterygium wilfordii preparations according to CONSORT HARMs statement].

PubMed

Feng, Xue; Fang, Sai-Nan; Gao, Yu-Xin; Liu, Jian-Ping; Chen, Wei

2018-02-01

To evaluate the quality of randomized controlled trials(RCT) on nephrotoxicity of Tripterygium wilfordii preparations according to the CONSORT HARMs statement. The report quality of each included study was evaluated according to the CONSORT HARMs statement， and the number of entries that comply with CONSORT HARMs statement was calculated in each study to evaluate the report quality on nephrotoxicity-related adverse reactions of T. wilfordii preparations and summarize the problems in domestic studies on nephrotoxicity-related adverse reactions. A total of 16 RCTs were included， with an average of 7 entries complying with CONSORT HARMs statement per study. The report of the nephrotoxic-associated RCT of T. wilfordii preparations was of poor quality and the most non-repeating entries included the following ones： using validated tools to report adverse effects， standards for coding of the adverse reactions， describing how and when to collect data on adverse reactions in Method， describing how adverse reactions are attributed to T. wilfordii， clearly stating who has reported the adverse reactions， describing the analysis method of adverse reactions， describing the method of collecting recurrent adverse reaction data， describing any subgroup analysis and exploratory analysis associated with the hazard. We suggest that the studies on adverse reactions of traditional Chinese medicine should strictly report the entries according to the CONSORT HARMs statement， and take the characteristics of traditional Chinese medicine into account to report the details of the Chinese medicine like compositions， dose， taking time， combined medication and the dialectical typology of research objects. Copyright© by the Chinese Pharmaceutical Association.

Effect of multivitamin and multimineral supplements on morbidity from infections in older people (MAVIS trial): pragmatic, randomised, double blind, placebo controlled trial.

PubMed

Avenell, Alison; Campbell, Marion K; Cook, Jonathan A; Hannaford, Philip C; Kilonzo, Mary M; McNeill, Geraldine; Milne, Anne C; Ramsay, Craig R; Seymour, D Gwyn; Stephen, Audrey I; Vale, Luke D

2005-08-06

To examine whether supplementation with multivitamins and multiminerals influences self reported days of infection, use of health services, and quality of life in people aged 65 or over. Randomised, placebo controlled trial, with blinding of participants, outcome assessors, and investigators. Communities associated with six general practices in Grampian, Scotland. 910 men and women aged 65 or over who did not take vitamins or minerals. Daily multivitamin and multimineral supplementation or placebo for one year. Primary outcomes were contacts with primary care for infections, self reported days of infection, and quality of life. Secondary outcomes included antibiotic prescriptions, hospital admissions, adverse events, and compliance. Supplementation did not significantly affect contacts with primary care and days of infection per person (incidence rate ratio 0.96, 95% confidence interval 0.78 to 1.19 and 1.07, 0.90 to 1.27). Quality of life was not affected by supplementation. No statistically significant findings were found for secondary outcomes or subgroups. Routine multivitamin and multimineral supplementation of older people living at home does not affect self reported infection related morbidity. ISRCTN: 66376460.

Assessment of quality of life of nasopharyngeal carcinoma patients with EORTC QLQ-C30 and H and N-35 modules

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cengiz, Mustafa; Ozyar, Enis; Esassolak, Mustafa

2005-12-01

Purpose: The current study reports on long-term quality of life (QoL) status after conventional radiotherapy in 187 nasopharyngeal carcinoma patients from 14 centers in Turkey. Patients and Methods: Patients with the diagnosis of nasopharyngeal carcinoma, who were treated in 14 centers in Turkey with minimum 6 months of follow-up and were in complete remission, were asked to complete Turkish versions of EORTC QLQ-C30 questionnaire and the HN-35 module. Each center participated with the required clinical data that included age at diagnosis, gender, symptoms on admission, follow-up period, treatment modalities, radiotherapy dose, and AJCC 1997 tumor stage. Each patient's 33 QoLmore » scores, which included function, global health status, and symptoms, were calculated as instructed in EORTC QLQ-C30 scoring manual. All of the scales and single-item measures range from 0 to 100. A high score represents a higher response level. Kruskal-Wallis and Mann-Whitney U nonparametric tests were used for comparisons. Results: One hundred eighty-seven patients with median age of 46 years (range, 16-79 years) participated and completed the questionnaires. Median follow-up time was 3.4 years (range, 6 months-24 years). All patients have received external-beam radiotherapy. Beside external-beam radiotherapy, 59 patients underwent brachytherapy boost, 70 patients received concomitant chemotherapy, and 95 patients received adjuvant/neoadjuvant chemotherapy. Most of the patients in the analysis (75%) were in advanced stage (Stage III, n = 85 [45.4%]; Stage IV, n = 55 [29%]). Mean global health status was calculated as 73. Parameters that increased global health status were male gender, early-stage disease, and less than 4-year follow-up (p < 0.05). Functional parameters were better in males and in early-stage disease. Factors that yielded better symptom scores were short interval after treatment (10 scores), male gender (7 scores), and lower radiation dose (6 scores). Neoadjuvant or adjuvant chemotherapy did not have any effect on QoL, whereas concomitant chemotherapy adversely affected 5 symptom scores. Conclusion: Quality of life is adversely affected in our nasopharyngeal carcinoma patients treated with combined therapies. The factors that adversely affect quality of life are advanced tumor stage, female gender, and long-term follow-up. Further controlled studies to evaluate both preradiotherapy and postradiotherapy status are necessary to clarify the contribution of each treatment modality to QoL.« less

The potential protective effect of friendship on the association between childhood adversity and psychological distress in adulthood: A retrospective, preliminary, three-wave population-based study.

PubMed

Sheikh, Mashhood Ahmed

2018-01-15

Previous studies that assessed the mediating role of social support in the association between childhood adversity and psychological distress based their inferences on very small, selective samples, which makes it impossible to generalise the findings to general population. The aim of this paper was to assess the mediating role of quantity and quality of social support in adulthood in the association between childhood adversity and psychological distress in adulthood. The study has a three-wave design; the present analysis used longitudinal data collected from 1994 to 2008 within the framework of the Tromsø Study (N = 4530), a representative prospective cohort study of men and women. Quantity and quality of social support were measured at a mean age of 54.7 years, and psychological distress in adulthood was measured at a mean age of 61.7 years. Mediation analysis was used to assess the indirect effect of childhood adversity (via quantity and quality of social support) on psychological distress in adulthood. Childhood adversity was associated with deficits in quantity and quality of social support in adulthood (p < 0.05). Childhood adversity and deficits in quantity and quality of social support were associated with psychological distress in adulthood (p < 0.05). Quantity and quality of social support significantly (p < 0.05) mediated the association between childhood adversity and psychological distress in adulthood. Childhood adversity was assessed retrospectively and social support was measured with two items. Interventions aimed at reducing social isolation may alleviate the burden carried by survivors of childhood adversity. Copyright © 2017 Elsevier B.V. All rights reserved.

Identification of Patient Safety Risks Associated with Electronic Health Records: A Software Quality Perspective.

PubMed

Virginio, Luiz A; Ricarte, Ivan Luiz Marques

2015-01-01

Although Electronic Health Records (EHR) can offer benefits to the health care process, there is a growing body of evidence that these systems can also incur risks to patient safety when developed or used improperly. This work is a literature review to identify these risks from a software quality perspective. Therefore, the risks were classified based on the ISO/IEC 25010 software quality model. The risks identified were related mainly to the characteristics of "functional suitability" (i.e., software bugs) and "usability" (i.e., interface prone to user error). This work elucidates the fact that EHR quality problems can adversely affect patient safety, resulting in errors such as incorrect patient identification, incorrect calculation of medication dosages, and lack of access to patient data. Therefore, the risks presented here provide the basis for developers and EHR regulating bodies to pay attention to the quality aspects of these systems that can result in patient harm.

Duloxetine for the treatment of painful diabetic peripheral neuropathy in Venezuela: economic evaluation.

PubMed

Carlos, Fernando; Espejel, Luis; Novick, Diego; López, Rubén; Flores, Daniel

2015-09-25

Painful diabetic peripheral neuropathy affects 40-50% of patients with diabetic neuropathy, leading to impaired quality of life and substantial costs. Duloxetine and pregabalin have evidence-based support, and are formally approved for controlling painful diabetic peripheral neuropathy. We used a 12-week decision model for examining painful diabetic peripheral neuropathy first-line therapy with daily doses of duloxetine 60mg or pregabalin 300mg, under the perspective of the Instituto Venezolano de los Seguros Sociales. We gathered model parameters from published literature and expert´s opinion, focusing on the magnitude of pain relief, the presence of adverse events, the possibility of withdrawal owing to intolerable adverse events or due to lack of efficacy, and the quality-adjusted life years expected in each strategy. We analyzed direct medical costs (which are expressed in Bolívares Fuertes, BsF) comprising drug acquisition besides additional care devoted to treatment of adverse events and poor pain relief. We conducted both deterministic and probabilistic sensitivity analyses. Total expected costs per 1000 patients were BsF 1 046 146 (26%) lower with duloxetine than with pregabalin. Most of these savings (91%) corresponds to the difference in the acquisition’s cost of each medication. duloxetine also provided 23 more patients achieving good pain relief and a gain of about two quality-adjusted life years per 1000 treated. Model was robust to plausible changes in main parameters. Duloxetine remained the preferred option in 93.9% of the second-order Monte Carlo simulations. This study suggests duloxetine dominates (i.e., is more effective and lead to gains in quality-adjusted life years), remaining less costly than pregabalin for treatment of painful diabetic peripheral neuropathy.

Family Impacts among Children with Autism Spectrum Disorder: The Role of Health Care Quality

PubMed Central

Zuckerman, Katharine E.; Lindly, Olivia J.; Bethell, Christina D.; Kuhlthau, Karen

2014-01-01

Objectives To compare health care quality and family employment and financial impacts among children with special health care needs (CSHCN) with autism spectrum disorder (CSHCN+ASD), CSHCN with functional limitations (CSHCN+FL), and CSHCN lacking these conditions (other CSHCN). To test whether high health care quality was associated with reduced family impacts among CSHCN+ASD. Methods Data from the 2009-2010 National Survey of CSHCN were used to compare 3025 CSHCN+ASD, 6505 CSHCN+FL, and 28 296 other CSHCN. Weighted multivariate logistic regression analyses examined six age-relevant, federally-defined health care quality indicators and five family financial and employment impact indicators. Two composite measures were additionally used: (1) receipt of care that met all age-relevant quality indicators; and (2) had ≥ two of the five adverse family impacts. Results Across all health care quality indicators CSHCN+ASD fared poorly, with only 7.4% meeting all age-relevant indicators. CSHCN+ASD had worse health care quality than other CSHCN, including CSHCN+FL. CSHCN+ASD also had high rates of adverse family impact, with over half experiencing two or more adverse impacts. Rates of adverse family impact were higher in CSHCN+ASD than other CSHCN, including CSHCN+FL. Among CSHCN+ASD, those whose health care that met federal quality standards were less likely to have multiple adverse family impacts than CSHCN+ASD whose health care did not meet federal quality standards. Conclusions CSHCN+ASD are more prone to experience poor health care quality and family impacts than other CSHCN, even CSHCN+FL. Receipt of care meeting federal quality standards may potentially lessen adverse family impacts for CSHCN+ASD. PMID:24976352

RACISM IN ORGANIZATIONS: THE CASE OF A COUNTY PUBLIC HEALTH DEPARTMENT.

PubMed

Griffith, Derek M; Childs, Erica L; Eng, Eugenia; Jeffries, Vanessa

2007-01-01

Racism is part of the foundation of U.S. society and institutions, yet few studies in community psychology or organizational studies have examined how racism affects organizations. This paper proposes a conceptual framework of institutional racism, which describes how, in spite of professional standards and ethics, racism functions within organizations to adversely affect the quality of services, the organizational climate, and staff job satisfaction and morale. Grounded in systems theory and organizational empowerment, the framework is based on data that describe how racism was made manifest in a county public health department. The findings highlight the importance of understanding how organizations are influenced by external forces and can negatively affect clients, communities, and their own staff members.

RACISM IN ORGANIZATIONS: THE CASE OF A COUNTY PUBLIC HEALTH DEPARTMENT

PubMed Central

Griffith, Derek M.; Childs, Erica L.; Eng, Eugenia; Jeffries, Vanessa

2008-01-01

Racism is part of the foundation of U.S. society and institutions, yet few studies in community psychology or organizational studies have examined how racism affects organizations. This paper proposes a conceptual framework of institutional racism, which describes how, in spite of professional standards and ethics, racism functions within organizations to adversely affect the quality of services, the organizational climate, and staff job satisfaction and morale. Grounded in systems theory and organizational empowerment, the framework is based on data that describe how racism was made manifest in a county public health department. The findings highlight the importance of understanding how organizations are influenced by external forces and can negatively affect clients, communities, and their own staff members. PMID:18852826

A prospective observational study to examine the relationship between quality of life and adverse events of first-line chemotherapy plus cetuximab in patients with KRAS wild-type unresectable metastatic colorectal cancer: QUACK Trial.

PubMed

Ooki, Akira; Ando, Masahiko; Sakamoto, Junichi; Sato, Atushi; Fujii, Hirofumi; Yamaguchi, Kensei

2014-04-01

We have planned a multicentre prospective study to examine the relative impact of the efficacy and adverse events of cetuximab plus first-line chemotherapy on the quality of life in Japanese patients with KRAS wild-type unresectable colorectal cancer. The Dermatology Life Quality Index and the European Organization for Research Treatment of Cancer Quality of Life Questionnaire Core 30 will be used to assess dermatology-specific and health-related quality of life. The severity of adverse events will be assessed by using the National Cancer Institute Common Terminology Criteria for adverse Events ver. 4.0. The endpoints will be the following associations: adverse events, including skin toxicity and quality of life; efficacy and skin toxicity; efficacy and quality of life; and skin-related quality of life and health-related quality of life. A total of 140 patients are considered to be appropriate for inclusion in this study. The results of this study will provide more information to both patients and physicians regarding the practical use of cetuximab and its impact on quality of life in patients with unresectable colorectal cancer in Japan. This study was registered at the University Hospital Medical Information Network Clinical Trial Registry as UMIN000010985.

Improving high resolution retinal image quality using speckle illumination HiLo imaging

PubMed Central

Zhou, Xiaolin; Bedggood, Phillip; Metha, Andrew

2014-01-01

Retinal image quality from flood illumination adaptive optics (AO) ophthalmoscopes is adversely affected by out-of-focus light scatter due to the lack of confocality. This effect is more pronounced in small eyes, such as that of rodents, because the requisite high optical power confers a large dioptric thickness to the retina. A recently-developed structured illumination microscopy (SIM) technique called HiLo imaging has been shown to reduce the effect of out-of-focus light scatter in flood illumination microscopes and produce pseudo-confocal images with significantly improved image quality. In this work, we adopted the HiLo technique to a flood AO ophthalmoscope and performed AO imaging in both (physical) model and live rat eyes. The improvement in image quality from HiLo imaging is shown both qualitatively and quantitatively by using spatial spectral analysis. PMID:25136486

Improving high resolution retinal image quality using speckle illumination HiLo imaging.

PubMed

Zhou, Xiaolin; Bedggood, Phillip; Metha, Andrew

2014-08-01

Retinal image quality from flood illumination adaptive optics (AO) ophthalmoscopes is adversely affected by out-of-focus light scatter due to the lack of confocality. This effect is more pronounced in small eyes, such as that of rodents, because the requisite high optical power confers a large dioptric thickness to the retina. A recently-developed structured illumination microscopy (SIM) technique called HiLo imaging has been shown to reduce the effect of out-of-focus light scatter in flood illumination microscopes and produce pseudo-confocal images with significantly improved image quality. In this work, we adopted the HiLo technique to a flood AO ophthalmoscope and performed AO imaging in both (physical) model and live rat eyes. The improvement in image quality from HiLo imaging is shown both qualitatively and quantitatively by using spatial spectral analysis.

Childhood socioeconomic status and risk in early family environments: predictors of global sleep quality in college students.

PubMed

Counts, Cory J; Grubin, Fiona C; John-Henderson, Neha A

2018-06-01

Low socioeconomic status (SES) in childhood associates with poor sleep quality in adulthood. Separately, childhood family environments shape health into adulthood. Here, we investigated whether these early life factors independently or interactively inform global sleep quality in college students. Cross-sectional. College students at a state university (N = 391). As a measure of childhood SES, we asked participants to consider their families' socioeconomic standing relative to the rest of the society during their childhood. We used the Risky Family questionnaire to measure adversity and the presence of warmth and affection in the family environment during childhood, and the Pittsburgh Sleep Quality Index as a measure of current global sleep quality. We used linear regressions adjusting for age and sex to examine relationships between childhood SES, risk in childhood family environments, and global sleep quality. Lower childhood SES and greater risk in childhood family environments independently predicted poor sleep quality. Importantly, in low-risk family environments, there was no significant difference in sleep quality as a function of childhood SES. However, students who were from low childhood SES backgrounds who also reported high levels of risk in their early family environments had the worst sleep quality. Findings highlight the importance of considering socioeconomic and family environments in childhood as informants of sleep quality across the lifespan. Compromised sleep quality in college students could affect academic performance and health over time. Copyright © 2018 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Mechanisms of change for interventions aimed at improving the wellbeing, mental health and resilience of children and adolescents affected by war and armed conflict: a systematic review of reviews.

PubMed

Bosqui, Tania Josiane; Marshoud, Bassam

2018-01-01

Despite increasing research and clinical interest in delivering psychosocial interventions for children affected by war, little research has been conducted on the underlying mechanisms of change associated with these interventions. This review aimed to identify these processes in order to inform existing interventions and highlight research gaps. A systematic review of reviews was conducted drawing from academic databases (PubMed, PILOTS, Cochrane Library for Systematic Reviews) and field resources (e.g. Médecins Sans Frontières and the Psychosocial Centre of the International Federation of Red Cross and Red Crescent Societies), with extracted data analysed using Thematic Content Analysis. Thirteen reviews of psychosocial or psychological interventions for children and adolescents (< 25 years old) affected by war, armed conflict or political violence were identified, covering over 30 countries worldwide. Qualitative analysis identified 16 mechanisms of change, one of which was an adverse mechanism. Themes included protection from harm, play, community and family capacity building, strengthening relationships with caregivers, improved emotional regulation, therapeutic rapport, trauma processing, and cognitive restructuring; with the adverse mechanism relating to the pathologising of normal reactions. However, only 4 mechanisms were supported by strong empirical evidence, with only moderate or poor quality evidence supporting the other mechanisms. The poor quality of supporting evidence limits what can be inferred from this review's findings, but serves to highlight clinically informed mechanisms of change for existing and widely used non-specialist interventions in the field, which urgently need rigorous scientific testing to inform their continued practice.

Uses of Complementary and Alternative Medicine in Multiple Sclerosis

PubMed Central

Namjooyan, Foroogh; Ghanavati, Rahil; Majdinasab, Nastaran; Jokari, Shiva; Janbozorgi, Mohammad

2014-01-01

Multiple sclerosis (MS) is a chronic, disabling, recurrent demyelination of the central nervous system (CNS). It could affect different regions in the brain and spinal cord, and according to the domain which is affected, it could cause different symptoms such as motor, sensory, or visual impairment; fatigue; bowel, bladder, and sexual dysfunction; cognitive impairment; and depression. MS patients also face reduced quality of life. Drugs that are used in MS are not fully efficient and patients suffer from many symptoms and adverse effects. Today there is an increasing trend of using complementary and alternative medicine (CAM). People are more likely to use this type of treatment. Using appropriate lifestyle and CAM therapy can subside some of the symptoms and could improve the quality of life in these patients. Many people with MS explore CAM therapies for their symptoms. This review is aimed to introduce CAM therapies that could be used in MS patients. PMID:25161918

The effect of using propylene glycol as a vehicle on the microhardness of mineral trioxide aggregate.

PubMed

Salem Milani, Amin; Banifatemeh, Alireza; Rahimi, Saeed; Jafarabadi, Mohammad Asghari

2015-01-01

While it has been proven that the handling properties of mineral trioxide aggregate (MTA) are improved upon mixing it with propylene glycol (PG), this study sought to evaluate how PG affects the microhardness of MTA in terms of setting quality. MTA was mixed with different proportions of distilled water (DW) and PG to prepare 5 groups (n = 30). The DW/PG percent proportions used in Groups 1-5 were 100/0, 80/20, 50/50, 20/80, and 0/100, respectively. The mixed MTA was condensed into acrylic molds. Half of the samples of each group were evaluated on Day 4, the other half on Day 28. The results indicated that PG reduces the microhardness of MTA, thus adversely affecting its setting process. Group 2 (80% DW/20% PG) best improved the handling of MTA without a significant reduction in setting quality.

Special issue: Chemical characterization of secondary organic aerosol - Dedication to Professor Magda Claeys

NASA Astrophysics Data System (ADS)

Surratt, Jason D.; Szmigielski, Rafal; Faye McNeill, V.

2016-04-01

Atmospheric aerosols are suspensions of liquid and solid particles that have diameters ranging from a few nanometers to several micrometers (μm). Atmospheric fine particulate matter (PM2.5, aerosols with aerodynamic diameters of 2.5 μm or less) are especially important since they can adversely affect air quality and human health as well as play a critical role in Earth's climate system. In terms of aerosol climate effects, PM2.5 can directly affect climate by scattering or absorbing incoming solar radiation or indirectly by acting as nuclei on which cloud droplets and ice particles form. As a result, a better understanding of processes that determine the formation and sinks of PM2.5 is needed for developing effective policies that improve air quality and public health as well as to accurately predict the response of the climate system due to changes in anthropogenic emissions.

The association of adverse childhood experiences with mid-life depressive symptoms and quality of life among incarcerated males: exploring multiple mediation.

PubMed

Skarupski, Kimberly A; Parisi, Jeanine M; Thorpe, Roland; Tanner, Elizabeth; Gross, Deborah

2016-01-01

To explore the association of experiencing death, trauma, and abuse during childhood with depressive symptoms and quality of life at mid-life among incarcerated men and to understand how current social support and coping strategies mediate the impact of childhood trauma histories on mental health. Study participants were 192 male inmates in a maximum security prison. Participants completed measures of adverse childhood experiences related to death, trauma, and abuse, and depressive symptoms and quality of life. Data were analyzed using multiple mediation modeling. Men who reported having experienced adverse childhood experiences reported more depressive symptoms and lower quality of life than their counterparts. The results showed that in models both unadjusted and adjusted for age, race, education, number of years served, and whether the inmate had a life sentence, the association between adverse childhood experiences and quality of life were partially explained by the total of the indirect effects (point estimate = -.5052; CI.95 = -1.0364, -.0429 and point estimate = -.7792; CI.95 = -1.6369, -.0381), primarily via social support. However, the associations between adverse childhood experiences and depressive symptoms were not explained by social support and coping. Adverse childhood experiences are associated with deleterious mental health effects in later life. Social support and coping partially mediate the association between adverse childhood experiences and quality of life. The high prevalence of childhood trauma among aging prison inmates warrants attention to increasing social support mechanisms to improve mental health.

Application of a Structured Decision Process for Informing ...

EPA Pesticide Factsheets

The Guánica Bay watershed has been a priority for research, assessment and management since the 1970s, and since 2008, has been the focus of a U.S. Coral Reef Task Force (USCRTF) research initiative involving multiple agencies assembled to address the effect of land management decisions on coastal resources. Municipal and agricultural growth in the Guánica Bay watershed has provided social and economic value but has led to changes in forest cover (highly valued for biodiversity, endangered species and ecotourism), declining quality and availability of drinking water, and increased sediment and nutrient runoff that adversely affects coastal seagrasses, mangroves and coral reefs. Communities in the coastal region, such as the city of Guánica, rely partially on fishing and tourism economies, both of which are adversely affected by diminishing coastal water quality. In 2008, with funding from NOAA’s Coral Reef Conservation Program, the Center for Watershed Protection developed a Watershed Management Plan (WMP) that included a suite of proposed management actions to reduce sediment runoff and its harmful effects in the coastal zone. The WMP served as the initial SDM decision context for EPA’s research to generate tools and procedures to better inform the decisions made across the watershed and to facilitate complementary actions.Application of SDM in Guánica Bay included archival research on social and economic history of the region and three workshops with s

Hepatitis C virus adversely affects quality of life.

PubMed

Cillo, Umberto; Amodio, Piero; Ronco, Claudio; Soni, Sachin S; Zanus, Giacomo; Minazzato, Lina; Salari, Annalisa; Neri, Daniele; Bombonato, Giancarlo; Schiff, Sami; Bianco, Tonino

2011-01-01

Chronic liver disease secondary to hepatitis C virus (HCV) infection is a common clinical problem. HCV is likely to adversely affect the quality of life (QoL) of the patient. This effect is said to be disproportionate to the severity of the disease. The aim of our study was to evaluate QoL in HCV-positive patients focusing both on health status and subjective satisfaction. Twenty-four patients with combined HCV and alcoholic liver disease (ETOH-HCV) were enrolled in the study. We adopted two generic tools: SF-36 (a health status questionnaire) and SAT-P (a satisfaction profile) for psychological assessment of the patients. SF-36 and SAT-P scores of ETOH-HCV patients were compared with scores of 23 patients with alcoholic liver disease (ETOH). The scores obtained from the study groups were also compared with the reference scores of the healthy Italian population. Both the groups were comparable with respect to age, histological and clinical severity of liver disease (as assessed by MELD and Child Pugh scores). Patients with ETOH-HCV scored less in the vitality and role emotional status domains of the SF-36 scores and the psychological function, social function and free time domains of the satisfaction profile. These results show a significant impact of HCV infection on health status and subjective satisfaction. Copyright © 2011 S. Karger AG, Basel.

The specificity of childhood adversities and negative life events across the life span to anxiety and depressive disorders.

PubMed

Spinhoven, Philip; Elzinga, Bernet M; Hovens, Jacqueline G F M; Roelofs, Karin; Zitman, Frans G; van Oppen, Patricia; Penninx, Brenda W J H

2010-10-01

Although several studies have shown that life adversities play an important role in the etiology and maintenance of both depressive and anxiety disorders, little is known about the relative specificity of several types of life adversities to different forms of depressive and anxiety disorder and the concurrent role of neuroticism. Few studies have investigated whether clustering of life adversities or comorbidity of psychiatric disorders critically influence these relationships. Using data from the Netherlands Study of Depression and Anxiety (NESDA), we analyzed the association of childhood adversities and negative life experiences across the lifespan with lifetime DSM-IV-based diagnoses of depression or anxiety among 2288 participants with at least one affective disorder. Controlling for comorbidity and clustering of adversities the association of childhood adversity with affective disorders was greater than that of negative life events across the life span with affective disorders. Among childhood adversities, emotional neglect was specifically associated with depressive disorder, dysthymia, and social phobia. Persons with a history of emotional neglect and sexual abuse were more likely to develop more than one lifetime affective disorder. Neuroticism and current affective disorder did not affect the adversity-disorder relationships found. Using a retrospective study design, causal interpretations of the relationships found are not warranted. Emotional neglect seems to be differentially related to depression, dysthymia and social phobia. This knowledge may help to reduce underestimation of the impact of emotional abuse and lead to better recognition and treatment to prevent long-term disorders. Copyright 2010 Elsevier B.V. All rights reserved.

Happy employees lead to loyal patients. Survey of nurses and patients shows a strong link between employee satisfaction and patient loyalty.

PubMed

Atkins, P M; Marshall, B S; Javalgi, R G

1996-01-01

A strong relationship exists between employee satisfaction and patients' perceptions of the quality of their care, measured in terms of their intent to return and to recommend the hospital to others. Employee dissatisfaction can negatively affect quality of care and have an adverse effect on patient loyalty and, thus hospital profitability. Therefore, health care marketers should regularly measure employee satisfaction as one way to monitor service quality. Health care marketers must work more closely with their human-resource departments to understand and influence employees' work environment and maintain a high level of job satisfaction. Marketers also should place an increased emphasis on both employee and patient perceptions of satisfaction when developing internal and external strategic marketing plans and formulating future research.

Conditions of transfer and quality of food.

PubMed

Southern, K J; Rasekh, J G; Hemphill, F E; Thaler, A M

2006-08-01

Many factors contribute to the production of safe foods of animal origin. Initiatives for an integrated approach to food safety recognise the importance of optimising transportation conditions to ensure on-farm interventions are preserved. Physical, microbial, and environmental hazards during the transportation process may adversely affect the safety and quality of meat, poultry, and egg products. Additionally, the stress level in animals can be raised by transportation conditions, potentially causing increased pathogen shedding in carrier animals which exposes other animals to possible contamination. The physiological effects of stress on animals can reduce the quality of meat, poultry, and egg products produced by the animals, thus decreasing the economic value of the animal. Increased globalisation of markets provides an incentive for transportation standards of food animals within a country as well as transportation standards between countries.

Mu-opioid antagonists for opioid-induced bowel dysfunction in people with cancer and people receiving palliative care.

PubMed

Candy, Bridget; Jones, Louise; Vickerstaff, Victoria; Larkin, Philip J; Stone, Patrick

2018-06-05

Opioid-induced bowel dysfunction (OIBD) is characterised by constipation, incomplete evacuation, bloating, and gastric reflux. It is one of the major adverse events of treatment for pain in cancer and in palliative care, resulting in increased morbidity and reduced quality of life.This is an update of two Cochrane reviews. One was published in 2011, Issue 1 on laxatives and methylnaltrexone for the management of constipation in people receiving palliative care; this was updated in 2015 and excluded methylnaltrexone. The other was published in 2008, Issue 4 on mu-opioid antagonists (MOA) for OIBD. In this updated review, we only included trials on MOA (including methylnaltrexone) for OIBD in people with cancer and people receiving palliative care. To assess the effectiveness and safety of MOA for OIBD in people with cancer and people receiving palliative care. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, and Web of Science to August 2017. We also searched clinical trial registries and regulatory websites. We contacted manufacturers of MOA to identify further data. We included randomised controlled trials (RCTs) that assessed the effectiveness and safety of MOA for OIBD in people with cancer and people at a palliative stage irrespective of the type of terminal disease they experienced. Two review authors assessed risk of bias and extracted data. The appropriateness of combining data from the trials depended upon sufficient homogeneity across the trials. Our primary outcomes were laxation, impact on pain relief, and adverse events. Impact on pain relief was a primary outcome because a possible adverse effect of MOAs is a reduction in pain relief from opioids. We assessed the evidence on these outcomes using GRADE. We identified four new trials for this update, bringing the total number included in this review to eight. In total, 1022 men and women with cancer irrespective of stage or at a palliative care stage of any disease were randomised across the trials. The MOAs evaluated were oral naldemedine and naloxone (alone or in combination with oxycodone), and subcutaneous methylnaltrexone. The trials compared with MOA with a placebo or with the active intervention administered at different doses or in combination with other drugs. The trial of naldemedine and the two of naloxone in combination with oxycodone were in people with cancer irrespective of disease stage. The trial on naloxone alone was in people with advanced cancer. The four trials on methylnaltrexone were undertaken in palliative care where most participants had cancer. All trials were vulnerable to biases; four were at a high risk as they involved a sample of fewer than 50 participants per arm.In the trial of naldemedine compared to placebo in 225 participants, there were more spontaneous laxations over the two-week treatment for the intervention group (risk ratio (RR) 1.93, 95% confidence intervals (CI) 1.36 to 2.74; moderate-quality evidence). In comparison with higher doses, lower doses resulted in fewer spontaneous laxations (0.1 mg versus 0.2 mg: RR 0.73, 95% CI 0.55 to 0.95; 0.1 mg versus 0.4 mg: RR 0.69, 95% CI 0.53 to 0.89; moderate-quality evidence). There was moderate-quality evidence that naldemedine had no effect on opiate withdrawal. There were five serious adverse events. All were in people taking naldemedine (low-quality evidence). There was an increase in the occurrence of other (non-serious) adverse events in the naldemedine groups (RR 1.36, 95% CI 1.04 to 1.79, moderate-quality evidence). The most common adverse event was diarrhoea.The trials on naloxone taken either on its own, or in combination with oxycodone (an opioid) compared to oxycodone only did not evaluate laxation response over the first two weeks of administration. There was very low-quality evidence that naloxone alone, and moderate-quality evidence that oxycodone/naloxone, had no effect on analgesia. There was low-quality evidence that oxycodone/naloxone did not increase the risk of serious adverse events and moderate-quality evidence that it did not increase risk of adverse events.In combined analysis of two trials of 287 participants, we found methylnaltrexone compared to placebo induced more laxations within 24 hours (RR 2.77, 95% CI 1.91 to 4.04. I² = 0%; moderate-quality evidence). In combined analysis, we found methylnaltrexone induced more laxation responses over two weeks (RR 9.98, 95% CI 4.96 to 20.09. I² = 0%; moderate-quality evidence). The proportion of participants who had a rescue-free laxation response within 24 hours of the first dose was 59.1% in the methylnaltrexone arms and 19.1% in the placebo arm. There was moderate-quality evidence that the rate of opioid withdrawal was not affected. Methylnaltrexone did not increase the likelihood of a serious adverse event; there were fewer in the intervention arm (RR 0.59, 95% CI 0.38 to 0.93; I² = 0%; moderate-quality evidence). There was no difference in the proportion of participants experiencing an adverse event (RR 1.17, 95% CI 0.94 to 1.45; I² = 74%; low-quality evidence). Methylnaltrexone increased the likelihood of abdominal pain and flatulence.Two trials compared differing methylnaltrexone schedules of higher doses with lower doses. For early laxation, there was low-quality evidence of no clear difference between doses on analgesia and adverse events. Both trials measured laxation response within 24 hours of first dose (trial one: RR 0.82, 95% CI 0.41 to 1.66; trial two: RR 1.07, 95% CI 0.81 to 1.42). In this update, the conclusions for naldemedine are new. There is moderate-quality evidence to suggest that, taken orally, naldemedine improves bowel function over two weeks in people with cancer and OIBD but increases the risk of adverse events. The conclusions on naloxone and methylnaltrexone have not changed. The trials on naloxone did not assess laxation at 24 hours or over two weeks. There is moderate-quality evidence that methylnaltrexone improves bowel function in people receiving palliative care in the short term and over two weeks, and low-quality evidence that it does not increase adverse events. There is a need for more trials including more evaluation of adverse events. None of the current trials evaluated effects in children.

Development, evaluation, and application of sediment quality targets for assessing and managing contaminated sediments in Tampa Bay, Florida

USGS Publications Warehouse

MacDonald, D.D.; Carr, R.S.; Eckenrod, D.; Greening, H.; Grabe, S.; Ingersoll, C.G.; Janicki, S.; Janicki, T.; Lindskoog, R.A.; Long, E.R.; Pribble, R.; Sloane, G.; Smorong, D.E.

2004-01-01

Tampa Bay is a large, urban estuary that is located in west central Florida. Although water quality conditions represent an important concern in this estuary, information from numerous sources indicates that sediment contamination also has the potential to adversely affect aquatic organisms, aquatic-dependent wildlife, and human health. As such, protecting relatively uncontaminated areas of the bay from contamination and reducing the amount of toxic chemicals in contaminated sediments have been identified as high-priority sediment management objectives for Tampa Bay. To address concerns related to sediment contamination in the bay, an ecosystem-based framework for assessing and managing sediment quality conditions was developed that included identification of sediment quality issues and concerns, development of ecosystem goals and objectives, selection of ecosystem health indicators, establishment of metrics and targets for key indicators, and incorporation of key indicators, metrics, and targets into watershed management plans and decision-making processes. This paper describes the process that was used to select and evaluate numerical sediment quality targets (SQTs) for assessing and managing contaminated sediments. These SQTs included measures of sediment chemistry, whole-sediment and pore-water toxicity, and benthic invertebrate community structure. In addition, the paper describes how the SQTs were used to develop site-specific concentration-response models that describe how the frequency of adverse biological effects changes with increasing concentrations of chemicals of potential concern. Finally, a key application of the SQTs for defining sediment management areas is discussed.

Factors associated with intern fatigue.

PubMed

Friesen, Lindsay D; Vidyarthi, Arpana R; Baron, Robert B; Katz, Patricia P

2008-12-01

Prior data suggest that fatigue adversely affects patient safety and resident well-being. ACGME duty hour limitations were intended, in part, to reduce resident fatigue, but the factors that affect intern fatigue are unknown. To identify factors associated with intern fatigue following implementation of duty hour limitations. Cross-sectional confidential survey of validated questions related to fatigue, sleep, and stress, as well as author-developed teamwork questions. Interns in cognitive specialties at the University of California, San Francisco. Univariate statistics characterized the distribution of responses. Pearson correlations elucidated bivariate relationships between fatigue and other variables. Multivariate linear regression models identified factors independently associated with fatigue, sleep, and stress. Of 111 eligible interns, 66 responded (59%). In a regression analysis including gender, hours worked in the previous week, sleep quality, perceived stress, and teamwork, only poorer quality of sleep and greater perceived stress were significantly associated with fatigue (p < 0.001 and p = 0.02, respectively). To identify factors that may affect sleep, specifically duty hours and stress, a secondary model was constructed. Only greater perceived stress was significantly associated with diminished sleep quality (p = 0.04), and only poorer teamwork was significantly associated with perceived stress (p < 0.001). Working >80 h was not significantly associated with perceived stress, quality of sleep, or fatigue. Simply decreasing the number of duty hours may be insufficient to reduce intern fatigue. Residency programs may need to incorporate programmatic changes to reduce stress, improve sleep quality, and foster teamwork in order to decrease intern fatigue and its deleterious consequences.

Environmental impacts of dispersed development from federal infrastructure projects.

PubMed

Southerland, Mark T

2004-06-01

Dispersed development, also referred to as urban growth or sprawl, is a pattern of low-density development spread over previously rural landscapes. Such growth can result in adverse impacts to air quality, water quality, human health, aquatic and terrestrial ecosystems, agricultural land, military training areas, water supply and wastewater treatment, recreational resources, viewscapes, and cultural resources. The U.S. Environmental Protection Agency (U.S. EPA) is charged with protecting public health and the environment, which includes consideration of impacts from dispersed development. Specifically, because federal infrastructure projects can affect the progress of dispersed development, the secondary impacts resulting from it must be assessed in documents prepared under the National Environmental Policy Act (NEPA). The Council on Environmental Quality (CEQ) has oversight for NEPA and Section 309 of the Clean Air Act requires that U.S. EPA review and comment on federal agency NEPA documents. The adverse effects of dispersed development can be induced by federal infrastructure projects including transportation, built infrastructure, modifications in natural infrastructure, public land conversion and redevelopment of properties, construction of federal facilities, and large traffic or major growth generation developments requiring federal permits. This paper presents an approach that U.S. EPA reviewers and NEPA practitioners can use to provide accurate, realistic, and consistent analysis of secondary impacts of dispersed development resulting from federal infrastructure projects. It also presents 24 measures that can be used to mitigate adverse impacts from dispersed development by modifying project location and design, participating in preservation or restoration activities, or informing and supporting local communities in planning.

Nonlinear frequency compression: effects on sound quality ratings of speech and music.

PubMed

Parsa, Vijay; Scollie, Susan; Glista, Danielle; Seelisch, Andreas

2013-03-01

Frequency lowering technologies offer an alternative amplification solution for severe to profound high frequency hearing losses. While frequency lowering technologies may improve audibility of high frequency sounds, the very nature of this processing can affect the perceived sound quality. This article reports the results from two studies that investigated the impact of a nonlinear frequency compression (NFC) algorithm on perceived sound quality. In the first study, the cutoff frequency and compression ratio parameters of the NFC algorithm were varied, and their effect on the speech quality was measured subjectively with 12 normal hearing adults, 12 normal hearing children, 13 hearing impaired adults, and 9 hearing impaired children. In the second study, 12 normal hearing and 8 hearing impaired adult listeners rated the quality of speech in quiet, speech in noise, and music after processing with a different set of NFC parameters. Results showed that the cutoff frequency parameter had more impact on sound quality ratings than the compression ratio, and that the hearing impaired adults were more tolerant to increased frequency compression than normal hearing adults. No statistically significant differences were found in the sound quality ratings of speech-in-noise and music stimuli processed through various NFC settings by hearing impaired listeners. These findings suggest that there may be an acceptable range of NFC settings for hearing impaired individuals where sound quality is not adversely affected. These results may assist an Audiologist in clinical NFC hearing aid fittings for achieving a balance between high frequency audibility and sound quality.

FACTORS ADVERSELY AFFECTING AMPHIBIAN POPULATIONS IN THE US

EPA Science Inventory

Factors known or suspected to be adversely affecting native amphibian populations in the US were identified using information from species accounts written in a standardized format by multiple authors in a forthcoming book. Specific adverse factors were identified for 53 (58%) of...

Variations in data collection methods between national databases affect study results: a comparison of the nationwide inpatient sample and national surgical quality improvement program databases for lumbar spine fusion procedures.

PubMed

Bohl, Daniel D; Russo, Glenn S; Basques, Bryce A; Golinvaux, Nicholas S; Fu, Michael C; Long, William D; Grauer, Jonathan N

2014-12-03

There has been an increasing use of national databases to conduct orthopaedic research. Questions regarding the validity and consistency of these studies have not been fully addressed. The purpose of this study was to test for similarity in reported measures between two national databases commonly used for orthopaedic research. A retrospective cohort study of patients undergoing lumbar spinal fusion procedures during 2009 to 2011 was performed in two national databases: the Nationwide Inpatient Sample and the National Surgical Quality Improvement Program. Demographic characteristics, comorbidities, and inpatient adverse events were directly compared between databases. The total numbers of patients included were 144,098 from the Nationwide Inpatient Sample and 8434 from the National Surgical Quality Improvement Program. There were only small differences in demographic characteristics between the two databases. There were large differences between databases in the rates at which specific comorbidities were documented. Non-morbid obesity was documented at rates of 9.33% in the Nationwide Inpatient Sample and 36.93% in the National Surgical Quality Improvement Program (relative risk, 0.25; p < 0.05). Peripheral vascular disease was documented at rates of 2.35% in the Nationwide Inpatient Sample and 0.60% in the National Surgical Quality Improvement Program (relative risk, 3.89; p < 0.05). Similarly, there were large differences between databases in the rates at which specific inpatient adverse events were documented. Sepsis was documented at rates of 0.38% in the Nationwide Inpatient Sample and 0.81% in the National Surgical Quality Improvement Program (relative risk, 0.47; p < 0.05). Acute kidney injury was documented at rates of 1.79% in the Nationwide Inpatient Sample and 0.21% in the National Surgical Quality Improvement Program (relative risk, 8.54; p < 0.05). As database studies become more prevalent in orthopaedic surgery, authors, reviewers, and readers should view these studies with caution. This study shows that two commonly used databases can identify demographically similar patients undergoing a common orthopaedic procedure; however, the databases document markedly different rates of comorbidities and inpatient adverse events. The differences are likely the result of the very different mechanisms through which the databases collect their comorbidity and adverse event data. Findings highlight concerns regarding the validity of orthopaedic database research. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Regulation of low-density lipoprotein subfractions by carbohydrates.

PubMed

Gerber, Philipp A; Berneis, Kaspar

2012-07-01

This article aims at reviewing the recent findings that have been made concerning the crosstalk of carbohydrate metabolism with the generation of small, dense low-density lipoprotein (LDL) particles, which are known to be associated with an adverse cardiovascular risk profile. Studies conducted during the past few years have quite unanimously shown that the quantity of carbohydrates ingested is associated with a decrease of LDL particle size and an increase in its density. Conversely, diets that aim at a reduction of carbohydrate intake are able to improve LDL quality. Furthermore, a reduction of the glycaemic index without changing the amount of carbohydrates ingested has similar effects. Diseases with altered carbohydrate metabolism, for example, type 2 diabetes, are associated with small, dense LDL particles. Finally, even the kind of monosaccharide the carbohydrate intake consists of is important concerning LDL particle size: fructose has been shown to alter the LDL particle subclass profile more adversely than glucose in many recent studies. LDL particle quality, rather than its quantity, is affected by carbohydrate metabolism, which is of clinical importance, in particular, in the light of increased carbohydrate consumption in today's world.

Deriving criteria to select arthropod species for laboratory tests to assess the ecological risks from cultivating arthropod-resistant genetically engineered crops.

PubMed

Romeis, Jörg; Raybould, Alan; Bigler, Franz; Candolfi, Marco P; Hellmich, Richard L; Huesing, Joseph E; Shelton, Anthony M

2013-01-01

Arthropods form a major part of the biodiversity in agricultural landscapes. Many species are valued because they provide ecosystem services, including biological control, pollination and decomposition, or because they are of conservation interest. Some arthropods reduce crop yield and quality, and conventional chemical pesticides, biological control agents and genetically engineered (GE) crops are used to control them. A common concern addressed in the ecological risk assessment (ERA) that precedes regulatory approval of these pest control methods is their potential to adversely affect valued non-target arthropods (NTAs). A key concept of ERA is early-tier testing using worst-case exposure conditions in the laboratory and surrogate test species that are most likely to reveal an adverse effect. If no adverse effects are observed in those species at high exposures, confidence of negligible ecological risk from the use of the pest control method is increased. From experience with chemical pesticides and biological control agents, an approach is proposed for selecting test species for early-tier ERA of GE arthropod-resistant crops. Surrogate species should be selected that most closely meet three criteria: (i) Potential sensitivity: species should be the most likely to be sensitive to the arthropod-active compound based on the known spectrum of activity of the active ingredient, its mode of action, and the phylogenetic relatedness of the test and target species; (ii) species should be representative of valued taxa or functional groups that are most likely to be exposed to the arthropod-active compound in the field; and (iii) Availability and reliability: suitable life-stages of the test species must be obtainable in sufficient quantity and quality, and validated test protocols must be available that allow consistent detection of adverse effects on ecologically relevant parameters. Our proposed approach ensures that the most suitable species are selected for testing and that the resulting data provide the most rigorous test of the risk hypothesis of no adverse effect in order to increase the quality and efficiency of ERAs for cultivation of GE crops. Copyright © 2012 Elsevier Ltd. All rights reserved.

Water resources during drought conditions and postfire water quality in the upper Rio Hondo Basin, Lincoln County, New Mexico, 2010-13

USGS Publications Warehouse

Sherson, Lauren R.; Rice, Steven E.

2015-07-16

Changes in climate and increased groundwater and surface-water use are likely to affect the availability of water in the upper Rio Hondo Basin. Increased drought probably will increase the potential for wildfires, which can affect downstream water quality and increase flood potential. Climate-research predicted decreases in winter precipitation may have an adverse effect on the amount of groundwater recharge that occurs in the upper Rio Hondo Basin, given the predominance of winter precipitation recharge as indicated by the stable isotope results. Decreases in surface-water supplies because of persistent drought conditions and reductions in the quality of water because of the effects of wildfire may lead to a larger reliance on groundwater reserves in the upper Rio Hondo Basin. Decreasing water levels because of increasing groundwater withdrawal could reduce base flows in the Rio Bonito and Rio Ruidoso. Well organized and scientifically supported regional water-resources management will be necessary for dealing with the likely scenario of increases in demand coupled with decreases in supply in the upper Rio Hondo Basin.

An in-flight investigation of pilot-induced oscillation suppression filters during the fighter approach and landing task

NASA Technical Reports Server (NTRS)

Bailey, R. E.; Smith, R. E.

1982-01-01

An investigation of pilot-induced oscillation suppression (PIOS) filters was performed using the USAF/Flight Dynamics Laboratory variable stability NT-33 aircraft, modified and operated by Calspan. This program examined the effects of PIOS filtering on the longitudinal flying qualities of fighter aircraft during the visual approach and landing task. Forty evaluations were flown to test the effects of different PIOS filters. Although detailed analyses were not undertaken, the results indicate that PIOS filtering can improve the flying qualities of an otherwise unacceptable aircraft configuration (Level 3 flying qualities). However, the ability of the filters to suppress pilot-induced oscillations appears to be dependent upon the aircraft configuration characteristics. Further, the data show that the filters can adversely affect landing flying qualities if improperly designed. The data provide an excellent foundation from which detail analyses can be performed.

Nuts Improve Diet Quality Compared to Other Energy-Dense Snacks While Maintaining Body Weight

PubMed Central

Tey, Siew Ling; Brown, Rachel; Gray, Andrew; Chisholm, Alexandra; Delahunty, Conor

2011-01-01

Previous studies have reported that regular nut consumption reduces cardiovascular disease (CVD) risk and does not promote weight gain despite the fact that nuts are energy-dense. However, no studies have investigated the body composition of those regularly consuming nuts compared to similar intakes of other snacks of equal energy density. This parallel study (n = 118) examined the effects of providing daily portions (~1100 kJ/d) of hazelnuts, chocolate, or potato crisps compared to a control group receiving no snacks for twelve weeks. Effects on body weight and composition, blood lipids and lipoproteins, resting metabolic rate (RMR), appetite indices, and dietary quality were compared. At week 12, there was no significant difference in any of the outcome measurements between the groups except for dietary quality, which improved significantly in the nut group. Nuts can be incorporated into the diet without adversely affecting body weight and can improve diet quality. PMID:21845219

Estimating the risks for adverse effects of total phosphorus in receiving streams with the Stochastic Empirical Loading and Dilution Model (SELDM)

USGS Publications Warehouse

Granato, Gregory E.; Jones, Susan C.

2015-01-01

Results of this study indicate the potential benefits of the multi-decade simulations that SELDM provides because these simulations quantify risks and uncertainties that affect decisions made with available data and statistics. Results of the SELDM simulations indicate that the WQABI criteria concentrations may be too stringent for evaluating the stormwater quality in receiving streams, highway runoff, and BMP discharges; especially with the substantial uncertainties inherent in selecting representative data.

ACHP | Section 106 Regulations Flow Chart

Science.gov Websites

undertaking/no potential to cause effects Undertaking is type that might affect historic properties Identify No historic properties affected Historic properties are affected Assess Adverse Effects Apply affected Resolve Adverse Effects Continue consultation Memorandum of Agreement FAILURE TO AGREE COUNCIL

Efficacy of Complementary Therapies in the Quality of Life of Breast Cancer Survivors

PubMed Central

Zaidi, Sahar; Hussain, Showket; Verma, Shalini; Veqar, Zubia; Khan, Asiya; Nazir, Sheeraz Un; Singh, Neha; Moiz, Jamal Ali; Tanwar, Pranay; Srivastava, Anurag; Rath, G. K.; Mehrotra, Ravi

2018-01-01

Breast cancer (BC) is the most common cancer diagnosed in women and the second most common cancer overall, ranking as the fifth cause of death from cancer. The chronicity of the disease produces long-term physiological and psychological manifestations, which adversely affect the quality of life of the individual. The primary treatment while managing cancer presents with various debilitating side effects. With the recent advances in treatment techniques that have improved the survival rate, patients suffer from continuing posttreatment complications. Patients seem to cope well with the stress of treatment of BC and sustain a normal life; however, the deterioration in physical well-being makes the patient functionally inefficient. Exercise has been proven to be an effective, safe, and feasible tool in combating the adverse effects of treatment, prevents complications and decreases the risk of BC-specific mortality. This review briefly presents an overview of the burden of the disease and its management strategies. Owing to the heterogeneity of the population and the multitude of therapies they receive, the response of each patient to treatment is different and so is the magnitude of adverse effects. The review discusses the late sequelae following treatment and evidence supporting the role of physical activity in their management. In conclusion, there is a need for personalized physical activity plans to be developed to suit the individual and their circumstances. PMID:29376027

An Evidence-Based Look at Misconceptions in the Treatment of Patients with IBS-D

PubMed Central

Lacy, Brian E.; Chey, William D.; Chang, Lin

2013-01-01

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder and affects up to 12% to 15% of adults in the United States, with a higher prevalence among women and those younger than 50 years. IBS adversely impacts quality of life and medical expenditures, with significant costs arising from healthcare visits and reduced workplace productivity. Recent studies have shown that the adverse effects of IBS are so significant that many patients are willing to accept risks of adverse events from effective treatment to gain symptom relief. Alosetron is a 5-HT3 receptor antagonist approved by the US Food and Drug Administration (FDA) for women with severe diarrhea-predominant IBS that has not responded to traditional therapies. Alosetron yields overall improvements in IBS symptoms in 51% of patients vs 36% treated with placebo, with efficacy continuing undiminished over the course of a 48-week randomized, controlled trial. In real-world clinical practice, patients receiving alosetron had significant improvements in multiple IBS-related clinical parameters, including the new FDA IBS-diarrhea composite endpoint, lower gastrointestinal symptoms, fecal incontinence, and quality of life. Ischemic colitis and complications of constipation have been rare in occurrence. After nearly a decade of alosetron use under the risk management plan, adjudication of ischemic colitis and complications of constipation cases indicate that their incidence rates have remained low and stable. PMID:24872792

Cognitive and psychosocial effects of oxcarbazepine monotherapy in newly diagnosed partial epilepsy.

PubMed

Kim, Daeyoung; Seo, Ji-Hye; Joo, Eun Yeon; Lee, Hyang Woon; Shin, Won Chul; Hong, Seung Bong

2014-01-01

The aim of this study was to assess the effects of oxcarbazepine (OXC) on cognition and psychosocial difficulties in patients with new-onset partial epilepsy. Cognitive and psychosocial assessments were performed before and after 6 to 12 months of OXC monotherapy in 52 drug-naive patients (25 women; mean age, 31.1 years; SD, 12.1 years). Cognitive functions were evaluated with well-structured and validated tools. Mood, psychological distress, subjective handicap, and quality of life were also evaluated. Differences between baseline and after-treatment evaluation were compared and adjusted for possible confounders such as age, sex, seizure control, duration of epilepsy, assessment interval, and epileptogenic region. Mean assessment interval was 231.8 (range, 182-348) days, and mean (SD) OXC dose at retest was 693.8 (208.9) mg. The OXC was found to have no significant adverse effect on cognition. Furthermore, OXC monotherapy was not found to affect psychosocial difficulties, including psychological distress and subjective handicap. The results suggest that OXC monotherapy could be used to treat newly diagnosed partial epilepsy without adversely affecting cognitive and psychosocial functions.

Facets of career satisfaction for women physicians in the United States: a systematic review.

PubMed

Rizvi, Rabab; Raymer, Lindsay; Kunik, Mark; Fisher, Joslyn

2012-01-01

Women make up a growing proportion of the physician workforce, and their career satisfaction may affect their health. The authors hypothesized that many facets adversely affecting career satisfaction in women physicians were extrinsic, therefore, preventable or modifiable. The authors conducted a systematic review of the literature in English published through February 2010 to examine facets of career satisfaction of U.S. women physicians. The authors used the women physician AND job satisfaction OR career satisfaction Medical Subject Headings (MeSH) terms, and reviewed bibliographies of key articles to ensure inclusion of relevant studies. The authors used the "Strengthening the Reporting of Observation Studies in Epidemiology" quality tool. Of an initial 1,000 studies, only 30 met the inclusion criteria. Facets reported most frequently to influence career satisfaction for women physicians were income/prestige, practice characteristics, and personal/family characteristics. Overall, career satisfaction for women and men physicians was 73.4% (range = 56.4% to 90%) and 73.2% (range = 59% to 90%), respectively. When compared with men, women physicians were more concerned with perceived lack of time for relationships with patients, colleagues, and family; less satisfied with mentoring relationships and support from all sources; and less satisfied with career-advancement opportunities, recognition, and salary. Career satisfaction can affect health, as well as health and safety of patients. Many factors adversely affecting career satisfaction for women physicians are extrinsic and, therefore, modifiable.

Early Adverse Caregiving Experiences and Preschoolers' Current Attachment Affect Brain Responses during Facial Familiarity Processing: An ERP Study.

PubMed

Kungl, Melanie T; Bovenschen, Ina; Spangler, Gottfried

2017-01-01

When being placed into more benign environments like foster care, children from adverse rearing backgrounds are capable of forming attachment relationships to new caregivers within the first year of placement, while certain problematic social behaviors appear to be more persistent. Assuming that early averse experiences shape neural circuits underlying social behavior, neurophysiological studies on individual differences in early social-information processing have great informative value. More precisely, ERP studies have repeatedly shown face processing to be sensitive to experience especially regarding the caregiving background. However, studies on effects of early adverse caregiving experiences are restricted to children with a history of institutionalization. Also, no study has investigated effects of attachment security as a marker of the quality of the caregiver-child relationship. Thus, the current study asks how adverse caregiving experiences and attachment security to (new) caregivers affect early- and mid-latency ERPs sensitive to facial familiarity processing. Therefore, pre-school aged foster children during their second year within the foster home were compared to an age matched control group. Attachment was assessed using the AQS and neurophysiological data was collected during a passive viewing task presenting (foster) mother and stranger faces. Foster children were comparable to the control group with regard to attachment security. On a neurophysiological level, however, the foster group showed dampened N170 amplitudes for both face types. In both foster and control children, dampened N170 amplitudes were also found for stranger as compared to (foster) mother faces, and, for insecurely attached children as compared to securely attached children. This neural pattern may be viewed as a result of poorer social interactions earlier in life. Still, there was no effect on P1 amplitudes. Indicating heightened attentional processing, Nc amplitude responses to stranger faces were found to be enhanced in foster as compared to control children. Also, insecurely attached children allocated more attentional resources for the neural processing of mother faces. The study further confirms that early brain development is highly sensitive to the quality of caregiving. The findings are also relevant from a developmental perspective as miswiring of neural circuits may possibly play a critical role in children's psycho-social adjustment.

Prospective associations of social isolation and loneliness with poor sleep quality in older adults.

PubMed

Yu, Bin; Steptoe, Andrew; Niu, Kaijun; Ku, Po-Wen; Chen, Li-Jung

2018-03-01

There is evidence for negative associations between social isolation and loneliness and sleep quality in older adults. However, it is unclear to what extent these two factors independently affect sleep quality. This study examined the simultaneous associations of social isolation and loneliness with sleep quality in a longitudinal study of older adults. Data were analyzed from the Social Environment and Biomarkers of Aging Study in Taiwan collected in 2000 and 2006, involving a cohort of 639 participants (mean age = 66.14, SD 7.26). Poisson regression models were conducted to examine the association of social isolation and/or loneliness with sleep quality at follow-up after adjusting for multiple confounding variables. Univariate analysis showed that sleep quality was inversely associated with both social isolation and loneliness. After demographic, health, cognitive factors, and depressive symptoms were controlled in multivariable analysis, social isolation at the baseline still predicted poor sleep quality 6 years later (incident rate ratio, IRR 1.14; 95% CI 1.04-1.24; p < 0.01), while the association between loneliness and sleep quality was no longer significant (IRR 1.08; 95% CI 0.94-1.23; p = 0.27). The results were unchanged when participants who had poor sleep quality at the baseline were excluded from the analysis. These findings confirm an adverse effect of social isolation on the sleep quality of older adults, but indicate that this effect is independent of loneliness. Social isolation and loneliness seem to have distinct pathways in affecting the sleep quality of older adults.

CORRUPTION IN MEDICAL PRACTICE: WHERE DO WE STAND?

PubMed

Yousafzai, Abdul Wahab

2015-01-01

Corruption in health care sector affects all countries, including the United States, China and India. Pakistan is no exception. It is preventing people from having access to the quality medical care. Corruption in medical practice include ordering unnecessary investigations, and procedures for kickbacks and commissions; significant absenteeism, which adversely affects patient care; and the conflict of interest within the physician-pharmaceutical nexus, which exploits patients. To overcome corruption there is need to establish a framework for accountability, eliminating the physician-pharmaceutical nexus; and emphasizing medical ethics at the undergraduate and postgraduate levels. It is also important to open a dialogue amongst health care professionals and encourage the establishment of an ethical health care system in Pakistan.

Influence of Cattle Trails on Runoff Quantity and Quality.

PubMed

Miller, Jim J; Curtis, Tony; Chanasyk, David S; Willms, Walter D

2017-03-01

Cattle trails in grazed pastures close to rivers may adversely affect surface water quality of the adjacent river by directing runoff to it. The objective of this 3-yr study (2013-2015) in southern Alberta, Canada, was to determine if cattle trails significantly increased the risk of runoff and contaminants (sediment, nutrients) compared with the adjacent grazed pasture (control). A portable rainfall simulator was used to generate artificial rainfall (140 mm h) and runoff. The runoff properties measured were time to runoff and initial abstraction (infiltration), total runoff depth and average runoff rates, as well as concentrations and mass loads of sediment, N, and P fractions. Cattle trails significantly ( ≤ 0.10) decreased time to runoff and initial abstraction (26-32%) in the 2 yr measured and increased total runoff depth, runoff coefficients, and average runoff rates (21-51%) in 2 of 3 yr. Concentrations of sediment, N, and P fractions in runoff were not significantly greater for cattle trails than for control areas. However, mass loads of total suspended solids (57-85% increase), NH-N (31-90%), and dissolved reactive P (DRP) (30-92%) were significantly greater because of increased runoff volumes. Overall, runoff quantity and loads of sediment, NH-N, and DRP were greater for cattle trails compared with the adjacent grazed pasture, and hydrologic connection with cattle-access sites on the riverbank suggests that this could adversely affect water quality in the adjacent river. Extrapolation of the study results should be tempered by the specific conditions represented by this rainfall simulation study. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Exposure to phthalates: reproductive outcome and children health. A review of epidemiological studies.

PubMed

Jurewicz, Joanna; Hanke, Wojciech

2011-06-01

Phthalates are a family of industrial chemicals that have been used for a variety of purposes. As the potential consequences of human exposure to phthalates have raised concerns in the general population, they have been studied in susceptible subjects such as pregnant women, infants and children. This article aims at evaluating the impact of exposure to phthalates on reproductive outcomes and children health by reviewing most recent published literature. Epidemiological studies focusing on exposure to phthalates and pregnancy outcome, genital development, semen quality, precocious puberty, thyroid function, respiratory symptoms and neurodevelopment in children for the last ten years were identified by a search of the PubMed, Medline, Ebsco, Agricola and Toxnet literature bases. The results from the presented studies suggest that there are strong and rather consistent indications that phthalates increase the risk of allergy and asthma and have an adverse impact on children's neurodevelopment reflected by quality of alertness among girls, decreased (less masculine) composite score in boys and attention deficit hyperactivity disorder. Results of few studies demonstrate negative associations between phthalate levels commonly experienced by the public and impaired sperm quality (concentration, morphology, motility). Phthalates negatively impact also on gestational age and head circumference; however, the results of the studies were not consistent. In all the reviewed studies, exposure to phthalates adversely affected the level of reproductive hormones (luteinizing hormone, free testosterone, sex hormone-binding globulin), anogenital distance and thyroid function. The urinary levels of phthalates were significantly higher in the pubertal gynecomastia group, in serum in girls with premature thelarche and in girls with precocious puberty. Epidemiological studies, in spite of their limitations, suggest that phthalates may affect reproductive outcome and children health. Considering the suggested health effects, more epidemiologic data is urgently needed and, in the meantime, precautionary policies must be implemented.

Less iodine injected for the same diagnostic performances: comparison of two low-osmolar contrast agents (iobitridol 350 and iopamidol 370) in coronary angiography and ventriculography: a randomized double-blind clinical study.

PubMed

Velázquez, Maríia Teresa; Albarrán, Agustín; Hernández, Felipe; García Tejada, Julio; Zueco, Javier; Andreu, Javier; De la Torre, Jose-María; Figueroa, Alvaro; Sainz, Fermin; Tascón, Juan

2010-08-01

Mild reductions in iodine concentration could reduce acute side effects after intraarterial contrast media administration without affecting the quality of coronary artery images. This study was designed to show the equivalence in terms of image quality of two nonionic low-osmolar monomers, iobitridol 350 and iopamidol 370, and to compare their clinical safety in coronary angiography and ventriculography. In this multicentre, double-blind clinical trial, 98 adult patients were randomized to receive either iobitridol 350 or iopamidol 370. The image quality (primary evaluation criterion) of the whole examination was assessed using a 5-point scale (poor, fair, moderate, good, excellent). Secondary endpoints were the image quality per territory, diagnostic efficacy, practical comfort (5-point scale: impossible to evaluate, not practical, moderately practical, practical, very practical to use) and clinical safety (adverse events and vital signs). The proportions of examinations presenting with good or excellent global image quality was similar with both contrast media: 87.8% with iobitridol 350 vs. 89.8% with iopamidol 370. Similar results were observed when considering the image quality specifically for each major coronary artery and left ventricle. No difference between groups was found with respect to other secondary criteria. Adverse events occurred in 7 patients with iobitridol 350 (14.3%) and in 10 patients with iopamidol 370 (20.4%). This study showed that, with regard to image quality and diagnostic efficacy and using a lower iodine concentration, iobitridol 350 was comparable to iopamidol 370 in adult patients requiring coronary angiography and ventriculography for diagnostic indications.

The Kaiser Permanente implant registries: effect on patient safety, quality improvement, cost effectiveness, and research opportunities.

PubMed

Paxton, Elizabeth W; Inacio, Maria Cs; Kiley, Mary-Lou

2012-01-01

Considering the high cost, volume, and patient safety issues associated with medical devices, monitoring of medical device performance is critical to ensure patient safety and quality of care. The purpose of this article is to describe the Kaiser Permanente (KP) implant registries and to highlight the benefits of these implant registries on patient safety, quality, cost effectiveness, and research. Eight KP implant registries leverage the integrated health care system's administrative databases and electronic health records system. Registry data collected undergo quality control and validation as well as statistical analysis. Patient safety has been enhanced through identification of affected patients during major recalls, identification of risk factors associated with outcomes of interest, development of risk calculators, and surveillance programs for infections and adverse events. Effective quality improvement activities included medical center- and surgeon-specific profiles for use in benchmarking reports, and changes in practice related to registry information output. Among the cost-effectiveness strategies employed were collaborations with sourcing and contracting groups, and assistance in adherence to formulary device guidelines. Research studies using registry data included postoperative complications, resource utilization, infection risk factors, thromboembolic prophylaxis, effects of surgical delay on concurrent injuries, and sports injury patterns. The unique KP implant registries provide important information and affect several areas of our organization, including patient safety, quality improvement, cost-effectiveness, and research.

The effect of patient race and blood pressure control on patient-physician communication.

PubMed

Cené, Crystal W; Roter, Debra; Carson, Kathryn A; Miller, Edgar R; Cooper, Lisa A

2009-09-01

Racial disparities in hypertension control contribute to higher rates of cardiovascular mortality among blacks. Patient-physician communication quality is associated with better health outcomes, including blood pressure (BP) control. Both race/ethnicity and BP control may adversely affect communication. To determine whether being black and having poor BP control interact to adversely affect patient-physician communication more than either condition alone, a situation referred to as "double jeopardy." Cross-sectional study of enrollment data from a randomized controlled trial of interventions to enhance patient adherence to therapy for hypertension. Participants included 226 hypertensive patients and 39 physicians from 15 primary care practices in Baltimore, MD. Communication behaviors and visit length from coding of audiotapes. After controlling for patient and physician characteristics, blacks with uncontrolled BP have shorter visits (B = -3.9 min, p < 0.01) with less biomedical (B = -24.0, p = 0.05), psychosocial (B = -19.4, p < 0.01), and rapport-building (B = -19.5, p = 0.01) statements than whites with controlled BP. Of all communication outcomes, blacks with uncontrolled BP are only in "double jeopardy" for a patient positive affect-coders give them lower ratings than all other patients. Blacks with controlled BP also experience shorter visits and less communication with physicians than whites with controlled BP. There are no significant communication differences between the visits of whites with uncontrolled versus controlled BP. This study reveals that patient race is associated with the quality of patient-physician communication to a greater extent than BP control. Interventions that improve patient-physician communication should be tested as a strategy to reduce racial disparities in hypertension care and outcomes.

Adverse childhood experiences and health anxiety in adulthood.

PubMed

Reiser, Sarah J; McMillan, Katherine A; Wright, Kristi D; Asmundson, Gordon J G

2014-03-01

Childhood experiences are thought to predispose a person to the development of health anxiety later in life. However, there is a lack of research investigating the influence of specific adverse experiences (e.g., childhood abuse, household dysfunction) on this condition. The current study examined the cumulative influence of multiple types of childhood adversities on health anxiety in adulthood. Adults 18-59 years of age (N=264) completed a battery of measures to assess adverse childhood experiences, health anxiety, and associated constructs (i.e., negative affect and trait anxiety). Significant associations were observed between adverse childhood experiences, health anxiety, and associated constructs. Hierarchical multiple regression analysis indicted that adverse childhood experiences were predictive of health anxiety in adulthood; however, the unique contribution of these experience were no longer significant following the inclusion of the other variables of interest. Subsequently, mediation analyses indicated that both negative affect and trait anxiety independently mediated the relationship between adverse childhood experiences and health anxiety in adulthood. Increased exposure to adverse childhood experiences is associated with higher levels of health anxiety in adulthood; this relationship is mediated through negative affect and trait anxiety. Findings support the long-term negative impact of cumulative adverse childhood experiences and emphasize the importance of addressing negative affect and trait anxiety in efforts to prevent and treat health anxiety. Copyright © 2013 Elsevier Ltd. All rights reserved.

Methods developed to elucidate nursing related adverse events in Japan.

PubMed

Yamagishi, Manaho; Kanda, Katsuya; Takemura, Yukie

2003-05-01

Financial resources for quality assurance in Japanese hospitals are limited and few hospitals have quality monitoring systems of nursing service systems. However, recently its necessity has been recognized. This study has cost effectively used adverse event occurrence rates as indicators of the quality of nursing service, and audited methods of collecting data on adverse events to elucidate their approximate true numbers. Data collection was conducted in July, August and November 2000 at a hospital in Tokyo that administered both primary and secondary health care services (281 beds, six wards, average length of stay 23 days). We collected adverse events through incident reports, logs, check-lists, nurse interviews, medication error questionnaires, urine leucocyte tests, patient interviews and medical records. Adverse events included the unplanned removals of invasive lines, medication errors, falls, pressure sores, skin deficiencies, physical restraints, and nosocomial infections. After evaluating the time and useful outcomes of each source, it soon became clear that we could elucidate adverse events most consistently and cost-effectively through incident reports, check lists, nurse interviews, urine leucocyte tests and medication error questionnaires. This study suggests that many hospitals in Japan could monitor the quality of the nursing service using these sources.

The impact of outpatient chemotherapy-related adverse events on the quality of life of breast cancer patients.

PubMed

Tachi, Tomoya; Teramachi, Hitomi; Tanaka, Kazuhide; Asano, Shoko; Osawa, Tomohiro; Kawashima, Azusa; Yasuda, Masahiro; Mizui, Takashi; Nakada, Takumi; Noguchi, Yoshihiro; Tsuchiya, Teruo; Goto, Chitoshi

2015-01-01

The objective of our study was to clarify the impact of adverse events associated with the initial course of outpatient chemotherapy on the quality of life of breast cancer patients. We conducted a survey to assess the quality of life in 48 breast cancer patients before and after receiving their first course of outpatient chemotherapy at Gifu Municipal Hospital. Patients completed the European Quality of Life 5 Dimensions and Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs before and after 1 course of outpatient chemotherapy. European Quality of Life 5 Dimensions utility value and Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs total score decreased significantly after chemotherapy (p<0.001 and p = 0.018, respectively). The mean scores for the activity, physical condition, and psychological condition subscales of the Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs decreased significantly after chemotherapy (p = 0.003, p<0.001, and p = 0.032, respectively), whereas the social relationships score increased significantly (p<0.001). Furthermore, in the evaluation of quality of life according to individual adverse events, the decrease in quality of life after chemotherapy in terms of the European Quality of Life 5 Dimensions utility value and the Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs total score was greater in anorexic patients than in non-anorexic patients (p = 0.009 and p<0.001, respectively). This suggests that anorexia greatly reduces quality of life. Our findings reveal that anticancer drug-related adverse events, particularly anorexia, reduce overall quality of life following the first course of outpatient chemotherapy in current breast cancer patients. These findings are extremely useful and important in understanding the impact of anticancer drug-related adverse events on quality of life.

Effect of a quality program with adverse events identification on airway management during overtube-assisted enteroscopy.

PubMed

Lara, Luis F; Ukleja, Andrew; Pimentel, Ronnie; Charles, Roger J

2014-11-01

Adverse events associated with overtube-assisted enteroscopy are similar to those with routine endoscopy. Our endoscopy quality program identified a number of respiratory adverse events resulting in emergency resuscitation efforts. The aim is to report all adverse events identified by quality monitoring and outcomes of adverse events associated with overtube-assisted enteroscopy. A retrospective study used data prospectively obtained from consecutive patients undergoing overtube-assisted enteroscopy between December 2008 and July 2012. Patient characteristics, medical history, procedure indication, and procedure outcomes, including diagnosis, endoscopic therapy, and complications, were obtained. In 432 overtube-assisted enteroscopies, 15 adverse events (most frequently hypoxemia, 9 /15, 60 %) occurred in 14 patients (3.2 % of total cohort; 12 were outpatients) mostly during antegrade enteroscopy. Four patients required endotracheal intubation and 4 /12 outpatients required intensive care. The procedure was aborted in 13 /14 patients, and only 1 of 10 patients scheduled for repeat antegrade enteroscopy returned. There was no mortality. Based on the frequency of adverse events, and in consultation with anesthesia providers, from August 2012 all antegrade overtube-assisted enteroscopies at our institution were done with general anesthesia. From then till September 2013, 145 antegrade and 52 retrograde overtube-assisted enteroscopies have been done, with no adverse events. Monitoring of endoscopy practice identified adverse events associated with overtube-assisted enteroscopy. The peer-review prompted a change in practice: all patients undergoing antegrade overtube-assisted enteroscopy at our institution now have endotracheal intubation which has dramatically decreased the rate of respiratory adverse events. The impact of endoscopic quality measurements on practices, procedures, and outcomes will be of further interest. © Georg Thieme Verlag KG Stuttgart · New York.

The quality of our Nation's waters: water quality in the Denver Basin aquifer system, Colorado, 2003-05

USGS Publications Warehouse

Bauch, Nancy J.; Musgrove, MaryLynn; Mahler, Barbara J.; Paschke, Suzanne

2015-01-01

Availability and sustainability of groundwater in the Denver Basin aquifer system depend on water quantity and water quality. The Denver Basin aquifer system underlies about 7,000 square miles of the Great Plains in eastern Colorado and is the primary or sole source of water for domestic and public supply in many areas of the basin. Use of groundwater from the Denver Basin sandstone aquifers has been instrumental for development of the south Denver metropolitan area and other areas, but has resulted in a decline in water levels in some parts of the system. Human activities in many areas have adversely affected the quality of water in the aquifer system, especially the shallow parts. Groundwater in deeper parts of the system used for drinking water, once considered isolated from the effects of overlying land use, is increasingly vulnerable to contamination from human activities and geologic materials. Availability and sustainability of high-quality groundwater are vital to the economic health of the Denver Basin area.

Modelling of 10 Gbps Free Space Optics Communication Link Using Array of Receivers in Moderate and Harsh Weather Conditions

NASA Astrophysics Data System (ADS)

Gupta, Amit; Shaina, Nagpal

2017-08-01

Intersymbol interference and attenuation of signal are two major parameters affecting the quality of transmission in Free Space Optical (FSO) Communication link. In this paper, the impact of these parameters on FSO communication link is analysed for delivering high-quality data transmission. The performance of the link is investigated under the influence of amplifier in the link. The performance parameters of the link like minimum bit error rate, received signal power and Quality factor are examined by employing erbium-doped fibre amplifier in the link. The effects of amplifier are visualized with the amount of received power. Further, the link is simulated for moderate weather conditions at various attenuation levels on transmitted signal. Finally, the designed link is analysed in adverse weather conditions by using high-power laser source for optimum performance.

Relationships of Childhood Adverse Experiences With Mental Health and Quality of Life at Treatment Start for Adult Refugees Traumatized by Pre-Flight Experiences of War and Human Rights Violations.

PubMed

Opaas, Marianne; Varvin, Sverre

2015-09-01

Adverse and potentially traumatic experiences (PTEs) in childhood were examined among 54 adult refugee patients with pre-flight PTEs of war and human rights violations (HRVs) and related to mental health and quality of life at treatment start. Extent of childhood PTEs was more strongly related to mental health and quality of life than the extent of war and HRV experiences. Childhood PTEs were significantly related to arousal and avoidance symptoms of posttraumatic stress disorder (PTSD) and to quality of life, whereas pre-flight war and HRV experiences were significantly related to reexperiencing symptoms of PTSD only. Within childhood adversities, experiences of family violence and external violence, but not of loss and illness, were significantly related to increased mental health symptoms and reduced quality of life. These results point to the importance of taking childhood adverse experiences into account in research and treatment planning for adult refugees with war and HRVs trauma.

Ameliorating the biological impacts of childhood adversity: A review of intervention programs.

PubMed

Purewal Boparai, Sukhdip K; Au, Vanessa; Koita, Kadiatou; Oh, Debora Lee; Briner, Susan; Burke Harris, Nadine; Bucci, Monica

2018-05-01

Childhood adversity negatively impacts the biological development of children and has been linked to poor health outcomes across the life course. The purpose of this literature review is to explore and evaluate the effectiveness of interventions that have addressed an array of biological markers and physical health outcomes in children and adolescents affected by adversity. PubMed, CINAHL, PsychInfo, Sociological Abstracts databases and additional sources (Cochrane, WHO, NIH trial registries) were searched for English language studies published between January 2007 and September 2017. Articles with a childhood adversity exposure, biological health outcome, and evaluation of intervention using a randomized controlled trial study design were selected. The resulting 40 intervention studies addressed cortisol outcomes (n = 20) and a range of neurological, epigenetic, immune, and other outcomes (n = 22). Across institutional, foster care, and community settings, intervention programs demonstrated success overall for improving or normalizing morning and diurnal cortisol levels, and ameliorating the impacts of adversity on brain development, epigenetic regulation, and additional outcomes in children. Factors such as earlier timing of intervention, high quality and nurturant parenting traits, and greater intervention engagement played a role in intervention success. This study underlines progress and promise in addressing the health impacts of adversity in children. Ongoing research efforts should collect baseline data, improve retention, replicate studies in additional samples and settings, and evaluate additional variables, resilience factors, mediators, and long-term implications of results. Clinicians should integrate lessons from the intervention sciences for preventing and treating the health effects of adversity in children and adolescents. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Recording Adverse Events Following Joint Arthroplasty: Financial Implications and Validation of an Adverse Event Assessment Form.

PubMed

Lee, Matthew J; Mohamed, Khalid M S; Kelly, John C; Galbraith, John G; Street, John; Lenehan, Brian J

2017-09-01

In Ireland, funding of joint arthroplasty procedures has moved to a pay-by-results national tariff system. Typically, adverse clinical events are recorded via retrospective chart-abstraction methods by administrative staff. Missed or undocumented events not only affect the quality of patient care but also may unrealistically skew budgetary decisions that impact fiscal viability of the service. Accurate recording confers clinical benefits and financial transparency. The aim of this study was to compare a prospectively implemented adverse events form with the current national retrospective chart-abstraction method in terms of pay-by-results financial implications. An adverse events form adapted from a similar validated model was used to prospectively record complications in 51 patients undergoing total hip or knee arthroplasties. Results were compared with the same cohort using an existing data abstraction method. Both data sets were coded in accordance with current standards for case funding. Overall, 114 events were recorded during the study through prospective charting of adverse events, compared with 15 events documented by customary method (a significant discrepancy). Wound drainage (15.8%) was the most common complication, followed by anemia (7.9%), lower respiratory tract infections (7.9%), and cardiac events (7%). A total of €61,956 ($67,778) in missed funding was calculated as a result. This pilot study demonstrates the ability to improve capture of adverse events through use of a well-designed assessment form. Proper perioperative data handling is a critical aspect of financial subsidies, enabling optimal allocation of funds. Copyright © 2017 Elsevier Inc. All rights reserved.

Mastering Resilience in Oncology: Learn to Thrive in the Face of Burnout.

PubMed

Hlubocky, Fay J; Rose, Miko; Epstein, Ronald M

2017-01-01

Oncology clinician burnout has become a noteworthy issue in medical oncology directly affecting the quality of patient care, patient satisfaction, and overall organizational success. Due to the increasing demands on clinical time, productivity, and the evolving medical landscape, the oncology clinician is at significant risk for burnout. Long hours in direct care with seriously ill patients/families, limited control over daily responsibilities, and endless electronic documentation, place considerable professional and personal demands on the oncologist. As a result, the oncology clinician's wellness is adversely impacted. Physical/emotional exhaustion, cynicism, and feelings of ineffectiveness evolve as core signs of burnout. Unaddressed burnout may affect cancer clinician relationships with their patients, the quality of care delivered, and the overall physical and emotional health of the clinician. Oncology clinicians should be encouraged to build upon their strengths, thrive in the face of adversity and stress, and learn to positively adapt to the changing cancer care system. Fostering individual resilience is a key protective factor against the development of and managing burnout. Empowering clinicians at both the individual and organizational level with tailored resilience strategies is crucial to ensuring clinician wellness. Resilience interventions may include: burnout education, work-life balance, adjustment of one's relationship to work, mindful practice, and acceptance of the clinical work environment. Health care organizations must act to provide institutional solutions through the implementation of: team-based oncology care, communication skills training, and effective resiliency training programs in order to mitigate the effects of stress and prevent burnout in oncology.

International Space Station Air Quality Assessed According to Toxicologically-Grouped Compounds

NASA Technical Reports Server (NTRS)

James, John T.; Limero, Thomas F.; Beck, Steve; Cheng, Patti F.; deVera, Vanessa J.; Hand, Jennifer; Macatangay, Ariel

2010-01-01

Scores of compounds are found in the International Space Station (ISS) atmospheric samples that are returned to the Johnson Space Center Toxicology Laboratory for analysis. Spacecraft Maximum Allowable Concentrations (SMACs) are set with the view that each compound is present as if there were no other compounds present. In order to apply SMACs to the interpretation of the analytical data, the toxicologist must employ some method of combining the potential effects of the aggregate of compounds found in the atmospheric samples. The simplest approach is to assume that each quantifiable compound has the potential for some effect in proportion to the applicable SMAC, and then add all the proportions. This simple paradigm disregards the fact that most compounds have potential to adversely affect only a few physiological systems, and their effects would be independent rather than additive. An improved approach to dealing with exposure to mixtures is to add the proportions only for compounds that adversely affect the same physiological system. For example, toxicants that cause respiratory irritation are separated from those that cause neurotoxicity or cardio-toxicity. Herein we analyze ISS air quality data according to toxicological groups with a view that this could be used for understanding any crew symptoms occurring at the time of the sample acquisition. In addition, this approach could be useful in post-flight longitudinal surveys where the flight surgeon may need to identify post-flight, follow-up medical studies because of on-orbit exposures that target specific physiological systems.

International Space Station Air Quality Assessed According to Toxicologically-Grouped Compounds

NASA Technical Reports Server (NTRS)

James, John T.; Limero, Tom; DeVera, Vanessa; Cheng, Patti; Hand, Jennifer; Macatangay, Ariel; Beck, Steve

2009-01-01

Scores of compounds are found in the International Space Station (ISS) atmospheric samples that are returned to the Johnson Space Center Toxicology Laboratory for analysis. Spacecraft Maximum Allowable Concentrations (SMACs) are set with the view that each compound is present as if there were no other compounds present. In order to apply SMACs to the interpretation of the analytical data, the toxicologist must employ some method of combining the potential effects of the aggregate of compounds found in the atmospheric samples. The simplest approach is to assume that each quantifiable compound has the potential for some effect in proportion to the applicable SMAC, and then add all the proportions. This simple paradigm disregards the fact that most compounds have potential to adversely affect only a few physiological systems, and their effects would be independent rather than additive. An improved approach to dealing with exposure to mixtures is to add the proportions only for compounds that adversely affect the same physiological system. For example, toxicants that cause respiratory irritation are separated from those that cause neurotoxicity or cardio-toxicity. Herein we analyze ISS air quality data according to toxicological groups with a view that this could be used for understanding any crew symptoms occurring at the time of the sample. In addition, this approach could be useful in post-flight longitudinal surveys where the flight surgeon may need to identify post-flight, follow-up medical studies because of on-orbit exposures that target specific physiological systems.

Factors Associated with Intern Fatigue

PubMed Central

Vidyarthi, Arpana R.; Baron, Robert B.; Katz, Patricia P.

2008-01-01

ABSTRACT BACKGROUND Prior data suggest that fatigue adversely affects patient safety and resident well-being. ACGME duty hour limitations were intended, in part, to reduce resident fatigue, but the factors that affect intern fatigue are unknown. OBJECTIVE To identify factors associated with intern fatigue following implementation of duty hour limitations. DESIGN Cross-sectional confidential survey of validated questions related to fatigue, sleep, and stress, as well as author-developed teamwork questions. SUBJECTS Interns in cognitive specialties at the University of California, San Francisco. MEASUREMENTS Univariate statistics characterized the distribution of responses. Pearson correlations elucidated bivariate relationships between fatigue and other variables. Multivariate linear regression models identified factors independently associated with fatigue, sleep, and stress. RESULTS Of 111 eligible interns, 66 responded (59%). In a regression analysis including gender, hours worked in the previous week, sleep quality, perceived stress, and teamwork, only poorer quality of sleep and greater perceived stress were significantly associated with fatigue (p < 0.001 and p = 0.02, respectively). To identify factors that may affect sleep, specifically duty hours and stress, a secondary model was constructed. Only greater perceived stress was significantly associated with diminished sleep quality (p = 0.04), and only poorer teamwork was significantly associated with perceived stress (p < 0.001). Working >80 h was not significantly associated with perceived stress, quality of sleep, or fatigue. CONCLUSIONS Simply decreasing the number of duty hours may be insufficient to reduce intern fatigue. Residency programs may need to incorporate programmatic changes to reduce stress, improve sleep quality, and foster teamwork in order to decrease intern fatigue and its deleterious consequences. PMID:18807096

Health-related quality of life after maxillectomy: obturator rehabilitation compared with flap reconstruction.

PubMed

Breeze, J; Rennie, A; Morrison, A; Dawson, D; Tipper, J; Rehman, K; Grew, N; Snee, D; Pigadas, N

2016-10-01

Health-related quality of life (QoL) reported by patients has the potential to improve care after ablative surgery of the midface, as existing treatment algorithms still generally revolve around outcomes assessed traditionally only by clinicians. Decisions in particular relate to reconstruction with a flap compared with rehabilitation with an obturator, the need for adjuvant treatment, and morbidity related to the size of the defect. We prospectively collected health-related QoL assessments for 39 consecutive patients treated by maxillectomy between 01 January 2010 and 31 December 2014 using the University of Washington Quality of Life Questionnaire, and who had a mean (SD) duration of follow-up of 14 (4). We made sub-group analyses using paired t tests and analysis of variance (ANOVA) to compare reconstruction with a flap with rehabilitation with obturators, size of the vertical defect, and whether adjuvant treatment with radiotherapy or chemoradiotherapy adversely affected it. Overall there was a significant decrease in health-related QoL after treatment compared with before (p<0.001), but there was no significant difference in the effects of any of the paired reconstructive and rehabilitation treatments on it. Obturators remain an important option for rehabilitation in selected patients in addition to reconstruction with a flap. We found that neither increasing the size of the vertical defect (in an attempt to ensure clear margins) nor the use of postoperative radiotherapy seemed to have any adverse effect on QoL. More patients are required before we can conclude that the potential survival benefits of such measures may outweigh any adverse effects. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Low-fiber alfalfa (Medicago sativa L.) meal in the laying hen diet: effects on productive traits and egg quality.

PubMed

Laudadio, V; Ceci, E; Lastella, N M B; Introna, M; Tufarelli, V

2014-07-01

This study was designed to determine the effects on laying performance and egg quality resulting from partial substitution of soybean meal (SBM) with low-fiber alfalfa (LFA; Medicago sativa L.) meal in the diet of early-phase laying hens. ISA Brown layers, 18 wk of age, were randomly allocated to 2 dietary treatments and fed for 10 wk. The hens were fed 2 wheat middling-based diets: a control diet, which contained SBM (15% of diet), and a test diet containing LFA (15% of diet) as the main protein source. Low-fiber alfalfa meal was obtained by a combination of sieving and air-classification processes. Feed intake was recorded daily, and egg production was calculated on a hen-day basis; eggs from each group were weekly collected to evaluate egg components and quality. The partial substitution of SBM with LFA had no adverse effect on growth performance of early-phase laying hens. Egg production and none of the egg-quality traits examined were influenced by dietary treatment, except for yolk color (P < 0.001) and yolk percentage (P < 0.05) as well as yolk cholesterol and β-carotene contents (P < 0.001), which were improved in hens fed the LFA diet. Including LFA increased serum β-carotene and reduced serum cholesterol concentrations (P < 0.001). Our results suggest that partially replacing conventional SBM as protein source with low-fiber alfalfa meal in the laying-hen diet can positively influence yolk quality without adversely affecting productive traits. © 2014 Poultry Science Association Inc.

Benefit-cost analysis of moist exposed burn ointment.

PubMed

Atiyeh, Bishara S; Dham, Ruwayda; Kadry, Mohammaed; Abdallah, Abdel Fattah; Al-Oteify, Mahmoud; Fathi, Osman; Samir, Ahmed

2002-11-01

Burn injury is one of the most devastating injuries that may affect a patient. Even in economically deprived areas, burn care is largely driven by relatively plentiful resources equating quality of care with generous monitoring and clinical attention with little concern to management cost. Burn care costs have been the subject of very few investigations and are among the least studied by health services researchers. Nevertheless, it can be stated that local care of burn wounds accounts for a large proportion of the cost per day for treating patients. As economic times are changing and as market penetration of managed care contracts and stiff competition in the health care industry gains momentum, ways to reduce expenditures without adversely affecting the quality of care have become of primary importance. We report a randomized prospective comparative study analyzing the benefit-cost value of moist exposed burn ointment (MEBO) application, an exposed method for burn wound care without the need for a secondary covering dressing, as compared to conventional closed methods.

Inexact hardware for modelling weather & climate

NASA Astrophysics Data System (ADS)

Düben, Peter D.; McNamara, Hugh; Palmer, Tim

2014-05-01

The use of stochastic processing hardware and low precision arithmetic in atmospheric models is investigated. Stochastic processors allow hardware-induced faults in calculations, sacrificing exact calculations in exchange for improvements in performance and potentially accuracy and a reduction in power consumption. A similar trade-off is achieved using low precision arithmetic, with improvements in computation and communication speed and savings in storage and memory requirements. As high-performance computing becomes more massively parallel and power intensive, these two approaches may be important stepping stones in the pursuit of global cloud resolving atmospheric modelling. The impact of both, hardware induced faults and low precision arithmetic is tested in the dynamical core of a global atmosphere model. Our simulations show that both approaches to inexact calculations do not substantially affect the quality of the model simulations, provided they are restricted to act only on smaller scales. This suggests that inexact calculations at the small scale could reduce computation and power costs without adversely affecting the quality of the simulations.

Effects of Individual Nurse and Hospital Characteristics on Patient Adverse Events and Quality of Care: A Multilevel Analysis.

PubMed

Lee, Seung Eun; Vincent, Catherine; Dahinten, V Susan; Scott, Linda D; Park, Chang Gi; Dunn Lopez, Karen

2018-06-14

This study aimed to investigate effects of individual nurse and hospital characteristics on patient adverse events and quality of care using a multilevel approach. This is a secondary analysis of a combination of nurse survey data (N = 1,053 nurses) and facility data (N = 63 hospitals) in Canada. Multilevel ordinal logistic regression was employed to examine effects of individual nurse and hospital characteristics on patient adverse events. Multilevel linear regressions were used to investigate effects of individual nurse and hospital characteristics on quality of care. Organizational safety culture was associated with patient adverse events and quality of care. Controlling for effects of nurse and hospital characteristics, nurses in hospitals with a stronger safety culture were 64% less likely to report administration of wrong medication, time, or dose; 58% less likely to report patient falls with injury; and 60% less likely to report urinary tract infections; and were more likely to report higher levels of quality of care. Additionally, the effects of individual-level baccalaureate education and years of experience on quality of care differed across hospitals, and hospital-level nurse education interacted with individual-level baccalaureate education. This study makes significant contributions to existing knowledge regarding the positive effect of organizational safety culture on patient adverse events and quality of care. Healthcare organizations should strive to improve their safety culture by creating environments where healthcare providers trust each other, work collaboratively, and share accountability for patient safety and care quality. © 2018 Sigma Theta Tau International.

Medicare payment changes and nursing home quality: effects on long-stay residents.

PubMed

Konetzka, R Tamara; Norton, Edward C; Stearns, Sally C

2006-09-01

The Balanced Budget Act of 1997 dramatically changed the way that Medicare pays skilled nursing facilities, providing a natural experiment in nursing home behavior. Medicare payment policy (directed at short-stay residents) may have affected outcomes for long-stay, chronic-care residents if services for these residents were subsidized through cost-shifting prior to implementation of Medicare prospective payment for nursing homes. We link changes in both the form and level of Medicare payment at the facility level with changes in resident-level quality, as represented by pressure sores and urinary tract infections in Minimum Data Set (MDS) assessments. Results show that long-stay residents experienced increased adverse outcomes with the elimination of Medicare cost reimbursement.

The future of dentistry: new challenges, new directions.

PubMed Central

Sinkford, J. C.

1990-01-01

The challenge to our profession today is to improve the quality of oral health while overcoming both extrinsic and intrinsic factors which may adversely affect our progress toward this goal. The combined efforts of dental education, dental research, and dental practice will be needed to enable us to maintain the quality of our present system and to meet the myriad changes that will chart our new directions in the future. Our unified efforts can make a difference and, thereby, ensure a meaningful and productive future for dentistry in our country and throughout the world. Let us show the world that the future of dentistry matters to us and that we look to the future with great anticipation and optimism. PMID:2352286

High Efficiency InP Solar Cells from Low Toxicity Tertiarybutylphosphine

NASA Technical Reports Server (NTRS)

Hoffman, Richard W., Jr.; Fatemi, Navid S.; Wilt, David M.; Jenkins, Phillip P.; Brinker, David J.; Scheiman, David A.

1994-01-01

Large scale manufacture of phosphide based semiconductor devices by organo-metallic vapor phase epitaxy (OMVPE) typically requires the use of highly toxic phosphine. Advancements in phosphine substitutes have identified tertiarybutylphosphine (TBP) as an excellent precursor for OMVPE of InP. High quality undoped and doped InP films were grown using TBP and trimethylindium. Impurity doped InP films were achieved utilizing diethylzinc and silane for p and n type respectively. 16 percent efficient solar cells under air mass zero, one sun intensity were demonstrated with Voc of 871 mV and fill factor of 82.6 percent. It was shown that TBP could replace phosphine, without adversely affecting device quality, in OMVPE deposition of InP thus significantly reducing toxic gas exposure risk.

Effect of socioeconomic status disparity on child language and neural outcome: how early is early?

PubMed

Hurt, Hallam; Betancourt, Laura M

2016-01-01

It is not news that poverty adversely affects child outcome. The literature is replete with reports of deleterious effects on developmental outcome, cognitive function, and school performance in children and youth. Causative factors include poor nutrition, exposure to toxins, inadequate parenting, lack of cognitive stimulation, unstable social support, genetics, and toxic environments. Less is known regarding how early in life adverse effects may be detected. This review proposes to elucidate "how early is early" through discussion of seminal articles related to the effect of socioeconomic status on language outcome and a discussion of the emerging literature on effects of socioeconomic status disparity on brain structure in very young children. Given the young ages at which such outcomes are detected, the critical need for early targeted interventions for our youngest is underscored. Further, the fiscal reasonableness of initiating quality interventions supports these initiatives. As early life adversity produces lasting and deleterious effects on developmental outcome and brain structure, increased focus on programs and policies directed to reducing the impact of socioeconomic disparities is essential.

Impact of patient communication problems on the risk of preventable adverse events in acute care settings

PubMed Central

Bartlett, Gillian; Blais, Régis; Tamblyn, Robyn; Clermont, Richard J.; MacGibbon, Brenda

2008-01-01

Background Up to 50% of adverse events that occur in hospitals are preventable. Language barriers and disabilities that affect communication have been shown to decrease quality of care. We sought to assess whether communication problems are associated with an increased risk of preventable adverse events. Methods We randomly selected 20 general hospitals in the province of Quebec with at least 1500 annual admissions. Of the 145 672 admissions to the selected hospitals in 2000/01, we randomly selected and reviewed 2355 charts of patients aged 18 years or older. Reviewers abstracted patient characteristics, including communication problems, and details of hospital admission, and assessed the cause and preventability of identified adverse events. The primary outcome was adverse events. Results Of 217 adverse events, 63 (29%) were judged to be preventable, for an overall population rate of 2.7% (95% confidence interval [CI] 2.1%–3.4%). We found that patients with preventable adverse events were significantly more likely than those without such events to have a communication problem (odds ratio [OR] 3.00; 95% CI 1.43–6.27) or a psychiatric disorder (OR 2.35; 95% CI 1.09–5.05). Patients who were admitted urgently were significantly more likely than patients whose admissions were elective to experience an event (OR 1.64, 95% CI 1.07–2.52). Preventable adverse events were mainly due to drug errors (40%) or poor clinical management (32%). We found that patients with communication problems were more likely than patients without these problems to experience multiple preventable adverse events (46% v. 20%; p = 0.05). Interpretation Patients with communication problems appeared to be at highest risk for preventable adverse events. Interventions to reduce the risk for these patients need to be developed and evaluated. PMID:18519903

40 CFR 264.93 - Hazardous constituents.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Administrator will consider the following: (1) Potential adverse effects on ground-water quality, considering... (2) Potential adverse effects on hydraulically-connected surface water quality, considering: (i) The... specify in the facility permit the hazardous constituents to which the ground-water protection standard of...

40 CFR 264.94 - Concentration limits.

Code of Federal Regulations, 2013 CFR

2013-07-01

... consider the following factors: (1) Potential adverse effects on ground-water quality, considering: (i) The...) Potential adverse effects on hydraulically-connected surface-water quality, considering: (i) The volume and... specify in the facility permit concentration limits in the ground water for hazardous constituents...

40 CFR 264.94 - Concentration limits.

Code of Federal Regulations, 2012 CFR

2012-07-01

... consider the following factors: (1) Potential adverse effects on ground-water quality, considering: (i) The...) Potential adverse effects on hydraulically-connected surface-water quality, considering: (i) The volume and... specify in the facility permit concentration limits in the ground water for hazardous constituents...

40 CFR 264.94 - Concentration limits.

Code of Federal Regulations, 2014 CFR

2014-07-01

... consider the following factors: (1) Potential adverse effects on ground-water quality, considering: (i) The...) Potential adverse effects on hydraulically-connected surface-water quality, considering: (i) The volume and... specify in the facility permit concentration limits in the ground water for hazardous constituents...

40 CFR 264.93 - Hazardous constituents.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Administrator will consider the following: (1) Potential adverse effects on ground-water quality, considering... (2) Potential adverse effects on hydraulically-connected surface water quality, considering: (i) The... specify in the facility permit the hazardous constituents to which the ground-water protection standard of...

Effects of Heart Failure and its Pharmacological Management on Sleep

PubMed Central

Jiménez, Jessica A.; Greenberg, Barry H.; Mills, Paul J.

2011-01-01

Heart failure (HF) patients have a high prevalence of disturbed sleep. Optimal pharmacological management of HF includes the use of angiotensin converting enzyme inhibitors and β-blockers, which have been associated with decreased severity of central sleep apnea, which is likely secondary to improvements in cardiac performance. There is also evidence, however, indicating that other pharmacological treatments for HF might adversely affect sleep. This brief review introduces the topic of disturbed sleep in HF and examines the extent to which its standard pharmacological management impacts sleep quality. PMID:22125571

The Treatment of Allergic Respiratory Disease During Pregnancy.

PubMed

Namazy, Jai; Schatz, M

2016-01-01

Pregnancy may be complicated by new-onset or preexisting asthma and allergic rhinitis.This article reviews the recognition and management of asthma and allergic rhinitis during pregnancy, paying close attention to the general principles of allergy and use of asthma medication during pregnancy. Both allergic rhinitis and asthma can adversely affect both maternal quality of life and, in the case of maternal asthma, perinatal outcomes. Optimal management is thus important for both mother and baby. This article reviews the safety of asthma and allergy medications commonly used during pregnancy.

The Relationship between Self-Compassion and Sleep in the College Population

ERIC Educational Resources Information Center

Bricklin-Small, David

2017-01-01

Quality sleep is something which many people, notably those in the college population, fail to get. It is well known that poor sleep quality can lead to adverse functional outcomes in daily life. It is important to understand what factors are associated with better sleep quality and less adverse outcomes. The primary aim of this study was to…

Once-daily USL255 as adjunctive treatment of partial-onset seizures: Randomized phase III study

PubMed Central

Chung, Steve S; Fakhoury, Toufic A; Hogan, R Edward; Nagaraddi, Venkatesh N; Blatt, Ilan; Lawson, Balduin; Arnold, Stephan; Anders, Bob; Clark, Annie M; Laine, Dawn; Meadows, R Shawn; Halvorsen, Mark B

2014-01-01

Objective To evaluate the efficacy and safety of USL255, Qudexy™ XR (topiramate) extended-release capsules, as an adjunctive treatment for refractory partial-onset seizures (POS) in adults taking one to three concomitant antiepileptic drugs. Methods In this global phase III study (PREVAIL; NCT01142193), 249 adults with POS were randomized 1:1 to once-daily USL255 (200 mg/day) or placebo. The primary and key secondary efficacy endpoints were median percent reduction in weekly POS frequency and responder rate (proportion of patients with ≥50% reduction in seizure frequency). Seizure freedom was also assessed. Safety (adverse events, clinical and laboratory findings), as well as treatment effects on quality of life (QOLIE-31-P) and clinical global impression of change (CGI-C), were evaluated. Results Across the entire 11-week treatment phase, USL255 significantly reduced the median percent seizure frequency and significantly improved responder rate compared with placebo. Efficacy over placebo was observed early in treatment, in patients with highly refractory POS, and in those with the most debilitating seizure types (i.e., complex partial, partial secondarily generalized). USL255 was safe and generally well tolerated with a low incidence of neurocognitive adverse events. USL255 was associated with significant clinical improvement without adversely affecting quality of life. Significance The PREVAIL phase III clinical study demonstrated that once-daily USL255 (200 mg/day) significantly improved seizure control and was safe and generally well tolerated with few neurocognitive side effects. PMID:24902983

Household Food Insecurity Is Associated with Adverse Mental Health Indicators and Lower Quality of Life among Koreans: Results from the Korea National Health and Nutrition Examination Survey 2012-2013.

PubMed

Chung, Hye-Kyung; Kim, Oh Yoen; Kwak, So Young; Cho, Yoonsu; Lee, Kyong Won; Shin, Min-Jeong

2016-12-16

Food insecurity is an ongoing public health issue and contributes to mental health status. We investigated whether food insecurity is associated with inadequate nutrient intake and whether it affects mental health indicators (perceived stress/experience of depressive symptom/suicidal ideation) and quality of life (QOL) among Koreans ( n = 5862, 20-64 years) using data from the Korea National Health and Nutritional Examination Survey (2012-2013). Household food security status was categorized as "food-secure household", "food-insecure household without hunger", and "food-insecure household with hunger". Data on food insecurity, sociodemographic factors, nutrient intake, mental health indicators, and QOL were used. A logistic regression model was conducted to determine odds ratios (ORs) for psychological health. A greater proportion of food-insecure participants were nutritionally deficient compared with expectations of the 2015 Korean Dietary Reference Intakes. These deficiencies were generally higher in both "food-insecure household" groups. Both "food-insecure household" groups, particularly the "food-insecure household with hunger" group showed significantly adverse mental health status (ORs: 1.52-3.83) and lower QOL (ORs: 1.49-3.92) than did the "food-secure household" group before and after adjusting for sex, age, education, household income, smoking/alcohol consumption, physical activity, marital status, and receiving food assistance. In conclusion, food insecurity may be significantly associated with adverse mental health indicators and decreased QOL in young/middle-aged Koreans.

40 CFR 230.75 - Actions affecting plant and animal populations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Actions affecting plant and animal... Actions To Minimize Adverse Effects § 230.75 Actions affecting plant and animal populations. Minimization of adverse effects on populations of plants and animals can be achieved by: (a) Avoiding changes in...

40 CFR 230.75 - Actions affecting plant and animal populations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Actions affecting plant and animal... Actions To Minimize Adverse Effects § 230.75 Actions affecting plant and animal populations. Minimization of adverse effects on populations of plants and animals can be achieved by: (a) Avoiding changes in...

40 CFR 230.75 - Actions affecting plant and animal populations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Actions affecting plant and animal... Actions To Minimize Adverse Effects § 230.75 Actions affecting plant and animal populations. Minimization of adverse effects on populations of plants and animals can be achieved by: (a) Avoiding changes in...

40 CFR 230.75 - Actions affecting plant and animal populations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Actions affecting plant and animal... Actions To Minimize Adverse Effects § 230.75 Actions affecting plant and animal populations. Minimization of adverse effects on populations of plants and animals can be achieved by: (a) Avoiding changes in...

40 CFR 230.76 - Actions affecting human use.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Actions affecting human use. 230.76... Minimize Adverse Effects § 230.76 Actions affecting human use. Minimization of adverse effects on human use... aquatic areas; (c) Timing the discharge to avoid the seasons or periods when human recreational activity...

40 CFR 230.76 - Actions affecting human use.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Actions affecting human use. 230.76... Minimize Adverse Effects § 230.76 Actions affecting human use. Minimization of adverse effects on human use... aquatic areas; (c) Timing the discharge to avoid the seasons or periods when human recreational activity...

40 CFR 230.76 - Actions affecting human use.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Actions affecting human use. 230.76... Minimize Adverse Effects § 230.76 Actions affecting human use. Minimization of adverse effects on human use... aquatic areas; (c) Timing the discharge to avoid the seasons or periods when human recreational activity...

40 CFR 230.76 - Actions affecting human use.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Actions affecting human use. 230.76... Minimize Adverse Effects § 230.76 Actions affecting human use. Minimization of adverse effects on human use... aquatic areas; (c) Timing the discharge to avoid the seasons or periods when human recreational activity...

40 CFR 230.76 - Actions affecting human use.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Actions affecting human use. 230.76... Minimize Adverse Effects § 230.76 Actions affecting human use. Minimization of adverse effects on human use... aquatic areas; (c) Timing the discharge to avoid the seasons or periods when human recreational activity...

Relationships of Childhood Adverse Experiences With Mental Health and Quality of Life at Treatment Start for Adult Refugees Traumatized by Pre-Flight Experiences of War and Human Rights Violations

PubMed Central

Opaas, Marianne; Varvin, Sverre

2015-01-01

Abstract Adverse and potentially traumatic experiences (PTEs) in childhood were examined among 54 adult refugee patients with pre-flight PTEs of war and human rights violations (HRVs) and related to mental health and quality of life at treatment start. Extent of childhood PTEs was more strongly related to mental health and quality of life than the extent of war and HRV experiences. Childhood PTEs were significantly related to arousal and avoidance symptoms of posttraumatic stress disorder (PTSD) and to quality of life, whereas pre-flight war and HRV experiences were significantly related to reexperiencing symptoms of PTSD only. Within childhood adversities, experiences of family violence and external violence, but not of loss and illness, were significantly related to increased mental health symptoms and reduced quality of life. These results point to the importance of taking childhood adverse experiences into account in research and treatment planning for adult refugees with war and HRVs trauma. PMID:26103604

Quantifying and Reducing Light Pollution

NASA Astrophysics Data System (ADS)

Gokhale, Vayujeet; Caples, David; Goins, Jordan; Herdman, Ashley; Pankey, Steven; Wren, Emily

2018-06-01

We describe the current level of light pollution in and around Kirksville, Missouri and around Anderson Mesa near Flagstaff, Arizona. We quantify the amount of light that is projected up towards the sky, instead of the ground, using Unihedron sky quality meters installed at various locations. We also present results from DSLR photometry of several standard stars, and compare the photometric quality of the data collected at locations with varying levels of light pollution. Presently, light fixture shields and ‘warm-colored’ lights are being installed on Truman State University’s campus in order to reduce light pollution. We discuss the experimental procedure we use to test the effectiveness of the different light fixtures shields in a controlled setting inside the Del and Norma Robison Planetarium.Apart from negatively affecting the quality of the night sky for astronomers, light pollution adversely affects migratory patterns of some animals and sleep-patterns in humans, increases our carbon footprint, and wastes resources and money. This problem threatens to get particularly acute with the increasing use of outdoor LED lamps. We conclude with a call to action to all professional and amateur astronomers to act against the growing nuisance of light pollution.

Carcass traits and meat quality of Nellore cattle fed different non-fiber carbohydrates sources associated with crude glycerin.

PubMed

Favaro, V R; Ezequiel, J M B; Almeida, M T C; D'Aurea, A P; Paschoaloto, J R; van Cleef, E H C B; Carvalho, V B; Junqueira, N B

2016-08-01

Crude glycerin, a potential energy source for ruminant animals, has been evaluated, mainly, in diets with high starch content. However, a limit number of studies have evaluated the inclusion of crude glycerin in low starch diets. This study aimed to evaluate the effects of the association of crude glycerin with corn grain or citrus pulp on carcass traits and meat quality of Nellore bulls (n=30, 402±31 kg initial weight). The treatment consisted of: CON=control, without crude glycerin; CG10=10% of crude glycerin and corn grain; CG15=15% of crude glycerin and corn grain; CP10=10% of crude glycerin and citrus pulp; CP15=15% of crude glycerin and citrus pulp. The performance parameters and carcass traits were not affected by treatments (P>0.05). The inclusion of crude glycerin decreased yellow color intensity and increased fatty acids pentadecanoic and heptadecenoic in meat (P<0.05), without affecting neither the concentration of polyunsaturated fatty acids nor the relationship of saturated and unsaturated fatty acids. The association of crude glycerin with corn or citrus pulp has no adverse effects on carcass characteristics and meat quality.

Trainee participation is associated with adverse outcomes in emergency general surgery: an analysis of the National Surgical Quality Improvement Program database.

PubMed

Kasotakis, George; Lakha, Aliya; Sarkar, Beda; Kunitake, Hiroko; Kissane-Lee, Nicole; Dechert, Tracey; McAneny, David; Burke, Peter; Doherty, Gerard

2014-09-01

To identify whether resident involvement affects clinically relevant outcomes in emergency general surgery. Previous research has demonstrated a significant impact of trainee participation on outcomes in a broad surgical patient population. We identified 141,010 patients who underwent emergency general surgery procedures in the 2005-2010 Surgeons National Surgical Quality Improvement Program database. Because of the nonrandom assignment of complex cases to resident participation, patients were matched (1:1) on known risk factors [age, sex, inpatient status, preexisting comorbidities (obesity, diabetes, smoking, alcohol, steroid use, coronary artery disease, chronic renal failure, pulmonary disease)] and preoperatively calculated probability for morbidity and mortality. Clinically relevant outcomes were compared with a t or χ test. The impact of resident participation on outcomes was assessed with multivariable regression modeling, adjusting for risk factors and operative time. The most common procedures in the matched cohort (n = 83,790) were appendectomy (39.9%), exploratory laparotomy (8.8%), and adhesiolysis (6.6%). Trainee participation is independently associated with intra- and postoperative events, wound, pulmonary, and venous thromboembolic complications, and urinary tract infections. Trainee participation is associated with adverse outcomes in emergency general surgery procedures.

No adverse effect of vincristine on handwriting in children after completion of therapy.

PubMed

Hartman, A; van den Bos, C; van Dartel, N; Stijnen, Th; Pieters, R

2007-11-01

Long-term writing difficulties in children after treatment with vincristine for acute lymphoblastic leukemia, Wilms tumor, B non-Hodgkin lymphoma, and malignant mesenchymal tumors, were investigated. Handwriting of 33 survivors and 33 controls matched for age, sex, and grade, was assessed with the BHK-scale. The examiner was blinded for whether a child was a case or a control. No significant difference in writing speed was found. Mean difference in number of letters produced during 5 min was 6.4 (+/-67.1, range -103 to +169). No significant difference was found in quality of writing scores; mean difference in points was 1.5 (+/-7.7, range -19 to +22). Cumulative vincristine dose, age at diagnosis or time since completion of treatment did not affect writing speed or quality. Chemotherapy, including vincristine, does not lead to long-term problems in speed or quality of writing in children treated for cancer. (c) 2006 Wiley-Liss, Inc.

Low Temperature Photoluminescence Characterization of Orbitally Grown CdZnTe

NASA Technical Reports Server (NTRS)

Ritter, Timothy M.; Larson, D. J.

1998-01-01

The II-VI ternary alloy CdZnTe is a technologically important material because of its use as a lattice matched substrate for HgCdTe based devices. The increasingly stringent requirements on performance that must be met by such large area infrared detectors also necessitates a higher quality substrate. Such substrate material is typically grown using the Bridgman technique. Due to the nature of bulk semiconductor growth, gravitationally dependent phenomena can adversely affect crystalline quality. The most direct way to alleviate this problem is by crystal growth in a reduced gravity environment. Since it requires hours, even days, to grow a high quality crystal, an orbiting space shuttle or space station provides a superb platform on which to conduct such research. For well over ten years NASA has been studying the effects of microgravity semiconductor crystal growth. This paper reports the results of photoluminescence characterization performed on an arbitrary grown CdZnTe bulk crystal.

The quality of our Nation's waters: groundwater quality in the Columbia Plateau and Snake River Plain basin-fill and basaltic-rock aquifers and the Hawaiian volcanic-rock aquifers, Washington, Idaho, and Hawaii, 1993-2005

USGS Publications Warehouse

Rupert, Michael G.; Hunt, Charles D.; Skinner, Kenneth D.; Frans, Lonna M.; Mahler, Barbara J.

2015-01-01

The Columbia Plateau, Snake River Plain, and Hawaii are large volcanic areas in the western United States and mid-Pacific ocean that contain extensive regional aquifers of a hard, gray, volcanic rock called basalt. Residents of the Columbia Plateau, the Snake River Plain, and the island of Oahu depend on groundwater as their primary source of drinking water. Although the depth to the water table can be several hundred feet, the groundwater is highly vulnerable to contamination because the permeable sediments and rocks allow contaminants to move readily down to the water table. Intense agricultural and urban activities occur above the drinking-water supply and are increasing in some areas. Contaminants, such as nitrate, pesticides, and volatile organic compounds, associated with agricultural and urban activities, have adversely affected groundwater quality.

Premature menopause in young breast cancer: effects on quality of life and treatment interventions

PubMed Central

Partridge, Ann H.

2013-01-01

Many young women are at increased risk for premature menopause following adjuvant treatment for breast cancer. These women must deal with consequences of menopause, including loss of fertility and physiologic symptoms such as night sweats, hot flashes, vaginal dryness, and weight gain. These symptoms can be particularly distressing for young women and can adversely affect both health-related and psychosocial quality of life (QOL). While there are a wide range of pharmacologic and non-pharmacologic interventions available to help with these symptoms and in turn, improve QOL, there is little data available about the use and efficacy of these interventions in younger women who become menopausal as a result of their breast cancer treatment. Future studies should focus on this vulnerable population, with the goal of identifying effective strategies to relieve symptoms and improve quality of life in young breast cancer survivors. PMID:23819028

Monte Carlo simulation of PET/MR scanner and assessment of motion correction strategies

NASA Astrophysics Data System (ADS)

Işın, A.; Uzun Ozsahin, D.; Dutta, J.; Haddani, S.; El-Fakhri, G.

2017-03-01

Positron Emission Tomography is widely used in three dimensional imaging of metabolic body function and in tumor detection. Important research efforts are made to improve this imaging modality and powerful simulators such as GATE are used to test and develop methods for this purpose. PET requires acquisition time in the order of few minutes. Therefore, because of the natural patient movements such as respiration, the image quality can be adversely affected which drives scientists to develop motion compensation methods to improve the image quality. The goal of this study is to evaluate various image reconstructions methods with GATE simulation of a PET acquisition of the torso area. Obtained results show the need to compensate natural respiratory movements in order to obtain an image with similar quality as the reference image. Improvements are still possible in the applied motion field's extraction algorithms. Finally a statistical analysis should confirm the obtained results.

Does water chemistry affect the dietary uptake and toxicity of silver nanoparticles by the freshwater snail Lymnaea stagnalis?

USGS Publications Warehouse

López-Serrano Oliver, Ana; Croteau, Marie-Noële; Stoiber, Tasha L.; Tejamaya, Mila; Römer, Isabella; Lead, Jamie R.; Luoma, Samuel N.

2014-01-01

Silver nanoparticles (AgNPs) are widely used in many applications and likely released into the aquatic environment. There is increasing evidence that Ag is efficiently delivered to aquatic organisms from AgNPs after aqueous and dietary exposures. Accumulation of AgNPs through the diet can damage digestion and adversely affect growth. It is well recognized that aspects of water quality, such as hardness, affect the bioavailability and toxicity of waterborne Ag. However, the influence of water chemistry on the bioavailability and toxicity of dietborne AgNPs to aquatic invertebrates is largely unknown. Here we characterize for the first time the effects of water hardness and humic acids on the bioaccumulation and toxicity of AgNPs coated with polyvinyl pyrrolidone (PVP) to the freshwater snail Lymnaea stagnalis after dietary exposures. Our results indicate that bioaccumulation and toxicity of Ag from PVP-AgNPs ingested with food are not affected by water hardness and by humic acids, although both could affect interactions with the biological membrane and trigger nanoparticle transformations. Snails efficiently assimilated Ag from the PVP-AgNPs mixed with diatoms (Ag assimilation efficiencies ranged from 82 to 93%). Rate constants of Ag uptake from food were similar across the entire range of water hardness and humic acid concentrations. These results suggest that correcting regulations for water quality could be irrelevant and ineffective where dietary exposure is important.

Gene–environment interplay in Drosophila melanogaster: Chronic food deprivation in early life affects adult exploratory and fitness traits

PubMed Central

Burns, James Geoffrey; Svetec, Nicolas; Rowe, Locke; Mery, Frederic; Dolan, Michael J.; Boyce, W. Thomas; Sokolowski, Marla B.

2012-01-01

Early life adversity has known impacts on adult health and behavior, yet little is known about the gene–environment interactions (GEIs) that underlie these consequences. We used the fruit fly Drosophila melanogaster to show that chronic early nutritional adversity interacts with rover and sitter allelic variants of foraging (for) to affect adult exploratory behavior, a phenotype that is critical for foraging, and reproductive fitness. Chronic nutritional adversity during adulthood did not affect rover or sitter adult exploratory behavior; however, early nutritional adversity in the larval period increased sitter but not rover adult exploratory behavior. Increasing for gene expression in the mushroom bodies, an important center of integration in the fly brain, changed the amount of exploratory behavior exhibited by sitter adults when they did not experience early nutritional adversity but had no effect in sitters that experienced early nutritional adversity. Manipulation of the larval nutritional environment also affected adult reproductive output of sitters but not rovers, indicating GEIs on fitness itself. The natural for variants are an excellent model to examine how GEIs underlie the biological embedding of early experience. PMID:23045644

Do Holocaust survivors show increased vulnerability or resilience to post-Holocaust cumulative adversity?

PubMed

Shrira, Amit; Palgi, Yuval; Ben-Ezra, Menachem; Shmotkin, Dov

2010-06-01

Prior trauma can hinder coping with additional adversity or inoculate against the effect of recurrent adversity. The present study further addressed this issue by examining whether a subsample of Holocaust survivors and comparison groups, drawn from the Israeli component of the Survey of Health, Ageing, and Retirement in Europe, were differentially affected by post-Holocaust cumulative adversity. Post-Holocaust cumulative adversity had a stronger effect on the lifetime depression of Holocaust survivors than on that of comparisons. However, comparisons were more negatively affected by post-Holocaust cumulative adversity when examining markers of physical and cognitive functioning. Our findings suggest that previous trauma can both sensitize and immunize, as Holocaust survivors show general resilience intertwined with specific vulnerability when confronted with additional cumulative adversity.

Indoor air quality and sources in schools and related health effects.

PubMed

Annesi-Maesano, Isabella; Baiz, Nour; Banerjee, Soutrik; Rudnai, Peter; Rive, Solenne; SINPHONIE Group

2013-01-01

Good indoor air quality in schools is important to provide a safe, healthy, productive, and comfortable environment for students, teachers, and other school staff. However, existing studies demonstrated that various air pollutants are found in classrooms, sometimes at elevated concentrations. Data also indicated that poor air quality may impact children's health, in particular respiratory health, attendance, and academic performance. Nevertheless, it should be noted that there are other adverse health effects that are less documented. Few data exist for teachers and other adults that work in schools. Allergic individuals seem to be at a higher risk for adverse respiratory health consequences. Air quality improvement represents an important measure for prevention of adverse health consequences in children and adults in schools.

Childhood adversity predicts reduced physiological flexibility during the processing of negative affect among adolescents with major depression histories.

PubMed

Daches, Shimrit; Kovacs, Maria; George, Charles J; Yaroslavsky, Ilya; Kiss, Eniko; Vetró, Ágnes; Dochnal, Roberta; Benák, István; Baji, Ildikó; Halas, Kitti; Makai, Attila; Kapornai, Krisztina; Rottenberg, Jonathan

2017-11-01

Adversity during early development has been shown to have enduring negative physiological consequences. In turn, atypical physiological functioning has been associated with maladaptive processing of negative affect, including its regulation. The present study therefore explored whether exposure to adverse life events in childhood predicted maladaptive (less flexible) parasympathetic nervous system functioning during the processing of negative affect among adolescents with depression histories. An initially clinic-referred, pediatric sample (N=189) was assessed at two time points. At Time 1, when subjects were 10.17years old (SD=1.42), on average, and were depressed, parents reported on adverse life events the offspring experienced up to that point. At Time 2, when subjects were 17.18years old (SD=1.28), and were remitted from depression, parents again reported on adverse life events in their offspring's lives for the interim period. At time 2, subjects' parasympathetic nervous system functioning (quantified as respiratory sinus arrhythmia) also was assessed at rest, during sad mood induction, and during instructed mood repair. Extent of adverse life events experienced by T1 (but not events occurring between T1 and T2) predicted less flexible RSA functioning 7years later during the processing of negative affect. Adolescents with more extensive early life adversities exhibited less vagal withdrawal following negative mood induction and tended to show less physiological recovery following mood repair. Early adversities appear to be associated with less flexible physiological regulatory control during negative affect experience, when measured later in development. Stress-related autonomic dysfunction in vulnerable youths may contribute to the unfavorable clinical prognosis associated with juvenile-onset depression. Copyright © 2017 Elsevier B.V. All rights reserved.

Depressive symptoms, functional measures and long-term outcomes of high-risk ST-elevated myocardial infarction patients treated by primary angioplasty.

PubMed

Compostella, Leonida; Lorenzi, Sonia; Russo, Nicola; Setzu, Tiziana; Compostella, Caterina; Vettore, Elia; Isabella, Giambattista; Tarantini, Giuseppe; Iliceto, Sabino; Bellotto, Fabio

2017-02-01

The presence of major depressive symptoms is usually considered a negative long-term prognostic factor after an acute myocardial infarction (AMI); however, most of the supporting research was conducted before the era of immediate reperfusion by percutaneous coronary intervention. The aims of this study are to evaluate if depression still retains long-term prognostic significance in our era of immediate coronary reperfusion, and to study possible correlations with clinical parameters of physical performance. In 184 patients with recent ST-elevated AMI (STEMI), treated by immediate reperfusion, moderate or severe depressive symptoms (evaluated by Beck Depression Inventory version I) were present in 10 % of cases. Physical performance was evaluated by two 6-min walk tests and by a symptom-limited cardiopulmonary exercise test: somatic/affective (but not cognitive/affective) symptoms of depression and perceived quality of life (evaluated by the EuroQoL questionnaire) are worse in patients with lower levels of physical performance. Follow-up was performed after a median of 29 months by means of telephone interviews; 32 major adverse cardiovascular events (MACE) occurred. The presence of three vessels disease and low left ventricle ejection fraction are correlated with a greater incidence of MACE; only somatic/affective (but not cognitive/affective) symptoms of depression correlate with long-term outcomes. In patients with recent STEMI treated by immediate reperfusion, somatic/affective but not cognitive/affective symptoms of depression show prognostic value on long-term MACE. Depression symptoms are not predictors "per se" of adverse prognosis, but seem to express an underlying worse cardiac efficiency, clinically reflected by poorer physical performance.

Analysis of Minor Component Segregation in Ternary Powder Mixtures

NASA Astrophysics Data System (ADS)

Asachi, Maryam; Hassanpour, Ali; Ghadiri, Mojtaba; Bayly, Andrew

2017-06-01

In many powder handling operations, inhomogeneity in powder mixtures caused by segregation could have significant adverse impact on the quality as well as economics of the production. Segregation of a minor component of a highly active substance could have serious deleterious effects, an example is the segregation of enzyme granules in detergent powders. In this study, the effects of particle properties and bulk cohesion on the segregation tendency of minor component are analysed. The minor component is made sticky while not adversely affecting the flowability of samples. The segregation extent is evaluated using image processing of the photographic records taken from the front face of the heap after the pouring process. The optimum average sieve cut size of components for which segregation could be reduced is reported. It is also shown that the extent of segregation is significantly reduced by applying a thin layer of liquid to the surfaces of minor component, promoting an ordered mixture.

Computers in the exam room: differences in physician-patient interaction may be due to physician experience.

PubMed

Rouf, Emran; Whittle, Jeff; Lu, Na; Schwartz, Mark D

2007-01-01

The use of electronic medical records can improve the technical quality of care, but requires a computer in the exam room. This could adversely affect interpersonal aspects of care, particularly when physicians are inexperienced users of exam room computers. To determine whether physician experience modifies the impact of exam room computers on the physician-patient interaction. Cross-sectional surveys of patients and physicians. One hundred fifty five adults seen for scheduled visits by 11 faculty internists and 12 internal medicine residents in a VA primary care clinic. Physician and patient assessment of the effect of the computer on the clinical encounter. Patients seeing residents, compared to those seeing faculty, were more likely to agree that the computer adversely affected the amount of time the physician spent talking to (34% vs 15%, P = 0.01), looking at (45% vs 24%, P = 0.02), and examining them (32% vs 13%, P = 0.009). Moreover, they were more likely to agree that the computer made the visit feel less personal (20% vs 5%, P = 0.017). Few patients thought the computer interfered with their relationship with their physicians (8% vs 8%). Residents were more likely than faculty to report these same adverse effects, but these differences were smaller and not statistically significant. Patients seen by residents more often agreed that exam room computers decreased the amount of interpersonal contact. More research is needed to elucidate key tasks and behaviors that facilitate doctor-patient communication in such a setting.

High quality fuel gas from biomass pyrolysis with calcium oxide.

PubMed

Zhao, Baofeng; Zhang, Xiaodong; Chen, Lei; Sun, Laizhi; Si, Hongyu; Chen, Guanyi

2014-03-01

The removal of CO2 and tar in fuel gas produced by biomass thermal conversion has aroused more attention due to their adverse effects on the subsequent fuel gas application. High quality fuel gas production from sawdust pyrolysis with CaO was studied in this paper. The results of pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) experiments indicate that the mass ratio of CaO to sawdust (Ca/S) remarkably affects the behavior of sawdust pyrolysis. On the basis of Py-GC/MS results, one system of a moving bed pyrolyzer coupled with a fluid bed combustor has been developed to produce high quality fuel gas. The lower heating value (LHV) of the fuel gas was above 16MJ/Nm(3) and the content of tar was under 50mg/Nm(3), which is suitable for gas turbine application to generate electricity and heat. Therefore, this technology may be a promising route to achieve high quality fuel gas for biomass utilization. Copyright © 2014 Elsevier Ltd. All rights reserved.

Quality of herbal medicines: challenges and solutions.

PubMed

Zhang, Junhua; Wider, Barbara; Shang, Hongcai; Li, Xuemei; Ernst, Edzard

2012-01-01

The popularity of herbal medicines has risen worldwide. This increase in usage renders safety issues important. Many adverse events of herbal medicines can be attributed to the poor quality of the raw materials or the finished products. Different types of herbal medicines are associated with different problems. Quality issues of herbal medicines can be classified into two categories: external and internal. In this review, external issues including contamination (e.g. toxic metals, pesticides residues and microbes), adulteration and misidentification are detailed. Complexity and non-uniformity of the ingredients in herbal medicines are the internal issues affecting the quality of herbal medicines. Solutions to the raised problems are discussed. The rigorous implementation of Good Agricultural and Collection Practices (GACP) and Good Manufacturing Practices (GMP) would undoubtedly reduce the risk of external issues. Through the use of modern analytical methods and pharmaceutical techniques, previously unsolved internal issues have become solvable. Standard herbal products can be manufactured from the standard herbal extracts. Copyright © 2011 Elsevier Ltd. All rights reserved.

The association of colonoscopy quality indicators with the detection of screen-relevant lesions, adverse events, and postcolonoscopy cancers in an asymptomatic Canadian colorectal cancer screening population.

PubMed

Hilsden, Robert J; Dube, Catherine; Heitman, Steven J; Bridges, Ronald; McGregor, S Elizabeth; Rostom, Alaa

2015-11-01

Although several quality indicators of colonoscopy have been defined, quality assurance activities should be directed at the measurement of quality indicators that are predictive of key screening colonoscopy outcomes. The goal of this study was to examine the association among established quality indicators and the detection of screen-relevant lesions (SRLs), adverse events, and postcolonoscopy cancers. Historical cohort study. Canadian colorectal cancer screening center. A total of 18,456 asymptomatic men and women ages 40 to 74, at either average risk or increased risk for colorectal cancer because of a family history, who underwent a screening colonoscopy from 2008 to 2010. Using univariate and multivariate analyses, we explored the association among procedural quality indicators and 3 colonoscopy outcomes: detection of SRLs, adverse events, and postcolonoscopy cancers. The crude rates of SRLs, adverse events, and postcolonoscopy cancers were 240, 6.44, and .54 per 1000 colonoscopies, respectively. Several indicators, including endoscopist withdrawal time (OR, 1.3; 95% CI, 1.2-1.4) and cecal intubation rate (OR, 13.9; 95% CI, 1.9-96.9), were associated with the detection of SRLs. No quality indicator was associated with the risk of adverse events. Endoscopist average withdrawal time over 6 minutes (OR, .12; 95% CI, .002-.85) and SRL detection rate over 20% (OR, .17; 95% CI, .03-.74) were associated with a reduced risk of postcolonoscopy cancers. Single-center study. Quality assurance programs should prioritize the measurement of endoscopist average withdrawal time and adenoma (SRL) detection rate. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Statistical process control methods allow the analysis and improvement of anesthesia care.

PubMed

Fasting, Sigurd; Gisvold, Sven E

2003-10-01

Quality aspects of the anesthetic process are reflected in the rate of intraoperative adverse events. The purpose of this report is to illustrate how the quality of the anesthesia process can be analyzed using statistical process control methods, and exemplify how this analysis can be used for quality improvement. We prospectively recorded anesthesia-related data from all anesthetics for five years. The data included intraoperative adverse events, which were graded into four levels, according to severity. We selected four adverse events, representing important quality and safety aspects, for statistical process control analysis. These were: inadequate regional anesthesia, difficult emergence from general anesthesia, intubation difficulties and drug errors. We analyzed the underlying process using 'p-charts' for statistical process control. In 65,170 anesthetics we recorded adverse events in 18.3%; mostly of lesser severity. Control charts were used to define statistically the predictable normal variation in problem rate, and then used as a basis for analysis of the selected problems with the following results: Inadequate plexus anesthesia: stable process, but unacceptably high failure rate; Difficult emergence: unstable process, because of quality improvement efforts; Intubation difficulties: stable process, rate acceptable; Medication errors: methodology not suited because of low rate of errors. By applying statistical process control methods to the analysis of adverse events, we have exemplified how this allows us to determine if a process is stable, whether an intervention is required, and if quality improvement efforts have the desired effect.

Patient-reported adverse events after hernia surgery and socio-economic status: A register-based cohort study.

PubMed

Wefer, Agnes; Gunnarsson, Ulf; Fränneby, Ulf; Sandblom, Gabriel

2016-11-01

The aim of the present study was to assess how socio-economic background influences perception of an adverse postoperative event after hernia surgery, and to see if this affects the pattern of seeking healthcare advice during the early postoperative period. All patients aged 15 years or older with a primary unilateral inguinal or femoral hernia repair recorded in the Swedish Hernia Register (SHR) between November 1 and December 31, 2002 were sent a questionnaire inquiring about adverse events. Data on civil status, income, level of education and ethnic background were obtained from Statistics Sweden. Of the 1643 patients contacted, 1440 (87.6%) responded: 1333 (92.6%) were men and 107 (7.4%) women, mean age was 59 years. There were 203 (12.4%) non-responders. Adverse events were reported in the questionnaire by 390 (27.1%) patients. Patients born in Sweden and patients with high income levels reported a significantly higher incidence of perceived adverse events (p < 0.05). Patients born in Sweden and females reported more events requiring healthcare contact. There was no association between registered and self-reported outcome and civil status or level of education. We detected inequalities related to income level, gender and ethnic background. Even if healthcare utilization is influenced by socio-economic background, careful information of what may be expected in the postoperative period and how adverse events should be managed could lead to reduced disparity and improved quality of care in the community at large. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Changing social factors and their long-term implications for health.

PubMed

Wadsworthx, M E

1997-01-01

This paper presents findings and arguments to show the power of social factors to affect health at the individual and at the national level. Social factors most strongly and negatively associated with health, at both levels, are those that indicate disorganisation and disruption, perceived helplessness and lack of support, low educational attainment, and poverty. Adverse changes in these social factors and their negative effects on health have been observed in many studies. When such adverse changes affect the lives and health of children, and those who will become parents, they affect the present and long-term future health of individuals because of the processes of biological programming described in this and other papers presented here. Such adverse changes in social factors also adversely affect the social circumstances of childhood, which in turn have a negative impact on health. Because changing social factors affect biological programming and social capitalisation, awareness of the health damaging effects of recent social change provides information on the future health of the population.

Assessment and mitigation of power quality problems for PUSPATI TRIGA Reactor (RTP)

NASA Astrophysics Data System (ADS)

Zakaria, Mohd Fazli; Ramachandaramurthy, Vigna K.

2017-01-01

An electrical power systems are exposed to different types of power quality disturbances. Investigation and monitoring of power quality are necessary to maintain accurate operation of sensitive equipment especially for nuclear installations. This paper will discuss the power quality problems observed at the electrical sources of PUSPATI TRIGA Reactor (RTP). Assessment of power quality requires the identification of any anomalous behavior on a power system, which adversely affects the normal operation of electrical or electronic equipment. A power quality assessment involves gathering data resources; analyzing the data (with reference to power quality standards) then, if problems exist, recommendation of mitigation techniques must be considered. Field power quality data is collected by power quality recorder and analyzed with reference to power quality standards. Normally the electrical power is supplied to the RTP via two sources in order to keep a good reliability where each of them is designed to carry the full load. The assessment of power quality during reactor operation was performed for both electrical sources. There were several disturbances such as voltage harmonics and flicker that exceeded the thresholds. To reduce these disturbances, mitigation techniques have been proposed, such as to install passive harmonic filters to reduce harmonic distortion, dynamic voltage restorer (DVR) to reduce voltage disturbances and isolate all sensitive and critical loads.

In-flight sleep of flight crew during a 7-hour rest break: implications for research and flight safety.

PubMed

Signal, T Leigh; Gander, Philippa H; van den Berg, Margo J; Graeber, R Curtis

2013-01-01

To assess the amount and quality of sleep that flight crew are able to obtain during flight, and identify factors that influence the sleep obtained. Flight crew operating flights between Everett, WA, USA and Asia had their sleep recorded polysomnographically for 1 night in a layover hotel and during a 7-h in-flight rest opportunity on flights averaging 15.7 h. Layover hotel and in-flight crew rest facilities onboard the Boeing 777-200ER aircraft. Twenty-one male flight crew (11 Captains, mean age 48 yr and 10 First Officers, mean age 35 yr). N/A. Sleep was recorded using actigraphy during the entire tour of duty, and polysomnographically in a layover hotel and during the flight. Mixed model analysis of covariance was used to determine the factors affecting in-flight sleep. In-flight sleep was less efficient (70% vs. 88%), with more nonrapid eye movement Stage 1/Stage 2 and more frequent awakenings per h (7.7/h vs. 4.6/h) than sleep in the layover hotel. In-flight sleep included very little slow wave sleep (median 0.5%). Less time was spent trying to sleep and less sleep was obtained when sleep opportunities occurred during the first half of the flight. Multivariate analyses suggest age is the most consistent factor affecting in-flight sleep duration and quality. This study confirms that even during long sleep opportunities, in-flight sleep is of poorer quality than sleep on the ground. With longer flight times, the quality and recuperative value of in-flight sleep is increasingly important for flight safety. Because the age limit for flight crew is being challenged, the consequences of age adversely affecting sleep quantity and quality need to be evaluated.

Premenstrual Syndrome in Turkish college students and its effects on life quality.

PubMed

Pinar, Gul; Colak, Meric; Oksuz, Ergun

2011-01-01

The purpose of this research is to analyze the frequency of Premenstrual Syndrome (PMS) in college students, the factors affecting Premenstrual Syndrome and the effect of Premenstrual Syndrome on life quality. The research was performed on 316 students who study at Medical Sciences Faculty of Başkent University and accepted to take part in the research. The data of the research was compiled by using "Questionnaire Form", "PMS Rating Scale" and "Life Quality Scale" developed by the researchers. In the analysis of the data; Percentage distribution, Chi-square test, One Way Anova test, Logistic regression, Multi nominal regression analysis were used. PMS was detected in 72.1% of the students. The most frequent symptoms are mainly low back pain, stress-discomfort, nervous-anger, distention and breast tenderness. PMS was found significantly high in those students who have menstrual irregularity, who have dysmenorrhea, who consume 2 cups of coffee or above per day and who smoke and drink alcohol (p<0.05). When the relation of PMS with life quality was evaluated, it was determined that the life quality decreases as PMS score average increases (p<0.05). PMS rate is high in college students and this adversely affects the life quality. It was revealed that the preventive, instructive and consultancy roles of the medical staff became more of an issue in reducing the effect of the factors causing and/or aggravating these symptoms in order to decrease PMS incidence and to improve the life quality of the students. Copyright © 2010. Published by Elsevier B.V.

Development and evaluation of an instrument to measure health-related quality of life in Cuban breast cancer patients receiving radiotherapy.

PubMed

Lugo, Josefina; Nápoles, Misleidy; Pérez, Inés; Ordaz, Niurka; Luzardo, Mario; Fernández, Leticia

2014-01-01

INTRODUCTION Although modern technology has extended the survival of breast cancer patients, treatment's adverse effects impact their health-related quality of life. Currently, no instrument exists capable of identifying the range of problems affecting breast cancer patients receiving radiotherapy in Cuba's socioeconomic and cultural context. OBJECTIVES Construct and validate an instrument to measure the effects of breast cancer and radiotherapy on health-related quality of life in Cuban patients. METHODS The study was conducted at the Oncology and Radiobiology Institute, Havana, Cuba, from January 2010 through December 2011. Inclusion criteria were: adult female, histological diagnosis of breast cancer, treated with ambulatory radiotherapy, and written informed consent; patients unable to communicate orally or in writing, or who had neurologic or psychiatric conditions were excluded. Development phase: focus groups guided by a list of questions were carried out with 50 women. The patients reported 61 problems affecting their health-related quality-of-life. A nominal group (six oncologists and two nurses) identified the same problems. A syntactic analysis of the information was performed to create items for study and measurement scales. Content validity was determined by a nominal group of seven experts using professional judgment. Another 20 patients were selected to evaluate face validity. Validation phase: the instrument was applied to 230 patients at three different points: before radiotherapy, at the end of radiotherapy and four weeks after radiotherapy was concluded. Reliability, construct validity, discriminant validity, predictive validity, interpretability and response burden were evaluated. RESULTS The final instrument developed had 33 items distributed in 4 domains: physical functioning, psychological functioning, social and family relationships, and physical and emotional adverse effects of disease and treatment. There were two discrete items: perceived general health and perceived health-related quality of life. Content validity and face validity were assessed as acceptable, by experts and patients respectively. Homogeneity, construct validity, and discriminant validity were satisfactory. The best results were obtained with test-retest reliability, predictive validity, and interpretability; the low rate of unanswered questions indicated that the instrument did not produce excessive patient response burden. CONCLUSION The new instrument fulfilled the requirements for measuring impact of breast cancer and of radiotherapy on health-related quality of life in these Cuban patients, validating its usefulness for inclusion in clinical trial protocols.

Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review.

PubMed

Moonesinghe, S R; Lowery, J; Shahi, N; Millen, A; Beard, J D

2011-03-22

To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and clinical outcome. Systematic review. Medline, Embase, ISI Web of Science, Google Scholar, ERIC, and SIGLE were searched without language restriction for articles published between 1990 and December 2010. Reference lists and citations of selected articles. Studies that assessed the impact of a change in duty hours using any objective measure of outcome related to postgraduate medical training, patient safety, or clinical outcome. Any study design was eligible for inclusion. 72 studies were eligible for inclusion: 38 reporting training outcomes, 31 reporting outcomes in patients, and three reporting both. A reduction in working hours from greater than 80 hours a week (in accordance with US recommendations) does not seem to have adversely affected patient safety and has had limited effect on postgraduate training. Reports on the impact of European legislation limiting working hours to less than 56 or 48 a week are of poor quality and have conflicting results, meaning that firm conclusions cannot be made. Reducing working hours to less than 80 a week has not adversely affected outcomes in patient or postgraduate training in the US. The impact of reducing hours to less than 56 or 48 a week in the UK has not yet been sufficiently evaluated in high quality studies. Further work is required, particularly in the European Union, using large multicentre evaluations of the impact of duty hours' legislation on objective educational and clinical outcomes.

Reduction of Escherichia coli 0157:H7 in shredded iceberg lettuce by chlorination and gamma irradiation

NASA Astrophysics Data System (ADS)

Foley, D. M.; Dufour, A.; Rodriguez, L.; Caporaso, F.; Prakash, A.

2002-03-01

Lettuce was inoculated with a six-strain cocktail of acid-adapted Escherichia coli 0157:H7 at a level of 1×10 7 CFU/g. Following chlorination at 200 μg/ml, the lettuce was irradiated at 0.15, 0.38, or 0.55 kGy using a 60Co source. Survival of E. coli 0157:H7, aerobic mesophiles and yeast and molds were measured over a period of 10 days. For quality analysis, chlorinated lettuce was subjected to irradiation at 0.33 and 0.53 kGy and stored at 1.0°C, 4.0°C or 7.0°C. Changes in texture and color were determined by instrumental means and changes in flavor, odor, and visual quality were determined by sensory testing. Chlorination plus irradiation at 0.55 kGy produced a 5.4-log reduction in E. coli 0157:H7 levels. Chlorination alone reduced the E. coli 0157:H7 counts by 1-2 logs. Irradiation at 0.55 kGy was also effective in reducing standard plate counts and yeast and mold counts. Irradiation at this level did not cause softening of lettuce and sensory attributes were not adversely affected. In general, appearance and flavor were affected more by the length of storage than by temperature conditions. The 5+log reduction in E. coli counts and lack of adverse effects on sensory attributes indicate that low-dose irradiation can improve the safety and shelf-life of fresh-cut iceberg lettuce for retail sale or food service.

Undernutrition and quality of life.

PubMed

Gabr, M

1987-01-01

Malnutrition, the most pervasive human problem especially in less developed countries (LDCs), not only adversely affects quality of life but also socioeconomic development. 25% of pregnant women in LDCs suffer from protein energy malnutrition while only 4% do in developed countries. This and other forms of malnutrition cause low birth weight infants and consequently high infant mortality and morbidity rates and limited fetal brain development. Child mortality due to measles is 200-400 times greater in malnourished children in LDCs than those in developed countries. In addition, measles brings about acute malnutrition in marginally nourished children. Malnutrition also adversely affects fertility, such as reducing a woman's fecundity during the menstrual cycle. Studies demonstrate that severe malnutrition during the 1st 6 months of life and maybe up to the 1st 2 years impairs intellectual development and the effects cannot be reversed. However, breast milk provides adequate nutrition and protects infants from infection when they are most susceptible. Inadequately nourished children are often apathetic, nonresponsive, impulsive; exhibit nongoal directed behavior; do not respond normally in social interactions; and cannot cope with stress or frequent daily demands. Studies indicate that even inadequately nourished adults develop behavior patterns similar to those of malnourished children. A starvation period among adults reduces muscle strength by almost 30% and precision of movements by 15-20%. In addition, childhood malnutrition reduces adult body weight and therefore restricting working capacity. The known effects of malnutrition should convince policy makers of the need to invest in programs that improve the nutritional standards of the populace for humanitarian reasons and to stimulate economic growth.

Study of temporal variation in ambient air quality during Diwali festival in India.

PubMed

Singh, D P; Gadi, Ranu; Mandal, T K; Dixit, C K; Singh, Khem; Saud, T; Singh, Nahar; Gupta, Prabhat K

2010-10-01

The variation in air quality was assessed from the ambient concentrations of various air pollutants [total suspended particle (TSP), particulate matter < or =10 microm (PM(10)), SO(2), and NO(2)] for pre-Diwali, Diwali festival, post-Diwali, and foggy day (October, November, and December), Delhi (India), from 2002 to 2007. The extensive use of fireworks was found to be related to short-term variation in air quality. During the festival, TSP is almost of the same order as compared to the concentration at an industrial site in Delhi in all the years. However, the concentrations of PM(10), SO(2), and NO(2) increased two to six times during the Diwali period when compared to the data reported for an industrial site. Similar trend was observed when the concentrations of pollutants were compared with values obtained for a typical foggy day each year in December. The levels of these pollutants observed during Diwali were found to be higher due to adverse meteorological conditions, i.e., decrease in 24 h average mixing height, temperature, and wind speed. The trend analysis shows that TSP, PM(10), NO(2), and SO(2) concentration increased just before Diwali and reached to a maximum concentration on the day of the festival. The values gradually decreased after the festival. On Diwali day, 24-h values for TSP and PM(10) in all the years from 2002 to 2007 and for NO(2) in 2004 and 2007 were found to be higher than prescribed limits of National Ambient Air Quality Standards and exceptionally high (3.6 times) for PM(10) in 2007. These results indicate that fireworks during the Diwali festival affected the ambient air quality adversely due to emission and accumulation of TSP, PM(10), SO(2), and NO(2).

Quality of Life in Glaucoma: A Review of the Literature.

PubMed

Quaranta, Luciano; Riva, Ivano; Gerardi, Chiara; Oddone, Francesco; Floriano, Irene; Konstas, Anastasios G P

2016-06-01

The ultimate goal of glaucoma management is the preservation of patients' visual function and quality of life (QoL). The disease itself as well as the medical or surgical treatment can have an enormous impact on a patient's QoL. Even the mere diagnosis of a chronic, irreversible, potentially blinding disorder can adversely affect the patient's sense of well-being and QoL by eliciting significant anxiety. Patients with primary open-angle glaucoma rarely present with visual symptoms, at least early in the course of the disease. A better understanding of patient-reported QoL can improve patient-physician interaction and enhance treatment adherence by customizing treatment options based on individual patient profile, thus optimizing long-term prognosis. These aspects are summarized and critically appraised in this article.

The effect of refrigeration of bone marrow and peripheral blood on cytogenetic analysis.

PubMed

Martin, P K; Rowley, J D

1986-07-01

Bone marrow samples from patients with various hematologic disorders were stored at 4 degrees C for up to 5 d before the establishment of a 24-h culture. We tested various factors, including storage time, colony stimulating factor, and methotrexate in an effort to improve metaphase and chromosome quality. Cytogenetic findings for various hematologic diseases were compared in a total of 201 cultures. Cold storage for up to 3 d did not seem to adversely affect the number of mitoses or the quality of chromosome banding when cells were cultured in a system that used both colony stimulating factor and methotrexate. In samples studied in parallel, clonal abnormalities were noted as frequently in cells stored in the cold as in those processed directly.

75 FR 32657 - Delegations to Office of Energy Policy and Innovation

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-09

... Innovation (OEPI) to provide leadership in the development and formulation of policies and regulations to... Statement for any action that may have a significant adverse effect on the quality of the human environment... adverse effect on the quality of the human environment under the Commission's regulations implementing the...

30 CFR 716.2 - Steep-slope mining.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., will not vary in a way that adversely affects the ecology of any surface water or any existing or... flow during every season of the year shall not vary in a way that adversely affects the ecology of any...

30 CFR 716.2 - Steep-slope mining.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., will not vary in a way that adversely affects the ecology of any surface water or any existing or... flow during every season of the year shall not vary in a way that adversely affects the ecology of any...

30 CFR 716.2 - Steep-slope mining.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., will not vary in a way that adversely affects the ecology of any surface water or any existing or... flow during every season of the year shall not vary in a way that adversely affects the ecology of any...

30 CFR 716.2 - Steep-slope mining.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., will not vary in a way that adversely affects the ecology of any surface water or any existing or... flow during every season of the year shall not vary in a way that adversely affects the ecology of any...

Leveraging a Redesigned Morbidity and Mortality Conference That Incorporates the Clinical and Educational Missions of Improving Quality and Patient Safety.

PubMed

Tad-Y, Darlene B; Pierce, Read G; Pell, Jonathan M; Stephan, Lindsie; Kneeland, Patrick P; Wald, Heidi L

2016-09-01

The morbidity and mortality (M&M) conference is a vital event that can affect medical education, quality improvement, and peer review in academic departments. Historically, M&M conferences have emphasized cases that highlight diagnostic uncertainty or complex management conundrums. In this report, the authors describe the development, pilot, and refinement of a systems-based M&M conference model that combines the educational and clinical missions of improving quality and patient safety in the University of Colorado Department of Medicine. In 2011, a focused taskforce completed a literature review that informed the development of a framework for the redesigned systems-based M&M conference. The new model included a restructured monthly conference, longitudinal curriculum for residents, and formal channels for interaction with clinical effectiveness departments. Each conference features an in-depth discussion of an adverse event using specific quality improvement tools. Areas for improvement and suggested action items are identified during the conference and delegated to the relevant clinical departments. The new process has enabled the review of 27 adverse events over two years. Sixty-three action items were identified, and 33 were pursued. An average of 50 to 60 individuals participate in each conference, including interprofessional and interdisciplinary colleagues. Resident and faculty feedback regarding the new format has been positive, and other departments are starting to adopt this model. A more robust process for identifying and selecting cases to discuss is needed, as is a stable, sufficient mechanism to manage the improvement initiatives that come out of each conference.

Effect of environmental change on yield and quality of fruits and vegetables: two systematic reviews and projections of possible health effects

NASA Astrophysics Data System (ADS)

Smith, P.; Scheelbeek, P.; Bird, F.; Green, R.; Dangour, A.

2017-12-01

Background - Environmental changes—including climatic change, water scarcity, and biodiversity loss—threaten agricultural production and pose challenges to global food security. In this study, we review the evidence of the effects of environmental change on the yield and quality of fruits and vegetables - a food group that plays a highly important role in our diets - and assess possible implications for nutrition and health outcomes. Methods - We undertook two systematic reviews of the published literature on the effect of 8 different environmental stressors on yields and nutritional quality of (1) fruits and (2) vegetables, measured in greenhouse and field studies. We combined the review outcomes with Food Balance Sheet data to assess the potential consequences of changed availability and quality of fruits and vegetables for global nutrient deficiencies and related chronic diseases. Findings - Overall, fruits were affected more prominently by changing environmental patterns than vegetables. In tropical countries, there were largely adverse effects on yield of increased temperature and changing precipitation patterns, although in more temperate zones some beneficial effects were reported. In contrast, the effects on nutritional quality were mostly positive, especially in fruit crops, with higher vitamin and mineral content measured in most crops. Increased atmospheric CO2 concentrations had a predominantly positive effect on yield, especially in legumes, but a negative effect on nutritional quality of both fruits and vegetables. Adverse nutritional implications were estimated to be largest in areas characterised by high vulnerability to environmental change, high dependency on local markets, and high rates of food insecurity. Interpretation - Our study identified effects of environmental change on yields and quality of fruits and vegetables that might pose threats to population health, especially in areas vulnerable to climate-change and food insecurity. To obtain more precise estimates of the burden of disease attributable to these effects, further research is needed on farmers' and consumers' adaptation/substitution strategies, which would allow development of future food security scenarios.

Clinical outcomes and adverse effect monitoring in allergic rhinitis.

PubMed

Juniper, Elizabeth F; Ståhl, Elisabeth; Doty, Richard L; Simons, F Estelle R; Allen, David B; Howarth, Peter H

2005-03-01

The subjective recording in diary cards of symptoms of itch, sneeze, nose running, and blockage, with the use of a rating scale to indicate the level of severity, is usual for clinical trials in allergic rhinitis. The primary outcome measure is usually a composite score that enables a single total symptoms score endpoint. It is appreciated, however, that rhinitis has a greater effect on the individual than is reflected purely by the recording of anterior nasal symptoms. Nasal obstruction is troublesome and may lead to sleep disturbance in addition to impaired daytime concentration and daytime sleepiness. These impairments affect school and work performance. Individuals with rhinitis find it socially embarrassing to be seen sneezing, sniffing, or blowing their nose. To capture these and other aspects of the disease-specific health-related quality of life, questionnaires such as the Rhinoconjunctivitis Quality of Life Questionnaire have been developed and validated for clinical trial use. The adoption of health-related quality of life questionnaires into clinical trials broadens the information obtained regarding the effect of the therapeutic intervention and helps focus on issues relevant to the individual patient. It must be appreciated that it is not only the disease that may adversely affect health-related quality of life; administered therapy, although intended to be beneficial, may also cause health impairment. Adverse-event monitoring is thus essential in clinical trials. The first-generation H 1 -histamines, because of their effect on central H 1 -receptors, are classically associated with central nervous system (CNS) effects such as sedation. Although this is not always perceived by the patient, it is clearly evident with objective performance testing, and positron emission tomography scanning has directly demonstrated the central H 1 -receptor occupancy. The second-generation H 1 -antihistamines have reduced central H 1 -receptor occupancy and considerably reduced or absent CNS sedative effects. Therefore, the CNS effects are entirely avoidable, and the first-generation H 1 -antihistamines should no longer be used in the management of allergic rhinitis. The considerably rarer but potentially very serious cardiac arrhythmogenic effects of H 1 -antihistamines are appreciated to be molecule-specific rather than class-specific. The in vitro screening of new compounds to eliminate the further development of those with cardiotoxicity ideally will lead to this adverse effect being historic. The incorporation of electrocardiogram recording in clinical trials provides direct information relating to prolongation of QT interval corrected for heart rate. Although administered at low doses, intranasal steroids still have the potential for systemic absorption and adverse consequences. However, it is appreciated that meaningful differences exist in the bioavailability of different steroid molecules, and although a small but statistically significant effect on growth in children has been identified with the long-term use of intranasal beclomethasone when administered twice daily for 1 year, this is not evident with all intranasal steroids. In addition, twice-daily intranasal steroid administration may have more effect--from the endocrinologic perspective--than once-daily administration in the morning, which coincides better with the natural diurnal variation in cortisol. Thus, once-daily intranasal steroid administration is preferable, and when used in studies in children, measurement of height change during the study period is an important outcome variable together with other indices of systemic steroid bioavailability (eg, tests of hypothalamic-pituitary-adrenal axis function). These considerations have even greater relevance if children are concurrently also receiving inhaled steroids for asthma, because the total steroid load will be greater.

Oxcarbazepine in the maintenance treatment of bipolar disorder.

PubMed

Vasudev, A; Macritchie, K; Watson, S; Geddes, J R; Young, A H

2008-01-23

Some studies have suggested that oxcarbazepine has a role in preventing episode recurrence in bipolar affective disorder. This review attempted to investigate the existing evidence from randomised controlled trials for its use in the maintenance treatment of this illness. To review the efficacy of oxcarbazepine, relative to placebo and other agents, in the prevention of affective episodes of bipolar affective disorder. The efficacy of oxcarbazepine was considered in terms of episode recurrence, general and social functioning. Adverse effects, overall acceptability to participants and mortality were also considered. CCDANCTR-Studies and CCDANCTR-References were searched on 7/11/2007. Medline, CENTRAL, EMBASE and PsycINFO were searched in March 2007. Specialist journals and conference proceedings were handsearched. Reference lists of relevant papers and major textbooks of affective disorder were checked. Authors, experts in the field and pharmaceutical companies were contacted requesting information on published or unpublished trials. Randomised controlled trials comparing oxcarbazepine with placebo or alternative agents, where the stated intent of intervention was the maintenance treatment of bipolar affective disorder were sought. Participants with bipolar disorder, male and female, of all ages, were included. Data were extracted from the original reports individually by two review authors. The methodological quality of included studies was assessed individually by two review authors. The main outcomes were the efficacy of oxcarbazepine maintenance treatment in preventing or attenuating further episodes of bipolar affective disorder (including its efficacy in rapid cycling disorder), the acceptability of oxcarbazepine treatment to participants, the prevalence of side-effects, and mortality, if any, on oxcarbazepine treatment. Where appropriate, data concerning outcome measures and adverse effects were to be extracted from the studies and analysed using Review Manager software. Two randomised controlled trials were found that met the methodological criteria for inclusion in the review. However, they did not report data with sufficient clarity to allow their confident extraction for inclusion in the meta-analysis. Findings from the two studies were presented descriptively. There is an insufficient methodologically rigorous evidence base to provide guidance on the use of oxcarbazepine in the maintenance treatment of bipolar disorder. Given the need for more efficacious therapeutic agents, there is a need for good quality randomised controlled trials examining the therapeutic potential of this and related agents in bipolar disorder.

Chronic pelvic pain syndrome and semen quality of Korean men in their fourth decade.

PubMed

Byun, Jae Sang; Yoon, Tae Ki; Rhee, Hong Woo; Kim, Jin Hong; Shin, Jun Shik; Kim, Hong Seok; Bak, Chong Won

2012-01-01

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition that adversely affects men across a wide range of ages. A number of pharmacologic and nonpharmacologic therapies for CP/CPPS have been investigated. Our study aimed to evaluate the prevalence of CPPS in Korean men in their thirties and to investigate the effect of CPPS and medical treatment on semen quality. Of 314 men with prostatitis, 74 patients with CPPS class IIIA (23.6%) were eligible for the study; these patients underwent combined α-blocker and cyclo-oxygenase 2 inhibitor therapy. These 74 men were prospectively studied at a medical center in Seoul, Korea. A number of parameters, including ejaculations per month, semen variables, and the levels of hormones (such as follicle-stimulating hormone, estradiol [E(2)], luteinizing hormone [LH], testosterone, and prolactin) were evaluated. The mean number of ejaculations per month, the mean number of daily hours spent sitting at work, smoking, body mass index, LH and E(2) levels, and semen parameters all showed significant differences (P < .0001) between the study patients and the controls. The combined regimen was effective in improving all aspects of semen quality except morphology (P < .05). CPPS class IIIA, which is notably prevalent among Korean men in the fourth decade of life, affects semen quality and poses a challenge to fertility. Proper treatment of CPPS class IIIA results in improved semen quality. Men with CPPS therefore require proper evaluation and treatment by andrologists/urologists before planning a natural conception.

Quality of relationships as predictors of outcomes in people with dementia: a systematic review protocol.

PubMed

Edwards, Hannah B; Savović, Jelena; Whiting, Penny; Leach, Verity; Richards, Alison; Cullum, Sarah; Cheston, Richard

2016-04-04

Serious adverse outcomes for people with dementia include institutionalisation, hospitalisation, death, development of behavioural and psychiatric symptoms, and reduced quality of life. The quality of the relationship between the person with dementia and their informal/family carer is thought to affect the risk of these outcomes. However, little is known about which aspects of relationship quality are important, or how they affect outcomes for people with dementia. This will be a systematic review of the literature. Electronic databases MEDLINE, EMBASE, Web of Science, PsycInfo, the Cochrane Database, ALOIS and OpenGrey will be searched from inception. 2 independent reviewers will screen results for eligibility with standardised criteria. Data will be extracted for relevant studies, and information on the associations between relationship quality and dementia outcomes will be synthesised. Meta-analysis will be performed if possible to calculate pooled effect sizes. Narrative synthesis will be performed if study heterogeneity rules out meta-analysis. Ethical review is not necessary as this review summarises data from previous studies. Results will be disseminated via peer-reviewed publication. Results will also be disseminated to a patient and public involvement group and an expert panel for their views on the findings and implications for future work. CRD42015020518. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Exposure to Radiofrequency Electromagnetic Fields and Sleep Quality: A Prospective Cohort Study

PubMed Central

Mohler, Evelyn; Frei, Patrizia; Fröhlich, Jürg; Braun-Fahrländer, Charlotte; Röösli, Martin

2012-01-01

Background There is persistent public concern about sleep disturbances due to radiofrequency electromagnetic field (RF-EMF) exposure. The aim of this prospective cohort study was to investigate whether sleep quality is affected by mobile phone use or by other RF-EMF sources in the everyday environment. Methods We conducted a prospective cohort study with 955 study participants aged between 30 and 60 years. Sleep quality and daytime sleepiness was assessed by means of standardized questionnaires in May 2008 (baseline) and May 2009 (follow-up). We also asked about mobile and cordless phone use and asked study participants for consent to obtain their mobile phone connection data from the mobile phone operators. Exposure to environmental RF-EMF was computed for each study participant using a previously developed and validated prediction model. In a nested sample of 119 study participants, RF-EMF exposure was measured in the bedroom and data on sleep behavior was collected by means of actigraphy during two weeks. Data were analyzed using multivariable regression models adjusted for relevant confounders. Results In the longitudinal analyses neither operator-recorded nor self-reported mobile phone use was associated with sleep disturbances or daytime sleepiness. Also, exposure to environmental RF-EMF did not affect self-reported sleep quality. The results from the longitudinal analyses were confirmed in the nested sleep study with objectively recorded exposure and measured sleep behavior data. Conclusions We did not find evidence for adverse effects on sleep quality from RF-EMF exposure in our everyday environment. PMID:22624036

Exposure to ambient air pollution--does it affect semen quality and the level of reproductive hormones?

PubMed

Radwan, Michał; Jurewicz, Joanna; Polańska, Kinga; Sobala, Wojciech; Radwan, Paweł; Bochenek, Michał; Hanke, Wojciech

2016-01-01

Ambient air pollution has been associated with a variety of reproductive disorders. However, a limited amount of research has been conducted to examine the association between air pollution and male reproductive outcomes, specifically semen quality. The present study was designed to address the hypothesis that exposure to fluctuating levels of specific air pollutants adversely affects sperm parameters and the level of reproductive hormones. The study population consisted of 327 men who were attending an infertility clinic in Łodź, Poland for diagnostic purposes and who had normal semen concentration of 15-300 mln/ml. All participants were interviewed and provided a semen sample. Air quality data were obtained from AirBase database. The statistically significant association was observed between abnormalities in sperm morphology and exposure to all examined air pollutants (PM10, PM2.5, SO2, NOX, CO). Exposure to air pollutants (PM10, PM2.5, CO, NOx) was also negatively associated with the level of testosterone. Additional exposure to PM2.5, PM10 increase the percentage of cells with immature chromatin (HDS). The present study provides suggestive evidence of an association between ambient air pollution and sperm quality. Further research is needed to explore this association in more detail. Individual precise exposure assessment would be needed for more detailed risk characterization.

Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review.

PubMed

Sawa, Jake; Green, Robert S; Thoma, Brent; Erdogan, Mete; Davis, Philip J

2017-08-11

The objective of this study was to systematically review the published literature for risk factors associated with adverse outcomes in older adults sustaining blunt chest trauma. EMBASE and MEDLINE were searched from inception until March 2017 for prognostic factors associated with adverse outcomes in older adults sustaining blunt chest trauma using a pre-specified search strategy. References were independently screened for inclusion by two reviewers. Study quality was assessed using the Quality in Prognostic Studies tool. Where appropriate, descriptive statistics were used to evaluate study characteristics and predictors of adverse outcomes. Thirteen cohort studies representing 79,313 patients satisfied our selection criteria. Overall, 26 prognostic factors were examined across studies and were reported for morbidity (8 studies), length of stay (7 studies), mortality (6 studies), and loss of independence (1 study). No studies examined patient quality of life or emergency department recidivism. Prognostic factors associated with morbidity and mortality included age, number of rib fractures, and injury severity score. Although age and rib fractures were found to be associated with adverse outcomes in more than 3 studies, meta-analysis was not performed due to heterogeneity amongst included studies in how these variables were measured. While blunt chest wall trauma in older adults is relatively common, the literature on prognostic factors for adverse outcomes in this patient population remains inadequate due to a paucity of high quality studies and lack of consistent reporting standards.

40 CFR 141.521 - What updated watershed control requirements must my unfiltered system implement to continue to...

Code of Federal Regulations, 2011 CFR

2011-07-01

...) Identify watershed characteristics and activities which may have an adverse effect on source water quality; and (b) Monitor the occurrence of activities which may have an adverse effect on source water quality. ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL...

A Cross-Cultural Longitudinal Examination of the Effect of Cumulative Adversity on the Mental and Physical Health of Older Adults

PubMed Central

Palgi, Yuval; Shrira, Amit

2015-01-01

Self-oriented adversity refers to traumatic events that primarily inflict the self, whereas other-oriented adversity refers to events that affect the self by primarily targeting others. The present study aimed to examine whether cultural background moderates the effects of self-oriented and other-oriented adversity on mental and physical health of older adults. Using longitudinal data from the Israeli component of the Survey of Health and Retirement, we focused on 370 Jews and 239 Arabs who reported their exposure to various adversities across the lifespan, and completed questionnaires regarding mental and physical health. Results showed that the effect of self-oriented adversity on health did not differ among Jews and Arabs. However, other-oriented adversity showed a stronger effect on Arabs’ mental and physical health than on Jews’ health. Our findings suggest that the accumulation of adverse events that affect the self by primarily targeting others may have a stronger impact in collectivist cultures than in individualist cultures. PMID:25961862

14 CFR 431.55 - Payload reentry review.

Code of Federal Regulations, 2012 CFR

2012-01-01

....55 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT... any issues that would adversely affect U.S. national security or foreign policy interests, would... reentry of a proposed payload presents any issues adversely affecting U.S. national security. (c) The FAA...

14 CFR 431.55 - Payload reentry review.

Code of Federal Regulations, 2013 CFR

2013-01-01

....55 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT... any issues that would adversely affect U.S. national security or foreign policy interests, would... reentry of a proposed payload presents any issues adversely affecting U.S. national security. (c) The FAA...

14 CFR 431.55 - Payload reentry review.

Code of Federal Regulations, 2010 CFR

2010-01-01

....55 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT... any issues that would adversely affect U.S. national security or foreign policy interests, would... reentry of a proposed payload presents any issues adversely affecting U.S. national security. (c) The FAA...

14 CFR 431.55 - Payload reentry review.

Code of Federal Regulations, 2011 CFR

2011-01-01

....55 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT... any issues that would adversely affect U.S. national security or foreign policy interests, would... reentry of a proposed payload presents any issues adversely affecting U.S. national security. (c) The FAA...

Efficacy of Rasayana Avaleha as adjuvant to radiotherapy and chemotherapy in reducing adverse effects.

PubMed

Vyas, Purvi; Thakar, A B; Baghel, M S; Sisodia, Arvind; Deole, Yogesh

2010-10-01

Cancer is the most dreadful disease affecting mankind. The available treatments such as chemotherapy and radiotherapy have cytotoxic effects, which are hazardous to the normal cells of the patient, causing many unnecessary effects. This further leads to complications of the therapy, impaired health, and deterioration of quality of life, resulting in mandatory stoppage of the treatment. In the present study, the efficacy of an Ayurvedic formulation, Rasayana Avaleha, has been evaluated as an adjuvant medication to modern radiotherapy and chemotherapy. A total of 36 cancer patients were registered in this trial and were divided into two groups, group A and group B. In group A, the patients were treated with radiotherapy and chemotherapy along with adjuvant Rasayana Avaleha (RT + CT + RA), while in group B only radiotherapy and chemotherapy (RT + CT) were given, as the control group. After assessing the results, it was observed that Rasayana Avaleha gave better results in controlling the adverse effect of chemotherapy and radiotherapy in comparison with the control group. Therefore, Rasayana Avaleha has proved to be an effective adjuvant therapy in protecting patients from the adverse effects of chemotherapy and radiotherapy.

Institutional environmental impact statement (space shuttle development and operations) amendment no. 1. [space shuttle operations at Kennedy Space Center

NASA Technical Reports Server (NTRS)

1973-01-01

Data are presented to support the environmental impact statement on space shuttle actions at Kennedy Space Center. Studies indicate that land use to accommodate space shuttle operations may have the most significant impact. The impacts on air, water and noise quality are predicted to be less on the on-site environment. Considerations of operating modes indicate that long and short term land use will not affect wildlife productivity. The potential for adverse environmental impact is small and such impacts will be local, short in duration, controllable, and environmentally acceptable.

Effect of gamma irradiation on physical characteristics of Jordanian durum wheat and quality of semolina and lasagna products

NASA Astrophysics Data System (ADS)

Azzeh, F. S.; Amr, A. S.

2009-09-01

This study was conducted to determine the effect of using varying gamma irradiation doses on the physiochemical and rheological properties of semolina and its products. Ash, protein and water content were not influenced with gamma irradiation, while falling number and fungi counts decreased with increasing irradiation dose. Irradiation adversely affected wet gluten at 5 kGy dose. Dough stability was deteriorated vigorously with increasing irradiation dose. Sensory evaluation showed that lasagna produced from 0.25- and 1 kGy-irradiated semolina did not show any significant differences as compared with the control sample.

Effects of hospital generic drug substitution on diabetes therapy

PubMed Central

Chen, Hui-Yin; Chang, Hui-Ru; Lang, Hui-Chu

2014-01-01

Objectives To evaluate the effects on physicians’ prescribing behavior and on the therapeutic outcome of non-insulin-dependent diabetes patients of substituting different generic brands of metformin. Methods We adopt a retrospective cohort study involving 280 type-2 diabetes patients who regularly used the outpatient services of one medical center and who had changed metformin brands five times between 2003 and 2008. The aim was to examine the effects of switching brands. The generalized estimating equation was used to determine whether drug brand switching affected patient glycated hemoglobin A1c (HbA1c) levels, their prescribed daily dose, or their adherence to medication with metformin. Results HbA1c levels increased from 7.91 to 8.34 throughout the study period, although it was found that brand switching did not adversely affect HbA1c levels after controlling for patient characteristics and the time course of the study. Furthermore, the prescribed daily dose of metformin was stable throughout the study period, and was approximately 0.8 of the defined daily dose. Finally, although adherence was significantly higher with the original metformin than with the four generic brands, patients still maintained high levels of adherence of >0.8. Conclusion Although switching between different brands of metformin slightly affected the prescribing behavior of the physicians, there was no unfavorable effect on patient HbA1c levels. Thus, the policy of substituting between different generic brands of metformin is a good cost-effective approach that does not adversely affect the quality of diabetes patient care. PMID:24511228

Ocean Acidification Affects the Phyto-Zoo Plankton Trophic Transfer Efficiency

PubMed Central

Cripps, Gemma; Flynn, Kevin J.; Lindeque, Penelope K.

2016-01-01

The critical role played by copepods in ocean ecology and biogeochemistry warrants an understanding of how these animals may respond to ocean acidification (OA). Whilst an appreciation of the potential direct effects of OA, due to elevated pCO2, on copepods is improving, little is known about the indirect impacts acting via bottom-up (food quality) effects. We assessed, for the first time, the chronic effects of direct and/or indirect exposures to elevated pCO2 on the behaviour, vital rates, chemical and biochemical stoichiometry of the calanoid copepod Acartia tonsa. Bottom-up effects of elevated pCO2 caused species-specific biochemical changes to the phytoplanktonic feed, which adversely affected copepod population structure and decreased recruitment by 30%. The direct impact of elevated pCO2 caused gender-specific respiratory responses in A.tonsa adults, stimulating an enhanced respiration rate in males (> 2-fold), and a suppressed respiratory response in females when coupled with indirect elevated pCO2 exposures. Under the combined indirect+direct exposure, carbon trophic transfer efficiency from phytoplankton-to-zooplankton declined to < 50% of control populations, with a commensurate decrease in recruitment. For the first time an explicit role was demonstrated for biochemical stoichiometry in shaping copepod trophic dynamics. The altered biochemical composition of the CO2-exposed prey affected the biochemical stoichiometry of the copepods, which could have ramifications for production of higher tropic levels, notably fisheries. Our work indicates that the control of phytoplankton and the support of higher trophic levels involving copepods have clear potential to be adversely affected under future OA scenarios. PMID:27082737

Obesity is a concern for bone health with aging.

PubMed

Shapses, Sue A; Pop, L Claudia; Wang, Yang

2017-03-01

Accumulating evidence supports a complex relationship between adiposity and osteoporosis in overweight/obese individuals, with local interactions and endocrine regulation by adipose tissue on bone metabolism and fracture risk in elderly populations. This review was conducted to summarize existing evidence to test the hypothesis that obesity is a risk factor for bone health in aging individuals. Mechanisms by which obesity adversely affects bone health are believed to be multiple, such as an alteration of bone-regulating hormones, inflammation, oxidative stress, the endocannabinoid system, that affect bone cell metabolism are discussed. In addition, evidence on the effect of fat mass and distribution on bone mass and quality is reviewed together with findings relating energy and fat intake with bone health. In summary, studies indicate that the positive effects of body weight on bone mineral density cannot counteract the detrimental effects of obesity on bone quality. However, the exact mechanism underlying bone deterioration in the obese is not clear yet and further research is required to elucidate the effect of adipose depots on bone and fracture risk in the obese population. Copyright © 2017 Elsevier Inc. All rights reserved.

Maternal exposure to butyl paraben impairs testicular structure and sperm quality on male rats.

PubMed

Guerra, Marina T; Sanabria, Marciana; Leite, Gabriel A A; Borges, Cibele S; Cucielo, Maira S; Anselmo-Franci, Janete A; Foster, W G; Kempinas, W G

2017-04-01

Parabens are hormonally active chemicals widely used as preservatives in foods and are frequently detected in human fluids and tissues. Therefore, the objective of this study was to determine the effects of maternal butyl paraben (BP) exposure on male sexual development. Pregnant Wistar rats received corn oil (control group), or BP at doses of 10, 100, or 200 mg/kg, subcutaneously, from gestational day 12 until postnatal day 21. Our results demonstrated that developmental BP exposure significantly increased the number of adult Leydig cells and the circulating concentrations of testosterone and attenuated FSH and LH concentrations at 200 mg/kg. BP exposure adversely affected spermatogenesis kinetics at doses of 10 and 200 mg/kg and provoked a decrease in the immunostaining of EsR1 and AR at 200 mg/kg. The sperm motility was impaired at the 10 mg/kg dose, and sperm head abnormalities were increased in all BP dose groups. We suggest that BP impairs testicular structure and function in the rat, affecting sperm quality. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1273-1289, 2017. © 2016 Wiley Periodicals, Inc.

Effect of rigor temperature, ageing and display time on the meat quality and lipid oxidative stability of hot boned beef Semimembranosus muscle.

PubMed

Mungure, Tanyaradzwa E; Bekhit, Alaa El-Din A; Birch, E John; Stewart, Ian

2016-04-01

The effects of rigor temperature (5, 15, 20 and 25°C), ageing (3, 7, 14, and 21 days) and display time on meat quality and lipid oxidative stability of hot boned beef M. Semimembranosus (SM) muscle were investigated. Ultimate pH (pH(u)) was rapidly attained at higher rigor temperatures. Electrical conductivity increased with rigor temperature (p<0.001). Tenderness, purge and cooking losses were not affected by rigor temperature; however purge loss and tenderness increased with ageing (p<0.01). Lightness (L*) and redness (a*) of the SM increased as rigor temperature increased (p<0.01). Lipid oxidation was assessed using (1)H NMR where changes in aliphatic to olefinic (R(ao)) and diallylmethylene (R(ad)) proton ratios can be rapidly monitored. R(ad), R(ao), PUFA and TBARS were not affected by rigor temperature, however ageing and display increased lipid oxidation (p<0.05). This study shows that rigor temperature manipulation of hot boned beef SM muscle does not have adverse effects on lipid oxidation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Obesity is a concern for bone health with aging

PubMed Central

Shapses, Sue A.; Pop, L. Claudia; Wang, Yang

2017-01-01

Accumulating evidence supports a complex relationship between adiposity and osteoporosis in overweight/obese individuals, with local interactions and endocrine regulation by adipose tissue on bone metabolism and fracture risk in elderly populations. This review was conducted to summarize existing evidence to test the hypothesis that obesity is a risk factor for bone health in aging individuals. Mechanisms by which obesity adversely affects bone health are believed to be multiple, such as an alteration of bone-regulating hormones, inflammation, oxidative stress, the endocannabinoid system, that affect bone cell metabolism are discussed. In addition, evidence on the effect of fat mass and distribution on bone mass and quality is reviewed together with findings relating energy and fat intake with bone health. In summary, studies indicate that the positive effects of body weight on bone mineral density cannot counteract the detrimental effects of obesity on bone quality. However, the exact mechanism underlying bone deterioration in the obese is not clear yet and further research is required to elucidate the effect of adipose depots on bone and fracture risk in the obese population. PMID:28385284

Learning from Adverse Events in Obstetrics: Is a Standardized Computer Tool an Effective Strategy for Root Cause Analysis?

PubMed

Murray-Davis, Beth; McDonald, Helen; Cross-Sudworth, Fiona; Ahmed, Rashid; Simioni, Julia; Dore, Sharon; Marrin, Michael; DeSantis, Judy; Leyland, Nicholas; Gardosi, Jason; Hutton, Eileen; McDonald, Sarah

2015-08-01

Adverse events occur in up to 10% of obstetric cases, and up to one half of these could be prevented. Case reviews and root cause analysis using a structured tool may help health care providers to learn from adverse events and to identify trends and recurring systems issues. We sought to establish the reliability of a root cause analysis computer application called Standardized Clinical Outcome Review (SCOR). We designed a mixed methods study to evaluate the effectiveness of the tool. We conducted qualitative content analysis of five charts reviewed by both the traditional obstetric quality assurance methods and the SCOR tool. We also determined inter-rater reliability by having four health care providers review the same five cases using the SCOR tool. The comparative qualitative review revealed that the traditional quality assurance case review process used inconsistent language and made serious, personalized recommendations for those involved in the case. In contrast, the SCOR review provided a consistent format for recommendations, a list of action points, and highlighted systems issues. The mean percentage agreement between the four reviewers for the five cases was 75%. The different health care providers completed data entry and assessment of the case in a similar way. Missing data from the chart and poor wording of questions were identified as issues affecting percentage agreement. The SCOR tool provides a standardized, objective, obstetric-specific tool for root cause analysis that may improve identification of risk factors and dissemination of action plans to prevent future events.

Household Food Insecurity Is Associated with Adverse Mental Health Indicators and Lower Quality of Life among Koreans: Results from the Korea National Health and Nutrition Examination Survey 2012–2013

PubMed Central

Chung, Hye-Kyung; Kim, Oh Yoen; Kwak, So Young; Cho, Yoonsu; Lee, Kyong Won; Shin, Min-Jeong

2016-01-01

Food insecurity is an ongoing public health issue and contributes to mental health status. We investigated whether food insecurity is associated with inadequate nutrient intake and whether it affects mental health indicators (perceived stress/experience of depressive symptom/suicidal ideation) and quality of life (QOL) among Koreans (n = 5862, 20–64 years) using data from the Korea National Health and Nutritional Examination Survey (2012–2013). Household food security status was categorized as “food-secure household”, “food-insecure household without hunger”, and “food-insecure household with hunger”. Data on food insecurity, sociodemographic factors, nutrient intake, mental health indicators, and QOL were used. A logistic regression model was conducted to determine odds ratios (ORs) for psychological health. A greater proportion of food-insecure participants were nutritionally deficient compared with expectations of the 2015 Korean Dietary Reference Intakes. These deficiencies were generally higher in both “food-insecure household” groups. Both “food-insecure household” groups, particularly the “food-insecure household with hunger” group showed significantly adverse mental health status (ORs: 1.52–3.83) and lower QOL (ORs: 1.49–3.92) than did the “food-secure household” group before and after adjusting for sex, age, education, household income, smoking/alcohol consumption, physical activity, marital status, and receiving food assistance. In conclusion, food insecurity may be significantly associated with adverse mental health indicators and decreased QOL in young/middle-aged Koreans. PMID:27999277

Sperm Quality during Storage Is Not Affected by the Presence of Antibiotics in EquiPlus Semen Extender but Is Improved by Single Layer Centrifugation

PubMed Central

Spergser, Joachim; Kuhl, Juliane; Schmidt, Kathrin; Johannisson, Anders

2017-01-01

Contamination of semen with bacteria arises during semen collection and handling. This bacterial contamination is typically controlled by adding antibiotics to semen extenders but intensive usage of antibiotics can lead to the development of bacterial resistance and may be detrimental to sperm quality. The objective of this study was to determine the effects of antibiotics in a semen extender on sperm quality and to investigate the effects of removal of bacteria by modified Single Layer Centrifugation (MSLC) through a colloid. Semen was collected from six adult pony stallions (three ejaculates per male). Aliquots of extended semen were used for MSLC with Equicoll, resulting in four treatment groups: control and MSLC in extender with antibiotics (CA and SA, respectively); control and MSLC in extender without antibiotics (CW and SW, respectively). Sperm motility, membrane integrity, mitochondrial membrane potential and chromatin integrity were evaluated daily by computer-assisted sperm analysis (CASA) and flow cytometry. There were no differences in sperm quality between CA and CW, or between SA and SW, although progressive motility was negatively correlated to total bacterial counts at 0 h. However, MSLC groups showed higher mean total motility (P < 0.001), progressive motility (P < 0.05), membrane integrity (P < 0.0001) and mitochondrial membrane potential (P < 0.05), as well as better chromatin integrity (P < 0.05), than controls. Sperm quality remained higher in the MSLC groups than controls throughout storage. These results indicate that sperm quality was not adversely affected by the presence of antibiotics but was improved considerably by MSLC. PMID:29267226

Alcohol, drugs, caffeine, tobacco, and environmental contaminant exposure: reproductive health consequences and clinical implications.

PubMed

Sadeu, J C; Hughes, Claude L; Agarwal, Sanjay; Foster, Warren G

2010-08-01

Reproductive function and fertility are thought to be compromised by behaviors such as cigarette smoking, substance abuse, and alcohol consumption; however, the strength of these associations are uncertain. Furthermore, the reproductive system is thought to be under attack from exposure to environmental contaminants, particularly those chemicals shown to affect endocrine homeostasis. The relationship between exposure to environmental contaminants and adverse effects on human reproductive health are frequently debated in the scientific literature and these controversies have spread into the lay press drawing increased public and regulatory attention. Therefore, the objective of the present review was to critically evaluate the literature concerning the relationship between lifestyle exposures and adverse effects on fertility as well as examining the evidence for a role of environmental contaminants in the purported decline of semen quality and the pathophysiology of subfertility, polycystic ovarian syndrome, and endometriosis. The authors conclude that whereas cigarette smoking is strongly associated with adverse reproductive outcomes, high-level exposures to other lifestyle factors are only weakly linked with negative fertility impacts. Finally, there is no compelling evidence that environmental contaminants, at concentrations representative of the levels measured in contemporary biomonitoring studies, have any effect, positive or negative, on reproductive health in the general population. Further research using prospective study designs with robust sample sizes are needed to evaluate testable hypotheses that address the relationship between exposure and adverse reproductive health effects.

Factors Related to Healthcare Service Quality in Long-term Care Hospitals in South Korea: A Mixed-methods Study.

PubMed

Sohn, Minsung; Choi, Mankyu

2017-10-01

The environment of long-term care hospitals (LTCHs) is critical to the management of the quality of their services and to patient safety, as highlighted by international studies. However, there is a lack of evidence on this topic in South Korea. This study aimed to examine the factors affecting healthcare quality in LTCHs and to explore the effectiveness of their quality management. This study used a mixed methods approach with quantitative data collected in a national survey and qualitative data from semi-structured interviews with practice-based managers. The samples included 725 nationally representative LTCHs in South Korea for the quantitative analysis and 15 administrators for the in-depth interviews. A higher installation rate of patient-safety and hygiene-related facilities and staff with longer-tenures, especially nurses, were more likely to have better healthcare quality and education for both employees and patients. The need for patient-safety- and hygiene-related facilities in LTCHs that serve older adults reflects their vulnerability to certain adverse events (e.g., infections). Consistent and skillful nursing care to improve the quality of LTCHs can be achieved by developing relevant educational programs for staff and patients, thereby strengthening the relationships between them.

Effects of an Extreme Flood on Trace Elements in River Water-From Urban Stream to Major River Basin.

PubMed

Barber, Larry B; Paschke, Suzanne S; Battaglin, William A; Douville, Chris; Fitzgerald, Kevin C; Keefe, Steffanie H; Roth, David A; Vajda, Alan M

2017-09-19

Major floods adversely affect water quality through surface runoff, groundwater discharge, and damage to municipal water infrastructure. Despite their importance, it can be difficult to assess the effects of floods on streamwater chemistry because of challenges collecting samples and the absence of baseline data. This study documents water quality during the September 2013 extreme flood in the South Platte River, Colorado, USA. Weekly time-series water samples were collected from 3 urban source waters (municipal tap water, streamwater, and wastewater treatment facility effluent) under normal-flow and flood conditions. In addition, water samples were collected during the flood at 5 locations along the South Platte River and from 7 tributaries along the Colorado Front Range. Samples were analyzed for 54 major and trace elements. Specific chemical tracers, representing different natural and anthropogenic sources and geochemical behaviors, were used to compare streamwater composition before and during the flood. The results differentiate hydrological processes that affected water quality: (1) in the upper watershed, runoff diluted most dissolved constituents, (2) in the urban corridor and lower watershed, runoff mobilized soluble constituents accumulated on the landscape and contributed to stream loading, and (3) flood-induced groundwater discharge mobilized soluble constituents stored in the vadose zone.

Mentalization of complex emotions in borderline personality disorder: The impact of parenting and exposure to trauma on the performance in a novel cartoon-based task.

PubMed

Brüne, Martin; Walden, Sarah; Edel, Marc-Andreas; Dimaggio, Giancarlo

2016-01-01

Borderline personality disorder (BPD) is characterized by a range of interpersonal difficulties, which are, in part, related to adverse experiences during childhood. Unresponsive parenting and traumatization may cause functional impairment of mentalization, i.e. the ability to reflect upon own and others' mental states. However, the relationship of poor parenting, trauma and mentalization in BPD has not exhaustively been studied. Thirty patients diagnosed with BPD and 30 matched control subjects were asked to sequence a novel cartoon-based mentalization task involving complex emotions such as jealousy, shame, guilt etc. In addition, they were required to reason about cognitive and affective mental states of the cartoon characters. The quality of parental care was assessed using a self-report measure for recalled parental rearing style, and childhood trauma was measured in retrospect using the Childhood Trauma Questionnaire. Patients with BPD performed more poorly in all aspects of the cartoon task. Mentalizing skills, particularly relating to affective mental states, were uniquely associated with the quality of recalled parental care and childhood trauma. Together, the quality of parental care and the experience of childhood trauma negatively impact on mentalization in BPD, even in an experimental "offline" task. Copyright © 2015 Elsevier Inc. All rights reserved.

Geochemistry of dissolved trace elements and heavy metals in the Dan River Drainage (China): distribution, sources, and water quality assessment.

PubMed

Meng, Qingpeng; Zhang, Jing; Zhang, Zhaoyu; Wu, Tairan

2016-04-01

Dissolved trace elements and heavy metals in the Dan River drainage basin, which is the drinking water source area of South-to-North Water Transfer Project (China), affect large numbers of people and should therefore be carefully monitored. To investigate the distribution, sources, and quality of river water, this study integrating catchment geology and multivariate statistical techniques was carried out in the Dan River drainage from 99 river water samples collected in 2013. The distribution of trace metal concentrations in the Dan River drainage was similar to that in the Danjiangkou Reservoir, indicating that the reservoir was significantly affected by the Dan River drainage. Moreover, our results suggested that As, Sb, Cd, Mn, and Ni were the major pollutants. We revealed extremely high concentrations of As and Sb in the Laoguan River, Cd in the Qingyou River, Mn, Ni, and Cd in the Yinhua River, As and Sb in the Laojun River, and Sb in the Dan River. According to the water quality index, water in the Dan River drainage was suitable for drinking; however, an exposure risk assessment model suggests that As and Sb in the Laojun and Laoguan rivers could pose a high risk to humans in terms of adverse health and potential non-carcinogenic effects.

Effects of an extreme flood on trace elements in river water—From urban stream to major river basin

USGS Publications Warehouse

Barber, Larry B.; Paschke, Suzanne; Battaglin, William A.; Douville, Chris; Fitzgerald, Kevin C.; Keefe, Steffanie H.; Roth, David A.; Vajda, Alan M.

2017-01-01

Major floods adversely affect water quality through surface runoff, groundwater discharge, and damage to municipal water infrastructure. Despite their importance, it can be difficult to assess the effects of floods on streamwater chemistry because of challenges collecting samples and the absence of baseline data. This study documents water quality during the September 2013 extreme flood in the South Platte River, Colorado, USA. Weekly time-series water samples were collected from 3 urban source waters (municipal tap water, streamwater, and wastewater treatment facility effluent) under normal-flow and flood conditions. In addition, water samples were collected during the flood at 5 locations along the South Platte River and from 7 tributaries along the Colorado Front Range. Samples were analyzed for 54 major and trace elements. Specific chemical tracers, representing different natural and anthropogenic sources and geochemical behaviors, were used to compare streamwater composition before and during the flood. The results differentiate hydrological processes that affected water quality: (1) in the upper watershed, runoff diluted most dissolved constituents, (2) in the urban corridor and lower watershed, runoff mobilized soluble constituents accumulated on the landscape and contributed to stream loading, and (3) flood-induced groundwater discharge mobilized soluble constituents stored in the vadose zone.

Relationship between Dietary Fat Intake, Its Major Food Sources and Assisted Reproduction Parameters

PubMed Central

Kazemi, Ashraf; Ramezanzadeh, Fatemeh; Nasr-Esfahani, Mohammad Hosein

2014-01-01

Background High dietary fat consumption may alter oocyte development and embryonic development. This prospective study was conducted to determine the relation between dietary fat consumption level, its food sources and the assisted reproduction parameters. Methods A prospective study was conducted on 240 infertile women. In assisted reproduction treatment cycle, fat consumption and major food sources over the previous three months were identified. The number of retrieved oocytes, metaphase ΙΙ stage oocytes numbers, fertilization rate, embryo quality and clinical pregnancy rate were also determined. The data were analyzed using multiple regression, binary logistic regression, chi-square and t-test. The p-value of less than 0.05 was considered significant. Results Total fat intake adjusted for age, body mass index, physical activity and etiology of infertility was positively associated with the number of retrieved oocytes and inversely associated with the high embryo quality rate. An inverse association was observed between sausage and turkey ham intake and the number of retrieved oocytes. Also, oil intake level had an inverse association with good cleavage rate. Conclusion The results revealed that higher levels of fat consumption tend to increase the number of retrieved oocytes and were adversely related to embryonic development. Among food sources of fat, vegetable oil, sausage and turkey ham intake may adversely affect assisted reproduction parameters. PMID:25473630

36 CFR 60.14 - Changes and revisions to properties listed in the National Register.

Code of Federal Regulations, 2013 CFR

2013-07-01

... previously unrecognized significance in American history, architecture, archeology, engineering or culture... would be adversely affected by the intrusion of the property; and (iv) Photographs showing the proposed... adversely affected by intrusion of the property. In addition, new photographs, acreage, verbal boundary...

36 CFR 60.14 - Changes and revisions to properties listed in the National Register.

Code of Federal Regulations, 2014 CFR

2014-07-01

... previously unrecognized significance in American history, architecture, archeology, engineering or culture... would be adversely affected by the intrusion of the property; and (iv) Photographs showing the proposed... adversely affected by intrusion of the property. In addition, new photographs, acreage, verbal boundary...

36 CFR 60.14 - Changes and revisions to properties listed in the National Register.

Code of Federal Regulations, 2011 CFR

2011-07-01

... previously unrecognized significance in American history, architecture, archeology, engineering or culture... would be adversely affected by the intrusion of the property; and (iv) Photographs showing the proposed... adversely affected by intrusion of the property. In addition, new photographs, acreage, verbal boundary...

36 CFR 60.14 - Changes and revisions to properties listed in the National Register.

Code of Federal Regulations, 2012 CFR

2012-07-01

... previously unrecognized significance in American history, architecture, archeology, engineering or culture... would be adversely affected by the intrusion of the property; and (iv) Photographs showing the proposed... adversely affected by intrusion of the property. In addition, new photographs, acreage, verbal boundary...

The impact of childhood adversity on suicidality and clinical course in treatment-resistant depression.

PubMed

Tunnard, Catherine; Rane, Lena J; Wooderson, Sarah C; Markopoulou, Kalypso; Poon, Lucia; Fekadu, Abebaw; Juruena, Mario; Cleare, Anthony J

2014-01-01

Childhood adversity is a risk factor for the development of depression and can also affect clinical course. We investigated this specifically in treatment-resistant depression (TRD). One hundred and thirty-seven patients with TRD previously admitted to an inpatient affective disorders unit were included. Clinical, demographic and childhood adversity (physical, sexual, emotional abuse; bullying victimization, traumatic events) data were obtained during admission. Associations between childhood adversity, depressive symptoms and clinical course were investigated. Most patients had experienced childhood adversity (62%), with traumatic events (35%) and bullying victimization (29%) most commonly reported. Childhood adversity was associated with poorer clinical course, including earlier age of onset, episode persistence and recurrence. Logistic regression analyses revealed childhood adversity predicted lifetime suicide attempts (OR 2.79; 95% CI 1.14, 6.84) and childhood physical abuse predicted lifetime psychosis (OR 3.42; 95% CI 1.00, 11.70). The cross-sectional design and retrospective measurement of childhood adversity are limitations of the study. Childhood adversity was common amongst these TRD patients and was associated with poor clinical course, psychosis and suicide attempts. Routine assessment of early adversity may help identify at risk individuals and inform clinical intervention. Copyright © 2013 Elsevier B.V. All rights reserved.

Quality of Life in Children with Asthma in Bangladesh.

PubMed

Hassan, M R; Kabir, S; Basher, A E; Rahman, M A; Islam, M A; Khan, M K; Basher, M S

2017-07-01

Asthma is a public health problem that adversely affects different aspects of quality of life. Childhood asthma is common in Bangladesh affecting their lifestyle. The objective of the study was to assess health-related quality of life in children with bronchial asthma. A descriptive, cross-sectional study was carried out from January 2014 to December 2014 at the Outpatient Department of National Asthma Centre, Mohakhali, Dhaka among hundred sixty-two purposively selected children of both sexes with bronchial asthma aged from 7 to 17 years. Data were collected through interview with children or their parents using an interviewer-administered questionnaire based on Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Data were analyzed by computer software SPSS version 16.0. The mean age was 12.5 years with a standard deviation (SD) of 2.9 years. Overwhelming majority 157(96.9%) of children were literate, while only 5(3.1%) children were illiterate. Eighty (49.4%) children were male, while 82(50.6%) female. As many as 148(91.4%) children were students, while 10(6.2%) children were engaged in some type of job and 4(2.5%) children had no occupation. Parents of 145(89.5%) children were currently married, while 10(6.2%) children had single parent and 7(4.3%) children's parents were divorced or separated. Quality of life in children with asthma decreases with age as the disease intensity increases with age. Female asthmatic children had lower overall score of Quality of life (p=0.017), as well as lower activity domain score (p<0.001). Emotional domain score was found lower in children with single parent (p=0.021) and low monthly family income (p<0.001). Furthermore, children with lower monthly family income and working children had lower Quality of life score in all domains.

Controlling for quality in the hospital cost function.

PubMed

Carey, Kathleen; Stefos, Theodore

2011-06-01

This paper explores the relationship between the cost and quality of hospital care from the perspective of applied microeconomics. It addresses both theoretical and practical complexities entailed in incorporating hospital quality into the estimation of hospital cost functions. That literature is extended with an empirical analysis that examines the use of 15 Patient Safety Indicators (PSIs) as measures of hospital quality. A total operating cost function is estimated on 2,848 observations from five states drawn from the period 2001 to 2007. In general, findings indicate that the PSIs are successful in capturing variation in hospital cost due to adverse patient safety events. Measures that rely on the aggregate number of adverse events summed over PSIs are found to be superior to risk-adjusted rates for individual PSIs. The marginal cost of an adverse event is estimated to be $22,413. The results contribute to a growing business case for inpatient safety in hospital services.

Child Health, Maternal Marital and Socioeconomic Factors, and Maternal Health

PubMed Central

Witt, Whitney P.

2012-01-01

While maternal socioeconomic status and health predict in part children’s future health and socioeconomic prospects, it is possible that the intergenerational association flows in the other direction such that child health affects maternal outcomes. Previous research demonstrates that poor child health increases the risk of adverse maternal physical and mental health outcomes. We hypothesize that poor child health may also increase the risk of poor maternal health outcomes through an interaction between child health and factors associated with health outcomes, such as marital status, marital quality, and socioeconomic status. Using data on women in the National Longitudinal Study of Youth 1979 cohort (N = 2,279), we find evidence that the effects of certain maternal marital quality and socioeconomic factors on maternal physical and mental health depend on child health status and vice versa. PMID:23788824

Leachate Geochemical Results for Ash Samples from the June 2007 Angora Wildfire Near Lake Tahoe in Northern California

USGS Publications Warehouse

Hageman, Philip L.; Plumlee, Geoffrey S.; Martin, Deborah A.; Hoefen, Todd M.; Adams, Monique; Lamothe, Paul J.; Todorov, Todor I.; Anthony, Michael W.

2008-01-01

This report releases leachate geochemical data for ash samples produced by the Angora wildfire that burned from June 24 to July 2, 2007, near Lake Tahoe in northern California. The leaching studies are part of a larger interdisciplinary study whose goal is to identify geochemical characteristics and properties of the ash that may adversely affect human health, water quality, air quality, animal habitat, endangered species, debris flows, and flooding hazards. The leaching study helps characterize and understand the interactions that occur when the ash comes in contact with rain or snowmelt, and helps identify the constituents that may be mobilized as run-off from these materials. Similar leaching studies were conducted on ash and burned soils from the October 2007 southern California wildfires (Hageman and others, 2008; Plumlee and others, 2007).

Siblings, parents, and partners: family relationships within a longitudinal community study. ALSPAC study team. Avon Longitudinal Study of Pregnancy and Childhood.

PubMed

Dunn, J; Deater-Deckard, K; Pickering, K; Golding, J

1999-10-01

Links between sibling relationships, mother-partner, and parent-child relationships were studied in a longitudinal community sample of 3681 sibling pairs. Individual differences in sibling relationship quality were related to mother-partner affection and hostility assessed 4 years earlier, to contemporary parent-child negativity, and to indices of social adversity. Evidence for both direct and indirect pathways (via parent-child relations) linking mother-partner and sibling relations were found. Comparisons of prediction for non-stepfamilies and stepfather families showed similarities in patterns of association, but also differences: In stepfather families, mother-partner hostility was unrelated to parent-child negativity and sibling relationship quality. Both positivity and negativity towards young siblings decreased with the age of older siblings, and older sisters were more positive than older brothers.

Clean Air Markets - Where You Live (National and State Maps)

EPA Pesticide Factsheets

Where You Live accesses facility and unit attribute data as well as emissions data using a series of interactive national and state maps. This module allows the user to view data for regions of interest throughout the country using an intuitive interface, while also providing a national and statewide context for data specific to one or more facilities.EPA's Clean Air Markets Division (CAMD) includes several market-based regulatory programs designed to improve air quality and ecosystems. The most well-known of these programs are EPA's Acid Rain Program and the NOx Programs, which reduce emissions of sulfur dioxide (SO2) and nitrogen oxides (NOx)-compounds that adversely affect air quality, the environment, and public health. CAMD also plays an integral role in the development and implementation of the Clean Air Interstate Rule (CAIR).

Ankylosing Spondylitis and Pregnancy: A Literature Review.

PubMed

Giovannopoulou, Eirini; Gkasdaris, Grigorios; Kapetanakis, Stylianos; Kontomanolis, Emmanuel

2017-01-01

Ankylosing Spondylitis (AS) is the prototype of a group of systemic rheumatic diseases collectively referred to as Spondylarthitides (SpA). It has now become clear that AS is not as rare as previously thought and, although it has an early onset in life affecting patients in their reproductive years, it has not been proved to adversely affect fertility in females. The aim of this review is to summarize all the recent data on AS and pregnancy in terms of fertility, disease course and pregnancy outcome from a clinical perspective. A literature research was conducted based on the following medical databases: Pubmed/ Medline and the Cochrane Library. We searched for randomized controlled studies, casecontrol studies, cohort studies, patient and drug registers in relation to pregnancy and AS. The existing data do not support a causal relationship between AS and infertility. The state of pregnancy is not associated with reduced disease activity in patients with AS. Additionally, AS tends to adversely affect health-related quality of life during pregnancy, in comparison with normal population and patients with rheumatoid arthritis. As far as the obstetrical outcome is concerned, there is no consensus on the significant association between AS and specific pregnancy, delivery and fetal complications. Previous studies are highly heterogenous and mainly retrospective and thus, the existing data are controversial and inconclusive. Subsequent studies are required to enlighten our knowledge on the interaction between AS and pregnancy. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Effect of high pressure pasteurization on bacterial load and bioactivity of Echinacea purpurea.

PubMed

Chen, Xiu-Min; Hu, Chun; Raghubeer, Errol; Kitts, David D

2010-09-01

High hydrostatic pressure (HHP) technology was applied to organic Echinacea purpurea (E. purpurea) roots and flowers to determine the feasibility of using this technology for cold herb pasteurization, to produce microbiologically safe and shelf-stable products for the natural health products (NHPs) industry. HHP significantly (P < 0.01) reduced microbial contamination in both roots and flowers without affecting the phytochemical retention of chicoric and chlorogenic acids, and total alkamide contents. The antioxidant activity of E. purpurea methanol-derived extracts, evaluated in both chemical (2,2'-azino-bis(3-ethylbenzthiazoline-6-sulphonic acid) [ABTS] and oxygen radical absorption capacity [ORAC] assay) and in cell culture models (RAW264, 7 macrophage, H(2)O(2)-induced intracellular oxidation, and lipopolysaccharide [LPS]-induced nitric oxide production), was not adversely affected by the application of HHP at both 2 and 5 min at 600 mPa. Furthermore, HHP did not affect the capacity of E. purpurea extracts to suppress nitric oxide production in LPS-activated macrophage cells. Therefore, our results show that HHP is an effective pasteurization process treatment to reduce microbial-contamination load while not adversely altering chemical and bioactive function of active constituents present in organic E. purpurea. Our study reports for the first time, the effectiveness of using high hydrostatic pressure (HHP) technology pressure to pasteurize E. purpurea root and flower, and the comparative retention of bioactive phytochemicals. Therefore, this technique can be used in food and natural health product industries to produce high-quality, microbiologically safe, and shelf-stable products.

Understaning the "funding effect"

NASA Astrophysics Data System (ADS)

Oreskes, N.

2016-12-01

There is a long history of industry funding of scientific and engineering research in the USA. Much of this work has been of high quality. Research demonstrates, however, that corporate funding can represent a threat to scientific independence and integrity. Studies show that sponsors' interests can affect research results, particularly when sponsors have a strong interest in a particular research outcome. The effects may occur through the impact of subconscious bias on sampling, study design, data interpretation, and/or reporting of results. Corporate funding can also skew research toward investigating certain questions at the expense of others, downplaying the significance of adverse findings, and/or failing to report adverse results. Gifts can affect behavior, even when they are unrelated to research activities. These impacts that are so substantial that they have a name: "the funding effect."[i] Evidence shows that scientists who strive to be objective and fair-minded may nonetheless fall prey to the funding effect. In many cases, the challenges of corporate gifts and funding can be addressed through education and improved self-awareness, agreements that protect researchers' freedom to publish without sponsor approval, sensible disclosure policies, and reasonable sanctions for failures of disclosure. However, in some cases, it may be appropriate for researchers and scientific societies to decline funding.

'They can't report abuse, they can't move out. They are at the mercy of these men': exploring connections between intimate partner violence, gender and HIV in South African clinical settings.

PubMed

Sprague, Courtenay; Hatcher, Abigail M; Woollett, Nataly; Sommers, Theresa; Black, Vivian

2016-01-01

This qualitative study captured South African female health provider perspectives of intimate partner violence in female patients, gender norms and consequences for patients' health. Findings indicated female patients' health behaviours were predicated on sociocultural norms of submission to men's authority and economic dependence on their partners. Respondents described how men's preferences and health decision-making in clinics affected their patients' health. Adverse gender norms and gender inequalities affected women's opportunities to be healthy, contributing to HIV risk and undermining effective HIV management in this context. Some providers, seeking to deliver a standard of quality healthcare to their female patients, demonstrated a willingness to challenge patriarchal gender relations. Findings enhance understanding of how socially-sanctioned gender norms, intimate partner violence and HIV are synergistic, also reaffirming the need for integrated HIV-intimate partner violence responses in multi-sector national strategic plans. Health providers' intimate knowledge of the lived experiences of female patients with intimate partner violence and/or HIV deepens understanding of how adverse gender norms generate health risks for women in ways that may inform policy and clinical practice in South Africa and other high-HIV prevalence settings.

Fibrin glue for pilonidal sinus disease.

PubMed

Lund, Jon; Tou, Samson; Doleman, Brett; Williams, John P

2017-01-13

Pilonidal sinus disease is a common condition that mainly affects young adults. This condition can cause significant pain and impairment of normal activities. No consensus currently exists on the optimum treatment for pilonidal sinus and current therapies have various advantages and disadvantages. Fibrin glue has emerged as a potential treatment as both monotherapy and an adjunct to surgery. To assess the effects of fibrin glue alone or in combination with surgery compared with surgery alone in the treatment of pilonidal sinus disease. In December 2016 we searched: the Cochrane Wounds Specialised Register; CENTRAL; MEDLINE; Embase and CINAHL Plus. We also searched clinical trials registries and conference proceedings for ongoing and unpublished studies and scanned reference lists to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. We included randomised controlled trials (RCTs) only. We included studies involving participants of all ages and studies conducted in any setting. We considered studies involving people with both new and recurrent pilonidal sinus. We included studies which evaluated fibrin glue monotherapy or as an adjunct to surgery. Two study authors independently extracted data and assessed risk of bias. We used standard methods expected by Cochrane. We included four RCTs with 253 participants, all were at risk of bias. One unpublished study evaluated fibrin glue monotherapy compared with Bascom's procedure, two studies evaluated fibrin glue as an adjunct to Limberg flap and one study evaluated fibrin glue as an adjunct to Karydakis flap.For fibrin glue monotherapy compared with Bascom's procedure, there were no data available for the primary outcomes of time to healing and adverse events. There was low-quality evidence of less pain on day one after the procedure with fibrin glue monotherapy compared with Bascom's procedure (mean difference (MD) -2.50, 95% confidence interval (CI) -4.03 to -0.97) (evidence downgraded twice for risk of performance and detection bias). Fibrin glue may reduce the time taken to return to normal activities compared with Bascom's procedure (mean time 42 days with surgery and 7 days with glue, MD -34.80 days, 95% CI -66.82 days to -2.78 days) (very low-quality evidence, downgraded as above and for imprecision).Fibrin glue as an adjunct to the Limberg flap may reduce the healing time from 22 to 8 days compared with the Limberg flap alone (MD -13.95 days, 95% CI -16.76 days to -11.14 days) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and imprecision). It is uncertain whether use of fibrin glue affects the incidence of postoperative seroma (an adverse event) (risk ratio (RR) 0.27, 95% CI 0.05 to 1.61; very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and imprecision). There was low-quality evidence that fibrin glue, as an adjunct to Limberg flap, may reduce postoperative pain (median 2 versus 4; P < 0.001) and time to return to normal activities (median 8 days versus 17 days; P < 0.001). The addition of fibrin glue to the Limberg flap may reduce the length of hospital stay (MD -1.69 days, 95% CI -2.08 days to -1.29 days) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and for unexplained heterogeneity).A single RCT evaluating fibrin glue as an adjunct to the Karydakis flap did not report data for the primary outcome of time to healing. It is uncertain whether fibrin glue with the Karydakis flap affects the incidence of postoperative seroma (adverse event) (RR 3.00, 95% CI 0.67 to 13.46) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and for imprecision). Fibrin glue as an adjunct to Karydakis flap may reduce length of stay but this is highly uncertain (mean 2 days versus 3.7 days; P < 0.001, low-quality evidence downgraded twice for risk of selection, performance and detection bias). Current evidence is uncertain regarding any benefits associated with fibrin glue either as monotherapy or as an adjunct to surgery for people with pilonidal sinus disease. We identified only four RCTs and each was small and at risk of bias resulting in very low-quality evidence for the primary outcomes of time to healing and adverse events. Future studies should enrol many more participants, ensure adequate randomisation and blinding, whilst measuring clinically relevant outcomes.

45 CFR 305.62 - Disregard of a failure which is of a technical nature.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES PROGRAM PERFORMANCE MEASURES, STANDARDS, FINANCIAL INCENTIVES, AND... adversely affect the performance of the State's IV-D program or does not adversely affect the determination of the level of the State's paternity establishment or other performance measures percentages. ...

Predicting effects of climate and land use change on human well-being via changes in ecosystem services

EPA Science Inventory

Landuse and climate change have affected biological systems in many parts of the world, and are projected to further adversely affect associated ecosystem goods and services, including provisioning of clean air, clean water, food, and biodiversity. Such adverse effects on ecosyst...

Analysis of airborne particulate matter pollution in Timisoara city urban area and correlations between measurements and meteorological data

NASA Astrophysics Data System (ADS)

Lungu, Mihai; Lungu, Antoanetta; Stefu, Nicoleta; Neculae, Adrian; Strambeanu, Nicolae

2017-01-01

Air pollution is known to have many adverse effects, among which those on human health are considered the most important. Healthy people of all ages can be adversely affected by high levels of air pollutants. Nanoparticles can be considered among the most harmful of all pollutants as they can penetrate straight into the lungs and blood stream. Their role in the aging process has also recently been revealed. In Romania, practically in all important urban areas (Bucureşti, Iaşi, Timişoara, Braşov, Baia Mare, etc.) the daily limit values for airborne particulate matter are exceeded, so more efforts in controlling air quality are required, along with more research and policies with positive impact on reducing the pollutants concentration in air. The approaches that have been developed to assess the air quality and health impacts of pollution sources are based on analytical methods such as source apportionment, factor analyses, and the measurement of source-relevant indicator compounds. The goal of the present study is to offer preliminary but relevant information on the particulate matter distribution in the city of Timisoara, Romania. Measurements of inhalable coarse and fine particles in two areas of the city, the most affected by industrial particulate emissions, were performed in days with various meteorological conditions. Meteorological parameters for the specific measurement days were recorded (wind speed and direction, humidity, temperature, pressure, etc.) and the influence of these parameters on the particulate matter dispersion was studied. The results show that the meteorological conditions cause differences between airborne particulate matter distributions in different days in the same zones. Measurements were made in northern and southern areas of the city of Timisoara because previous results have shown high levels of airborne particulate matter in these areas.

Obesity, metabolic abnormality, and health-related quality of life by gender: a cross-sectional study in Korean adults.

PubMed

Yang, Youngran; Herting, Jerald R; Choi, Jongsan

2016-06-01

This study sought to compare the association between health-related quality of life (HRQoL) and four body health types by gender. The study included 6217 men and 8243 women over 30 years of age chosen from a population-based survey. Participants were grouped by body mass index and metabolic abnormality into four types: metabolically healthy normal weight, metabolically abnormal but normal weight (MANW), metabolically healthy obesity (MHO), and metabolically abnormal obesity (MAO). HRQoL was measured using the EQ-5D health questionnaire. The outcomes encompassed five dimensions (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression), and the impaired HRQoL dichotomized by the EQ-5D preference score. Complex sample multivariate binary logistic regression analyses were conducted to adjust for sociodemographic variables, lifestyle factors, and disease comorbidity. Among men, those in the MANW group presented worse conditions on all dimensions and the impaired HRQoL compared to other men. However, no significant effect remained after adjusting for relevant covariates. For women, those in the MAO group had the most adversely affected HRQoL followed by those females in the MHO group. The domain of mobility and impaired HRQoL variable of the MAO and MHO groups remained significant when controlling for all covariates in the model. The MANW is the least favorable condition of HRQoL for men, suggesting that metabolic health may associate with HRQoL more than obesity for males. In women, the MAO and MHO groups had the most adversely affected HRQoL, implying that MHO is not a favorable health condition and that obesity, in general, may be strongly associated with HRQoL in women.

Women’s perspectives on quality of maternal health care services in Malawi

PubMed Central

Machira, Kennedy; Palamuleni, Martin

2018-01-01

Despite promotion by many stakeholders to improve maternal health outcome in many developing countries including Malawi, many analysts agree that the utmost success in maternal health will arise if maternal health care services are an unparallel led source for women’s health care solutions for any problem related to childbirth. Health advocates worldwide claim that even though maternal services are provided, women’s utilization of such services has not been ascertained. The objective of this study was to explore women’s perspectives on the quality of health care service delivery in Malawi. This article therefore investigates women’s perspectives on the quality of maternal health care services in Malawi. We used six focus group discussions in six health facilities that were selected across Malawi. We found that erratic availability of medical resources and unethical practices among health workers adversely affected quality of maternal health care service delivery. We concluded that the expensive routine operational audits of medical resources and service delivery across health facilities are imperative if women’s health outcomes are to be enhanced in Malawi. PMID:29386917

Effect on Quality Characteristics of Tomatoes Grown Under Well-Watered and Drought Stress Conditions.

PubMed

Klunklin, Warinporn; Savage, Geoffrey

2017-07-25

Tomatoes are one of the most nutritionally and economically important crops in New Zealand and around the world. Tomatoes require large amounts of water to grow well and are adversely affected by drought stress. However, few studies have evaluated the physicochemical characteristics of commercial tomatoes grown under water stress conditions. Four tomato cultivars (Incas, Marmande, Scoresby Dwarf, and Window Box Red) were grown in a greenhouse under well-watered and drought stress conditions and the tomatoes were harvested when ripe. The physicochemical properties and antioxidant contents of the fruits were compared. There were significant differences between cultivars in quality characteristics-such as dry matter, total soluble solids, and pH parameters-but there were no differences in the quality characteristics between the two treatments of the fruits ( p > 0.05); however, there were significant differences ( p < 0.05) in the antioxidant compositions (lycopene, total phenolics, and flavonoids) and antioxidant activities (DPPH and ABTS) of the fruits of both cultivars and treatments. Overall, these results indicated that tomatoes increased their bioactive compounds without changing any quality characteristics when exposed to water stress conditions.

Effect on Quality Characteristics of Tomatoes Grown Under Well-Watered and Drought Stress Conditions

PubMed Central

Klunklin, Warinporn; Savage, Geoffrey

2017-01-01

Tomatoes are one of the most nutritionally and economically important crops in New Zealand and around the world. Tomatoes require large amounts of water to grow well and are adversely affected by drought stress. However, few studies have evaluated the physicochemical characteristics of commercial tomatoes grown under water stress conditions. Four tomato cultivars (Incas, Marmande, Scoresby Dwarf, and Window Box Red) were grown in a greenhouse under well-watered and drought stress conditions and the tomatoes were harvested when ripe. The physicochemical properties and antioxidant contents of the fruits were compared. There were significant differences between cultivars in quality characteristics—such as dry matter, total soluble solids, and pH parameters—but there were no differences in the quality characteristics between the two treatments of the fruits (p > 0.05); however, there were significant differences (p < 0.05) in the antioxidant compositions (lycopene, total phenolics, and flavonoids) and antioxidant activities (DPPH and ABTS) of the fruits of both cultivars and treatments. Overall, these results indicated that tomatoes increased their bioactive compounds without changing any quality characteristics when exposed to water stress conditions. PMID:28757563

Response surface methodology for predicting quality characteristics of beef patties added with flaxseed and tomato paste.

PubMed

Valenzuela Melendres, M; Camou, J P; Torrentera Olivera, N G; Alvarez Almora, E; González Mendoza, D; Avendaño Reyes, L; González Ríos, H

2014-05-01

Response surface methodology was used to study the effect of flaxseed flour (FS) and tomato paste (TP) addition, from 0 to 10% and 0 to 20% respectively, on beef patty quality characteristics. The assessed quality characteristics were color (L, a, and b), pH and texture profile analysis (TPA). Also, sensory analysis was performed for the assessment of color, juiciness, firmness, and general acceptance. FS addition reduced L and a values and decreased weight loss of cooked products (P<0.05). An opposite effect was observed when TP was added (P<0.05). All TPA parameters decreased when percentages of FS and TP were increased in the formulation of beef patties. Furthermore, FS and TP addition adversely affected the sensory characteristics of the cooked product (P<0.05); nevertheless, all sensory characteristics evaluated had an acceptable score (>5.6). Thus FS and TP are ingredients that can be used in beef patty preparation. Copyright © 2014 Elsevier Ltd. All rights reserved.

OC30 - Fracture reduction with nitrous oxide at the children's emergency department shortens the length of stay and reduces the use of full anaesthesia in the operating department.

PubMed

Lang, Sigrid; Wentzel, Anna-Pia; Ekstrom, Malin

2016-05-09

Theme: Accreditation and quality improvement. Dislocated fractures are common in the children's emergency department (ER). All forms of fracture reduction are very painful requiring nitrous oxide. The purpose is to shorten the length of stay in the hospital as well as sustain a high quality of care. All nurses received theoretical and practical training in the use of nitrous oxide. Evaluations with the families were made by telephone. A total of 40 enclosed fracture reductions were made at the ER, leading to a reduction of 33 patients in the operating department and the length of stay was shortened - this compared to the same time in 2014. No adverse event was reported and no patient felt any increase in pain during the treatment. All patients would repeat the procedure if necessary. The treatment has reduced the length of stay in the hospital without affecting the other patients in the ER or the quality of care.

[Impact factor, its variants and its influence in academic promotion].

PubMed

Puche, Rodolfo C

2011-01-01

Bibliometrics is a set of methods used to study or measure texts and information. While bibliometric methods are most often used in the field of library and information science, bibliometrics variables have wide applications in other areas. One popular bibliometric variable is Garfield's Impact Factor (IF). IF is used to explore the impact of a given field, the impact of a set of researchers, or the impact of a particular paper. This variable is used to assess academic output and it is believed to affect adversely the traditional approach and assessment of scientific research. In our country, the members of the evaluation committees of intensive research institutions, e.g. the National Scientific and Technical Research Council (CONICET) use IF to assess the quality of research. This article revises the exponential growth of bibliometrics and attempts to expose the overall dissatisfaction with the analytical quality of IF. Such dissatisfaction is expressed in the number of investigations attempting to obtain a better variable of improved analytical quality.

A reconnaissance of the effects of a forest fire on water quality in Kings Canyon National Park, California

USGS Publications Warehouse

Hoffman, Ray J.; Ferreira, Rodger F.

1976-01-01

Following two forest fires in the Roaring River drainage basin, Kings Canyon National Park, Calif., water samples were collected from May to July 1974 to determine water-quality changes resulting from the fires. Field measurements included alkalinity , pH, specific conductance, temperature, and discharge. Samples were analyzed in the laboratory for major dissolved chemical constituents, selected plant nutrients, trace metals, suspended sediment, total organic carbon, and seston. Periphytic algae and benthic invertebrate samples were collected. A noticeable increase in the concentration of nitrogen was found in Roaring River immediately downstream from the Moraine Creek fire. The increase in the concentration of inorganic nitrogen compounds, however, was not great enough to pose a serious threat to the aquatic ecosystem. High total organic nitrogen concentrations may have been due, in part, to factors other than the effect of fire. The results of other water-quality measurements were typical of dilute Sierra Nevada streams and indicate that Roaring River was not adversely affected by the fires. (Woodard-USGS)

Influence of debittered, defatted fenugreek seed powder and flaxseed powder on the rheological characteristics of dough and quality of cookies.

PubMed

Metwal, Nirmala; Jyotsna, R; Jeyarani, T; Venkateswara Rao, G

2011-06-01

A functional ingredient mix (FIM) comprising debittered and defatted fenugreek seed powder (70%) and flaxseed powder (30%) was used in cookies. Ash, fat and protein, dough development time, resistance to extension and peak viscosity values increased as the level of FIM increased from 10 to 30% in the blend. Beyond 20% of FIM substitution, the quality characteristics of cookies were adversely affected. Use of soya lecithin produced a significant improvement in the overall quality of the cookies with 20% FIM. Linolenic acid and total dietary fiber content of the cookies with 20% FIM and lecithin contained four times the amount of linolenic acid (2.3%) and double the amount of dietary fiber (13.04%) when compared with the control cookies (0.5% and 6.22%) respectively. Surface scanning electron microscopy of cookies with different levels of FIM from 10 to 30% showed that there was a disruption in the matrix.

Safety culture and care: a program to prevent surgical errors.

PubMed

Hemingway, Maureen White; O'Malley, Catherine; Silvestri, Sandra

2015-04-01

Surgical errors are under scrutiny in health care as part of ensuring a culture of safety in which patients receive quality care. Hospitals use safety measures to compare their performance against industry benchmarks. To understand patient safety issues, health care providers must have processes in place to analyze and evaluate the quality of the care they provide. At one facility, efforts made to improve its quality and safety led to the development of a robust safety program with resources devoted to enhancing the culture of safety in the Perioperative Services department. Improvement initiatives included changing processes for safety reporting and performance improvement plans, adding resources and nurse roles, and creating communication strategies around adverse safety events and how to improve care. One key outcome included a 54% increase in the percentage of personnel who indicated in a survey that they would speak up if they saw something negatively affecting patient care. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Managing storm water at airports

DOE Office of Scientific and Technical Information (OSTI.GOV)

Halm, M.J.

1996-09-01

Airports are active facilities with numerous on-going operations at their sites. The following operations may adversely affect the water quality of nearby aquatic environments: De-icing runways; de-icing taxiways; de-icing and anti-icing aircraft; aircraft maintenance; and salt de-icer application. Until the amendments to the Clean Water Act of 1972, referred to as the Water Quality Act of 1987, were passed by Congress, the majority of storm water discharges in the US were unregulated. The Water Quality Act of 1987 was promulgated as an effort to manage the pollution resulting from storm water runoff. Many industrial facilities, especially airports, were faced withmore » complex problems in attempting to comply with these new federal regulations. National Pollution Discharge Elimination System (NPDES) permits for airports with more than 50,000 flight operations per year require periodic monitoring of receiving waters and storm sewer outfalls. The federal government has given states jurisdiction in issuing NPDES permits for storm water discharges. States may require composite or grab samples.« less

Meditation as an Adjunct to the Management of Multiple Sclerosis

PubMed Central

Levin, Adam B.; Hadgkiss, Emily J.; Weiland, Tracey J.; Jelinek, George A.

2014-01-01

Background. Multiple sclerosis (MS) disease course is known to be adversely affected by several factors including stress. A proposed mechanism for decreasing stress and therefore decreasing MS morbidity and improving quality of life is meditation. This review aims to critically analyse the current literature regarding meditation and MS. Methods. Four major databases were used to search for English language papers published before March 2014 with the terms MS, multiple sclerosis, meditation, and mindfulness. Results. 12 pieces of primary literature fitting the selection criteria were selected: two were randomised controlled studies, four were cohort studies, and six were surveys. The current literature varies in quality; however common positive effects of meditation include improved quality of life (QOL) and improved coping skills. Conclusion. All studies suggest possible benefit to the use of meditation as an adjunct to the management of multiple sclerosis. Additional rigorous clinical trials are required to validate the existing findings and determine if meditation has an impact on disease course over time. PMID:25105026

Professional Quality of Life and Changes in Spirituality Among VHA Chaplains: A Mixed Methods Investigation.

PubMed

McCormick, Wesley H; Carroll, Timothy D; Slagel, Brett A; Drescher, Kent D; Nieuwsma, Jason A; Currier, Joseph M

2017-01-01

A mixed method design was implemented to examine the spirituality and emotional well-being of Veterans Health Administration (VHA) chaplains and how potential changes in spirituality and emotional well-being may affect their professional quality of life. Four distinct categories of changes emerged from the narrative statements of a nationally representative sample of 267 VHA chaplains: (1) positive changes (e.g., increased empathy), (2) negative changes (e.g., dysthymic mood, questioning religious beliefs), (3) combination of positive and negative changes, and (4) no change (e.g., sustenance through spirituality or self-care). Most chaplains reported positive (37%) or no change (30%) in their spirituality and/or emotional well-being. However, quantitative analyses revealed that chaplains who reported negative changes endorsed greater burnout and secondary traumatic stress. Overall, these findings suggest VHA chaplains are predominantly spiritually resilient, but negative changes in the spiritual domain can occur, potentially increasing the risk of adverse changes in professional quality of life.

Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes.

PubMed

Trinkoff, Alison M; Han, Kihye; Storr, Carla L; Lerner, Nancy; Johantgen, Meg; Gartrell, Kyungsook

2013-12-01

The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix. Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes. Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression. Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled. This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.

Climate and human intervention effects on future fire activity and consequences for air pollution across the 21st century

NASA Astrophysics Data System (ADS)

Val Martin, M.; Pierce, J. R.; Heald, C. L.; Li, F.; Lawrence, D. M.; Wiedinmyer, C.; Tilmes, S.; Vitt, F.

2016-12-01

Emissions of aerosols and gases from fires have been shown to adversely affect air quality across the world. Fire activity is strongly related to climate and anthropogenic activities. Current fire projections for the 21st century seem very uncertain, ranging from increasing to declining depending on the climate, land cover change and population growth scenarios used. Here we present an analysis of the changes in future wildfire activity and consequences on air quality, with focus on PM2.5 and surface O3 over regions vulnerable to fire. We use the global Community Earth System Model (CESM) with a process-based fire model to simulate emissions from agriculture, peatland, deforestation and landscape fires for present-day and throughout the current century. We consider two future Representative Concentration Pathways climate scenarios combined with population density changes predicted from Shared Socio-economic Pathways to project climate and demographic effects on fire activity and further consequences for future air quality.

Acupuncture for dysmenorrhoea.

PubMed

Smith, Caroline A; Armour, Mike; Zhu, Xiaoshu; Li, Xun; Lu, Zhi Yong; Song, Jing

2016-04-18

Primary dysmenorrhoea is the most common form of period pain and affects up to three-quarters of women at some stage of their reproductive life. Primary dysmenorrhoea is pain in the absence of any organic cause and is characterised by cramping pain in the lower abdomen, starting within the first eight to 72 hours of menstruation.This review examines the currently available evidence supporting the use of acupuncture (stimulation of points on the body using needles) and acupressure (stimulation of points on the body using pressure) to treat primary dysmenorrhoea. To determine the effectiveness and safety of acupuncture and acupressure in the treatment of primary dysmenorrhoea when compared with a placebo, no treatment, or conventional medical treatment. We searched the following databases: the Cochrane Menstrual Disorders and Subfertility Group Trials Register (to September 2015), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, EMBASE, PsycINFO, CINAHL and Chinese databases including Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP database and registers of ongoing trials. We included all published and unpublished randomised controlled trials (RCTs) comparing acupuncture with sham acupuncture or placebo control, usual care, pharmacological treatment or no treatment. We included the following modes of treatment: acupuncture, electro-acupuncture, and acupressure. Participants were women of reproductive age with primary dysmenorrhoea during the majority of the menstrual cycles or for three consecutive menstrual cycles, and moderate to severe symptoms. We calculated odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, with 95% confidence intervals (CIs). We pooled the data where appropriate. Our primary outcomes was pain. Secondary outcomes included menstrual symptoms, quality of life, and adverse effects. We included 42 RCTs (4640 women). Acupuncture or acupressure was compared with a sham/placebo group, medication, no treatment or other treatment. Many of the continuous data were not suitable for calculation of means, mainly due to evidence of skew.1. Acupuncture studies Acupuncture versus sham or placebo control (6 RCTs)Findings were inconsistent and inconclusive. However, the only study in the review that was at low risk of bias in all domains found no evidence of a difference between the groups at three, six or 12 months. The overall quality of the evidence was low. No studies reported adverse events. Acupuncture versus NSAIDs Seven studies reported visual analogue scale (VAS) pain scores, but were unsuitable for pooling due to extreme heterogeneity (I² = 94%). In all studies the scores were lower in the acupuncture group, with the mean difference varying across studies from 0.64 to 4 points on a VAS 0 - 10 scale (low-quality evidence). Four RCTs reported rates of pain relief, and found a benefit for the acupuncture group (OR 4.99, 95% CI 2.82 to 8.82, 352 women, I² = 0%, low-quality evidence). Adverse events were less common in the acupuncture group (OR 0.10, 95% CI 0.02 to 0.44, 4 RCTs, 239 women, 4 trials, I² = 15%, low-quality evidence). Acupuncture versus no treatment Data were unsuitable for analysis, but pain scores were lower in the acupuncture group in all six studies reporting this outcome. The quality of the evidence was low. No studies reported adverse events.2. Acupressure studiesNo studies of acupressure reported adverse events. Acupressure versus sham or placebo controlData were unsuitable for pooling, but two studies reported a mean benefit of one to three points on a 0 - 10 VAS pain scale. Another four studies reported data unsuitable for analysis: all found that pain scores were lower in the acupuncture group. No studies reported adverse events. The quality of the evidence was low. Acupressure versus NSAIDsOne study reported this outcome, using a 0 - 3 pain scale. The score was higher (indicating more pain) in the acupressure group (MD 0.39 points, 95% CI 0.21 to 0.57, 136 women, very low-quality evidence). Acupressure versus no treatmentThere was no clear evidence of a difference between the groups on a VAS 0 - 10 pain scale (MD -0.96 points, 95% CI -2.54 to 0.62, 2 trials, 140 women, I² = 83%, very low-quality evidence). There is insufficient evidence to demonstrate whether or not acupuncture or acupressure are effective in treating primary dysmenorrhoea, and for most comparisons no data were available on adverse events. The quality of the evidence was low or very low for all comparisons. The main limitations were risk of bias, poor reporting, inconsistency and risk of publication bias.

Percutaneous Breast Biopsy: Effect on Short-term Quality of Life

PubMed Central

Humphrey, Kathryn L.; Donelan, Karen; Kong, Chung Y.; Williams, Olubunmi; Itauma, Omosalewa; Halpern, Elkan F.; Gerade, Beverly J.; Rafferty, Elizabeth A.; Swan, J. Shannon

2014-01-01

Purpose To examine the effects of percutaneous breast biopsy on short-term quality of life. Materials and Methods The institutional review board approved this HIPAA-compliant prospective study. From December 1, 2007, through February 28, 2010, women undergoing percutaneous breast biopsy in an academic medical center were recruited to participate in a mixed-mode survey 2–4 days after biopsy. Patients described their biopsy experience by using the Testing Morbidities Index (TMI), a validated instrument for assessing short-term quality of life related to diagnostic testing. The scale ranged from 0 (worst possible experience) to 100 (no adverse effects). Seven attributes were assessed: pain or discomfort before and during testing, fear or anxiety before and during testing, embarrassment during testing, and physical and mental function after testing. Demographic and clinical information were also collected. Univariate and multivariate linear regression analyses were performed to identify significant predictors of TMI score. Results In 188 women (mean age, 51.4 years; range, 22–80 years), the mean TMI score (±standard deviation) was 82 ± 12. Univariate analysis revealed age and race as significant predictors of the TMI score (P < .05). In the multivariate model, only patient age remained a significant independent predictor (P = .001). TMI scores decreased by approximately three points for every decade decrease in patient age, which suggests that younger women were more adversely affected by the biopsy experience. Conclusion Younger patient age is a significant predictor of decreased short-term quality of life related to percutaneous breast biopsy procedures. Tailored prebiopsy counseling may better prepare women for percutaneous biopsy procedures and improve their experience. © RSNA, 2013 PMID:24471385

Occupational stress in the ED: a systematic literature review.

PubMed

Basu, Subhashis; Qayyum, Hasan; Mason, Suzanne

2017-07-01

Occupational stress is a major modern health and safety challenges. While the ED is known to be a high-pressure environment, the specific organisational stressors which affect ED staff have not been established. We conducted a systematic review of literature examining the sources of organisational stress in the ED, their link to adverse health outcomes and interventions designed to address them. A narrative review of contextual factors that may contribute to occupational stress was also performed. All articles written in English, French or Spanish were eligible for conclusion. Study quality was graded using a modified version of the Newcastle-Ottawa Scale. Twenty-five full-text articles were eligible for inclusion in our systematic review. Most were of moderate quality, with two low-quality and two high-quality studies, respectively. While high demand and low job control were commonly featured, other studies demonstrated the role of insufficient support at work, effort-reward imbalance and organisational injustice in the development of adverse health and occupational outcomes. We found only one intervention in a peer-reviewed journal evaluating a stress reduction programme in ED staff. Our review provides a guide to developing interventions that target the origins of stress in the ED. It suggests that those which reduce demand and increase workers' control over their job, improve managerial support, establish better working relationships and make workers' feel more valued for their efforts could be beneficial. We have detailed examples of successful interventions from other fields which may be applicable to this setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Developmental programming of cardiovascular disease by prenatal hypoxia.

PubMed

Giussani, D A; Davidge, S T

2013-10-01

It is now recognized that the quality of the fetal environment during early development is important in programming cardiovascular health and disease in later life. Fetal hypoxia is one of the most common consequences of complicated pregnancies worldwide. However, in contrast to the extensive research effort on pregnancy affected by maternal nutrition or maternal stress, the contribution of pregnancy affected by fetal chronic hypoxia to developmental programming is only recently becoming delineated and established. This review discusses the increasing body of evidence supporting the programming of cardiac susceptibility to ischaemia and reperfusion (I/R) injury, of endothelial dysfunction in peripheral resistance circulations, and of indices of the metabolic syndrome in adult offspring of hypoxic pregnancy. An additional focus of the review is the identification of plausible mechanisms and the implementation of maternal and early life interventions to protect against adverse programming.

A cross-cultural longitudinal examination of the effect of cumulative adversity on the mental and physical health of older adults.

PubMed

Palgi, Yuval; Shrira, Amit

2016-03-01

Self-oriented adversity refers to traumatic events that primarily inflict the self, whereas other-oriented adversity refers to events that affect the self by primarily targeting others. The present study aimed to examine whether cultural background moderates the effects of self-oriented and other-oriented adversity on mental and physical health of older adults. Using longitudinal data from the Israeli component of the Survey of Health and Retirement, we focused on 370 Jews and 239 Arabs who reported their exposure to various adversities across the life span, and completed questionnaires regarding mental and physical health. Results showed that the effect of self-oriented adversity on health did not differ among Jews and Arabs. However, other-oriented adversity showed a stronger effect on Arabs' mental and physical health than on Jews' health. Our findings suggest that the accumulation of adverse events that affect the self by primarily targeting others may have a stronger impact in collectivist cultures than in individualist cultures. (c) 2016 APA, all rights reserved).

Technology to promote safe mobility in the elderly.

PubMed

Nelson, Audrey; Powell-Cope, Gail; Gavin-Dreschnack, Deborah; Quigley, Pat; Bulat, Tatjana; Baptiste, Andrea S; Applegarth, Shawn; Friedman, Yvonne

2004-09-01

New technologies designed to help prevent adverse events related to the mobility of geriatric patients (ie, patient falls, bed-rail entrapment, patient handling, and wandering) are described. Technology offers the potential to eliminate or mitigate preventable adverse events that interfere with treatment, delay rehabilitation, potentiate impairment, and compromise patient safety. Unchecked, these adverse events can have a negative impact on patient health, functional status, and quality of life. It is not surprising that the elderly constitute the population at highest risk for adverse events, based on poor health, chronic conditions, long hospitalizations, and institutional care. Patient falls are a high-risk, high-volume, and high-cost adverse event. Key technologies to prevent falls and fall-related injuries include hip protectors, wheelchair/scooter safety features, intelligent walkers, fall alarms, and environmental aids. Bed-rail entrapment is a serious adverse event, which includes patients being trapped, entangled, or strangled in beds. New technologies to prevent bed-rail entrapment include new hospital bed designs, height-adjustable low beds, devices to close gaps in legacy beds, and bedside floor mats. Patients with mobility impairments necessitate physical assistance in transfers and other patient-handling tasks, which increases risk for the caregiver and the patient. Featured technologies to prevent patient handling injuries include innovations in floor-based lifts, new ceiling-mounted patient lifts, and improvements in powered standing lifts, new friction-reducing devices, and new patient transport technology. Wandering affects 39% of cognitively impaired nursing home residents and up to 70% of community-residing elderly persons with cognitive impairments. New technologies to prevent adverse events associated with wandering include door alarms and signal-transmitting devices. Nurses in geriatric settings would benefit from exposure to technologies that could improve patient and caregiver safety. To maximize the benefits of technology, it is critical that front-line nursing staff be involved in the testing and selection of devices that will be used in their practice. Further, to reap the full benefits of technology, a careful plan for implementation needs to be developed that would include integrating the new technology with existing infrastructure. Training needs to be provided for all staff who will be using the technology, and efforts to ensure competency over time is needed. A major barrier to widespread use of new technology is cost. Further research is needed to demonstrate the cost effectiveness of these devices. Results from these studies will help to build a business case, demonstrating that initial capital investments will result in cost savings, improved quality of care, and other benefits.

Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: a randomized trial.

PubMed

Brooks, B R; Thisted, R A; Appel, S H; Bradley, W G; Olney, R K; Berg, J E; Pope, L E; Smith, R A

2004-10-26

Patients with ALS commonly exhibit pseudobulbar affect. The authors conducted a multicenter, randomized, double-blind, controlled, parallel, three-arm study to test a defined combination of dextromethorphan hydrobromide (DM) and quinidine sulfate (Q) (AVP-923) for the treatment of pseudobulbar affect in ALS. Q inhibits the rapid first-pass metabolism of DM. The effects of AVP-923 (30 mg of DM plus 30 mg of Q) given twice daily for 28 days were compared with those of its components. Patients were evaluated on days 1, 15, and 29. The primary efficacy variable was the change from baseline in the Center for Neurologic Study Lability Scale (CNS-LS) score. Secondary efficacy variables were laughing/crying episode rates and changes in Visual Analog Scales for Quality of Life (QOL) and Relationships (QOR). Efficacy was evaluated in intention-to-treat subjects who were not poor metabolizers of DM (n = 65 for AVP-923, n = 30 for DM, and n = 34 for Q). Safety was assessed in all randomized subjects (n = 140). AVP-923 patients experienced 3.3-point greater improvements in CNS-LS than DM patients (p = 0.001) and 3.7-point greater improvements than Q patients (p < 0.001). AVP-923 patients exhibited lower overall episode rates, improved QOL scores, and improved QOR scores (p < 0.01 for all endpoints). Adverse effects were mostly mild or moderate; treatment-related discontinuation was 24% for AVP-923, 6% for DM, and 8% for Q. AVP-923 palliates pseudobulbar affect in ALS. Overall benefits of treatment are reflected in fewer episodes of crying and laughing and improvements in overall quality of life and quality of relationships.

Assessment of pollution in road runoff using a Bufo viridis biological assay.

PubMed

Dorchin, A; Shanas, U

2010-12-01

Road runoff is a major source of environmental pollution, significantly threatening nearby aquatic habitats. Chemical analyses indicate high pollutant concentrations in the road's "first flush", but bioassays are more advantageous for addressing the cumulative effects of the numerous pollutants within the runoff. We used Bufo viridis embryos and larvae to assess the toxicity of road runoff from two major highways in Israel. We show, for the first time, that exposure to midseason runoff not only has an adverse effect on growth and development rates of B. viridis larvae but can also lead to increased rates of morphological deformations. Seasonal first flushes, despite having higher metal concentrations, did not adversely affect the toad larvae, apparently due to a counter effect of organic matter that potentially served as a supplementary energy resource. Road runoff can be a major cause for a qualitative decrease in the quality of aquatic habitats threatening amphibians in Israel. Copyright © 2010 Elsevier Ltd. All rights reserved.

Air Pollution Exposure and Physical Activity in China: Current Knowledge, Public Health Implications, and Future Research Needs

PubMed Central

Lü, Jiaojiao; Liang, Leichao; Feng, Yi; Li, Rena; Liu, Yu

2015-01-01

Deteriorating air quality in China has created global public health concerns in regard to health and health-related behaviors. Although emerging environmental regulations address ambient air pollution in China, the level of enforcement and long-term impact of these measures remain unknown. Exposure to air pollution has been shown to lead to multiple adverse health outcomes, including increased rates of heart disease and mortality. However, a lesser-known but increasingly significant concern is the relationship between air pollution and its effects on outdoor exercise. This is especially important in China, which has a culturally rooted lifestyle that encourages participation in outdoor physical activity. This article evaluates the intersection of air pollution and outdoor exercise and provides a discussion of issues related to its public health impact in China, where efforts to promote a healthy lifestyle may be adversely affected by the ambient air pollution that has accompanied rapid economic development and urbanization. PMID:26610539

Air Pollution Exposure and Physical Activity in China: Current Knowledge, Public Health Implications, and Future Research Needs.

PubMed

Lü, Jiaojiao; Liang, Leichao; Feng, Yi; Li, Rena; Liu, Yu

2015-11-20

Deteriorating air quality in China has created global public health concerns in regard to health and health-related behaviors. Although emerging environmental regulations address ambient air pollution in China, the level of enforcement and long-term impact of these measures remain unknown. Exposure to air pollution has been shown to lead to multiple adverse health outcomes, including increased rates of heart disease and mortality. However, a lesser-known but increasingly significant concern is the relationship between air pollution and its effects on outdoor exercise. This is especially important in China, which has a culturally rooted lifestyle that encourages participation in outdoor physical activity. This article evaluates the intersection of air pollution and outdoor exercise and provides a discussion of issues related to its public health impact in China, where efforts to promote a healthy lifestyle may be adversely affected by the ambient air pollution that has accompanied rapid economic development and urbanization.

SU-F-I-71: Fetal Protection During Fluoroscopy: To Shield Or Not to Shield?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Joshi, S; Vanderhoek, M

Purpose: Lead aprons are routinely used to shield the fetus from radiation during fluoroscopically guided interventions (FGI) involving pregnant patients. When placed in the primary beam, lead aprons often reduce image quality and increase fluoroscopic radiation output, which can adversely affect fetal dose. The purpose of this work is to identify an effective and practical method to reduce fetal dose without affecting image quality. Methods: A pregnant patient equivalent abdominal phantom is set on the table along with an image quality test object (CIRS model 903) representing patient anatomy of interest. An ion chamber is positioned at the x-ray beammore » entrance to the phantom, which is used to estimate the relative fetal dose. For three protective methods, image quality and fetal dose measurements are compared to baseline (no protection):1. Lead apron shielding the entire abdomen; 2. Lead apron shielding part of the abdomen, including the fetus; 3. Narrow collimation such that fetus is excluded from the primary beam. Results: With lead shielding the entire abdomen, the dose is reduced by 80% relative to baseline along with a drastic deterioration of image quality. With lead shielding only the fetus, the dose is reduced by 65% along with complete preservation of image quality, since the image quality test object is not shielded. However, narrow collimation results in 90% dose reduction and a slight improvement of image quality relative to baseline. Conclusion: The use of narrow collimation to protect the fetus during FGI is a simple and highly effective method that simultaneously reduces fetal dose and maintains sufficient image quality. Lead aprons are not as effective at fetal dose reduction, and if placed improperly, they can severely degrade image quality. Future work aims to investigate a wider variety of fluoroscopy systems to confirm these results across many different system geometries.« less

Missing data treatments matter: an analysis of multiple imputation for anterior cervical discectomy and fusion procedures.

PubMed

Ondeck, Nathaniel T; Fu, Michael C; Skrip, Laura A; McLynn, Ryan P; Cui, Jonathan J; Basques, Bryce A; Albert, Todd J; Grauer, Jonathan N

2018-04-09

The presence of missing data is a limitation of large datasets, including the National Surgical Quality Improvement Program (NSQIP). In addressing this issue, most studies use complete case analysis, which excludes cases with missing data, thus potentially introducing selection bias. Multiple imputation, a statistically rigorous approach that approximates missing data and preserves sample size, may be an improvement over complete case analysis. The present study aims to evaluate the impact of using multiple imputation in comparison with complete case analysis for assessing the associations between preoperative laboratory values and adverse outcomes following anterior cervical discectomy and fusion (ACDF) procedures. This is a retrospective review of prospectively collected data. Patients undergoing one-level ACDF were identified in NSQIP 2012-2015. Perioperative adverse outcome variables assessed included the occurrence of any adverse event, severe adverse events, and hospital readmission. Missing preoperative albumin and hematocrit values were handled using complete case analysis and multiple imputation. These preoperative laboratory levels were then tested for associations with 30-day postoperative outcomes using logistic regression. A total of 11,999 patients were included. Of this cohort, 63.5% of patients had missing preoperative albumin and 9.9% had missing preoperative hematocrit. When using complete case analysis, only 4,311 patients were studied. The removed patients were significantly younger, healthier, of a common body mass index, and male. Logistic regression analysis failed to identify either preoperative hypoalbuminemia or preoperative anemia as significantly associated with adverse outcomes. When employing multiple imputation, all 11,999 patients were included. Preoperative hypoalbuminemia was significantly associated with the occurrence of any adverse event and severe adverse events. Preoperative anemia was significantly associated with the occurrence of any adverse event, severe adverse events, and hospital readmission. Multiple imputation is a rigorous statistical procedure that is being increasingly used to address missing values in large datasets. Using this technique for ACDF avoided the loss of cases that may have affected the representativeness and power of the study and led to different results than complete case analysis. Multiple imputation should be considered for future spine studies. Copyright © 2018 Elsevier Inc. All rights reserved.

Tibiofemoral osteoarthritis affects quality of life and function in elderly Koreans, with women more adversely affected than men.

PubMed

Kim, Inje; Kim, Hyun Ah; Seo, Young-Il; Song, Yeong Wook; Hunter, David J; Jeong, Jin Young; Kim, Dong Hyun

2010-06-22

The prevalence of knee osteoarthritis(OA) in East Asia is as common for men and even higher for women than that reported in the Caucasian population. Since both population aging and economic growth have taken place at a much faster pace in Asian countries, such as South Korea, one would expect knee OA to become a major public health problem. However, few studies have examined the influence of knee OA on the quality of life (QoL) and physical function in Asia. The aim of this cross-sectional study is to investigate the influence of knee osteoarthritis (OA) on the quality of life (QoL), function and lower extremity physical performance and the gender difference in its influence in elderly community residents in Korea. Participants were from the population-based Hallym Aging Study (HAS). The mean age of the 504 study subjects was 70.2 years and 274 (54%) were women. Demographic information was obtained by questionnaire, and radiographic evaluations consisted of weight-bearing semi-flexed knee radiographs. Self-reported QoL and function were assessed using Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index and Short Form 12-item (SF-12). Performance-based lower extremity function was assessed using the tests consisting of standing balance, usual walk and chair stands. The odds ratios(ORs) for belonging to the worst quartile of WOMAC and physical performance test were calculated by logistic regression analysis in radiographic knee OA compared to non-OA after adjustment of confounders. Scores for SF-12 items were analyzed using general linear models and means adjusted for age, BMI and OA severity were compared. Subjects with radiographic knee OA had significantly increased OR for belonging to the worst WOMAC quartile(for pain, 2.13,95% confidence interval[CI], 1.33-3.40, for stiffness, 2.94,95% CI,1.78-4.86, and for function, 2.97, 95% CI,1.83-4.81) and significantly worse SF-12 scores compared to non-OA after adjustment of age, BMI and sex. Women had worse WOMAC and SF-12 scores compared to men, regardless of the presence of radiographic knee OA after adjustment of age, BMI and OA severity. OA subjects had significantly worse performance score for usual walk and chair stands compared to non-OA subjects, but the ORs were no more significant after adjustment of sex. Knee OA negatively affects the QoL and physical function in both genders, but women are more adversely affected than men.

Statin-Associated Muscle-Related Adverse Effects: A Case Series of 354 Patients

PubMed Central

Cham, Stephanie; Evans, Marcella A.; Denenberg, Julie O.; Golomb, Beatrice A.

2016-01-01

Study Objective To characterize the properties and natural history of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin)-associated muscle-related adverse effects (MAEs). Design Patient-targeted postmarketing adverse-effect surveillance approach coupling survey design with an open-ended narrative. Setting University-affiliated health care system. Subjects Three hundred fifty-four patients (age range 34–86 yrs) who self-reported muscle-related problems associated with statin therapy. Measurements and Main Results Patients with perceived statin-associated MAEs completed a survey assessing statin drugs and dosages; characteristics of the MAEs; time course of onset, resolution, or recurrence; and impact on quality of life (QOL). Cases were assessed for putative drug adverse-effect causality by using the Naranjo adverse drug reaction probability scale criteria and were evaluated for inclusion in groups for which mortality benefit with statins has been shown. Patients reported muscle pain (93%), fatigue (88%), and weakness (85%). Three hundred patients (85%) met literature criteria for probable or definite drug adverse-effect causality. Ninety-four percent of atorvastatin usages (240/255) generated MAEs versus 61% of lovastatin usages (38/62, p<0.0001). Higher potency statins reproduced MAEs in 100% of 39 rechallenges versus 73% (29/40) with lower potency rechallenges (p<0.01). Time course of onset after statin initiation varied (median 14 wks); some MAEs occurred after long-term symptom-free use. Recurrence with rechallenge had a significantly shorter latency to onset (median 2 wks). The MAEs adversely affected all assessed functional and QOL domains. Most patients with probable or definite MAEs were in categories for which available randomized controlled trial evidence shows no trend to all-cause mortality benefit with statin therapy. Conclusion This study complements available information on the properties and natural history of statin-associated MAEs, affirming dose dependence and strong QOL impact. The data indicating a dose-dependent relationship between MAE risk and recurrence suggest lower potency statins or discontinuation may bear consideration for ameliorating symptoms. PMID:20500044

Statin-associated muscle-related adverse effects: a case series of 354 patients.

PubMed

Cham, Stephanie; Evans, Marcella A; Denenberg, Julie O; Golomb, Beatrice A

2010-06-01

To characterize the properties and natural history of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin)-associated muscle-related adverse effects (MAEs). Patient-targeted postmarketing adverse-effect surveillance approach coupling survey design with an open-ended narrative. University-affiliated health care system. Three hundred fifty-four patients (age range 34-86 yrs) who self-reported muscle-related problems associated with statin therapy. Patients with perceived statin-associated MAEs completed a survey assessing statin drugs and dosages; characteristics of the MAEs; time course of onset, resolution, or recurrence; and impact on quality of life (QOL). Cases were assessed for putative drug adverse-effect causality by using the Naranjo adverse drug reaction probability scale criteria and were evaluated for inclusion in groups for which mortality benefit with statins has been shown. Patients reported muscle pain (93%), fatigue (88%), and weakness (85%). Three hundred patients (85%) met literature criteria for probable or definite drug adverse-effect causality. Ninety-four percent of atorvastatin usages (240/255) generated MAEs versus 61% of lovastatin usages (38/62, p<0.0001). Higher potency statins reproduced MAEs in 100% of 39 rechallenges versus 73% (29/40) with lower potency rechallenges (p<0.01). Time course of onset after statin initiation varied (median 14 wks); some MAEs occurred after long-term symptom-free use. Recurrence with rechallenge had a significantly shorter latency to onset (median 2 wks). The MAEs adversely affected all assessed functional and QOL domains. Most patients with probable or definite MAEs were in categories for which available randomized controlled trial evidence shows no trend to all-cause mortality benefit with statin therapy. This study complements available information on the properties and natural history of statin-associated MAEs, affirming dose dependence and strong QOL impact. The data indicating a dose-dependent relationship between MAE risk and recurrence suggest lower potency statins or discontinuation may bear consideration for ameliorating symptoms.

IDAAPM: integrated database of ADMET and adverse effects of predictive modeling based on FDA approved drug data.

PubMed

Legehar, Ashenafi; Xhaard, Henri; Ghemtio, Leo

2016-01-01

The disposition of a pharmaceutical compound within an organism, i.e. its Absorption, Distribution, Metabolism, Excretion, Toxicity (ADMET) properties and adverse effects, critically affects late stage failure of drug candidates and has led to the withdrawal of approved drugs. Computational methods are effective approaches to reduce the number of safety issues by analyzing possible links between chemical structures and ADMET or adverse effects, but this is limited by the size, quality, and heterogeneity of the data available from individual sources. Thus, large, clean and integrated databases of approved drug data, associated with fast and efficient predictive tools are desirable early in the drug discovery process. We have built a relational database (IDAAPM) to integrate available approved drug data such as drug approval information, ADMET and adverse effects, chemical structures and molecular descriptors, targets, bioactivity and related references. The database has been coupled with a searchable web interface and modern data analytics platform (KNIME) to allow data access, data transformation, initial analysis and further predictive modeling. Data were extracted from FDA resources and supplemented from other publicly available databases. Currently, the database contains information regarding about 19,226 FDA approval applications for 31,815 products (small molecules and biologics) with their approval history, 2505 active ingredients, together with as many ADMET properties, 1629 molecular structures, 2.5 million adverse effects and 36,963 experimental drug-target bioactivity data. IDAAPM is a unique resource that, in a single relational database, provides detailed information on FDA approved drugs including their ADMET properties and adverse effects, the corresponding targets with bioactivity data, coupled with a data analytics platform. It can be used to perform basic to complex drug-target ADMET or adverse effects analysis and predictive modeling. IDAAPM is freely accessible at http://idaapm.helsinki.fi and can be exploited through a KNIME workflow connected to the database.Graphical abstractFDA approved drug data integration for predictive modeling.

50 CFR 402.45 - Alternative consultation on FIFRA actions that are not likely to adversely affect listed species...

Code of Federal Regulations, 2011 CFR

2011-10-01

... OF COMMERCE); ENDANGERED SPECIES COMMITTEE REGULATIONS SUBCHAPTER A INTERAGENCY COOPERATION-ENDANGERED SPECIES ACT OF 1973, AS AMENDED Counterpart Regulations Governing Actions by the U.S... that are not likely to adversely affect listed species or critical habitat. 402.45 Section 402.45...

50 CFR 402.45 - Alternative consultation on FIFRA actions that are not likely to adversely affect listed species...

Code of Federal Regulations, 2012 CFR

2012-10-01

... OF COMMERCE); ENDANGERED SPECIES COMMITTEE REGULATIONS SUBCHAPTER A INTERAGENCY COOPERATION-ENDANGERED SPECIES ACT OF 1973, AS AMENDED Counterpart Regulations Governing Actions by the U.S... that are not likely to adversely affect listed species or critical habitat. 402.45 Section 402.45...

50 CFR 402.45 - Alternative consultation on FIFRA actions that are not likely to adversely affect listed species...

Code of Federal Regulations, 2013 CFR

2013-10-01

... OF COMMERCE); ENDANGERED SPECIES COMMITTEE REGULATIONS SUBCHAPTER A INTERAGENCY COOPERATION-ENDANGERED SPECIES ACT OF 1973, AS AMENDED Counterpart Regulations Governing Actions by the U.S... that are not likely to adversely affect listed species or critical habitat. 402.45 Section 402.45...

50 CFR 402.45 - Alternative consultation on FIFRA actions that are not likely to adversely affect listed species...

Code of Federal Regulations, 2014 CFR

2014-10-01

... OF COMMERCE); ENDANGERED SPECIES COMMITTEE REGULATIONS SUBCHAPTER A INTERAGENCY COOPERATION-ENDANGERED SPECIES ACT OF 1973, AS AMENDED Counterpart Regulations Governing Actions by the U.S... that are not likely to adversely affect listed species or critical habitat. 402.45 Section 402.45...

50 CFR 402.45 - Alternative consultation on FIFRA actions that are not likely to adversely affect listed species...

Code of Federal Regulations, 2010 CFR

2010-10-01

... OF COMMERCE); ENDANGERED SPECIES COMMITTEE REGULATIONS SUBCHAPTER A INTERAGENCY COOPERATION-ENDANGERED SPECIES ACT OF 1973, AS AMENDED Counterpart Regulations Governing Actions by the U.S... that are not likely to adversely affect listed species or critical habitat. 402.45 Section 402.45...

17 CFR 270.19b-1 - Frequency of distribution of capital gains.

Code of Federal Regulations, 2010 CFR

2010-04-01

... eligible trust security which adversely affects the ability of such issuer to continue payment of principal... which adversely affects the ability of such issuer to continue payment of principal or interest on its... request as not being necessary or appropriate in the public interest or for the protection of investors...

75 FR 21528 - Airworthiness Directives; McDonnell Douglas Corporation Model MD-90-30 Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-26

... subsequently damage the hydraulic system and adversely affect the airplane's ability to make a safe landing... cylinder support fitting for the MLG failing during gear extension and subsequently damaging the hydraulic... the retract cylinder support fitting for the MLG, which could adversely affect the airplane's safe...

Adversity before Conception Will Affect Adult Progeny in Rats

ERIC Educational Resources Information Center

Shachar-Dadon, Alice; Schulkin, Jay; Leshem, Micah

2009-01-01

The authors investigated whether adversity in a female, before she conceives, will influence the affective and social behavior of her progeny. Virgin female rats were either undisturbed (controls) or exposed to varied, unpredictable, stressors for 7 days (preconceptual stress [PCS]) and then either mated immediately after the end of the stress…

Physiological and biochemical perspectives of non-salt tolerant plants during bacterial interaction against soil salinity.

PubMed

Radhakrishnan, Ramalingam; Baek, Kwang Hyun

2017-07-01

Climatic changes on earth affect the soil quality of agricultural lands, especially by increasing salt deposition in soil, which results in soil salinity. Soil salinity is a major challenge to growth and reproduction among glycophytes (including all crop plants). Soil bacteria present in the rhizosphere and/or roots naturally protect plants from the adverse effects of soil salinity by reprogramming the stress-induced physiological changes in plants. Bacteria can enrich the soil with major nutrients (nitrogen, phosphorus, and potassium) in a form easily available to plants and prevent the transport of excess sodium to roots (exopolysaccharides secreted by bacteria bind with sodium ions) for maintaining ionic balance and water potential in cells. Salinity also affects plant growth regulators and suppresses seed germination and root and shoot growth. Bacterial secretion of indole-3-acetic acid and gibberellins compensates for the salt-induced hormonal decrease in plants, and bacterial 1-aminocyclopropane-1-carboxylate (ACC) deaminase synthesis decreases ethylene production to stimulate plant growth. Furthermore, bacteria modulate the redox state of salinity-affected plants by enhancing antioxidants and polyamines, which leads to increased photosynthetic efficiency. Bacteria-induced accumulation of compatible solutes in stressed plants regulates plant cellular activities and prevents salt stress damage. Plant-bacterial interaction reprograms the expression of salt stress-responsive genes and proteins in salinity-affected plants, resulting in a precise stress mitigation metabolism as a defense mechanism. Soil bacteria increase the fertility of soil and regulate the plant functions to prevent the salinity effects in glycophytes. This review explains the current understanding about the physiological changes induced in glycophytes during bacterial interaction to alleviate the adverse effects of soil salinity stress. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Physical therapist assistant in a California home health agency.

PubMed

Roach, J P; Cook, L M

1981-09-01

A perpetual shortage of physical therapists qualified to provide home health care exists in Southern California. This paper presents one solution to the problem: the employment of a physical therapist assistant. The preparation, implementation, and evaluation of a program for employing a physical therapist assistant in a home health agency is presented and discussed. The use of the assistant increased the availability of physical therapy, and quality was not adversely affected. The assistant was accepted by staff and derived job satisfaction. We concluded that this assistant was a valuable adjunct to the home health team. Subsequently, The Visiting Nurse Association of Los Angeles employed two additional assistants in 1980.

A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI.

PubMed

Wolff, Andy; Joshi, Revan Kumar; Ekström, Jörgen; Aframian, Doron; Pedersen, Anne Marie Lynge; Proctor, Gordon; Narayana, Nagamani; Villa, Alessandro; Sia, Ying Wai; Aliko, Ardita; McGowan, Richard; Kerr, Alexander Ross; Jensen, Siri Beier; Vissink, Arjan; Dawes, Colin

2017-03-01

Medication-induced salivary gland dysfunction (MISGD), xerostomia (sensation of oral dryness), and subjective sialorrhea cause significant morbidity and impair quality of life. However, no evidence-based lists of the medications that cause these disorders exist. Our objective was to compile a list of medications affecting salivary gland function and inducing xerostomia or subjective sialorrhea. Electronic databases were searched for relevant articles published until June 2013. Of 3867 screened records, 269 had an acceptable degree of relevance, quality of methodology, and strength of evidence. We found 56 chemical substances with a higher level of evidence and 50 with a moderate level of evidence of causing the above-mentioned disorders. At the first level of the Anatomical Therapeutic Chemical (ATC) classification system, 9 of 14 anatomical groups were represented, mainly the alimentary, cardiovascular, genitourinary, nervous, and respiratory systems. Management strategies include substitution or discontinuation of medications whenever possible, oral or systemic therapy with sialogogues, administration of saliva substitutes, and use of electro-stimulating devices. While xerostomia was a commonly reported outcome, objectively measured salivary flow rate was rarely reported. Moreover, xerostomia was mostly assessed as an adverse effect rather than the primary outcome of medication use. This study may not include some medications that could cause xerostomia when administered in conjunction with others or for which xerostomia as an adverse reaction has not been reported in the literature or was not detected in our search. We compiled a comprehensive list of medications with documented effects on salivary gland function or symptoms that may assist practitioners in assessing patients who complain of dry mouth while taking medications. The list may also prove useful in helping practitioners anticipate adverse effects and consider alternative medications.

Chinese herbal medicine for subfertile women with polycystic ovarian syndrome.

PubMed

Zhou, Kunyan; Zhang, Jing; Xu, Liangzhi; Wu, Taixiang; Lim, Chi Eung Danforn

2016-10-12

Polycystic ovarian syndrome (PCOS) is one of the most common reproductive endocrinology abnormalities, and affects 5% to 10% of women of reproductive age. Western medicines, such as oral contraceptives, insulin sensitizers and laparoscopic ovarian drilling (LOD), have been used to treat PCOS. Recently, many studies have been published that consider Chinese herbal medicine (CHM) as an alternative treatment for women with PCOS. To assess the efficacy and safety of CHM for subfertile women with PCOS. We searched sources, including the following databases, from inception to 9 June 2016: the Cochrane Gynaecology and Fertility Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Allied and Complementary Medicine (AMED), PsycINFO, Chinese National Knowledge Infrastructure (CNKI), VIP, Wanfang and trial registries. In addition, we searched the reference lists of included trials and contacted experts in the field to locate trials. Randomized controlled trials (RCTs) that considered the use of CHM for the treatment of subfertile women with PCOS. Two review authors independently screened appropriate trials for inclusion, assessed the risk of bias in included studies and extracted data. We contacted primary study authors for additional information. We conducted meta-analyses. We used the odds ratios (ORs) to report dichotomous data, with 95% confidence intervals (CI). We assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. We included five RCTs with 414 participants. The comparisons in the included trials were as follows: CHM versus clomiphene, CHM plus clomiphene versus clomiphene (with or without ethinyloestradiol cyproterone acetate (CEA)), CHM plus follicle aspiration plus ovulation induction versus follicle aspiration plus ovulation induction alone, and CHM plus laparoscopic ovarian drilling (LOD) versus LOD alone. The overall quality of the evidence for most comparisons was very low.None of the included studies reported live birth rate, and only one study reported data on adverse events.When CHM was compared with clomiphene (with or without LOD in both arms), there was no evidence of a difference between the groups in pregnancy rates (odds ratio (OR) 1.98, 95% confidence interval (CI) 0.78 to 5.06; two studies, 90 participants, I² statistic = 0%, very low quality evidence). No study reported data on adverse events. When CHM plus clomiphene was compared with clomiphene (with or without CEA), there was low quality evidence of a higher pregnancy rate in the CHM plus clomiphene group (OR 2.62, 95% CI 1.65 to 4.14; three RCTs, 300 women, I² statistic = 0%,low quality evidence). No data were reported on adverse events.When CHM with follicle aspiration and ovulation induction was compared with follicle aspiration and ovulation induction alone, there was no evidence of a difference between the groups in pregnancy rates (OR 1.60, 95% CI 0.46 to 5.52; one study, 44 women, very low quality evidence), severe luteinized unruptured follicle syndrome (LUFS) (OR 0.60, 95% CI 0.06 to 6.14; one study, 44 women, very low quality evidence), ovarian hyperstimulation syndrome (OHSS) (OR 0.16, 95% CI 0.00 to 8.19; one study, 44 women, very low quality evidence) or multiple pregnancy (OR 0.60, 95% CI 0.06 to 6.14; one study, 44 women, very low quality evidence).When CHM with LOD was compared with LOD alone, there was no evidence of a difference between the groups in rates of pregnancy (OR 3.50, 95% CI 0.72 to 17.09; one study, 30 women, very low quality evidence), No data were reported on adverse events.There was no evidence of a difference between any of the comparison groups for any other outcomes. The quality of the evidence for all other comparisons and outcomes was very low. The main limitations in the evidence were failure to report live birth or adverse events, failure to describe study methods in adequate detail and imprecision due to very low event rates and wide CIs. There is insufficient evidence to support the use of CHM for women with PCOS and subfertility. No data are available on live birth, and there is no consistent evidence to indicate that CHM influences fertility outcomes. However there is very limited low quality evidence to suggest that the addition of CHM to clomiphene may improve pregnancy rates. There is insufficient evidence on adverse effects to indicate whether CHM is safe.

Australian pharmacies prevent potential adverse reactions in patients taking warfarin requesting over-the-counter analgesia.

PubMed

MacFarlane, Brett V; Bergin, Jenny K; Reeves, Peter; Matthews, Andrew

2015-06-01

The objective of this article was to assess if Australian pharmacy staff prevent potential adverse reactions in warfarin patients requesting over-the-counter (OTC) analgesia. Mystery shoppers entered 170 pharmacies across Australia to request OTC analgesia for a hypothetical patient with a wrist injury who currently takes warfarin following a heart valve replacement. The request was made to the first pharmacist or non-pharmacist staff member to approach the mystery shopper. The interaction was audio-taped and assessed by a pharmacist. The OTC analgesic recommended was assessed for the potential to cause an adverse bleeding event. The quality of advice given with the OTC analgesic was assessed against determined criteria. Results were compared with scenarios of similar request type where the hypothetical patient was not taking warfarin. Mystery shoppers enquiring about taking OTC analgesics concomitantly with warfarin had access to the pharmacist in 97.0% of cases. All 170 pharmacies recommended OTC analgesics that were less likely to cause adverse events when taken with warfarin. The advice given and the communication between pharmacy staff and mystery shoppers were of high quality. Australian pharmacies support the quality use of medicines by patients taking warfarin by providing expeditious access to the pharmacist, appropriate recommendations of OTC analgesics, high standards of quality of advice and they communicate in a way to ensure ease of understanding by the consumer. The protocols used by pharmacy staff help prevent potentially serious adverse drug events. © 2014 Royal Pharmaceutical Society.

Security and privacy qualities of medical devices: an analysis of FDA postmarket surveillance.

PubMed

Kramer, Daniel B; Baker, Matthew; Ransford, Benjamin; Molina-Markham, Andres; Stewart, Quinn; Fu, Kevin; Reynolds, Matthew R

2012-01-01

Medical devices increasingly depend on computing functions such as wireless communication and Internet connectivity for software-based control of therapies and network-based transmission of patients' stored medical information. These computing capabilities introduce security and privacy risks, yet little is known about the prevalence of such risks within the clinical setting. We used three comprehensive, publicly available databases maintained by the Food and Drug Administration (FDA) to evaluate recalls and adverse events related to security and privacy risks of medical devices. Review of weekly enforcement reports identified 1,845 recalls; 605 (32.8%) of these included computers, 35 (1.9%) stored patient data, and 31 (1.7%) were capable of wireless communication. Searches of databases specific to recalls and adverse events identified only one event with a specific connection to security or privacy. Software-related recalls were relatively common, and most (81.8%) mentioned the possibility of upgrades, though only half of these provided specific instructions for the update mechanism. Our review of recalls and adverse events from federal government databases reveals sharp inconsistencies with databases at individual providers with respect to security and privacy risks. Recalls related to software may increase security risks because of unprotected update and correction mechanisms. To detect signals of security and privacy problems that adversely affect public health, federal postmarket surveillance strategies should rethink how to effectively and efficiently collect data on security and privacy problems in devices that increasingly depend on computing systems susceptible to malware.

Security and Privacy Qualities of Medical Devices: An Analysis of FDA Postmarket Surveillance

PubMed Central

Kramer, Daniel B.; Baker, Matthew; Ransford, Benjamin; Molina-Markham, Andres; Stewart, Quinn; Fu, Kevin; Reynolds, Matthew R.

2012-01-01

Background Medical devices increasingly depend on computing functions such as wireless communication and Internet connectivity for software-based control of therapies and network-based transmission of patients’ stored medical information. These computing capabilities introduce security and privacy risks, yet little is known about the prevalence of such risks within the clinical setting. Methods We used three comprehensive, publicly available databases maintained by the Food and Drug Administration (FDA) to evaluate recalls and adverse events related to security and privacy risks of medical devices. Results Review of weekly enforcement reports identified 1,845 recalls; 605 (32.8%) of these included computers, 35 (1.9%) stored patient data, and 31 (1.7%) were capable of wireless communication. Searches of databases specific to recalls and adverse events identified only one event with a specific connection to security or privacy. Software-related recalls were relatively common, and most (81.8%) mentioned the possibility of upgrades, though only half of these provided specific instructions for the update mechanism. Conclusions Our review of recalls and adverse events from federal government databases reveals sharp inconsistencies with databases at individual providers with respect to security and privacy risks. Recalls related to software may increase security risks because of unprotected update and correction mechanisms. To detect signals of security and privacy problems that adversely affect public health, federal postmarket surveillance strategies should rethink how to effectively and efficiently collect data on security and privacy problems in devices that increasingly depend on computing systems susceptible to malware. PMID:22829874

Parenting begets parenting: A neurobiological perspective on early adversity and the transmission of parenting styles across generations.

PubMed

Lomanowska, A M; Boivin, M; Hertzman, C; Fleming, A S

2017-02-07

The developing brains of young children are highly sensitive to input from their social environment. Nurturing social experience during this time promotes the acquisition of social and cognitive skills and emotional competencies. However, many young children are confronted with obstacles to healthy development, including poverty, inappropriate care, and violence, and their enhanced sensitivity to the social environment means that they are highly susceptible to these adverse childhood experiences. One source of social adversity in early life can stem from parenting that is harsh, inconsistent, non-sensitive or hostile. Parenting is considered to be the cornerstone of early socio-emotional development and an adverse parenting style is associated with adjustment problems and a higher risk of developing mood and behavioral disorders. Importantly, there is a growing literature showing that an important predictor of parenting behavior is how parents, especially mothers, were parented themselves. In this review, we examine how adversity in early-life affects mothering behavior in later-life and how these effects may be perpetuated inter-generationally. Relying on studies in humans and animal models, we consider evidence for the intergenerational transmission of mothering styles. We then describe the psychological underpinnings of mothering, including responsiveness to young, executive function and affect, as well as the physiological mediators of mothering behavior, including hormones, brain regions and neurotransmitters, and we consider how development in these relevant domains may be affected by adversity experienced in early life. Finally, we explore how genes and early experience interact to predict mothering behavior, including the involvement of epigenetic mechanisms. Understanding how adverse parenting begets adverse parenting in the next generation is critical for designing interventions aimed at preventing this intergenerational cycle of early adversity. Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.

An investigation into the relationship between region specific quality of life and adverse tuberculosis treatment outcomes in Istanbul, Turkey.

PubMed

Babalik, A; Kiziltas, S; Gencer, S; Kilicaslan, Z

2014-01-01

Istanbul has the highest incidence of tuberculosis (TB) in Turkey. It is also the largest city, with considerable differences in quality of life across its urban regions. The aim of this study is to investigate the relationship between (i) the diverse quality of life across specific urban regions, (ii) TB incidence rates, inclusive of demographic and clinical characteristics of TB patients, and (iii) adverse treatment outcomes. This retrospective study included 23,845 new TB patients (recorded in the National TB Registry between 2006 and 2010) in Istanbul. Thirty-nine urban districts of Istanbul were ranked into five groups on the basis of an urban quality of life index. Patient data were matched with these groups, and further categorized according to 'age', 'sex', 'country of birth' and 'antibiotics resistance'. Adverse treatment outcomes and TB incidence rates were extracted from official records. Logistic regression, clustered analyses, 95% CI and p values (STATA) were reported to describe the association between variables. Six per cent of total cases had 'at least one adverse treatment outcome' (default 3.8%, failure 0.5%, death 1.7% in total cases). 'An adverse treatment outcome' was found to be associated with age OR (CI 95%) (1.02 (1.01-1.03)); 'male sex' 1.65 (1.28-2.12); 'other country of birth' 4.82 (3.05-7.62); 100,000 per 'over 60' insidence goups 1.61 (1.32-1.97), the lowest quality of life index 0.65 (0.47-0.83). Patients with high tuberculosis risk factors living in high incidence regions need to be closely monitored. Patients living in lower ranking regions are more likely to have 'poor treatment outcomes'. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

Quality of groundwater in the Denver Basin aquifer system, Colorado, 2003-5

USGS Publications Warehouse

Musgrove, MaryLynn; Beck, Jennifer A.; Paschke, Suzanne; Bauch, Nancy J.; Mashburn, Shana L.

2014-01-01

Water-quality data were synthesized to evaluate factors that affect spatial and depth variability in water quality and to assess aquifer vulnerability to contaminants from geologic materials and those of human origin. The quality of shallow groundwater in the alluvial aquifer and shallow bedrock aquifer system has been adversely affected by development of agricultural and urban areas. Land use has altered the pattern and composition of recharge. Increased recharge from irrigation water has mobilized dissolved constituents and increased concentrations in the shallow groundwater. Concentrations of most constituents associated with poor or degraded water quality in shallow groundwater decreased with depth; many of these constituents are not geochemically conservative and are affected by geochemical reactions such as oxidation-reduction reactions. Groundwater age tracers provide additional insight into aquifer vulnerability and help determine if young groundwater of potentially poor quality has migrated to deeper parts of the bedrock aquifers used for drinking-water supply. Age-tracer results were used to group samples into categories of young, mixed, and old groundwater. Groundwater ages transitioned from mostly young in the water-table wells to mostly mixed in the shallowest bedrock aquifer, the Dawson aquifer, to mostly old in the deeper bedrock aquifers. Although the bedrock aquifers are mostly old groundwater of good water quality, several lines of evidence indicate that young, contaminant-bearing recharge has reached shallow to moderate depths in some areas of the bedrock aquifers. The Dawson aquifer is the most vulnerable of the bedrock aquifers to contamination, but results indicate that the older (deeper) bedrock aquifers are also vulnerable to groundwater contamination and that mixing with young recharge has occurred in some areas. Heavy pumping has caused water-level declines in the bedrock aquifers in some parts of the Denver Basin, which has the potential to enhance the transport of contaminants from overlying units. Results of this study are consistent with the existing conceptual understanding of aquifer processes and groundwater issues in the Denver Basin and add new insight into the vulnerability of the bedrock aquifers to groundwater contamination.

Vantage Sensitivity: Environmental Sensitivity to Positive Experiences as a Function of Genetic Differences.

PubMed

Pluess, Michael

2017-02-01

A large number of gene-environment interaction studies provide evidence that some people are more likely to be negatively affected by adverse experiences as a function of specific genetic variants. However, such "risk" variants are surprisingly frequent in the population. Evolutionary analysis suggests that genetic variants associated with increased risk for maladaptive development under adverse environmental conditions are maintained in the population because they are also associated with advantages in response to different contextual conditions. These advantages may include (a) coexisting genetic resilience pertaining to other adverse influences, (b) a general genetic susceptibility to both low and high environmental quality, and (c) a coexisting propensity to benefit disproportionately from positive and supportive exposures, as reflected in the recent framework of vantage sensitivity. After introducing the basic properties of vantage sensitivity and highlighting conceptual similarities and differences with diathesis-stress and differential susceptibility patterns of gene-environment interaction, selected and recent empirical evidence for the notion of vantage sensitivity as a function of genetic differences is reviewed. The unique contribution that the new perspective of vantage sensitivity may make to our understanding of social inequality will be discussed after suggesting neurocognitive and molecular mechanisms hypothesized to underlie the propensity to benefit disproportionately from benevolent experiences. © 2015 Wiley Periodicals, Inc.

Adverse childhood experiences, dispositional mindfulness, and adult health.

PubMed

Whitaker, Robert C; Dearth-Wesley, Tracy; Gooze, Rachel A; Becker, Brandon D; Gallagher, Kathleen C; McEwen, Bruce S

2014-10-01

To determine whether greater dispositional mindfulness is associated with better adult health across a range of exposures to adverse childhood experiences (ACEs). In 2012, a web-based survey of 2160 Pennsylvania Head Start staff was conducted. We assessed ACE score (count of eight categories of childhood adversity), dispositional mindfulness (Cognitive and Affective Mindfulness Scale-Revised), and the prevalence of three outcomes: multiple health conditions (≥ 3 of 7 conditions), poor health behavior (≥ 2 of 5 behaviors), and poor health-related quality of life (HRQOL) (≥ 2 of 5 indicators). Respondents were 97% females, and 23% reported ≥ 3 ACEs. The prevalences of multiple health conditions, poor health behavior, and poor HRQOL were 29%, 21%, and 13%, respectively. At each level of ACE exposure, health outcomes were better in those with greater mindfulness. For example, among persons reporting ≥ 3 ACEs, those in the highest quartile of mindfulness had a prevalence of multiple health conditions two-thirds that of those in the lowest quartile (adjusted prevalence ratio (95% confidence interval)=0.66 (0.51, 0.86)); for those reporting no ACEs, the ratio was 0.62 (0.41, 0.94). Across a range of exposures to ACEs, greater dispositional mindfulness was associated with fewer health conditions, better health behavior, and better HRQOL. Copyright © 2014 Elsevier Inc. All rights reserved.

Detailed study of irrigation drainage in and near wildlife management areas, west-central Nevada, 1987-90; Part C, Summary of irrigation-drainage effects on water quality, bottom sediment, and biota

USGS Publications Warehouse

Hoffman, Ray J.

1993-01-01

This report presents a summary of the detailed scientific study of Stillwater Wildlife Management Area and other nearby wetlands in west-central Nevada during 1987-90. The work was funded by the National Irrigation Water Quality Program of the U.S. Department of the Interior with the overall objectives of determining (1) the extent, magnitude, and effects of selected water-quality constituents associated with irrigation drainage on fish, wildlife, and human health, and (2) the sources and exposure pathways that cause contamination where adverse effects are documented. Much of the information in this report was summarized from two previously published interpretive reports that were completed to fulfill study objectives. Where applicable, data for the study area from other published sources also were utilized. The results of these studies indicate that the aquatic biota in natural wetlands of the Carson Desert are adversely affected by hydrological and geochemical sources and processes in the Newlands Irrigation Project area. Reactions between water and naturally occurring minerals in the shallow alluvial aquifer increase concentrations of potentially toxic constituents in ground water that eventually enters the wetlands. Once in the wetlands, these constituents are furhter concentrated by evaporation and transpiration. Water from some agricultural drains that enter Stillwater WMA was acutely toxic to aquatic organisms. The drains in the agricultural areas, which eventually discharge to the wetlands, were also implicated as sites of uptake of selenium and mercury by aquatic organisms.

Impact of High-Intensity-NIV on the heart in stable COPD: a randomised cross-over pilot study.

PubMed

Duiverman, Marieke Leontine; Maagh, Petra; Magnet, Friederike Sophie; Schmoor, Claudia; Arellano-Maric, Maria Paola; Meissner, Axel; Storre, Jan Hendrik; Wijkstra, Peter Jan; Windisch, Wolfram; Callegari, Jens

2017-05-02

Although high-intensity non-invasive ventilation has been shown to improve outcomes in stable COPD, it may adversely affect cardiac performance. Therefore, the aims of the present pilot study were to compare cardiac and pulmonary effects of 6 weeks of low-intensity non-invasive ventilation and 6 weeks of high-intensity non-invasive ventilation in stable COPD patients. In a randomised crossover pilot feasibility study, the change in cardiac output after 6 weeks of each NIV mode compared to baseline was assessed with echocardiography in 14 severe stable COPD patients. Furthermore, CO during NIV, gas exchange, lung function, and health-related quality of life were investigated. Three patients dropped out: two deteriorated on low-intensity non-invasive ventilation, and one presented with decompensated heart failure while on high-intensity non-invasive ventilation. Eleven patients were included in the analysis. In general, cardiac output and NTproBNP did not change, although individual effects were noticed, depending on the pressures applied and/or the co-existence of heart failure. High-intensity non-invasive ventilation tended to be more effective in improving gas exchange, but both modes improved lung function and the health-related quality of life. Long-term non-invasive ventilation with adequate pressure to improve gas exchange and health-related quality of life did not have an overall adverse effect on cardiac performance. Nevertheless, in patients with pre-existing heart failure, the application of very high inspiratory pressures might reduce cardiac output. The trial was registered in the Deutsches Register Klinischer Studien (DRKS-ID: DRKS00007977 ).

Endoscopically placed stents: a useful alternative for the management of refractory benign cervical esophageal stenosis.

PubMed

Nogales, Óscar; Clemente, Ana; Caballero-Marcos, Aránzazu; García-Lledó, Javier; Pérez-Carazo, Leticia; Merino, Beatriz; López-Ibáñez, María; Pérez Valderas, María Dolores; Bañares, Rafael; González-Asanza, Cecilia

2017-07-01

Benign esophageal strictures are relatively frequent and can severely affect the quality of life of a patient. Stenting has been proposed for the treatment of refractory cases. Lesions affecting the cervical esophagus are more difficult to treat, and the placement of stents in this location has traditionally been restricted due to potential adverse events. The aim of this study was to describe the efficacy and safety of endoscopic stenting in the management of refractory benign cervical esophageal strictures (RBCES) in a single-center cohort study. We analyzed 12 patients with RBCES (Kochman's criteria) and severe dysphagia. We recorded previous endoscopic treatments, stricture characteristics and demographic data. The two types of stents used were fully covered self-expandable metallic stents (FCSEMS) and uncovered biodegradable stents (BDS). FCSEMS were removed eight weeks after placement, and BDS were followed-up until degradation. We assessed technical and clinical success, rate of stricture recurrence and adverse events. The mean age of participants was 64 years (range 30-85). A total of 23 stents (13 FCSEMS and 10 BDS) were placed in 12 patients (median 1.92, range 1-4). The technical success rate was 96% (22/23 stents). Eight patients (66.6%) maintained adequate oral intake at the end of follow-up (median 33.3 months, range 3-84 months). Migration was recorded in 7/23 stents (30.4%) and epithelial hyperplasia in 4/23 stents (17.4%). No severe adverse events were noted. All patients complained of minor cervical pain after placement that was well controlled with mild analgesia. Endoscopic stent therapy seems to be effective and safe in the management of RBCES.

Ambient Air Pollutants Have Adverse Effects on Insulin and Glucose Homeostasis in Mexican Americans

PubMed Central

Chen, Zhanghua; Salam, Muhammad T.; Toledo-Corral, Claudia; Watanabe, Richard M.; Xiang, Anny H.; Buchanan, Thomas A.; Habre, Rima; Bastain, Theresa M.; Lurmann, Fred; Wilson, John P.; Trigo, Enrique

2016-01-01

OBJECTIVE Recent studies suggest that air pollution plays a role in type 2 diabetes (T2D) incidence and mortality. The underlying physiological mechanisms have yet to be established. We hypothesized that air pollution adversely affects insulin sensitivity and secretion and serum lipid levels. RESEARCH DESIGN AND METHODS Participants were selected from BetaGene (n = 1,023), a study of insulin resistance and pancreatic β-cell function in Mexican Americans. All participants underwent DXA and oral and intravenous glucose tolerance tests and completed dietary and physical activity questionnaires. Ambient air pollutant concentrations (NO2, O3, and PM2.5) for short- and long-term periods were assigned by spatial interpolation (maximum interpolation radius of 50 km) of data from air quality monitors. Traffic-related air pollution from freeways (TRAP) was estimated using the dispersion model as NOx. Variance component models were used to analyze individual and multiple air pollutant associations with metabolic traits. RESULTS Short-term (up to 58 days cumulative lagged averages) exposure to PM2.5 was associated with lower insulin sensitivity and HDL-to-LDL cholesterol ratio and higher fasting glucose and insulin, HOMA-IR, total cholesterol, and LDL cholesterol (LDL-C) (all P ≤ 0.036). Annual average PM2.5 was associated with higher fasting glucose, HOMA-IR, and LDL-C (P ≤ 0.043). The effects of short-term PM2.5 exposure on insulin sensitivity were largest among obese participants. No statistically significant associations were found between TRAP and metabolic outcomes. CONCLUSIONS Exposure to ambient air pollutants adversely affects glucose tolerance, insulin sensitivity, and blood lipid concentrations. Our findings suggest that ambient air pollutants may contribute to the pathophysiology in the development of T2D and related sequelae. PMID:26868440

Subject Reaction to Human-Caused and Naturally-Occurring Radioactive Threat.

ERIC Educational Resources Information Center

Belford, Susan; Gibbs, Margaret

While research has shown that people are adversely psychologically affected by knowledge that their communities have been toxically contaminated, it has been suggested that those who see a disaster as naturally occurring tend to be less adversely affected than those who see a disaster as caused by human acts. To examine this issue, questionnaires…

Predictors of NCLEX-RN Success of Associate Degree Graduates: A Correlational Study

ERIC Educational Resources Information Center

Kehm, Bonny J.

2013-01-01

The outcome of Associate Degree Nursing (ADN) students not passing the initial National Council of Licensure Examination for Registered Nursing (NCLEX-RN) can adversely affect schools of nursing. This failure also adversely affects the national nursing shortage. The declining national pass rates on the NCLEX-RN for ADN graduates and the increasing…

Do environmental effects on human emotions cause cardiovascular disorders?

PubMed

Rosenman, R H

1997-01-01

Environmental influences on human health include the effects of toxic materials and adverse ecological factors. Natural milieu stressors also affect emotions that may adversely affect cardiovascular function and precipitate or otherwise contribute to complications of cardiovascular diseases. However, although variously hypothesized, there is inadequate evidence that they directly contribute to the pathogenesis of sustained hypertension or coronary atherosclerosis.

Managing the transcription revolution. Industry forces shape future of field.

PubMed

Faulkner, Scott D

2003-01-01

You may be struggling with contract issues with a vendor. Or maybe you're contemplating the pros and cons of working with outsource, at-home, or overseas transcriptionists. It's a fact: if transcription processes aren't working efficiently, the entire HIM department may be adversely affected. Factor in additional concerns such as data capture for electronic health records, compliance, and patient safety, and the importance of ensuring quality and cost-efficient transcription becomes even more apparent. To help you answer some of these questions, the Journal of AHIMA is launching a four-part series dedicated to transcription issues from the HIM professional's point of view. In this issue, we begin with MTIA president Scott Faulkner's overview of the industry and where it's going next. In upcoming issues, other experts will look at controlling cost and monitoring quality, navigating new technologies, and dealing with contract-related issues.

Pathophysiology and Treatment of Hyperhidrosis.

PubMed

Fujimoto, Tomoko

2016-01-01

Primary focal hyperhidrosis is a disease of unknown cause with profuse perspiration of local sites (head, face, palms, soles of feet, and axillae) that adversely affects daily life. Guidelines have been proposed in the USA [1], Canada [2], and Japan [3]. The symptoms impair quality of life, with significant negative effects on daily existence and personal relationships. The current goal in medical practice for patients with hyperhidrosis is to provide guidance and encourage coping skills for a normal daily life, as well as give appropriate advice regarding treatment options. On occasion, in order to improve quality of life, it is necessary to recommend surgical therapy when conservative treatment fails; this requires an understanding of the mechanisms of available treatments and their effects. This paper reviews theories of primary focal hyperhidrosis with regard to pathology, epidemiology, and treatment. © 2016 S. Karger AG, Basel.

Minimising losses to predation during microalgae cultivation.

PubMed

Flynn, Kevin J; Kenny, Philip; Mitra, Aditee

2017-01-01

We explore approaches to minimise impacts of zooplanktonic pests upon commercial microalgal crops using system dynamics models to describe algal growth controlled by light and nutrient availability and zooplankton growth controlled by crop abundance and nutritional quality. Losses of microalgal crops are minimised when their growth is fastest and, in contrast, also when growing slowly under conditions of nutrient exhaustion. In many culture systems, however, dwindling light availability due to self-shading in dense suspensions favours slow growth under nutrient sufficiency. Such a situation improves microalgal quality as prey, enhancing zooplankton growth, and leads to rapid crop collapse. Timing of pest entry is important; crop losses are least likely in established, nutrient-exhausted microalgal communities grown for high C-content (e.g. for biofuels). A potentially useful approach is to promote a low level of P-stress that does not adversely affect microalgal growth but which produces a crop that is suboptimal for zooplankton growth.

Factors Related to Healthcare Service Quality in Long-term Care Hospitals in South Korea: A Mixed-methods Study

PubMed Central

Sohn, Minsung; Choi, Mankyu

2017-01-01

Objectives The environment of long-term care hospitals (LTCHs) is critical to the management of the quality of their services and to patient safety, as highlighted by international studies. However, there is a lack of evidence on this topic in South Korea. This study aimed to examine the factors affecting healthcare quality in LTCHs and to explore the effectiveness of their quality management. Methods This study used a mixed methods approach with quantitative data collected in a national survey and qualitative data from semi-structured interviews with practice-based managers. The samples included 725 nationally representative LTCHs in South Korea for the quantitative analysis and 15 administrators for the in-depth interviews. Results A higher installation rate of patient-safety and hygiene-related facilities and staff with longer-tenures, especially nurses, were more likely to have better healthcare quality and education for both employees and patients. Conclusion The need for patient-safety- and hygiene-related facilities in LTCHs that serve older adults reflects their vulnerability to certain adverse events (e.g., infections). Consistent and skillful nursing care to improve the quality of LTCHs can be achieved by developing relevant educational programs for staff and patients, thereby strengthening the relationships between them. PMID:29164045

Research on improvement of power quality of Micro - grid based on SVG pulse load

NASA Astrophysics Data System (ADS)

Lv, Chuang; Xie, Pu

2017-05-01

Pulse load will make the micro-grid public bus power to produce a high peak pulse due to its cyclical pulsation characteristics,, and make the micro-grid voltage fluctuations, frequency fluctuations, voltage and current distortion, power factor reduction and other adverse effects. In order to suppress the adverse effects of the pulse load on the microgrid and improve the power quality of the microgrid, this paper established the SVG simulation model in Matlab / Simulink environment, the superiority of SVG is verified by comparing the improvement of power quality before and after adding the SVG to microgrid system. The results show that the SVG model can suppress the adverse effects effectively of the pulse load on the microgrid, which is of great value and significance to the reactive power compensation and harmonic suppression of the microgrid.

Stress, fatigue, and sleep quality leading up to and following a stressful life event.

PubMed

Van Laethem, Michelle; Beckers, Debby G J; Dijksterhuis, Ap; Geurts, Sabine A E

2017-10-01

This study aims to examine (a) the time course of stress, fatigue, and sleep quality among PhD students awaiting a stressful event and (b) whether daily anticipation of this event influences day-level stress, fatigue, and sleep quality. Forty-four PhD students completed evening and morning questionnaires on eight days from 1 month before their dissertation defense until one month thereafter. Results showed increased stress leading up to the defense, while fatigue and sleep quality remained unchanged. Comparing the night before the defense with the night after, stress rapidly decreased, whereas fatigue and sleep quality increased. Following the defense, stress and sleep quality remained stable, whereas fatigue declined. Stress 1 month before the defense was higher than 1 month thereafter. Regarding day-level relations, stress was adversely affected by negative anticipation and favorably by positive outcome expectancy, whereas positive anticipation had no influence. Positive outcome expectancy was an important predictor of improved sleep quality. We conclude that stress may be elevated long before a stressful event takes place but that one can recover rather quickly from temporary stress. Positive outcome expectancy of a stressful event may be an important predictor of reduced day-level stress and improved day-level sleep quality leading up to a stressful event. Copyright © 2016 John Wiley & Sons, Ltd.

Safety, Tolerability and Efficacy of Drugs for Treating Behavioural Insomnia in Children with Attention-Deficit/Hyperactivity Disorder: A Systematic Review with Methodological Quality Assessment.

PubMed

Anand, Shweta; Tong, Henry; Besag, Frank M C; Chan, Esther W; Cortese, Samuele; Wong, Ian C K

2017-06-01

A large proportion of paediatric patients with attention-deficit/hyperactivity disorder (ADHD) have associated sleep problems which not only affect the child's wellbeing but also impact family functioning. Management of sleep problems is consequently an important aspect of overall ADHD management in paediatric patients. Although some drugs are being used off-label for the management of paediatric insomnia, there is scant clinical evidence supporting their use. Our aim was to identify and assess the quality of published studies reporting the safety, tolerability and efficacy of drugs used for treating behavioural insomnia in children with ADHD. After an initial screen to determine which drugs were most commonly used, we conducted a systematic review of English-language publications from searches of PubMed, EMBASE, PsycINFO and two trial register databases to February 2017, using keywords 'clonidine', 'melatonin', 'zolpidem', 'eszopiclone', 'L-theanine', 'guanfacine', 'ADHD', 'sleep disorder' and 'children'. For quality assessment of included studies, we used the CONSORT checklist for randomised control trials (RCTs) and the Downs and Black checklist for non-RCTs. Twelve studies were included. Two case series for clonidine, two RCTs and four observational studies for melatonin and one RCT each for zolpidem, eszopiclone, L-theanine and guanfacine. Of the 12 included studies, only one on eszopiclone scored excellent for quality. The quality of the rest of the studies varied from moderate to low. For clonidine, melatonin and L-theanine, improvements in sleep-onset latency and total sleep duration were reported; however, zolpidem, eszopiclone and guanfacine failed to show any improvement when compared with placebo. Clonidine, melatonin, L-theanine, eszopiclone and guanfacine were well tolerated with mild to moderate adverse events; zolpidem was associated with neuropsychiatric adverse effects. There is generally poor evidence for prescribing drugs for behavioural insomnia in children with ADHD. Further controlled studies are warranted.

Losigamone add-on therapy for partial epilepsy.

PubMed

Xiao, Yousheng; Luo, Man; Wang, Jin; Luo, Hongye

2012-06-13

Epilepsy is a common neurologic disorder, affecting approximately 50 million people worldwide; nearly a third of these people are not well controlled by a single antiepileptic drug and usually require treatment with a combination of two or more antiepileptic drugs. In recent years, many newer antiepileptic drugs have been investigated as add-on therapy for partial epilepsy; losigamone is one of these drugs and is the focus of this systematic review. To investigate the efficacy and safety of losigamone when used as an add-on therapy for partial epilepsy. We searched the Cochrane Epilepsy Group Specialized Register (1 May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL Issue 4 of 12, The Cochrane Library, 2012) and MEDLINE (1 May 2012). We searched trials registers and contacted the manufacturer of losigamone and authors of included studies for additional information. There were no language restrictions. Randomized controlled add-on trials comparing losigamone with placebo for partial epilepsy. Two review authors independently assessed trial quality and extracted data. The primary outcomes were 50% or greater reduction in seizure frequency and seizure freedom; the secondary outcomes were treatment withdrawal and adverse events. Results are presented as risk ratios (RR) with 95% confidence intervals (CIs) or 99% CIs (for the individual listed adverse events to make an allowance for multiple testing). Two trials involving a total of 467 patients were eligible for inclusion. Both trials assessed losigamone 1200 or 1500 mg/d as an add-on therapy for partial epilepsy. One trial was assessed as being of good methodologic quality while the other was of uncertain quality. For the efficacy outcomes, results did show patients taking losigamone were significantly more likely to achieve a 50% or greater reduction in seizure frequency (RR 1.75; 95% CI 1.14 to 2.72), but associated with a significant increase of treatment withdrawal when compared with those taking placebo (RR 2.16; 95% CI 1.28 to 3.67). For the safety outcomes, results indicated the proportion of patients who experienced adverse events in the losigamone group was higher than the placebo group (RR 1.34; 95% CI 1.00 to 1.80), dizziness was the only adverse event significantly in relation to losigamone (RR 3.82; 99% CI 1.69 to 8.64). The proportion of patients achieving seizure freedom was not reported in either trial report. A subgroup analysis according to different doses of losigamone showed that a higher dose of losigamone (1500 mg/d) is associated with a greater reduction in seizure frequency than lower doses, but is also associated with more dropouts due to adverse events. The results of this review showed losigamone can reduce seizure frequency but was associated with more treatment withdrawals when used as an add-on therapy for people with partial epilepsy. However, trials included were of short-term duration and uncertain quality. Future well-designed randomized, double-blind, placebo-controlled trials with a longer-term duration are needed.

Mismatch or allostatic load? Timing of life adversity differentially shapes gray matter volume and anxious temperament.

PubMed

Kuhn, Manuel; Scharfenort, Robert; Schümann, Dirk; Schiele, Miriam A; Münsterkötter, Anna L; Deckert, Jürgen; Domschke, Katharina; Haaker, Jan; Kalisch, Raffael; Pauli, Paul; Reif, Andreas; Romanos, Marcel; Zwanzger, Peter; Lonsdorf, Tina B

2016-04-01

Traditionally, adversity was defined as the accumulation of environmental events (allostatic load). Recently however, a mismatch between the early and the later (adult) environment (mismatch) has been hypothesized to be critical for disease development, a hypothesis that has not yet been tested explicitly in humans. We explored the impact of timing of life adversity (childhood and past year) on anxiety and depression levels (N = 833) and brain morphology (N = 129). Both remote (childhood) and proximal (recent) adversities were differentially mirrored in morphometric changes in areas critically involved in emotional processing (i.e. amygdala/hippocampus, dorsal anterior cingulate cortex, respectively). The effect of adversity on affect acted in an additive way with no evidence for interactions (mismatch). Structural equation modeling demonstrated a direct effect of adversity on morphometric estimates and anxiety/depression without evidence of brain morphology functioning as a mediator. Our results highlight that adversity manifests as pronounced changes in brain morphometric and affective temperament even though these seem to represent distinct mechanistic pathways. A major goal of future studies should be to define critical time periods for the impact of adversity and strategies for intervening to prevent or reverse the effects of adverse childhood life experiences. © The Author (2015). Published by Oxford University Press.

Mismatch or allostatic load? Timing of life adversity differentially shapes gray matter volume and anxious temperament

PubMed Central

Kuhn, Manuel; Scharfenort, Robert; Schümann, Dirk; Schiele, Miriam A.; Münsterkötter, Anna L.; Deckert, Jürgen; Domschke, Katharina; Haaker, Jan; Kalisch, Raffael; Pauli, Paul; Reif, Andreas; Romanos, Marcel; Zwanzger, Peter

2016-01-01

Traditionally, adversity was defined as the accumulation of environmental events (allostatic load). Recently however, a mismatch between the early and the later (adult) environment (mismatch) has been hypothesized to be critical for disease development, a hypothesis that has not yet been tested explicitly in humans. We explored the impact of timing of life adversity (childhood and past year) on anxiety and depression levels (N = 833) and brain morphology (N = 129). Both remote (childhood) and proximal (recent) adversities were differentially mirrored in morphometric changes in areas critically involved in emotional processing (i.e. amygdala/hippocampus, dorsal anterior cingulate cortex, respectively). The effect of adversity on affect acted in an additive way with no evidence for interactions (mismatch). Structural equation modeling demonstrated a direct effect of adversity on morphometric estimates and anxiety/depression without evidence of brain morphology functioning as a mediator. Our results highlight that adversity manifests as pronounced changes in brain morphometric and affective temperament even though these seem to represent distinct mechanistic pathways. A major goal of future studies should be to define critical time periods for the impact of adversity and strategies for intervening to prevent or reverse the effects of adverse childhood life experiences. PMID:26568620

Identification of water-quality trends using sediment cores from Dillon Reservoir, Summit County, Colorado

USGS Publications Warehouse

Greve, Adrienne I.; Spahr, Norman E.; Van Metre, Peter C.; Wilson, Jennifer T.

2001-01-01

Since the construction of Dillon Reservoir, in Summit County, Colorado, in 1963, its drainage area has been the site of rapid urban development and the continued influence of historical mining. In an effort to assess changes in water quality within the drainage area, sediment cores were collected from Dillon Reservoir in 1997. The sediment cores were analyzed for pesticides, polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs), and trace elements. Pesticides, PCBs, and PAHs were used to determine the effects of urban development, and trace elements were used to identify mining contributions. Water-quality and streambed-sediment samples, collected at the mouth of three streams that drain into Dillon Reservoir, were analyzed for trace elements. Of the 14 pesticides and 3 PCBs for which the sediment samples were analyzed, only 2 pesticides were detected. Low amounts of dichloro-diphenyldichloroethylene (DDE) and dichloro-diphenyldichloroethane (DDD), metabolites of dichlorodiphenyltrichloroethane (DDT), were found at core depths of 5 centimeters and below 15 centimeters in a core collected near the dam. The longest core, which was collected near the dam, spanned the entire sedimentation history of the reservoir. Concentrations of total combustion PAH and the ratio of fluoranthene to pyrene in the core sample decreased with core depth and increased over time. This relation is likely due to growth in residential and tourist populations in the region. Comparisons between core samples gathered in each arm of the reservoir showed the highest PAH concentrations were found in the Tenmile Creek arm, the only arm that has an urban area on its shores, the town of Frisco. All PAH concentrations, except the pyrene concentration in one segment in the core near the dam and acenaphthylene concentrations in the tops of three cores taken in the reservoir arms, were below Canadian interim freshwater sediment-quality guidelines. Concentrations of arsenic, cadmium, chromium, copper, lead, and zinc in sediment samples from Dillon Reservoir exceeded the Canadian interim freshwater sediment-quality guidelines. Copper, iron, lithium, nickel, scandium, titanium, and vanadium concentrations in sediment samples decreased over time. Other elements, while no trend was evident, displayed concentration spikes in the down-core profiles, indicating loads entering the reservoir may have been larger than they were in 1997. The highest concentrations of copper, lead, manganese, mercury, and zinc were detected during the late 1970's and early 1980's. Elevated concentrations of trace elements in sediment in Dillon Reservoir likely resulted from historical mining in the drainage area. The downward trend identified for copper, iron, lithium, nickel, scandium, titanium, and vanadium may be due in part to restoration efforts in mining-affected areas and a decrease in active mining in the Dillon Reservoir watershed. Although many trace-element core-sediment concentrations exceeded the Canadian probable effect level for freshwater lakes, under current limnological conditions, the high core-sediment concentrations do not adversely affect water quality in Dillon Reservoir. The trace-element concentrations in the reservoir water column meet the standards established by the Colorado Water Quality Control Commission. Although many trace-element core-sediment concentrations exceeded the Canadian probable effect level for freshwater lakes, under current limnological conditions, the high core-sediment concentrations do not adversely affect water quality in Dillon Reservoir. The trace-element concentrations in the reservoir water column meet the standards established by the Colorado Water Quality Control Commission.

Response of Rocky Mountain elk (Cervus elaphus) to wind-power development

USGS Publications Warehouse

Walter, W. David; Leslie, David M.; Jenks, J.A.

2006-01-01

Wind-power development is occurring throughout North America, but its effects on mammals are largely unexplored. Our objective was to determine response (i.e., home-range, diet quality) of Rocky Mountain elk (Cervus elaphus) to wind-power development in southwestern Oklahoma. Ten elk were radiocollared in an area of wind-power development on 31 March 2003 and were relocated bi-weekly through March 2005. Wind-power construction was initiated on 1 June 2003 and was completed by December 2003 with 45 active turbines. The largest composite home range sizes (>80 km2) occurred April-June and September, regardless of the status of wind-power facility development. The smallest home range sizes (<50 km2) typically occurred in October-February when elk aggregated to forage on winter wheat. No elk left the study site during the study and elk freely crossed the gravel roads used to access the wind-power facility. Carbon and nitrogen isotopes and percent nitrogen in feces suggested that wind-power development did not affect nutrition of elk during construction. Although disturbance and loss of some grassland habitat was apparent, elk were not adversely affected by wind-power development as determined by home range and dietary quality.

Responsiveness of the quality of life in late-stage dementia scale to psychotropic drug treatment in late-stage dementia.

PubMed

Martin-Cook, Kristin; Hynan, Linda S; Rice-Koch, Kathleen; Svetlik, Doris A; Weiner, Myron F

2005-01-01

We report on the responsiveness of a previously validated quality-of-life scale, the Quality of Life in Late-Stage Dementia scale (QUALID), as an outcome measure in a clinical trial of two psychotropic medications. Secondary analyses were conducted comparing outcome measures used in a randomized double-blind trial of two antipsychotics (olanzapine and risperidone) for the treatment of dementia-related behavioral symptoms. The QUALID was completed for 31 of the patients in addition to several measures of behavior-related dementia symptoms including the Neuropsychiatric Inventory, the Withdrawn Behavior subscale of the Multidimensional Observation Scale for Elderly Subjects, the Mini-Mental State Examination, and the Clinical Global Impression. Measures of safety and adverse effects included the Simpson-Angus Scale and records of specific adverse events. A significant positive relationship was found between QUALID score and improvement in behavioral symptoms, and a negative association was found with adverse medication effects. The QUALID was sensitive to both the treatment effects and the adverse effects of medication in this sample of patients.

Environmental Assessment for Construction of Small Arms Range at Tinker Air Force Base, Oklahoma

DTIC Science & Technology

2008-11-01

Air Force Material Command Tinker Air Force Base, Oklahoma Prepared by: CHEROKEE CRC, LLC 916 West 23rd Street Tulsa, OK 74107...activities to avoid potential for short-term soil erosion which could result in adverse effects to water quality. Hazardous Materials and Waste...erosion which could result in adverse effects to water quality. Hazardous Materials and Waste. Soil from the remediation activities could potentially

Improvement, Verification, and Refinement of Spatially-Explicit Exposure Models in Risk Assessment - SEEM

DTIC Science & Technology

2015-06-01

hazard quotient HSI Habitat Suitability Index LOAEL lowest observed adverse effect level mg/kg milligrams per kilogram NOAEL no observed adverse... effect level NPL National Priorities List PRR Patuxent Research Refuge QA quality assurance QC quality control ACRONYMS AND...mean and maximum) for each individual for the exposure period; EHQs are then compiled to arrive at a modeled population— effects curve. Figure 1

Improvement, Verification, and Refinement of Spatially Explicit Exposure Models in Risk Assessment - SEEM Demonstration

DTIC Science & Technology

2015-06-01

hazard quotient HSI Habitat Suitability Index LOAEL lowest observed adverse effect level mg/kg milligrams per kilogram NOAEL no observed adverse... effect level NPL National Priorities List PRR Patuxent Research Refuge QA quality assurance QC quality control ACRONYMS AND...mean and maximum) for each individual for the exposure period; EHQs are then compiled to arrive at a modeled population— effects curve. Figure 1

Nonsteroidal Anti-inflammatory Drugs for Sciatica: An Updated Cochrane Review.

PubMed

Rasmussen-Barr, Eva; Held, Ulrike; Grooten, Wilhelmus J A; Roelofs, Pepijn D D M; Koes, Bart W; van Tulder, Maurits W; Wertli, Maria M

2017-04-15

Systematic review and meta-analysis. To determine the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) on pain reduction, overall improvement, and reported adverse effects in people with sciatica. NSAIDs are one of the most frequently prescribed drugs for sciatica. We updated a 2008 Cochrane Review through June 2015. Randomized controlled trials that compared NSAIDs with placebo, with other NSAIDs, or with other medication were included. Outcomes included pain using mean difference (MD, 95% confidence intervals [95% CI]). For global improvement and adverse effects risk ratios (RR, 95% CI) were used. We assessed level of evidence using the Grades of Recommendation, Assessment, Development and Evaluation approach. Ten trials were included (N = 1651). Nine out of 10 trials were assessed at high risk of bias. For pain reduction (visual analog scale, 0 to 100) NSAIDs were no more effective than placebo (MD -4.56, 95% CI -11.11 to 1.99, quality of evidence: very low). For global improvement NSAIDs were more effective than placebo (RR 1.14 [95% CI 1.03 to 1.27], low quality of evidence). One trial reported the effect of NSAIDs on disability with very low-quality evidence that NSAIDs are no more effective than placebo. There was low-quality evidence that the risk for adverse effects is higher for NSAID than placebo (RR 1.40, 95% CI 1.02 to 1.93). Our findings show very low-quality evidence that the efficacy of NSAIDs for pain reduction is comparable with that of placebo, low-quality evidence that NSAIDs is better than placebo for global improvement and low-quality evidence for higher risk of adverse effects using NSAIDs compared with placebo. The findings must be interpreted with caution, due to small study samples, inconsistent results, and a high risk of bias in the included trials. 1.

Quality indicators for eye bank.

PubMed

Acharya, Manisha; Biswas, Saurabh; Das, Animesh; Mathur, Umang; Dave, Abhishek; Singh, Ashok; Dubey, Suneeta

2018-03-01

The aim of this study is to identify quality indicators of the eye bank and validate their effectivity. Adverse reaction rate, discard rate, protocol deviation rate, and compliance rate were defined as Quality Indicators of the eye bank. These were identified based on definition of quality that captures two dimensions - "result quality" and "process quality." The indicators were measured and tracked as part of quality assurance (QA) program of the eye bank. Regular audits were performed to validate alignment of standard operating procedures (SOP) with regulatory and surgeon acceptance standards and alignment of activities performed in the eye bank with the SOP. Prospective study of the indicators was performed by comparing their observed values over the period 2011-2016. Adverse reaction rate decreased more than 8-fold (from 0.61% to 0.07%), discard rate decreased and stabilized at 30%, protocol deviation rate decreased from 1.05% to 0.08%, and compliance rate reported by annual quality audits improved from 59% to 96% at the same time. In effect, adverse reaction rate, discard rate, and protocol deviation rate were leading indicators, and compliance rate was the trailing indicator. These indicators fulfill an important gap in available literature on QA in eye banking. There are two ways in which these findings can be meaningful. First, eye banks which are new to quality measurement can adopt these indicators. Second, eye banks which are already deeply engaged in quality improvement can test these indicators in their eye bank, thereby incorporating them widely and improving them over time.

A review of low-level air pollution and adverse effects on human health: implications for epidemiological studies and public policy

PubMed Central

Olmo, Neide Regina Simões; do Nascimento Saldiva, Paulo Hilário; Braga, Alfésio Luís Ferreira; Lin, Chin An; de Paula Santos, Ubiratan; Pereira, Luiz Alberto Amador

2011-01-01

The aim of this study was to review original scientific articles describing the relationship between atmospheric pollution and damage to human health. We also aimed to determine which of these studies mentioned public policy issues. Original articles relating to atmospheric pollution and human health published between 1995 and 2009 were retrieved from the PubMed database and analyzed. This study included only articles dealing with atmospheric pollutants resulting primarily from vehicle emissions. Three researchers were involved in the final selection of the studies, and the chosen articles were approved by at least two of the three researchers. Of the 84 non-Brazilian studies analyzed, 80 showed an association between atmospheric pollution and adverse effects on human health. Moreover, 66 showed evidence of adverse effects on human health, even at levels below the permitted emission standards. Three studies mentioned public policies aimed at changing emission standards. Similarly, the 29 selected Brazilian studies reported adverse associations with human health, and 27 showed evidence of adverse effects even at levels below the legally permitted emission standards. Of these studies, 16 mentioned public policies aimed at changing emission standards. Based on the Brazilian and non-Brazilian scientific studies that have been conducted, it can be concluded that, even under conditions that are compliant with Brazilian air quality standards, the concentration of atmospheric pollutants in Brazil can negatively affect human health. However, as little discussion of this topic has been generated, this finding demonstrates the need to incorporate epidemiological evidence into decisions regarding legal regulations and to discuss the public policy implications in epidemiological studies. PMID:21655765

Commercial breakfast cereals available in Mexican markets and their contribution in dietary fiber, β-glucans and protein quality by rat bioassays.

PubMed

Falcón-Villa, María R; Barrón-Hoyos, Jesús M; Cinco-Moroyoqui, Francisco J

2014-09-01

The beneficial effect of dietary fiber (DF) consumption has long been recognized. The global economy and open market trade policies have increased the availability of food products in Mexican markets, resulting in a wide variety of ready-to-eat commercial breakfast cereals classified as 'high fiber'. This research was aimed to evaluate the total dietary fiber contents, its fractions (soluble and insoluble) and β-glucan in 13 commercial 'high-fiber' breakfast cereals, as well as to evaluate their protein quality by rat bioassays. Commercial 'high-fiber' breakfast cereals had 7.42-39.82% insoluble dietary fiber, 2.53-12.85% soluble dietary fiber, and 0.45-4.96% β-glucan. These ready-to-eat commercial 'high-fiber' breakfast cereals differed significantly in their total dietary fiber, their soluble and insoluble DF fractions, and also in their β-glucan contents. When supplied as experimental diets, in 14-day rat feeding trials, the 'high-fiber' breakfast cereals showed an adverse effect on the % N digestibility but protein utilization, as measured as net protein ratio (NPR), was not significantly affected. The consumption of these commercial breakfast cereals, especially those made of oats as the basic ingredient, is highly recommended, since these products, being a concentrated source of dietary fiber, do not affect their protein quality.

Automatic Control of the Concrete Mixture Homogeneity in Cycling Mixers

NASA Astrophysics Data System (ADS)

Anatoly Fedorovich, Tikhonov; Drozdov, Anatoly

2018-03-01

The article describes the factors affecting the concrete mixture quality related to the moisture content of aggregates, since the effectiveness of the concrete mixture production is largely determined by the availability of quality management tools at all stages of the technological process. It is established that the unaccounted moisture of aggregates adversely affects the concrete mixture homogeneity and, accordingly, the strength of building structures. A new control method and the automatic control system of the concrete mixture homogeneity in the technological process of mixing components have been proposed, since the tasks of providing a concrete mixture are performed by the automatic control system of processing kneading-and-mixing machinery with operational automatic control of homogeneity. Theoretical underpinnings of the control of the mixture homogeneity are presented, which are related to a change in the frequency of vibrodynamic vibrations of the mixer body. The structure of the technical means of the automatic control system for regulating the supply of water is determined depending on the change in the concrete mixture homogeneity during the continuous mixing of components. The following technical means for establishing automatic control have been chosen: vibro-acoustic sensors, remote terminal units, electropneumatic control actuators, etc. To identify the quality indicator of automatic control, the system offers a structure flowchart with transfer functions that determine the ACS operation in transient dynamic mode.

Frequency of adverse events in plateletpheresis donors in regional transfusion centre in North India.

PubMed

Patidar, Gopal Kumar; Sharma, Ratti Ram; Marwaha, Neelam

2013-10-01

Although automated cell separators have undergone a lot of technical refinements, attention has been focused on the quality of platelet concentrates than on donor safety. We planned this prospective study to look into donor safety aspect by studying adverse events in normal healthy plateletpheresis donors. The study included 500 healthy, first-time (n=301) and repeat (n=199) plateletpheresis donors after informed consent. The plateletpheresis procedures were performed on Trima Accel (5.1 version, GAMBRO BCT) and Amicus (3.2 version FENWAL) cell separators. The adverse events during procedure were recorded and classified according to their nature. The pre and post procedure hematological and biochemical profiles of these donors were also assessed with the help of automated cell counter and analyser respectively. A total of 18% (n=90) adverse events were recorded in 500 plateletpheresis donors, of which 9% of were hypocalcaemia in nature followed by hematoma (7.4%), vasovagal reaction (0.8%) and kit related adverse events in (0.8%). There was significant post procedure drop in Hb, Hct, platelet count of the donors (p<0.0001) whereas WBC count showed a statistically significant rise (p<0.0001). Divalent cations (iCa(+), TCa(+), TMg(+)) also showed a statistically significant decline after donation (p<0.0001). However there were no statistically significance difference between adverse events in Trima Accel (5.1 version, GAMBRO BCT) and Amicus (3.2 version FENWAL) cell separators. Donor reactions can adversely affect the voluntary donor recruitment strategies to increase the public awareness regarding constant need for blood and blood products. Commonly observed adverse events in plateletpheresis donors were hypocalcemia, hematoma formation and vasovagal reactions which can be prevented by pre-donation education of the donors and change of machine configuration. Nevertheless, more prospective studies on this aspect are required in order to establish guidelines for donor safety in apheresis and also to help in assessing donor suitability, especially given the present trend of double product apheresis collections. Copyright © 2013 Elsevier Ltd. All rights reserved.

The impact of herbal remedies on adverse effects and quality of life in HIV-infected individuals on antiretroviral therapy

PubMed Central

Bepe, Nyasha; Madanhi, Nathan; Mudzviti, Tinashe; Gavi, Samuel; Maponga, Charles Chiedza; Morse, Gene D

2012-01-01

Introduction Use of herbal remedies among HIV-infected individuals in Africa increased in the past decade, mainly due to traditional beliefs and at times inconsistent access to antiretroviral drugs. In Zimbabwe, accessibility and availability of antiretroviral drugs has increased in recent years; however, the use of herbal remedies remains high. This study was conducted to determine the impact of concomitant use of herbal remedies with antiretroviral drugs on adverse events and on quality of life. Methodology A convenient sample of HIV positive patients at Parirenyatwa group of hospitals' Family Care Clinic (Harare, Zimbabwe) was enrolled. A questionnaire was used to collect data on the adverse event experiences of the patients using herbal remedies for their HIV, as well as the types of herbal remedy used. Quality of life index was measured using an HIV/AIDS targeted quality of life (HAT-QOL) tool developed by the World Health Organization. Results Abdominal pain (odds ratio = 2.7, p-value = 0.01) and rash (odds ratio = 2.5, p-value = 0.02) had significant associations with using herbal remedies during antiretroviral therapy. Improved quality of life index was not significantly associated with herbal remedy use during antiretroviral therapy. Conclusions There is evidence to suggest that some traditional herbal remedies used in Zimbabwe may increase incidence of certain types of adverse events when used in combination with antiretroviral drugs. Use of herbal drugs in combination with antiretroviral therapy does not significantly improve quality of life index in comparison to antiretroviral drug use only. PMID:21330740

Sickness absence and psychosocial job quality: an analysis from a longitudinal survey of working Australians, 2005-2012.

PubMed

Milner, Allison; Butterworth, Peter; Bentley, Rebecca; Kavanagh, Anne M; LaMontagne, Anthony D

2015-05-15

Sickness absence is associated with adverse health, organizational, and societal outcomes. Using data from a longitudinal cohort study of working Australians (the Household, Income and Labour Dynamics in Australia (HILDA) Survey), we examined the relationship between changes in individuals' overall psychosocial job quality and variation in sickness absence. The outcome variables were paid sickness absence (yes/no) and number of days of paid sickness absence in the past year (2005-2012). The main exposure variable was psychosocial job quality, measured using a psychosocial job quality index (levels of job control, demands and complexity, insecurity, and perceptions of unfair pay). Analysis was conducted using longitudinal fixed-effects logistic regression models and negative binomial regression models. There was a dose-response relationship between the number of psychosocial job stressors reported by an individual and the odds of paid sickness absence (1 adversity: odds ratio (OR) = 1.26, 95% confidence interval (CI): 1.09, 1.45 (P = 0.002); 2 adversities: OR = 1.28, 95% CI: 1.09, 1.51 (P = 0.002); ≥3 adversities: OR = 1.58, 95% CI: 1.29, 1.94 (P < 0.001)). The negative binomial regression models also indicated that respondents reported a greater number of days of sickness absence in response to worsening psychosocial job quality. These results suggest that workplace interventions aiming to improve the quality of work could help reduce sickness absence. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Seasonal occurrence and production effects of the biting louse Damalinia limbata on Angora goats and 2 treatment options.

PubMed

Brown, L; van der Linde, T C de K; Fourie, L J; Horak, I G

2005-06-01

Adult biting lice Damalinia limbata (Gervais 1844) were most numerous on Angora goats in southwestern Free State Province from November to May with the smallest numbers present during August. Nymphs were most numerous from January to March with the smallest numbers present during July. The largest proportion of adult lice was present on the ventral surface of goats during winter, when population numbers were lowest, and the largest proportion of nymphs during summer, when population numbers were highest. Infestation did not affect the body weight of goats, but adversely affected both the quantity and quality of mohair produced. A single treatment with deltamethrin, applied as a pour-on along the mid-line of the backs of the goats, effectively controlled infestation and resulted in a significant increase in mohair production compared with untreated goats. Deltamethrin sprayed along the sides of the animals was equally effective in controlling infestation.

Rationale for Using Exercise in the Treatment of Stimulant Use Disorders

PubMed Central

Greer, Tracy L.; Ring, Kolette M.; Warden, Diane; Grannemann, Bruce D.; Church, Timothy S.; Somoza, Eugene; Blair, Steven N.; Szapocznik, Jose; Stoutenberg, Mark; Rethorst, Chad; Walker, Robrina; Morris, David W.; Kosinski, Andrzej S.; Kyle, Tiffany; Marcus, Bess; Crowell, Becca; Oden, Neal; Nunes, Edward; Trivedi, Madhukar H.

2013-01-01

Novel approaches to the treatment of stimulant abuse and dependence are needed. Clinical data examining the use of exercise as a treatment for the abuse of nicotine, alcohol, and other substances suggest that exercise may be a beneficial treatment for stimulant abuse. In addition, exercise has been associated with improvements in many other health-related areas that may be adversely affected by stimulant use or its treatment, such as sleep disturbance, cognitive function, mood, weight, quality of life, and anhedonia. Neurobiological evidence provides plausible mechanisms by which exercise could positively affect treatment outcomes in stimulant abuse. The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) CTN-0037 Stimulant Reduction Intervention using Dosed Exercise (STRIDE) study is a multisite randomized clinical trial that compares exercise to health education as potential treatments for stimulant abuse or dependence. If effective, exercise may provide an additional approach to the treatment of stimulant use disorders. PMID:25364477

Saw palmetto and benign prostatic hyperplasia.

PubMed

Gong, Edward M; Gerber, Glenn S

2004-01-01

Benign prostatic hyperplasia (BPH) is a common health issue that affects 8% of all men at the age of 40, 60% of men in their 70s, and 90% of those greater than 80 years of age. One-fourth of these men will develop moderate to severe lower urinary tract symptoms that greatly affect their quality of life. Recent evidence suggests that the use of saw palmetto leads to improvements in urinary function for those suffering from BPH. The favorable comparison of saw palmetto with tamsulosin, a well-known first line agent in the treatment of urinary tract symptoms, demonstrates promise towards a beneficial effect of this herbal agent, with very few, if any, adverse effects. However, what degree of this beneficial activity is due to placebo effects is yet to be determined. In addition, the precise mechanism of action of saw palmetto in men with BPH remains unclear.

Mild cognitive impairment affects motor control and skill learning.

PubMed

Wu, Qiaofeng; Chan, John S Y; Yan, Jin H

2016-02-01

Mild cognitive impairment (MCI) is a transitional phase between normal cognitive aging and dementia. As the world population is aging rapidly, more MCI patients will be identified, posing significant problems to society. Normal aging is associated with cognitive and motor decline, and MCI brings additional impairments. Compared to healthy older adults, MCI patients show poorer motor control in a variety of tasks. Efficient motor control and skill learning are essential for occupational and leisure purposes; degradation of motor behaviors in MCI patients often adversely affects their health and quality of life. In this article, we first define MCI and describe its pathology and neural correlates. After this, we review cognitive changes and motor control and skill learning in normal aging. This section is followed by a discussion of MCI-related degradation of motor behaviors. Finally, we propose that multicomponent interventions targeting both cognitive and motor domains can improve MCI patients' motor functions. Future research directions are also raised.

Orthopaedic Snafus: When Adverse Events Happen in Orthopaedics.

PubMed

Smith, Mary Atkinson; Walsh, Colleen; Levin, Barbara; Eaten, Kathyrn; Yager, Melissa

The potential for adverse events exists when treating and managing orthopaedic patients in the intraoperative or postoperative environments, especially when it comes to falls, surgical site infections, venous thromboembolism, and injuries to nerves and blood vessels. Orthopaedic nurses play a vital role in the promotion and use of evidence-based interventions to decrease the incidence of these adverse events, improve quality of care, and minimize the financial burden related to these adverse events.

Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis.

PubMed

Montroy, Joshua; Breau, Rodney H; Cnossen, Sonya; Witiuk, Kelsey; Binette, Andrew; Ferrier, Taylor; Lavallée, Luke T; Fergusson, Dean A; Schramm, David

2016-01-01

The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72-0.91), deep (pRR 0.82; 95% CI0.64-1.05) and organ space (pRR 1.15; 95% CI 0.96-1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39-0.77; deep pRR 0.61, 95% CI 0.50-0.75, and organ space pRR 0.60, 95% CI 0.50-0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities.

Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis

PubMed Central

Montroy, Joshua; Breau, Rodney H.; Cnossen, Sonya; Witiuk, Kelsey; Binette, Andrew; Ferrier, Taylor; Lavallée, Luke T.; Fergusson, Dean A.; Schramm, David

2016-01-01

Background The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. Study Design A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). Results Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72–0.91), deep (pRR 0.82; 95% CI0.64–1.05) and organ space (pRR 1.15; 95% CI 0.96–1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39–0.77; deep pRR 0.61, 95% CI 0.50–0.75, and organ space pRR 0.60, 95% CI 0.50–0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. Conclusions These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities. PMID:26812596

Psychological and health impact of working with victims of sex trafficking.

PubMed

Kliner, Merav; Stroud, Laura

2012-01-01

The UK is a major destination country for trafficking for sexual exploitation, and so increasing numbers of victims of trafficking are managed within health and social services. This study aims to assess the psychological and physical impact on health and social care staff working with an identified sex-trafficked population in a Northern City within England and identify methods to assist staff to manage this complex population. This research is a qualitative study of 12 members of health and social care staff through semi-structured interviews. The subjects were identified using purposive sampling, and data were analyzed using thematic analysis. Staff found working with sex-trafficked populations more difficult than with other vulnerable groups. They frequently described burnout and other adverse effects on their psychological and physical health. In general, staff felt undersupported and undertrained by their organizations. This led to concerns about the quality and sustainability of the service. Working with victims of sex trafficking significantly impacts on the physical and psychological health of staff. Staff working with such vulnerable groups require training and high levels of support to ensure that they are not adversely affected by their work and to ensure that high quality services are maintained. Practices to promote occupational health must be instilled within workplace policy and the organizational culture to limit the impact on psychological and physical health in staff working with vulnerable populations.

Direct and correlated responses to selection in two lines of rabbits selected for feed efficiency under ad libitum and restricted feeding: II. Carcass and meat quality.

PubMed

Molette, C; Gilbert, H; Larzul, C; Balmisse, E; Ruesche, J; Manse, H; Tircazes, A; Theau-Clément, M; Joly, T; Gidenne, T; Garreau, H; Drouilhet, L

2016-01-01

To get insights into selection criteria for feed efficiency, 2 rabbit lines have been created: the ConsoResidual line was selected for residual feed intake (RFI) with ad libitum feeding and the ADGrestrict line was selected for ADG under restricted feeding. The aim of the present study was to evaluate the impact on carcass and meat quality of the genetic selections. This comparison was performed using 2 different feeding strategies corresponding to the selection design. Carcass and meat quality traits were recorded for the 3 lines (ConsoResidual, ADGrestrict, and an unselected control [generation 0 {G0}]) in the 2 feeding systems (ad libitum and restricted) for 163 animals. Concerning the line effect, the BW at 63 d old was higher for the ADGrestrict line compared with the G0 and ConsoResidual lines ( < 0.0001). There was no line effect on the gastrointestinal tract. The rabbits did not exhibit a different carcass yield but showed different carcass traits. Indeed, the ConsoResidual rabbits had a higher hind leg yield ( < 0.0001) but no difference in the meat-to-bone ratio of the hind leg. On the contrary, the ADGrestrict line had a higher proportion of forelegs plus thoracic cage ( = 0.03). We also found lower perirenal ( < 0.0001) and scapular fat yields ( < 0.0001) in ConsoResidual rabbits. The ADGrestrict line had an intermediate perirenal fat yield compared with the other 2 lines. The G0 line always exhibited higher fat yields. Concerning meat quality, the ConsoResidual rabbits showed a lower ultimate pH ( < 0.0001) and higher water loss (drip and cooking loss; < 0.002) compared with the G0 and ADGrestrict rabbits. The feeding level had a strong effect on the gastrointestinal tract ( = 0.0004) and the carcass yield ( = 0.001). The latter was decreased in restricted rabbits. The effects of feeding strategy on meat quality were detrimental in the case of restricted feeding. Even if the ultimate pH was slightly higher in restricted rabbits ( = 0.0002), the carcass chilling loss ( = 0.0005) and the drip loss during 6 d ( < 0.0001) were higher. The selection on ADG with restricted access to feed seems to be less adversely correlated with carcass traits and meat quality traits but it leads to an increase in the live weight of the rabbits. Adversely, the selection on RFI, without affecting growth rate, would not modify age at slaughter because growth rate is not affected, but it might induce detrimental effects on meat quality.

The Role of Mindfulness in Reducing the Adverse Effects of Childhood Stress and Trauma

PubMed Central

Ortiz, Robin; Sibinga, Erica M.

2017-01-01

Research suggests that many children are exposed to adverse experiences in childhood. Such adverse childhood exposures may result in stress and trauma, which are associated with increased morbidity and mortality into adulthood. In general populations and trauma-exposed adults, mindfulness interventions have demonstrated reduced depression and anxiety, reduced trauma-related symptoms, enhanced coping and mood, and improved quality of life. Studies in children and youth also demonstrate that mindfulness interventions improve mental, behavioral, and physical outcomes. Taken together, this research suggests that high-quality, structured mindfulness instruction may mitigate the negative effects of stress and trauma related to adverse childhood exposures, improving short- and long-term outcomes, and potentially reducing poor health outcomes in adulthood. Future work is needed to optimize implementation of youth-based mindfulness programs and to study long-term outcomes into adulthood. PMID:28264496

Evaluation of increases in dissolved solids in ground water, Stovepipe Wells Hotel, Death Valley National Monument, California

USGS Publications Warehouse

Buono, Anthony; Packard, E.M.

1982-01-01

Increases in dissolved solids have been monitored in two observation wells near Stovepipe Wells Hotel, Death Valley National Monument, California. One of the hotel 's supply wells delivers water to a reverse-osmosis treatment plant that produces the area 's potable water supply. Should water with increased dissolved solids reach the supply well, the costs of production of potable water will increase. The reverse-osmosis plant supply well is located about 0.4 mile south of one of the wells where increases have been monitored, and 0.8 mile southwest of the well where the most significant increases have been monitored. The direction of local ground-water movement is eastward, which reduces the probability of the supply well being affected. Honey mesquite, a phreatophyte located about 1.5 miles downgradient from the well where the most significant increases have been monitored, might be adversely affected should water with increased dissolved solids extend that far. Available data and data collected during this investigation do not indicate the source of the dissolved-solids increases. Continued ground-water-quality monitoring of existing wells and the installation of additional wells for water-quality monitoring would be necessary before the area affected by the increases, and the source and direction of movement of the water with increased dissolved solids, can be determined. (USGS)

An Update on Female Sexual Function and Dysfunction in Old Age and Its Relevance to Old Age Psychiatry

PubMed Central

Wood, Alison; Runciman, Ross; Wylie, Kevan R.; McManus, Ross

2012-01-01

Numerous studies have now demonstrated that many older women retain an interest in their sexual lives. Yet, how many old age psychiatrists commonly check with older women about whether the depression they are treating, or the SSRIs (Selective Serotonin Re-uptake Inhibitors) they have prescribed, have adversely affected their patient’s sexual lives? We consider the latest evidence regarding cultural, social and medical influences on older women’s sexual lives and some specific issues which affect lesbian and transsexual people. We examine how mental illness and psychotropic medication in particular can adversely affect older women’s sexual functioning and at how difficult it often proves to be for women to seek help. We also focus on why doctors and in particular psychiatrists may not take a sexual history, look for sexual side effects or refer for appropriate treatment, especially when interviewing older women patients. Most published information about psychiatric training and sexual issues focuses on the younger male patient. We therefore aimed to provide a broad-ranging review of the literature regarding female sexual functioning in old age, the difficulties that can arise and the role that old age psychiatrists have an opportunity to fulfil, in this often neglected aspect of their patients’ treatment. From our review it was clear that, in the light of the increasing cultural acceptability of discussions regarding sexuality and older women, the training of student doctors and trainee psychiatrists needs to reflect this change so that old age psychiatrists can enhance the quality of their patient care. PMID:23185718

Corruption, inequality and population perception of healthcare quality in Europe

PubMed Central

2013-01-01

Background Evaluating the quality of healthcare and patient safety using general population questionnaires is important from research and policy perspective. Using a special wave of the Eurobarometer survey, we analysed the general population’s perception of health care quality and patient safety in a cross-country setting. Methods We used ordered probit, ordinary least squares and probit analysis to estimate the determinants of health care quality, and ordered logit analysis to analyse the likelihood of being harmed by a specific medical procedure. The models used population weights as well as country-clustered standard errors. Results We found robust evidence for the impact of socio-demographic variables on the perception of quality of health care. More specifically, we found a non-linear impact of age on the perception of quality of health care and patient safety, as well as a negative impact of poverty on both perception of quality and patient safety. We also found robust evidence that countries with higher corruption levels were associated with worse perceptions of quality of health care. Finally, we found evidence that income inequality affects patients’ perception vis-à-vis safety, thus feeding into the poverty/health care quality nexus. Conclusions Socio-demographic factors and two macro variables (corruption and income inequality) explain the perception of quality of health care and likelihood of being harmed by adverse events. The results carry significant policy weight and could explain why targeting only the health care sector (without an overall reform of the public sector) could potentially be challenging. PMID:24215401

Corruption, inequality and population perception of healthcare quality in Europe.

PubMed

Nikoloski, Zlatko; Mossialos, Elias

2013-11-11

Evaluating the quality of healthcare and patient safety using general population questionnaires is important from research and policy perspective. Using a special wave of the Eurobarometer survey, we analysed the general population's perception of health care quality and patient safety in a cross-country setting. We used ordered probit, ordinary least squares and probit analysis to estimate the determinants of health care quality, and ordered logit analysis to analyse the likelihood of being harmed by a specific medical procedure. The models used population weights as well as country-clustered standard errors. We found robust evidence for the impact of socio-demographic variables on the perception of quality of health care. More specifically, we found a non-linear impact of age on the perception of quality of health care and patient safety, as well as a negative impact of poverty on both perception of quality and patient safety. We also found robust evidence that countries with higher corruption levels were associated with worse perceptions of quality of health care. Finally, we found evidence that income inequality affects patients' perception vis-à-vis safety, thus feeding into the poverty/health care quality nexus. Socio-demographic factors and two macro variables (corruption and income inequality) explain the perception of quality of health care and likelihood of being harmed by adverse events. The results carry significant policy weight and could explain why targeting only the health care sector (without an overall reform of the public sector) could potentially be challenging.

Workplace lighting for improving alertness and mood in daytime workers.

PubMed

Pachito, Daniela V; Eckeli, Alan L; Desouky, Ahmed S; Corbett, Mark A; Partonen, Timo; Rajaratnam, Shantha Mw; Riera, Rachel

2018-03-02

Exposure to light plays a crucial role in biological processes, influencing mood and alertness. Daytime workers may be exposed to insufficient or inappropriate light during daytime, leading to mood disturbances and decreases in levels of alertness. To assess the effectiveness and safety of lighting interventions to improve alertness and mood in daytime workers. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, seven other databases; ClinicalTrials.gov and the World Health Organization trials portal up to January 2018. We included randomised controlled trials (RCTs), and non-randomised controlled before-after trials (CBAs) that employed a cross-over or parallel-group design, focusing on any type of lighting interventions applied for daytime workers. Two review authors independently screened references in two stages, extracted outcome data and assessed risk of bias. We used standardised mean differences (SMDs) and 95% confidence intervals (CI) to pool data from different questionnaires and scales assessing the same outcome across different studies. We combined clinically homogeneous studies in a meta-analysis. We used the GRADE system to rate quality of evidence. The search yielded 2844 references. After screening titles and abstracts, we considered 34 full text articles for inclusion. We scrutinised reports against the eligibility criteria, resulting in the inclusion of five studies (three RCTs and two CBAs) with 282 participants altogether. These studies evaluated four types of comparisons: cool-white light, technically known as high correlated colour temperature (CCT) light versus standard illumination; different proportions of indirect and direct light; individually applied blue-enriched light versus no treatment; and individually applied morning bright light versus afternoon bright light for subsyndromal seasonal affective disorder.We found no studies comparing one level of illuminance versus another.We found two CBA studies (163 participants) comparing high CCT light with standard illumination. By pooling their results via meta-analysis we found that high CCT light may improve alertness (SMD -0.69, 95% CI -1.28 to -0.10; Columbia Jet Lag Scale and the Karolinska Sleepiness Scale) when compared to standard illumination. In one of the two CBA studies with 94 participants there was no difference in positive mood (mean difference (MD) 2.08, 95% CI -0.1 to 4.26) or negative mood (MD -0.45, 95% CI -1.84 to 0.94) assessed using the Positive and Negative Affect Schedule (PANAS) scale. High CCT light may have fewer adverse events than standard lighting (one CBA; 94 participants). Both studies were sponsored by the industry. We graded the quality of evidence as very low.We found no studies comparing light of a particular illuminance and light spectrum or CCT versus another combination of illuminance and light spectrum or CCT.We found no studies comparing daylight versus artificial light.We found one RCT (64 participants) comparing the effects of different proportions of direct and indirect light: 100% direct lighting, 70% direct lighting plus 30% indirect lighting, 30% direct lighting plus 70% indirect lighting and 100% indirect lighting. There was no substantial difference in mood, as assessed by the Beck Depression Inventory, or in adverse events, such as ocular, reading or concentration problems, in the short or medium term. We graded the quality of evidence as low.We found two RCTs comparing individually administered light versus no treatment. According to one RCT with 25 participants, blue-enriched light individually applied for 30 minutes a day may enhance alertness (MD -3.30, 95% CI -6.28 to -0.32; Epworth Sleepiness Scale) and may improve mood (MD -4.8, 95% CI -9.46 to -0.14; Beck Depression Inventory). We graded the quality of evidence as very low. One RCT with 30 participants compared individually applied morning bright light versus afternoon bright light for subsyndromal seasonal affective disorder. There was no substantial difference in alertness levels (MD 7.00, 95% CI -10.18 to 24.18), seasonal affective disorder symptoms (RR 1.60, 95% CI 0.81, 3.20; number of participants presenting with a decrease of at least 50% in SIGH-SAD scores) or frequency of adverse events (RR 0.53, 95% CI 0.26 to 1.07). Among all participants, 57% had a reduction of at least 50% in their SIGH-SAD score. We graded the quality of evidence as low.Publication bias could not be assessed for any of these comparisons. There is very low-quality evidence based on two CBA studies that high CCT light may improve alertness, but not mood, in daytime workers. There is very low-quality evidence based on one CBA study that high CCT light may also cause less irritability, eye discomfort and headache than standard illumination. There is low-quality evidence based on one RCT that different proportions of direct and indirect light in the workplace do not affect alertness or mood. There is very low-quality evidence based on one RCT that individually applied blue-enriched light improves both alertness and mood. There is low-quality evidence based on one RCT that individually administered bright light during the afternoon is as effective as morning exposure for improving alertness and mood in subsyndromal seasonal affective disorder.

30 CFR 285.816 - What must I do if environmental or other conditions adversely affect a cable, pipeline, or facility?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Environmental Effects § 285.816 What must I do if environmental or other conditions adversely affect a cable... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What must I do if environmental or other... EXISTING FACILITIES ON THE OUTER CONTINENTAL SHELF Environmental and Safety Management, Inspections, and...

Sleep and optimism: A longitudinal study of bidirectional causal relationship and its mediating and moderating variables in a Chinese student sample.

PubMed

Lau, Esther Yuet Ying; Hui, C Harry; Lam, Jasmine; Cheung, Shu-Fai

2017-01-01

While both sleep and optimism have been found to be predictive of well-being, few studies have examined their relationship with each other. Neither do we know much about the mediators and moderators of the relationship. This study investigated (1) the causal relationship between sleep quality and optimism in a college student sample, (2) the role of symptoms of depression, anxiety, and stress as mediators, and (3) how circadian preference might moderate the relationship. Internet survey data were collected from 1,684 full-time university students (67.6% female, mean age = 20.9 years, SD = 2.66) at three time-points, spanning about 19 months. Measures included the Attributional Style Questionnaire, the Pittsburgh Sleep Quality Index, the Composite Scale of Morningness, and the Depression Anxiety Stress Scale-21. Moderate correlations were found among sleep quality, depressive mood, stress symptoms, anxiety symptoms, and optimism. Cross-lagged analyses showed a bidirectional effect between optimism and sleep quality. Moreover, path analyses demonstrated that anxiety and stress symptoms partially mediated the influence of optimism on sleep quality, while depressive mood partially mediated the influence of sleep quality on optimism. In support of our hypothesis, sleep quality affects mood symptoms and optimism differently for different circadian preferences. Poor sleep results in depressive mood and thus pessimism in non-morning persons only. In contrast, the aggregated (direct and indirect) effects of optimism on sleep quality were invariant of circadian preference. Taken together, people who are pessimistic generally have more anxious mood and stress symptoms, which adversely affect sleep while morningness seems to have a specific protective effect countering the potential damage poor sleep has on optimism. In conclusion, optimism and sleep quality were both cause and effect of each other. Depressive mood partially explained the effect of sleep quality on optimism, whereas anxiety and stress symptoms were mechanisms bridging optimism to sleep quality. This was the first study examining the complex relationships among sleep quality, optimism, and mood symptoms altogether longitudinally in a student sample. Implications on prevention and intervention for sleep problems and mood disorders are discussed.

A tool to determine financial impact of adverse events in health care: healthcare quality calculator.

PubMed

Yarbrough, Wendell G; Sewell, Andrew; Tickle, Erin; Rhinehardt, Eric; Harkleroad, Rod; Bennett, Marc; Johnson, Deborah; Wen, Li; Pfeiffer, Matthew; Benegas, Manny; Morath, Julie

2014-12-01

Hospital leaders lack tools to determine the financial impact of poor patient outcomes and adverse events. To provide health-care leaders with decision support for investments to improve care, we created a tool, the Healthcare Quality Calculator (HQCal), which uses institution-specific financial data to calculate impact of poor patient outcomes or quality improvement on present and future margin. Excel and Web-based versions of the HQCal were based on a cohort study framework and created with modular components including major drivers of cost and reimbursement. The Healthcare Quality Calculator (HQCal) compares payment, cost, and profit/loss for patients with and without poor outcomes or quality issues. Cost and payment information for groups with and without quality issues are used by the HQCal to calculate profit or loss. Importantly, institution-specific payment and cost data are used to calculate financial impact and attributable cost associated with poor patient outcomes, adverse events, or quality issues. Because future cost and reimbursement changes can be forecast, the HQCal incorporates a forward-looking component. The flexibility of the HQCal was demonstrated using surgical site infections after abdominal surgery and postoperative surgical airway complications. The Healthcare Quality Calculator determines financial impact of poor patient outcomes and the benefit of initiatives to improve quality. The calculator can identify quality issues that would provide the largest financial benefit if improved; however, it cannot identify specific interventions. The calculator provides a tool to improve transparency regarding both short- and long-term financial consequences of funding, or failing to fund, initiatives to close gaps in quality or improve patient outcomes.

The effect of Fusarium culmorum infection and deoxynivalenol (DON) application on proteome response in barley cultivars Chevron and Pedant.

PubMed

Kosová, Klára; Chrpová, Jana; Šantrůček, Jiří; Hynek, Radovan; Štěrbová, Lenka; Vítámvás, Pavel; Bradová, Jana; Prášil, Ilja Tom

2017-10-03

Fusarium head blight (FHB) disease adversely affects grain quality and final yield in small-grain cereals including barley. In the present study, the effect of an artificial infection with Fusarium culmorum and an application of deoxynivalenol (DON) on barley spikes of cultivars Chevron and Pedant during flowering was investigated at grain mid-dough stage (BBCH 73) 10days after pathogen inoculation (10 dai). Proteomic analysis using a two-dimensional differential gel electrophoresis (2D-DIGE) technique coupled with LC-MS/MS investigated 98 protein spots revealing quantitative or qualitative differences between the experimental variants. Protein functional annotation of 93 identified protein spots revealed that most affected functional groups represent storage proteins (globulins, hordeins), followed by proteins involved in carbohydrate metabolism (α-amylase inhibitor, β-amylase, glycolytic enzymes), amino acid metabolism (aminotransferases), defence response (chitinase, xylanase inhibitor, serpins, SGT1, universal stress protein USP), protein folding (chaperones, chaperonins), redox metabolism (ascorbate-glutathione cycle), and proteasome-dependent protein degradation. The obtained results indicate adverse effects of infection on plant proteome as well as an active plant response to pathogen as shown by enhanced levels of several inhibitors of pathogen-produced degradation enzymes (α-amylase inhibitor, xylanase inhibitor, serpins), chaperones, and other stress-related proteins (SGT1, USP). Genotypic differences were found in hordein abundance between Chevron and Pedant. Copyright © 2017 Elsevier B.V. All rights reserved.

Nursing work environment, patient safety and quality of care in pediatric hospital.

PubMed

Alves, Daniela Fernanda Dos Santos; Guirardello, Edinêis de Brito

2016-06-01

Objectives To describe the characteristics of the nursing work environment, safety attitudes, quality of care, measured by the nursing staff of the pediatric units, as well as to analyze the evolution of quality of care and hospital indicators. Methods Descriptive study with 136 nursing professionals at a paediatric hospital, conducted through personal and professional characterization form, Nursing Work Index - Revised, Safety Attitudes Questionnaire - Short Form 2006 and quality indicators. Results The professionals perceive the environment as favourable to professional practice, and consider good quality care that is also observed by reducing the incidence of adverse events and decreased length of stay. The domain job satisfaction was considered favourable to patient safety. Conclusions The work environment is favourable to nursing practice, the professionals nursing approve the quality of care and the indicators tended reducing adverse events and length of stay.

Effect of high hydrostatic pressure processing on the background microbial loads and quality of cantaloupe puree.

PubMed

Mukhopadhyay, Sudarsan; Sokorai, Kimberly; Ukuku, Dike; Fan, Xuetong; Juneja, Vijay

2017-01-01

The objective of this study was to investigate and evaluate the effects of high hydrostatic pressure (HHP) applied to cantaloupe puree (CP) on microbial loads and product quality during storage for 10days at 4°C. Freshly prepared, double sealed and double bagged CP (ca. 5g) was pressure treated at 300, 400 and 500MPa at 8°C and 15°C for 5min. Microflora populations, soluble solid content, pH, color, antioxidant activity, appearance and aroma were measured at 1, 6, and 10d of storage. Results showed that high pressure treatment of 300MPa (8°C and 15°C) resulted in reduction of total aerobic plate count from 3.3 to 1.8logCFU/g. The treatment reduced the populations of native aerobic plate count to non-detectable levels (detection limit 1logCFU/g) at 400MPa and 500MPa pressures at 15°C. Pressure treatment completely inactivated mold and yeast in puree below the limits of detection at day 1 and no regrowth was observed during 10days of storage at 4°C while mold and yeast in untreated puree survived during the storage. High pressure treatment did not show any adverse impact on physical properties as soluble solid content (SSC, 11.2°Brix) and acidity (pH, 6.9). The instrumental color parameters (L*, a*, b*) were affected due to HHP treatment creating a slightly lighter product, compared to control, as indicated by higher L.* and lower a* values. However the change was not detected by the sensory panel while evaluating appearance scores. Pressure treatment did not affect the antioxidant capacity of puree product compared to control. Visual appearance and sniffing aroma test by panel revealed no adverse changes in the sensory parameters as a result of HHP treatment. HHP method described in this study appears to be a promising way to inactivate spoilage microorganisms in the cantaloupe puree and maintain quality. This study provides a viable option for preservation and marketing this product. Published by Elsevier Ltd.

Hydrological Modeling of Rainfall-Watershed-Bioretention System with EPA SWMM

NASA Astrophysics Data System (ADS)

gülbaz, sezar; melek kazezyılmaz-alhan, cevza

2016-04-01

Water resources should be protected for the sustainability of water supply and water quality. Human activities such as high urbanization with lack of infrastructure system and uncontrolled agricultural facilities adversely affect the water resources. Therefore, recent techniques should be investigated in detail to avoid present and future problems like flood, drought and water pollution. Low Impact Development-Best Management Practice (LID-BMP) is such a technique to manage storm water runoff and quality. There are several LID storm water BMPs such as bioretention facilities, rain gardens, storm water wetlands, vegetated rooftops, rain barrels, vegetative swales and permeable pavements. Bioretention is a type of Low Impact Developments (LIDs) implemented to diminish adverse effects of urbanization by reducing peak flows over the surface and improving surface water quality simultaneously. Different soil types in different ratios are considered in bioretention design which affects the performance of bioretention systems. Therefore, in this study, a hydrologic model for bioretention is developed by using Environmental Protection Agency Storm Water Management Model (EPA SWMM). Part of the input data is supplied to the hydrologic model by experimental setup called Rainfall-Watershed-Bioretention (RWB). RWB System is developed to investigate the relation among rainfall, watershed and bioretention. This setup consists of three main parts which are artificial rainfall system, drainage area and four bioretention columns with different soil mixture. EPA SWMM is a dynamic simulation model for the surface runoff which develops on a watershed during a rainfall event. The model is commonly used to plan, analyze, and control storm water runoff, to design drainage system components and to evaluate watershed management of both urban and rural areas. Furthermore, EPA SWMM is a well-known program to model LID-Bioretention in the literature. Therefore, EPA SWMM is employed in drainage and bioretention modeling. Calibration of hydrologic model is made using part of the measured data in RWB System for drainage area and for each bioretention column separately. Finally, performance of the model is evaluated by comparing the model results with the experimental data collected in RWB system.

The cost of nurse-sensitive adverse events.

PubMed

Pappas, Sharon Holcombe

2008-05-01

The aim of this study was to describe the methodology for nursing leaders to determine the cost of adverse events and effective levels of nurse staffing. The growing transparency of quality and cost outcomes motivates healthcare leaders to optimize the effectiveness of nurse staffing. Most hospitals have robust cost accounting systems that provide actual patient-level direct costs. These systems allow an analysis of the cost consumed by patients during a hospital stay. By knowing the cost of complications, leaders have the ability to justify the cost of improved staffing when quality evidence shows that higher nurse staffing improves quality. An analysis was performed on financial and clinical data from hospital databases of 3,200 inpatients. The purpose was to establish a methodology to determine actual cost per case. Three diagnosis-related groups were the focus of the analysis. Five adverse events were analyzed along with the costs. A regression analysis reported that the actual direct cost of an adverse event was dollars 1,029 per case in the congestive heart failure cases and dollars 903 in the surgical cases. There was a significant increase in the cost per case in medical patients with urinary tract infection and pressure ulcers and in surgical patients with urinary tract infection and pneumonia. The odds of pneumonia occurring in surgical patients decreased with additional registered nurse hours per patient day. Hospital cost accounting systems are useful in determining the cost of adverse events and can aid in decision making about nurse staffing. Adverse events add costs to patient care and should be measured at the unit level to adjust staffing to reduce adverse events and avoid costs.

Impact of Life History on Fear Memory and Extinction

PubMed Central

Remmes, Jasmin; Bodden, Carina; Richter, S. Helene; Lesting, Jörg; Sachser, Norbert; Pape, Hans-Christian; Seidenbecher, Thomas

2016-01-01

Behavioral profiles are strongly shaped by an individual's whole life experience. The accumulation of negative experiences over lifetime is thought to promote anxiety-like behavior in adulthood (“allostatic load hypothesis”). In contrast, the “mismatch hypothesis” of psychiatric disease suggests that high levels of anxiety-like behavior are the result of a discrepancy between early and late environment. The aim of the present study was to investigate how different life histories shape the expression of anxiety-like behavior and modulate fear memory. In addition, we aimed to clarify which of the two hypotheses can better explain the modulation of anxiety and fear. For this purpose, male mice grew up under either adverse or beneficial conditions during early phase of life. In adulthood they were further subdivided in groups that either matched or mismatched the condition experienced before, resulting in four different life histories. The main results were: (i) Early life benefit followed by late life adversity caused decreased levels of anxiety-like behavior. (ii) Accumulation of adversity throughout life history led to impaired fear extinction learning. Late life adversity as compared to late life benefit mainly affected extinction training, while early life adversity as compared to early life benefit interfered with extinction recall. Concerning anxiety-like behavior, the results do neither support the allostatic load nor the mismatch hypothesis, but rather indicate an anxiolytic effect of a mismatched early beneficial and later adverse life history. In contrast, fear memory was strongly affected by the accumulation of adverse experiences over the lifetime, therefore supporting allostatic load hypothesis. In summary, this study highlights that anxiety-like behavior and fear memory are differently affected by specific combinations of adverse or beneficial events experienced throughout life. PMID:27757077

[Assessing the economic impact of adverse events in Spanish hospitals by using administrative data].

PubMed

Allué, Natalia; Chiarello, Pietro; Bernal Delgado, Enrique; Castells, Xavier; Giraldo, Priscila; Martínez, Natalia; Sarsanedas, Eugenia; Cots, Francesc

2014-01-01

To evaluate the incidence and costs of adverse events registered in an administrative dataset in Spanish hospitals from 2008 to 2010. A retrospective study was carried out that estimated the incremental cost per episode, depending on the presence of adverse events. Costs were obtained from the database of the Spanish Network of Hospital Costs. This database contains data from 12 hospitals that have costs per patient records based on activities and clinical records. Adverse events were identified through the Patient Safety Indicators (validated in the Spanish Health System) created by the Agency for Healthcare Research and Quality together with indicators of the EuroDRG European project. This study included 245,320 episodes with a total cost of 1,308,791,871€. Approximately 17,000 patients (6.8%) experienced an adverse event, representing 16.2% of the total cost. Adverse events, adjusted by diagnosis-related groups, added a mean incremental cost of between €5,260 and €11,905. Six of the 10 adverse events with the highest incremental cost were related to surgical interventions. The total incremental cost of adverse events was € 88,268,906, amounting to an additional 6.7% of total health expenditure. Assessment of the impact of adverse events revealed that these episodes represent significant costs that could be reduced by improving the quality and safety of the Spanish Health System. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

A cross-sectional study of anxiety and marital quality among women with breast cancer at a university clinic in western Saudi Arabia.

PubMed

Al-Zaben, Faten N; Sehlo, Mohammad G; Koenig, Harold G

2015-10-01

To examine relationship between the quality of marital relationship and anxiety among women with breast cancer (BC) in the Kingdom of Saudi Arabia (KSA). This cross-sectional study recruited a consecutive series of 49 married women with BC seen in the Al-Amoudi Breast Cancer Center of Excellence at King Abdulaziz University, Jeddah, KSA in early 2013. Participants completed the Hospital Anxiety and Depression Scale, Spouse Perception Scale, and Quality of Marriage Index forms, and answered questions on demographic and cancer characteristics. Anxiety symptoms indicating "possible" anxiety disorder were present in 10.4% and "probable" anxiety disorder in 14.6% (25% total). No significant relationship was found between the quality of marital relationship and anxiety symptoms (B=-0.04, standard error=0.05, t=-0.81, p=0.42). Anxiety was primarily driven by low education, poor socioeconomic status, and young age. Anxiety symptoms are prevalent among married women with BC seen in a university-based clinic in the KSA. Further research is needed to determine whether a diagnosis of BC adversely affects marital relationship, and whether this is the cause for anxiety in these women.

Fluvial sediment in the environment: a national challenge

USGS Publications Warehouse

Larsen, Matthew C.; Gellis, Allen C.; Glysson, G. Douglas; Gray, John R.; Horowitz, Arthur J.

2010-01-01

Sediment and sediment-associated constituents can contribute substantially to water-quality impairment. In the past, sediment was viewed mainly as an engineering problem that affected reservoir storage capacity, shipping channel maintenance, and bridge scour, as well as the loss of agricultural soil. Sediment is now recognized as a major cause of aquatic system degradation in many rivers and streams as a result of light attenuation, loss of spawning substrate due to fine-grained sediment infilling, reduction in primary productivity, decreases in biotic diversity, and effects from sediment-associated chemical constituents. Recent advances in sediment measurement, assessment, source-identification, and analytical protocols provide new capabilities to quantify sediment and solid-phase chemical fluxes in aquatic systems. Developing, maintaining, and augmenting current sediment- and water-quality-monitoring networks is essential for determining the health of U.S. waterways and for evaluating the effectiveness of management actions in reducing sediment-related problems. The application of new scientific capabilities that address the adverse effects of sediment and sediment- associated constituents represents a major step in managing the Nation’s water quality. A robust Federal, national-scale eff rt, in collaboration with vested stakeholders, is needed to address these sediment-related water-quality issues across the United States.

Development and validation of a Hindi language health-related quality of life questionnaire for melasma in Indian patients.

PubMed

Sarkar, Rashmi; Garg, Shilpa; Dominguez, Arturo; Balkrishnan, Rajesh; Jain, R K; Pandya, Amit G

2016-01-01

Melasma, which is fairly common in Indians, causes significant emotional and psychological impact. A Hindi instrument would be useful to assess the impact of melasma on the quality of life in Indian patients. To create a semantic equivalent of the original MELASQOL questionnaire in Hindi and validate it. A Hindi adaptation of the original MELASQOL (Hi-MELASQOL) was prepared using previously established guidelines. After pre-testing, the Hi-MELASQOL questionnaire was administered to 100 women with melasma visiting the out-patient registration counter of Safdarjung Hospital, Delhi. These women were also administered a Hindi equivalent of the Health Related Quality of Life (HRQOL) questionnaire. Melasma area severity index (MASI) of all the participants was calculated. The mean MASI score was 20.0 ± 7.5 and Hi-MELASQOL score was 37.19 ± 18.15; both were highly, positively and significantly correlated. Reliability analysis showed satisfactory results. Physical health, emotional well-being and social life were the most adversely affected life domains. It was a single-center study and the number of patients studied could have been larger. Hi-MELASQOL is a reliable and validated tool to measure the quality of life in Indians with melasma.

The utilization of six sigma and statistical process control techniques in surgical quality improvement.

PubMed

Sedlack, Jeffrey D

2010-01-01

Surgeons have been slow to incorporate industrial reliability techniques. Process control methods were applied to surgeon waiting time between cases, and to length of stay (LOS) after colon surgery. Waiting times between surgeries were evaluated by auditing the operating room records of a single hospital over a 1-month period. The medical records of 628 patients undergoing colon surgery over a 5-year period were reviewed. The average surgeon wait time between cases was 53 min, and the busiest surgeon spent 291/2 hr in 1 month waiting between surgeries. Process control charting demonstrated poor overall control of the room turnover process. Average LOS after colon resection also demonstrated very poor control. Mean LOS was 10 days. Weibull's conditional analysis revealed a conditional LOS of 9.83 days. Serious process management problems were identified in both analyses. These process issues are both expensive and adversely affect the quality of service offered by the institution. Process control mechanisms were suggested or implemented to improve these surgical processes. Industrial reliability and quality management tools can easily and effectively identify process control problems that occur on surgical services. © 2010 National Association for Healthcare Quality.

A novel approach to increase residents' involvement in reporting adverse events.

PubMed

Scott, David R; Weimer, Melissa; English, Clea; Shaker, Lynn; Ward, William; Choi, Dongseok; Cedfeldt, Andrea; Girard, Donald

2011-06-01

In the wake of the Patient Safety and Quality Improvement Act of 2005, national attention has increasingly focused on adverse-event reporting as a means of identifying systems changes to improve patient safety. However, physicians and residents have demonstrated meager involvement in this effort. In 2008-2009, the authors measured participation in adverse-event reporting by 680 residents at Oregon Health & Science University before and after implementing a quality improvement initiative, which consisted of a financial incentive and multifaceted educational campaign. The primary measure of success was an increase in the average monthly adverse-event reports submitted by residents to greater than 5% of the institution's overall report submissions. The average number of adverse events reported by residents increased from 1.6% to 9.0% of the institution's overall event reports, representing a 5.6-fold increase during the initiative (P < .001). The relative percentage of resident-submitted reports defined as "near-misses" increased from 6% to 27% during the initiative (P < .001). The novel approach of integrating a retirement benefit and educational campaign to increase residents' involvement in adverse-event reporting was successful. In addition to increasing residents' contributions to adverse-event reporting to levels higher than any documented in the current literature, there was also a remarkable increase in the relative frequency of near-miss reporting by residents.

Filling quality of the reports of adverse drug reactions received at the Pharmacovigilance Centre of São Paulo (Brazil): missing information hinders the analysis of suspected associations.

PubMed

Ribeiro, Adalton; Lima, Silvana; Zampieri, Maria-Elisa; Peinado, Mirtes; Figueras, Albert

2017-12-01

The completeness and accuracy of the reports of suspected adverse drug reactions is important in pharmacovigilance. The aim of the present study was to analyze the quality of the information included in the reports sent to the Pharmacovigilance Centre of São Paulo (Brazil). A sample of 999 reports received from January 2013 to December 2014 was selected. The quality of the filled information was evaluated according to a 'sufficiency' criterion to apply the Karch-Lasagna causality algorithm. There were 820 reports from manufacturers and 179 from health centres. Only 4.4% (44) were fully filled, thus allowing the adequate analysis of the causal relationship between the suspected medication and the adverse event. In 30% of the reports from manufacturers, the information about the critical variables was lacking or incomplete, preventing the adequate evaluation of the report. It was also noted that the reports' poor filling quality was not related with less severity or with old and well-known medicines. The poor quality of the information included in the reports received by this centre, especially those sent by pharmaceutical manufacturers, hampers the identification of potential safety signals. Measures to improve the quality of the reports must be urgently adopted.

Randomized Trial of Interventions to Improve Childhood Asthma in Homes with Wood-burning Stoves.

PubMed

Noonan, Curtis W; Semmens, Erin O; Smith, Paul; Harrar, Solomon W; Montrose, Luke; Weiler, Emily; McNamara, Marcy; Ward, Tony J

2017-09-13

Household air pollution due to biomass combustion for residential heating adversely affects vulnerable populations. Randomized controlled trials to improve indoor air quality in homes of children with asthma are limited, and no such studies have been conducted in homes using wood for heating. Our aims were to test the hypothesis that household-level interventions, specifically improved-technology wood-burning appliances or air-filtration devices, would improve health measures, in particular Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores, relative to placebo, among children living with asthma in homes with wood-burning stoves. A three-arm placebo-controlled randomized trial was conducted in homes with wood-burning stoves among children with asthma. Multiple preintervention and postintervention data included PAQLQ (primary outcome), peak expiratory flow (PEF) monitoring, diurnal peak flow variability (dPFV, an indicator of airway hyperreactivity) and indoor particulate matter (PM) PM2.5. Relative to placebo, neither the air filter nor the woodstove intervention showed improvement in quality-of-life measures. Among the secondary outcomes, dPFV showed a 4.1 percentage point decrease in variability [95% confidence interval (CI)=-7.8 to -0.4] for air-filtration use in comparison with placebo. The air-filter intervention showed a 67% (95% CI: 50% to 77%) reduction in indoor PM2.5, but no change was observed with the improved-technology woodstove intervention. Among children with asthma and chronic exposure to woodsmoke, an air-filter intervention that improved indoor air quality did not affect quality-of-life measures. Intent-to-treat analysis did show an improvement in the secondary measure of dPFV. ClincialTrials.gov NCT00807183. https://doi.org/10.1289/EHP849.

Effects of night-time on-call work on heart rate variability before bed and sleep quality in visiting nurses.

PubMed

Kikuchi, Yukiko; Ishii, Noriko; Kodama, Hideya

2018-05-28

In Japan, many visiting nurses work carrying cell phones to respond to calls from users even at night (on-call work). The purpose of this study was to investigate whether on-call work affected heart rate variability (HRV) before bed and decreased sleep quality in visiting nurses even if their sleep was not interrupted due to actual calls. Thirty-one visiting nurses (mean age, 49.8 years; standard deviation, 6.3 years) were asked to record their 2.5-min resting HRV before bed, and to undergo one-channel sleep electroencephalography (EEG) and subjective sleep evaluations upon waking (Oguri, Shirakawa, and Azumi Sleep Inventory) at home for 4-5 consecutive days, including both on-call and non-on-call days. Paired data sets of outcome measures, including HRV parameters, sleep macrostructure variables, and subjective sleep quality scores between on-call and non-on-call days were compared; the most recent measurements for each category were used for each subject. There were no differences in HRV measures and objective sleep EEG variables. A significant increase in "sleepiness on rising" and a decrease in "feeling refreshed" were observed on on-call days (P = 0.019 and 0.021, respectively), and younger subjects (≤ 51 years old) demonstrated a significant reduction in "sleepiness on rising" (significant interaction effect, P = 0.029). Adverse effects of on-call work on sleep quality in most visiting nurses are thought to be subjective, and relatively young nurses tend to notice a decrease in sleep quality. On-call work itself does not appear to be a substantial stressor that could affect HRV and sleep structure.

Randomized Trial of Interventions to Improve Childhood Asthma in Homes with Wood-burning Stoves

PubMed Central

Semmens, Erin O.; Smith, Paul; Harrar, Solomon W.; Montrose, Luke; Weiler, Emily; McNamara, Marcy; Ward, Tony J.

2017-01-01

Background: Household air pollution due to biomass combustion for residential heating adversely affects vulnerable populations. Randomized controlled trials to improve indoor air quality in homes of children with asthma are limited, and no such studies have been conducted in homes using wood for heating. Objectives: Our aims were to test the hypothesis that household-level interventions, specifically improved-technology wood-burning appliances or air-filtration devices, would improve health measures, in particular Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores, relative to placebo, among children living with asthma in homes with wood-burning stoves. Methods: A three-arm placebo-controlled randomized trial was conducted in homes with wood-burning stoves among children with asthma. Multiple preintervention and postintervention data included PAQLQ (primary outcome), peak expiratory flow (PEF) monitoring, diurnal peak flow variability (dPFV, an indicator of airway hyperreactivity) and indoor particulate matter (PM) PM2.5. Results: Relative to placebo, neither the air filter nor the woodstove intervention showed improvement in quality-of-life measures. Among the secondary outcomes, dPFV showed a 4.1 percentage point decrease in variability [95% confidence interval (CI)=−7.8 to −0.4] for air-filtration use in comparison with placebo. The air-filter intervention showed a 67% (95% CI: 50% to 77%) reduction in indoor PM2.5, but no change was observed with the improved-technology woodstove intervention. Conclusions: Among children with asthma and chronic exposure to woodsmoke, an air-filter intervention that improved indoor air quality did not affect quality-of-life measures. Intent-to-treat analysis did show an improvement in the secondary measure of dPFV. Trial registration: ClincialTrials.gov NCT00807183. https://doi.org/10.1289/EHP849 PMID:28935614

The effect of comorbidities upon ocular and systemic health-related quality of life.

PubMed

Real, F J; Brown, G C; Brown, H C; Brown, M M

2008-06-01

The purpose of the study was to assess whether, and to what degree, comorbidities affect patient quality of life. A cross-sectional, quality-of-life study of 170 consecutive vitreoretinal patients compared the utility associated with a participant's primary (most incapacitating) disease and the utility associated with a grouping of all of the participants' diseases. The ocular diseases present included diabetic retinopathy (44%), macular degeneration (30%), lattice degeneration/retinal tear (14%), retinal vascular obstruction (5%), uveitis, macular oedema, macular pucker (5%) and others (2%). Participants underwent interviewer-administered, time trade-off utility questions for each disease, then for a compilation of all diseases. Their primary disease was defined by the lowest utility reported for a single disease, while other health conditions were considered comorbidities. A two-tailed, paired t test was used to compare the means of the primary disease utilities and compilation utilities. The study was powered to have a 90% chance of detecting an 8% difference in mean utility between the two utility groups The mean lowest utility for the most disabling single health condition (primary disease) was 0.82 (SD 0.22; 95% CI 0.79 to 0.85. The mean utility for the grouping together of all diseases was 0.80 (SD 0.24, 95% CI 0.76 to 0.84). No significant difference was found between the mean utilities of the two groups (p = 0.56). The overall health-related quality of life of a patient in an ophthalmic population with serious diseases appears to be primarily determined by the single disease that most adversely affects the individual's quality of life. This conclusion has significant implications in clinical care and when considering the use of comorbidities in cost-utility analyses.

Global Assessment of the Impact of Type 2 Diabetes on Sleep through Specific Questionnaires. A Case-Control Study.

PubMed

Lecube, Albert; Sánchez, Enric; Gómez-Peralta, Fernando; Abreu, Cristina; Valls, Joan; Mestre, Olga; Romero, Odile; Martínez, María Dolores; Sampol, Gabriel; Ciudin, Andreea; Hernández, Cristina; Simó, Rafael

2016-01-01

Type 2 diabetes (T2D) is an independent risk factor for sleep breathing disorders. However, it is unknown whether T2D affects daily somnolence and quality of sleep independently of the impairment of polysomnographic parameters. A case-control study including 413 patients with T2D and 413 non-diabetic subjects, matched by age, gender, BMI, and waist and neck circumferences. A polysomnography was performed and daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). In addition, 135 subjects with T2D and 45 controls matched by the same previous parameters were also evaluated through the Pittsburgh Sleep Quality Index (PSQI) to calculate sleep quality. Daytime sleepiness was higher in T2D than in control subjects (p = 0.003), with 23.9% of subjects presenting an excessive daytime sleepiness (ESS>10). Patients with fasting plasma glucose (FPG ≥13.1 mmol/l) were identified as the group with a higher risk associated with an ESS>10 (OR 3.9, 95% CI 1.8-7.9, p = 0.0003). A stepwise regression analyses showed that the presence of T2D, baseline glucose levels and gender but not polysomnographic parameters (i.e apnea-hyoapnea index or sleeping time spent with oxigen saturation lower than 90%) independently predicted the ESS score. In addition, subjects with T2D showed higher sleep disturbances [PSQI: 7.0 (1.0-18.0) vs. 4 (0.0-12.0), p<0.001]. The presence of T2D and high levels of FPG are independent risk factors for daytime sleepiness and adversely affect sleep quality. Prospective studies addressed to demonstrate whether glycemia optimization could improve the sleep quality in T2D patients seem warranted.

Systematic review on the prevalence, frequency and comparative value of adverse events data in social media

PubMed Central

Golder, Su; Norman, Gill; Loke, Yoon K

2015-01-01

Aim The aim of this review was to summarize the prevalence, frequency and comparative value of information on the adverse events of healthcare interventions from user comments and videos in social media. Methods A systematic review of assessments of the prevalence or type of information on adverse events in social media was undertaken. Sixteen databases and two internet search engines were searched in addition to handsearching, reference checking and contacting experts. The results were sifted independently by two researchers. Data extraction and quality assessment were carried out by one researcher and checked by a second. The quality assessment tool was devised in-house and a narrative synthesis of the results followed. Results From 3064 records, 51 studies met the inclusion criteria. The studies assessed over 174 social media sites with discussion forums (71%) being the most popular. The overall prevalence of adverse events reports in social media varied from 0.2% to 8% of posts. Twenty-nine studies compared the results from searching social media with using other data sources to identify adverse events. There was general agreement that a higher frequency of adverse events was found in social media and that this was particularly true for ‘symptom’ related and ‘mild’ adverse events. Those adverse events that were under-represented in social media were laboratory-based and serious adverse events. Conclusions Reports of adverse events are identifiable within social media. However, there is considerable heterogeneity in the frequency and type of events reported, and the reliability or validity of the data has not been thoroughly evaluated. PMID:26271492

Systematic review on the prevalence, frequency and comparative value of adverse events data in social media.

PubMed

Golder, Su; Norman, Gill; Loke, Yoon K

2015-10-01

The aim of this review was to summarize the prevalence, frequency and comparative value of information on the adverse events of healthcare interventions from user comments and videos in social media. A systematic review of assessments of the prevalence or type of information on adverse events in social media was undertaken. Sixteen databases and two internet search engines were searched in addition to handsearching, reference checking and contacting experts. The results were sifted independently by two researchers. Data extraction and quality assessment were carried out by one researcher and checked by a second. The quality assessment tool was devised in-house and a narrative synthesis of the results followed. From 3064 records, 51 studies met the inclusion criteria. The studies assessed over 174 social media sites with discussion forums (71%) being the most popular. The overall prevalence of adverse events reports in social media varied from 0.2% to 8% of posts. Twenty-nine studies compared the results from searching social media with using other data sources to identify adverse events. There was general agreement that a higher frequency of adverse events was found in social media and that this was particularly true for 'symptom' related and 'mild' adverse events. Those adverse events that were under-represented in social media were laboratory-based and serious adverse events. Reports of adverse events are identifiable within social media. However, there is considerable heterogeneity in the frequency and type of events reported, and the reliability or validity of the data has not been thoroughly evaluated. © 2015 The British Pharmacological Society.

Antipsychotics for fibromyalgia in adults.

PubMed

Walitt, Brian; Klose, Petra; Üçeyler, Nurcan; Phillips, Tudor; Häuser, Winfried

2016-06-02

This review is one of a series on drugs used to treat fibromyalgia. Fibromyalgia is a clinically well-defined chronic condition of unknown aetiology characterised by chronic widespread pain that often co-exists with sleep problems and fatigue. It affects approximately 2% of the general population. Up to 70% of patients with fibromyalgia meet the criteria for a depressive or anxiety disorder. People often report high disability levels and poor health-related quality of life. Drug therapy focuses on reducing key symptoms and disability, and improving health-related quality of life. Antipsychotics might reduce fibromyalgia and associated mental health symptoms. To assess the efficacy, tolerability and safety of antipsychotics in fibromyalgia in adults. We searched CENTRAL (2016, Issue 4), MEDLINE and EMBASE to 20 May 2016, together with reference lists of retrieved papers and reviews and two clinical trial registries. We also contacted trial authors. We selected controlled trials of at least four weeks duration of any formulation of antipsychotics used for the treatment of fibromyalgia in adults. We extracted the data from all included studies and two review authors independently assessed study risks of bias. We resolved discrepancies by discussion. We performed analysis using three tiers of evidence. We derived first tier evidence from data meeting current best standards and subject to minimal risk of bias (outcome equivalent to substantial pain intensity reduction, intention-to-treat analysis without imputation for drop-outs, at least 200 participants in the comparison, eight to 12 weeks duration, parallel design), second tier evidence from data that failed to meet one or more of these criteria and that we considered at some risk of bias but with adequate numbers in the comparison, and third tier evidence from data involving small numbers of participants that we considered very likely to be biased or used outcomes of limited clinical utility, or both. We rated the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We included a total of four studies with 296 participants.Three studies with 206 participants compared quetiapine, an atypical (second-generation) antipsychotic, with placebo. One study used a cross-over design and two studies a parallel-group design. Study duration was eight or 12 weeks. Quetiapine was used in all studies with a bedtime dosage between 50 and 300 mg/day. All studies had one or more sources of potential major bias and we judged them to be at moderate risk of bias overall. The primary outcomes in this review were participant-reported pain relief of 50% or greater, Patient Global Impression of Change (PGIC) much or very much improved, withdrawal due to adverse events (tolerability) and serious adverse events (safety).Second tier evidence indicated that quetiapine was not statistically superior to placebo in the number of participants with a 50% or more pain reduction (very low quality evidence). No study reported data on PGIC. A greater proportion of participants on quetiapine reported a 30% or more pain reduction (risk difference (RD) 0.12, 95% confidence interval (CI) 0.00 to 0.23; number needed to treat for an additional benefit (NNTB) 8, 95% CI 5 to 100) (very low quality evidence). A greater proportion of participants on quetiapine reported a clinically relevant improvement of health-related quality of life compared to placebo ( RD 0.18, 95% CI 0.05 to 0.31; NNTB 5, 95% CI 3 to 20) (very low quality evidence). Quetiapine was statistically superior to placebo in reducing sleep problems (standardised mean difference (SMD) -0.67, 95% CI -1.10 to -0.23), depression (SMD -0.39, 95% CI -0.74 to -0.04) and anxiety (SMD -0.40, 95% CI -0.69 to -0.11) (very low quality evidence). Quetiapine was statistically superior to placebo in reducing the risk of withdrawing from the study due to a lack of efficacy (RD -0.14, 95% CI -0.23 to -0.05) (very low quality evidence). There was no statistically significant difference between quetiapine and placebo in the proportion of participants withdrawing due to adverse events (tolerability) (very low quality evidence), in the frequency of serious adverse events (safety) (very low quality evidence) and in the proportion of participants reporting dizziness and somnolence as an adverse event (very low quality evidence). In more participants in the quetiapine group a substantial weight gain was noted (RD 0.08, 95% CI 0.02 to 0.15; number needed to treat for an additional harm (NNTH) 12, 95% CI 6 to 50) (very low quality evidence). We downgraded the quality of evidence by three levels to a very low quality rating because of limitations of study design, indirectness (patients with major medical diseases and mental disorders were excluded) and imprecision (fewer than 400 patients were analysed).One parallel design study with 90 participants compared quetiapine (50 to 300 mg/day flexible at bedtime) to amitriptyline (10 to 75 mg/day flexible at bedtime). The study had three major risks of bias and we judged it to be at moderate risk of bias overall. We downgraded the quality of evidence by two levels to a low quality rating because of indirectness (patients with major medical diseases and mental disorders were excluded) and imprecision (fewer than 400 patients were analysed). Third tier evidence indicated no statistically significant differences between the two drugs. Both drugs did not statistically significantly differ in the reduction of average scores for pain, fatigue, sleep problems, depression, anxiety and for limitations of health-related quality of life and in the proportion of participants reporting dizziness, somnolence and weight gain as a side effect (low quality evidence). Compared to amitriptyline, more participants left the study due to adverse events (low quality evidence). No serious adverse events were reported (low quality evidence).We found no relevant study with other antipsychotics than quetiapine in fibromyalgia. Very low quality evidence suggests that quetiapine may be considered for a time-limited trial (4 to 12 weeks) to reduce pain, sleep problems, depression and anxiety in fibromyalgia patients with major depression. Potential side effects such as weight gain should be balanced against the potential benefits in shared decision making with the patient.

Committee Opinion No. 681: Disclosure and Discussion of Adverse Events.

PubMed

2016-12-01

Adverse outcomes, preventable or otherwise, are a reality of medical care. Most importantly, adverse events affect patients, but they also affect health care practitioners. Disclosing information about adverse events has benefits for the patient and the physician and, ideally, strengthens the patient-physician relationship and promotes trust. Studies show that after an adverse outcome, patients expect and want timely and full disclosure of the event, an acknowledgment of responsibility, an understanding of what happened, expressions of sympathy, and a discussion of what is being done to prevent recurrence. Surveys have shown that patients are less likely to pursue litigation if they perceive that the event was honestly disclosed. Barriers to full disclosure are many and include fear of retribution for reporting an adverse event, lack of training, a culture of blame, and fear of lawsuits. To reduce these concerns, it is recommended that health care facilities establish a nonpunitive, blame-free culture that encourages staff to report adverse events and near misses (close calls) without fear of retaliation. Health care institutions should have written policies that address the management of adverse events. Having a responsive process to inform and aid the patient, loved ones, and practitioners is required. A commitment on the part of all health care practitioners and institutions to establish programs and develop the tools needed to help patients, families, health care practitioners, and staff members deal with adversity is essential.

Committee Opinion No. 681 Summary: Disclosure and Discussion of Adverse Events.

PubMed

2016-12-01

Adverse outcomes, preventable or otherwise, are a reality of medical care. Most importantly, adverse events affect patients, but they also affect health care practitioners. Disclosing information about adverse events has benefits for the patient and the physician and, ideally, strengthens the patient-physician relationship and promotes trust. Studies show that after an adverse outcome, patients expect and want timely and full disclosure of the event, an acknowledgment of responsibility, an understanding of what happened, expressions of sympathy, and a discussion of what is being done to prevent recurrence. Surveys have shown that patients are less likely to pursue litigation if they perceive that the event was honestly disclosed. Barriers to full disclosure are many and include fear of retribution for reporting an adverse event, lack of training, a culture of blame, and fear of lawsuits. To reduce these concerns, it is recommended that health care facilities establish a nonpunitive, blame-free culture that encourages staff to report adverse events and near misses (close calls) without fear of retaliation. Health care institutions should have written policies that address the management of adverse events. Having a responsive process to inform and aid the patient, loved ones, and practitioners is required. A commitment on the part of all health care practitioners and institutions to establish programs and develop the tools needed to help patients, families, health care practitioners, and staff members deal with adversity is essential.

Disparities in reportable quality metrics by insurance status in the primary spine neoplasm population.

PubMed

Mehdi, Syed K; Tanenbaum, Joseph E; Alentado, Vincent J; Miller, Jacob A; Lubelski, Daniel; Benzel, Edward C; Mroz, Thomas E

2017-02-01

The Centers for Medicare and Medicaid Services (CMS) defines "adverse quality events" as the incidence of certain complications such as postsurgical hematoma or iatrogenic pneumothorax during an inpatient stay. Patient safety indicators (PSI) are a means to measure the incidence of these adverse events. When adverse events occur, reimbursement to the hospital decreases. The incidence of adverse quality events among patients hospitalized for primary spinal neoplasms is unknown. Similarly, it is unclear what the impact of insurance status is on adverse care quality among this patient population. We aimed to determine the incidence of PSI among patients admitted with primary spinal neoplasms, and to determine the association between insurance status and the incidence of PSI in this population. This is a retrospective cohort study. We included all patients, 18 years and older, in the Nationwide Inpatient Sample (NIS) who were hospitalized for primary spine neoplasms from 1998 to 2011. Incidence of PSI from 1998 to 2011 served as outcome variable. The NIS was queried for all hospitalizations with a diagnosis of primary spinal neoplasm during the inpatient episode from 1998 to 2011. Incidence of PSI was determined using publicly available lists of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. Logistic regression models were used to determine the effect of primary payer status on PSI incidence. All comparisons were made between privately insured patients and Medicaid or self-pay patients. We identified 6,095 hospitalizations in which a primary spinal neoplasm was recorded during the inpatient episode. We excluded patients younger than 18 years and those with "other" or "missing" primary insurance status, leaving 5,880 patients for analysis. After adjusting for patient demographics and hospital characteristics, Medicaid or self-pay patients had significantly greater odds of experiencing one or more PSI (odds ratio [OR] 1.81 95% confidence interval [CI] 1.11-2.95) relative to privately insured patients. Among patients hospitalized for primary spinal neoplasms, primary payer status predicts the incidence of PSI, an indicator of adverse health-care quality used to determine hospital reimbursement by the CMS. As reimbursement continues to be intertwined with reportable quality metrics, identifying vulnerable populations is critical to improving patient care. Copyright © 2016 Elsevier Inc. All rights reserved.

42 CFR 482.96 - Condition of participation: Quality assessment and performance improvement (QAPI).

Code of Federal Regulations, 2011 CFR

2011-10-01

... to address and document adverse events that occur during any phase of an organ transplantation case... document any adverse event and must utilize the analysis to effect changes in the transplant center's...