Clinical efficacy and safety of chelation treatment with typical penicillamine in cross combination with DMPS repeatedly for Wilson's disease.

PubMed

Xu, San-Qing; Li, Xu-Fang; Zhu, Hui-Yun; Liu, Yan; Fang, Feng; Chen, Ling

2013-10-01

The aim of this study was to assess the clinical efficacy and safety of chelation treatment with penicillamine (PCA) in cross combination with sodium 2, 3-dimercapto-1-propane sulfonate (DMPS) repeatedly in patients with Wilson's disease (WD). Thirty-five patients with WD were enrolled. They were administrated intravenous DMPS in cross combination with oral PCA alternately which was practiced repeatedly, all with Zinc in the meantime. During the treatment, clinical observations and 24-h urine copper excretion as well as adverse effects of medicines were recorded and analyzed. Although the incidence of adverse effects was not significantly different after either intravenous DMPS or oral PCA treatment, levels of 24-h urine copper tended to be higher after short-term intravenous DMPS than that of oral PCA. Adverse effects in the course of intravenous DMPS were mainly neutropenia, thrombocytopenia, allergic reaction and bleeding tendency. As compared with oral PCA alone or intravenous DMPS alone, such repeated cross combination treatment could as much as possible avoid continued drug adverse effects or poor curative effect and had less chance to stop treatment in WD patients. Improved or recovered liver function in 71% of the patients, alleviated neurologic symptoms in 50% of the patients, and disappeared hematuria in 70% of the patients could be observed during the follow-up period of 6 months to 5 years after such combined chelation regimen. Chelation treatment repeatedly with oral penicillamine in cross combination with intravenous DMPS alternately could be more beneficial for WD patients to relieve symptoms, avoid continued drug adverse effects and maintain lifelong therapy.

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.

ACHP | Advisory Council on Historic Preservation Section 213 Reports

Science.gov Websites

affected historic property, describe the effects of any proposed undertaking on the property, and recommend measures to avoid, minimize, or mitigate adverse effects to the property. Section 213 reports have been

Stay Legal and Safe in Treating for Bed Bugs

EPA Pesticide Factsheets

Quick fix solutions may sound appealing, but they may not be legal, safe, or effective. To avoid adverse effects such as poisoning, buy EPA-registered pesticides labeled for bed bug control, and follow all label directions and precautions.

Health Benefits and Adverse Effects of a Gluten-Free Diet in Non–Celiac Disease Patients

PubMed Central

Niland, Benjamin

2018-01-01

Gluten-related diseases such as celiac disease and gluten ataxia are rare conditions, affecting less than 1% of the population in the United States. Despite the rarity of these diseases, there have been significant increases in the adoption of a gluten-free lifestyle and the consumption of gluten-free foods in the United States over the last 3 decades. More than $15.5 billion were spent on retail sales of gluten-free foods in 2016. The gluten-free diet is driven by multiple factors, including social and traditional media coverage, aggressive consumer-directed marketing by manufacturers and retail outlets, and reports in the medical literature and mainstream press of the clinical benefits of gluten avoidance. Individuals may restrict gluten from their diets for a variety of reasons, such as improvement of gastrointestinal and nongastrointestinal symptoms, as well as a perception that gluten is potentially harmful and, thus, restriction represents a healthy lifestyle. Emerging evidence shows that gluten avoidance may be beneficial for some patients with gastrointestinal symptoms, such as those commonly encountered with irritable bowel syndrome. However, high-quality evidence supporting gluten avoidance for physical symptoms or diseases other than those specifically known to be caused by immune-mediated responses to gluten is neither robust nor convincing. In fact, gluten avoidance may be associated with adverse effects in patients without proven gluten-related diseases. This article provides insight regarding gluten avoidance patterns and effects on patients without gluten-related diseases, and highlights concerns surrounding gluten avoidance in the absence of a gluten-mediated immunologic disease. PMID:29606920

Health Benefits and Adverse Effects of a Gluten-Free Diet in Non-Celiac Disease Patients.

PubMed

Niland, Benjamin; Cash, Brooks D

2018-02-01

Gluten-related diseases such as celiac disease and gluten ataxia are rare conditions, affecting less than 1% of the population in the United States. Despite the rarity of these diseases, there have been significant increases in the adoption of a gluten-free lifestyle and the consumption of gluten-free foods in the United States over the last 3 decades. More than $15.5 billion were spent on retail sales of gluten-free foods in 2016. The gluten-free diet is driven by multiple factors, including social and traditional media coverage, aggressive consumer-directed marketing by manufacturers and retail outlets, and reports in the medical literature and mainstream press of the clinical benefits of gluten avoidance. Individuals may restrict gluten from their diets for a variety of reasons, such as improvement of gastrointestinal and nongastrointestinal symptoms, as well as a perception that gluten is potentially harmful and, thus, restriction represents a healthy lifestyle. Emerging evidence shows that gluten avoidance may be beneficial for some patients with gastrointestinal symptoms, such as those commonly encountered with irritable bowel syndrome. However, high-quality evidence supporting gluten avoidance for physical symptoms or diseases other than those specifically known to be caused by immune-mediated responses to gluten is neither robust nor convincing. In fact, gluten avoidance may be associated with adverse effects in patients without proven gluten-related diseases. This article provides insight regarding gluten avoidance patterns and effects on patients without gluten-related diseases, and highlights concerns surrounding gluten avoidance in the absence of a gluten-mediated immunologic disease.

Burns induced by cupping therapy in a burn center in northeast china.

PubMed

Jing-Chun, Zhao; Jia-Ao, Yu; Chun-Jing, Xian; Kai, Shi; Lai-Jin, Lu

2014-07-01

Cupping therapy as a curative skill has been developed and applied throughout history. Despite reports of adverse effects, this therapy is considered to be relatively safe with no systemic reviews documenting negative side effects. The aim of this study was to explore methods that avoid the adverse effects sometimes associated with this therapy. Clinical records of 14 outpatients and inpatients that visited the First Hospital of Jilin University (Changchun, China) for management of burn injuries caused by cupping therapy were retrospectively reviewed. Characteristics, history of injury, and treatment of each patient was collected and analyzed. Burn injury induced by cupping therapy was not uncommon. Most of the injuries were mild to moderate and cured by conservative methods without severe complications. The use of wet cupping was more prevalent among injured patients than dry cupping. Cupping therapy as an ancient alternative treatment is still popular with a large number of devoted practitioners. Although there is the potential for injury during the application of this therapy, this is mostly preventable. Standardized training for health care professionals and increased the awareness among the public about the proper methods to administer this therapy to avoid adverse effects is important.

What is the role of autologous blood transfusion in major spine surgery?

PubMed

Kumar, Naresh; Chen, Yongsheng; Nath, Chinmoy; Liu, Eugene Hern Choon

2012-06-01

Major spine surgery is associated with significant blood loss, which has numerous complications. Blood loss is therefore an important concern when undertaking any major spine surgery. Blood loss can be addressed by reducing intraoperative blood loss and replenishing perioperative blood loss. Reducing intraoperative blood loss helps maintain hemodynamic equilibrium and provides a clearer operative field during surgery. Homologous blood transfusion is still the mainstay for replenishing blood loss in major spine surgery across the world, despite its known adverse effects. These significant adverse effects can be seen in up to 20% of patients. Autologous blood transfusion avoids the risks associated with homologous blood transfusion and has been shown to be cost-effective. This article reviews the different methods of autologous transfusion and focuses on the use of intraoperative cell salvage in major spine surgery. Autologous blood transfusion is a proven alternative to homologous transfusion in major spine surgery, avoiding most, if not all of these adverse effects. However, autologous blood transfusion rates in major spine surgery remain low across the world. Autologous blood transfusion may obviate the need for homologous transfusion completely. We encourage spine surgeons to consider autologous blood transfusion wherever feasible.

ODOT research news : fall 2004.

DOT National Transportation Integrated Search

2004-01-01

ODOT research newsletter includes: 1) project solicitation and selection. 2) GIS mapping and environmental justice which environmental justice requires ODOT to avoid, minimize, or mitigate disproportionately high and adverse effects of its activities...

Preventing Infectious Disease in Sports.

ERIC Educational Resources Information Center

Howe, Warren B.

2003-01-01

Preventing infectious disease in sports is fundamental to maintaining team effectiveness and helping athletes avoid the adverse effects of illness. Good hygiene, immunization, minimal exposure to specific diseases, and certain prophylactic measures are essential. Teammates, coaches, trainers, officials, healthcare providers, and community public…

7 CFR 650.7 - When to prepare an EIS.

Code of Federal Regulations, 2010 CFR

2010-01-01

... objectives but avoid adverse environmental effects? (4) Short-term uses versus long-term productivity. Will...-term productivity as a tradeoff for short-term uses? (5) Commitment of resources. Will the proposed...

Psychosocial job conditions, fear avoidance beliefs and expected return to work following acute coronary syndrome: a cross-sectional study of fear-avoidance as a potential mediator.

PubMed

Söderberg, Mia; Rosengren, Annika; Gustavsson, Sara; Schiöler, Linus; Härenstam, Annika; Torén, Kjell

2015-12-21

Despite improvements in treatment, acute coronary syndrome remains a substantial cause for prolonged sick absences and premature retirement. Knowledge regarding what benefits return to work is limited, especially the effect of psychological processes and psychosocial work factors. The purposes of this cross-sectional study were two-fold: to examine associations between adverse psychosocial job conditions and fear-avoidance beliefs towards work, and to determine whether such beliefs mediated the relationship between work conditions and expected return to work in acute coronary syndrome survivors. Study inclusion criteria: acute myocardial infarction or unstable angina diagnosis, below 65 years of age, being a resident in the West county of Sweden and currently working. In all, 509 individuals (21.8 % women) accepted study participation and for whom all data of study interest were available for analysis. Psychosocial work variables; job demand-control and effort-reward imbalance, were assessed with standard questionnaire batteries. Linear regression models were used to investigate relationships between psychosocial factors and fear-avoidance, and to evaluate mediator effects for fear-avoidance. Both total sample and gender stratified analyses were calculated. Fear-avoidance beliefs about work were associated to psychosocial job environments characterized by high strain (β 1.4; CI 1.2-1.6), active and passive work and high effort-reward imbalance (β 0.6; CI 0.5-0.7). Further, such beliefs also mediated the relationship between adverse work conditions and expected time for return to work. However, these results were only observed in total sample analyses or among or male participants. For women only high strain was linked to fear-avoidance, and these relationships became non-significant when entering chosen confounders. This cross-sectional study showed that acute coronary syndrome survivors, who laboured under adverse psychosocial work conditions, held fear-avoidance beliefs towards their workplace. Furthermore, these beliefs mediated the relationships between - high strained or high effort-reward imbalanced work - and expected return to work. However, mentioned results were primarily found among men, which could results from few female study participants or gender differences in return to work mechanisms. Still, an earlier return to work might be promoted by interventions focusing on improved psychosocial work conditions and cognitive behavioural therapy targeting fear-avoidance beliefs.

Environmental Assessment for the Construction of a Community Activities Center Malmstron Air Force Base, Montana

DTIC Science & Technology

2008-12-01

extinction of a threatened or endangered species or the demolition of a historical building). For the proposed project alternatives, most resource...Resources The Endangered Species Act (16 USC 1531-1544) requires federal agencies to avoid jeopardizing the continued existence of endangered or...threatened species and avoid destroying or adversely modifying their critical habitat. Federal agencies must evaluate the effects of their actions on

The impact of childhood emotional abuse and experiential avoidance on maladaptive problem solving and intimate partner violence.

PubMed

Bell, Kathryn M; Higgins, Lorrin

2015-04-16

The purpose of the current study was to examine the joint influences of experiential avoidance and social problem solving on the link between childhood emotional abuse (CEA) and intimate partner violence (IPV). Experiential avoidance following CEA may interfere with a person's ability to effectively problem solve in social situations, increasing risk for conflict and interpersonal violence. As part of a larger study, 232 women recruited from the community completed measures assessing childhood emotional, physical, and sexual abuse, experiential avoidance, maladaptive social problem solving, and IPV perpetration and victimization. Final trimmed models indicated that CEA was indirectly associated with IPV victimization and perpetration via experiential avoidance and Negative Problem Orientation (NPO) and Impulsivity/Carelessness Style (ICS) social problem solving strategies. Though CEA was related to an Avoidance Style (AS) social problem solving strategy, this strategy was not significantly associated with IPV victimization or perpetration. Experiential avoidance had both a direct and indirect effect, via NPO and ICS social problem solving, on IPV victimization and perpetration. Findings suggest that CEA may lead some women to avoid unwanted internal experiences, which may adversely impact their ability to effectively problem solve in social situations and increase IPV risk.

The Impact of Childhood Emotional Abuse and Experiential Avoidance on Maladaptive Problem Solving and Intimate Partner Violence

PubMed Central

Bell, Kathryn M.; Higgins, Lorrin

2015-01-01

The purpose of the current study was to examine the joint influences of experiential avoidance and social problem solving on the link between childhood emotional abuse (CEA) and intimate partner violence (IPV). Experiential avoidance following CEA may interfere with a person’s ability to effectively problem solve in social situations, increasing risk for conflict and interpersonal violence. As part of a larger study, 232 women recruited from the community completed measures assessing childhood emotional, physical, and sexual abuse, experiential avoidance, maladaptive social problem solving, and IPV perpetration and victimization. Final trimmed models indicated that CEA was indirectly associated with IPV victimization and perpetration via experiential avoidance and Negative Problem Orientation (NPO) and Impulsivity/Carelessness Style (ICS) social problem solving strategies. Though CEA was related to an Avoidance Style (AS) social problem solving strategy, this strategy was not significantly associated with IPV victimization or perpetration. Experiential avoidance had both a direct and indirect effect, via NPO and ICS social problem solving, on IPV victimization and perpetration. Findings suggest that CEA may lead some women to avoid unwanted internal experiences, which may adversely impact their ability to effectively problem solve in social situations and increase IPV risk. PMID:25893570

[Isotretinoin embryopathy: An entity that can be avoided].

PubMed

Cammarata-Scalisi, Francisco; Nieves, Dairelis; Avendaño, Andrea; Lacruz-Rengel, María A; Alviárez, Karelys; Dávila, Francys; Yavuz, Izzet; Callea, Michele

2018-04-01

Isotretinoin is the most effective drug in the treatment of severe recalcitrant nodulocystic acne. However, treatment with this drug is associated with adverse effects, the most severe being teratogenesis. It has been estimated that 40% of pregnancies exposed to isotretinoin present spontaneous abortion and 35% develop embryopathy. We present the case of a newborn with a history of prenatal exposure to isotretinoin, a clinical entity that can be avoided, with severe congenital defects in the central nervous system and important facial dysmorphisms, with unfavorable clinical course. Sociedad Argentina de Pediatría.

[Cyclosporine A in the treatment of autoimmune hepatitis in the child: a case report].

PubMed

Ben Halima, Nabil; Chaabouni, Melek; Karray, Abderrahmen; Krichen, Anas; Masmoudi, Hatem; Jlidi, Rachid; Triki, Ali

2002-09-01

The current immunosuppressive treatment of patients with autoimmune hepatitis consists of prednisone and azathioprine. High doses of prednisone used to obtain the remission of the disease are associated with serious adverse effects. To avoid harmful consequences of prednisone, we proposed to treat patients with oral cyclosporine to obtain the remission of the inflammatory process. This case and review of the cases in the literature show that cyclosporine can induce remission of liver disease in children with autoimmune hepatitis, with few and well tolerated adverse effects.

Adverse events related to blood transfusion

PubMed Central

Sahu, Sandeep; Hemlata; Verma, Anupam

2014-01-01

The acute blood transfusion reactions are responsible for causing most serious adverse events. Awareness about various clinical features of acute and delayed transfusion reactions with an ability to assess the serious reactions on time can lead to a better prognosis. Evidence-based medicine has changed today's scenario of clinical practice to decrease adverse transfusion reactions. New evidence-based algorithms of transfusion and improved haemovigilance lead to avoidance of unnecessary transfusions perioperatively. The recognition of adverse events under anaesthesia is always challenging. The unnecessary blood transfusions can be avoided with better blood conservation techniques during surgery and with anaesthesia techniques that reduce blood loss. Better and newer blood screening methods have decreased the infectious complications to almost negligible levels. With universal leukoreduction of red blood cells (RBCs), selection of potential donors such as use of male donors only plasma and restriction of RBC storage, most of the non-infectious complications can be avoided. PMID:25535415

Global Aesthetics Consensus: Avoidance and Management of Complications from Hyaluronic Acid Fillers—Evidence- and Opinion-Based Review and Consensus Recommendations

PubMed Central

Liew, Steven; Sundaram, Hema; De Boulle, Koenraad L.; Goodman, Greg J.; Monheit, Gary; Wu, Yan; Trindade de Almeida, Ada R.; Swift, Arthur; Vieira Braz, André

2016-01-01

Background: Although the safety profile of hyaluronic acid fillers is favorable, adverse reactions can occur. Clinicians and patients can benefit from ongoing guidance on adverse reactions to hyaluronic acid fillers and their management. Methods: A multinational, multidisciplinary group of experts in cosmetic medicine convened the Global Aesthetics Consensus Group to review the properties and clinical uses of Hylacross and Vycross hyaluronic acid products and develop updated consensus recommendations for early and late complications associated with hyaluronic acid fillers. Results: The consensus panel provided specific recommendations focusing on early and late complications of hyaluronic acid fillers and their management. The impact of patient-, product-, and technique-related factors on such reactions was described. Most of these were noted to be mild and transient. Serious adverse events are rare. Early adverse reactions to hyaluronic acid fillers include vascular infarction and compromise; inflammatory reactions; injection-related events; and inappropriate placement of filler material. Among late reactions are nodules, granulomas, and skin discoloration. Most adverse events can be avoided with proper planning and technique. Detailed understanding of facial anatomy, proper patient and product selection, and appropriate technique can further reduce the risks. Should adverse reactions occur, the clinician must be prepared and have tools available for effective treatment. Conclusions: Adverse reactions with hyaluronic acid fillers are uncommon. Clinicians should take steps to further reduce the risk and be prepared to treat any complications that arise. PMID:27219265

Cyclooxygenases, microsomal prostaglandin E synthase-1, and cardiovascular function

PubMed Central

Cheng, Yan; Wang, Miao; Yu, Ying; Lawson, John; Funk, Colin D.; FitzGerald, Garret A.

2006-01-01

We investigated the mechanisms by which inhibitors of prostaglandin G/H synthase-2 (PGHS-2; known colloquially as COX-2) increase the incidence of myocardial infarction and stroke. These inhibitors are believed to exert both their beneficial and their adverse effects by suppression of PGHS-2–derived prostacyclin (PGI2) and PGE2. Therefore, the challenge remains to identify a mechanism whereby PGI2 and PGE2 expression can be suppressed while avoiding adverse cardiovascular events. Here, selective inhibition, knockout, or mutation of PGHS-2, or deletion of the receptor for PGHS-2–derived PGI2, was shown to accelerate thrombogenesis and elevate blood pressure in mice. These responses were attenuated by COX-1 knock down, which mimics the beneficial effects of low-dose aspirin. PGE2 biosynthesis is catalyzed by the coordinate actions of COX enzymes and microsomal PGE synthase-1 (mPGES-1). We show that deletion of mPGES-1 depressed PGE2 expression, augmented PGI2 expression, and had no effect on thromboxane biosynthesis in vivo. Most importantly, mPGES-1 deletion affected neither thrombogenesis nor blood pressure. These results suggest that inhibitors of mPGES-1 may retain their antiinflammatory efficacy by depressing PGE2, while avoiding the adverse cardiovascular consequences associated with PGHS-2–mediated PGI2 suppression. PMID:16614756

76 FR 22724 - Draft Program Environmental Impact Statement/Environmental Impact Report (PEIS/R) and Public...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-22

... (Restoration Goal); and (2) to reduce or avoid adverse water supply impacts to all of the Friant Division long... populations of salmon and other fish. Water Management Goal--To reduce or avoid adverse water supply impacts... Bureau of Reclamation and the California Department of Water Resources (DWR) have prepared a joint Draft...

40 CFR 230.70 - Actions concerning the location of the discharge.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Actions To Minimize Adverse Effects § 230.70 Actions concerning the location of the discharge. The effects...) Designing the discharge to avoid a disruption of periodic water inundation patterns; (c) Selecting a... minimize or prevent the creation of standing bodies of water in areas of normally fluctuating water levels...

Parents' preferences strongly influence their decisions to withhold prescribed opioids when faced with analgesic trade-off dilemmas for children: a prospective observational study.

PubMed

Voepel-Lewis, Terri; Zikmund-Fisher, Brian J; Smith, Ellen Lavoie; Zyzanski, Sarah; Tait, Alan R

2015-08-01

Despite parents' stated desire to treat pain in their children, recent studies have critiqued their underuse of prescribed analgesics to treat pain in their children after painful procedures. Parents' analgesic preferences, including their perceived importance of providing pain relief or avoiding adverse drug effects may have important implications for their analgesic decisions, yet no studies have evaluated the influence of preferences on decisions to withhold prescribed opioids for children. We prospectively explored how parents' preferences influenced decisions to withhold prescribed opioids when faced with hypothetical dilemmas and after hospital discharge. Prospective Observational Study Design: Phase 1 included hypothetical analgesic decisions and Phase 2, real analgesic decisions after hospital discharge. Large tertiary care pediatric hospital in the Midwest of the United States. Five-hundred seven parents whose children underwent a painful surgical procedure requiring an opioid prescription were included. At baseline, parents completed surveys assessing their pain relief preference (i.e., their rated importance of pain relief relative to adverse drug event avoidance), preferred treatment thresholds (i.e., pain level at which they would give an opioid), adverse drug event understanding, and hypothetical trade-off decisions (i.e., scenarios presenting variable pain and adverse drug event symptoms in a child). After discharge, parents recorded all analgesics they gave their child as well as pain scores at the time of administration. Higher preference to provide pain relief (over avoid analgesic risk) lessened the likelihood that parents would withhold the prescribed opioid when adverse drug event symptoms were present together with high pain scores in the hypothetical scenarios. Additionally, higher preferred treatment thresholds increased the likelihood of parents withholding opioids during their hypothetical decision-making as well as at home. The strong influence of these preferences weakened the effect of opioid ADE understanding on decisions to withhold opioids when ADEs (i.e., nausea/vomiting or oversedation) were present together with high pain. Findings from this study suggest that preferences strongly influence and may interfere with parents' effective and safe analgesic decision-making when conflicting symptoms (i.e., high pain and an ADE) are present. To improve effective analgesic use, there is a need to shape parents' preferences and improve their understanding of safe actions that will treat pain when ADE symptoms are present. Copyright © 2015 Elsevier Ltd. All rights reserved.

Educational-entertainment as an intervention with Black adolescents exposed to community violence.

PubMed

Allen, Valerie Dorsey; Solomon, Phyllis

2012-01-01

Witnessing violence is one adverse childhood experience (ACE) associated with living in impoverished Black urban communities. Youth with higher violence avoidance self-efficacy and positive coping are more likely to avoid violence. This study evaluates educational entertainment (edutainment) as an intervention with Black adolescents exposed to community violence. Edutainment has shown success in increasing self-efficacy and positive coping skills in other domains. Self-administered scales were used to measure stress, anxiety, violence avoidance self-efficacy, and coping strategies. Data were collected pre- and nine days post-interventions/no intervention from 20 subjects receiving the edutainment intervention, 19 subjects participating in a group discussion about violence, and 21 subjects receiving no intervention (N = 60). Edutainment and no intervention were more effective than group discussion alone in increasing violence avoidance self-efficacy. Violence avoidance self-efficacy was found to have an intervening relationship between edutainment and the outcome of stress. This study indicates limited but positive effects for edutainment.

Predicting the clinical efficacy and potential adverse effects of a humanized anticocaine monoclonal antibody

PubMed Central

Norman, Andrew B; Ball, William J

2012-01-01

The effects of a humanized monoclonal antibody (mAb) having high affinity and specificity for cocaine in animal models are reviewed. The mAb reduced the concentration of cocaine in the brain of mice after intravenous injection of cocaine. In addition, the mAb increased the concentration of cocaine required to reinstate cocaine self-administration. These effects may predict clinical efficacy of a passive immunotherapy for reducing the probability of cocaine-induced relapse. However, in the presence of the mAb, once cocaine self-administration was reinstated, the consumption rate of cocaine was increased. This effect is hypothesized to result from a pharmacokinetic/pharmacodynamic interaction. A humanized mAb should minimize adverse events related to the immunogenicity of the mAb protein, and the specificity for cocaine should avoid adverse events related to interactions with physiologically relevant endogenous proteins. PMID:22401638

Diagnosis, Prevention, and Management of Statin Adverse Effects and Intolerance: Canadian Consensus Working Group Update (2016).

PubMed

Mancini, G B John; Baker, Steven; Bergeron, Jean; Fitchett, David; Frohlich, Jiri; Genest, Jacques; Gupta, Milan; Hegele, Robert A; Ng, Dominic; Pearson, Glen J; Pope, Janet; Tashakkor, A Yashar

2016-07-01

The Canadian Consensus Working Group has updated its evaluation of the literature pertaining to statin intolerance and adverse effects. This overview introduces a pragmatic definition of statin intolerance (goal-inhibiting statin intolerance) that emphasizes the effects of symptoms on achieving nationally vetted goals in patients fulfilling indications for lipid-lowering therapy and cardiovascular risk reduction. The Canadian Consensus Working Group provides a structured framework for avoiding, evaluating and managing goal-inhibiting statin intolerance. Particularly difficult practice situations are reviewed, including management in young and elderly individuals, and in athletes and labourers. Finally, targeted at specialty practitioners, more detailed analyses of specific but more unusual adverse effects ascribed to statins are updated including evidence regarding new-onset diabetes, cognitive dysfunction, cataracts, and the rare but important immune-mediated necrotizing myopathy. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: a prospective study of 1756 patients.

PubMed

Franceschi, Marilisa; Scarcelli, Carlo; Niro, Valeria; Seripa, Davide; Pazienza, Anna Maria; Pepe, Giovanni; Colusso, Anna Maria; Pacilli, Luigi; Pilotto, Alberto

2008-01-01

Drug use increases with advancing age, and in older patients it is associated with an increase in adverse drug reactions (ADRs). ADRs are a primary cause of morbidity and mortality worldwide. To evaluate the prevalence, clinical characteristics and avoidability of ADR-related hospital admissions in elderly patients. From November 2004 to December 2005, all patients aged >or=65 years consecutively admitted to the Geriatric Unit of the Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo in Italy, were evaluated for enrolment in the study. ADRs were defined according to the WHO Adverse Reaction Terminology system. Drugs were classified according to Anatomical Therapeutic Chemical classification system. The Naranjo algorithm was used to evaluate the relationship between drug use and the ADR (definite, probable, possible or doubtful) and Hallas criteria were used to evaluate the avoidability of the ADR (definitely avoidable, possibly avoidable or unavoidable). All cases of a suspected ADR were discussed by a team trained in drug safety, including three geriatricians, one clinical pharmacologist and one pharmacist. Only cases of an ADR with an agreement >or=80% were included. Of the 1756 patients observed, 102 (5.8%, 42 males, 60 females, mean age 76.5 +/- 7.4 years, range 65-93 years) showed certain (6.8%) or probable (91.2%) ADR-related hospitalization. Gastrointestinal disorders (48 patients, 47.1%); platelet, bleeding and clotting disorders (20 patients, 19.6%); and cardiovascular disorders (13 patients, 12.7%) were the most frequent ADRs. NSAIDs (23.5%), oral anticoagulants (20.6%), low-dose aspirin (acetylsalicylic acid) [13.7%] and digoxin (12.7%) were the drugs most frequently involved in ADRs. Of the ADRs, 45.1% were defined as definitely avoidable, 31.4% as possibly avoidable, 18.6% as unavoidable and 4.9% as unclassifiable. Of 78 patients with definitely or possibly avoidable ADRs, 17 patients (21.8%) had received an inappropriate prescription, 29 patients (37.2%) had not received a prescription for an effective gastroprotective drug concomitantly with NSAID or low-dose aspirin treatment and 32 patients (41%) were not monitored during drug treatment. In the elderly, almost 6% of hospitalizations are ADR related. Most of these ADRs are potentially avoidable. Strategies that reduce inappropriate prescriptions and monitoring errors, as well as improving active prevention of ADRs, are needed in elderly subjects.

CONCRETE BLOCKS' ADVERSE EFFECTS ON INDOOR AIR AND RECOMMENDED SOLUTIONS

EPA Science Inventory

Air infiltration through highly permeable concrete blocks can allow entry of various serious indoor air pollutants. An easy approach to avoiding these pollutants is to select a less–air-permeable concrete block. Tests show that air permeability of concrete blocks can vary by a fa...

Antidepressant use in the elderly: the role of pharmacodynamics and pharmacokinetics in drug safety.

PubMed

Sultana, Janet; Spina, Edoardo; Trifirò, Gianluca

2015-06-01

Antidepressants (ADs) are widely used among elderly persons, making AD-related safety an important issue. This review highlights safety considerations related to AD use including risks associated with inappropriate and off-label use. The age-related pharmacokinetic and pharmacodynamic changes underlying safety concerns connected to ADs are outlined. Drug-drug interactions as a cause of AD-related adverse drug reactions (ADRs) are also discussed. We reviewed scientific evidence concerning three important safety outcomes related to ADs in elderly persons: cardiac arrhythmias, hyponatraemia and falls/fractures. Several AD-related ADRs in elderly people are likely to be preventable. Current evidence suggests that selective serotonin re-uptake inhibitors (SSRIs) are best avoided particularly in persons with kidney disease due to the risk of hyponatraemia. The use of tricyclic antidepressants (TCAs) should be limited in the elderly due to anticholinergic adverse effects. TCAs should also be avoided in elderly persons at high risk of cardiovascular events due to a risk of cardiac arrhythmia. Emerging evidence suggests that SSRIs also have arrhythmogenic potential. Both TCAs and SSRIs should be used cautiously in elderly persons at risk of falls. Future research in this area should aim to investigate the lowest effective dose of AD possible, the relationship between AD dose and adverse effects, and which elderly subgroups are most prone to develop severe ADRs.

Relevance of pharmacogenetic aspects of mercaptopurine metabolism in the treatment of interstitial lung disease.

PubMed

Bakker, Jaap A; Drent, Marjolein; Bierau, Jörgen

2007-09-01

Mercaptopurine therapy is increasingly important as immunosuppressive therapy in interstitial lung disease. We focus on human mercaptopurine metabolism and the defects in this metabolism causing adverse drug reactions. Defects in mercaptopurine metabolizing enzymes like thiopurine methyltransferase and inosine triphosphate pyrophosphohydrolase lead to severe adverse drug reactions, sometimes with fatal outcome. Other enzymes, still not thoroughly investigated, can give rise to toxic effects or decreased efficacy in mercaptopurine therapy when the activity of these enzymes is altered. Pharmacogenetic screening of potential patients for mercaptopurine therapy is important to avoid adverse drug reactions caused by inherited enzyme deficiencies in these metabolic pathways. Pretreatment screening for deficiencies of mercaptopurine metabolizing enzymes will significantly reduce the number of patients with an adverse drug reaction and concomitantly associated healthcare costs.

28 CFR 91.51 - Policy.

Code of Federal Regulations, 2012 CFR

2012-07-01

... affect the quality of the human environment. (4) Use the NEPA process to identify and assess reasonable alternatives to proposed actions that will avoid or minimize adverse effects of these actions upon the quality of the human environment. (5) Use all practicable means to restore and enhance the quality of the...

28 CFR 91.51 - Policy.

Code of Federal Regulations, 2013 CFR

2013-07-01

... affect the quality of the human environment. (4) Use the NEPA process to identify and assess reasonable alternatives to proposed actions that will avoid or minimize adverse effects of these actions upon the quality of the human environment. (5) Use all practicable means to restore and enhance the quality of the...

28 CFR 91.51 - Policy.

Code of Federal Regulations, 2011 CFR

2011-07-01

... affect the quality of the human environment. (4) Use the NEPA process to identify and assess reasonable alternatives to proposed actions that will avoid or minimize adverse effects of these actions upon the quality of the human environment. (5) Use all practicable means to restore and enhance the quality of the...

28 CFR 91.51 - Policy.

Code of Federal Regulations, 2010 CFR

2010-07-01

... affect the quality of the human environment. (4) Use the NEPA process to identify and assess reasonable alternatives to proposed actions that will avoid or minimize adverse effects of these actions upon the quality of the human environment. (5) Use all practicable means to restore and enhance the quality of the...

28 CFR 91.51 - Policy.

Code of Federal Regulations, 2014 CFR

2014-07-01

... affect the quality of the human environment. (4) Use the NEPA process to identify and assess reasonable alternatives to proposed actions that will avoid or minimize adverse effects of these actions upon the quality of the human environment. (5) Use all practicable means to restore and enhance the quality of the...

Evaluating leaf and canopy reflectance of stressed rice plants to monitor arsenic contamination

USDA-ARS?s Scientific Manuscript database

Arsenic contamination is a serious problem in rice cultivated soils of many developing countries. Hence, it is critical to monitor and control arsenic uptake in rice plants to avoid adverse effects on human health. This study evaluated the feasibility of using reflectance spectroscopy to monitor ars...

Use of a GIS-based model of habitat cores and landscape corridors for the Virginia Department of Transportation's project planning and environmental scoping.

DOT National Transportation Integrated Search

2006-01-01

As important habitats are being lost to human development, transportation agencies are facing increased expectations that their road projects avoid or minimize further habitat destruction and adverse effects on wildlife populations. Wildlife linkage ...

76 FR 72645 - Calculation of Maximum Obligation Limitation

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-25

... United States and the use of OLA would avoid or mitigate such adverse effects. Under the systemic risk... the designated Federal agencies to the Secretary to make a systemic risk determination must include a... similar to the way that systemic risk determinations are made under section 13 of the Federal Deposit...

Development of glucocorticoid receptor regulation in the rat forebrain: Implications for adverse effects of glucocorticoids in preterm infants

EPA Science Inventory

Glucocorticoids are the consensus treatment to avoid respiratory distress in preterm infants but there is accumulating evidence that these agents evoke long-term neurobehavioral deficits. Earlier, we showed that the developing rat forebrain is far more sensitive to glucocorticoi...

Management of mediastinal syndromes in pediatrics: a new challenge of ultrasound guidance to avoid high-risk general anesthesia.

PubMed

Sola, Chrystelle; Choquet, Olivier; Prodhomme, Olivier; Capdevila, Xavier; Dadure, Christophe

2014-05-01

Adverse events associated with anesthetic management of anterior mediastinal masses in pediatrics are common. To avoid an extremely hazardous general anesthesia, the use of real-time ultrasonography offers an effective alternative in high-risk cases. We report the anesthetic management including a light sedation and ultrasound guidance for regional anesthesia, surgical node biopsy, and placement of a central venous line in two children with an anterior symptomatic mediastinal mass. For pediatric patients with clinical and/or radiologic signs of airway compression, ultrasound guidance provides safety technical assistance to avoid general anesthesia and should be performed for the initial diagnostic and therapeutic procedures. © 2013 John Wiley & Sons Ltd.

Hyaluronidase: Understanding Its Properties and Clinical Application for Cosmetic Injection Adverse Events.

PubMed

Harrison, Jeanine; Rhodes, Oriol

The recent global consensus on the management of cosmetic aesthetic injectable complications from hyaluronic acid (HA) has increased the focus on the use of hyaluronidase more than ever before (M. Signorini et al., 2016). A comprehensive knowledge of facial anatomy, including structural positioning of facial arteries and veins, and an extensive knowledge of HA products available for injection procedures, combined with best practice protocols, will assist to prevent adverse events. Despite the growing number of patients using cosmetic fillers for facial restoration, the incidents incidence of adverse events remains low. Indeed, the avoidance of complications through safe and effective injection practice remains the key to preventing the need to use hyaluronidase.

Complications During Ketogenic Diet Initiation: Prevalence, Treatment, and Influence on Seizure Outcomes.

PubMed

Lin, Abigail; Turner, Zahava; Doerrer, Sarah C; Stanfield, Anthony; Kossoff, Eric H

2017-03-01

Many centers still admit children for several days to start the ketogenic diet. The exact incidence of adverse effects during the admission and their potential later impact on seizure reduction has not been widely studied. We performed a retrospective study of children with intractable epilepsy electively admitted for ketogenic diet initiation at our institution from 2011 to 2016. Charts were reviewed for adverse effects during the admission period and then examined for seizure reduction and compliance at three months. A rating scale (1 to 4) was created for severity of any adverse events. A total of 158 children were included, with the mean age 4.6 years. Potentially attributable adverse effects occurred in 126 (80%) children, most commonly emesis, food refusal, and hypoglycemia. Seventy-three (46%) children received some form of intervention by the medical team, most commonly the administration of juice (24%). Younger age was correlated with an increased likelihood of moderate to severe adverse effects during admission, often repeated hypoglycemia (3.6 versus 4.9 years, P = 0.04). Fasting was more likely to result in lethargy and a single blood glucose in the 30 to 40 mg/dL range, but it was not correlated with emesis, repeated hypoglycemia, or higher adverse effect scores. There was no statistically significant correlation between the severity of adverse effects and the three-month seizure reduction. Mild easily treated adverse effects occurred in most children admitted for the ketogenic diet. Younger children were at greater risk for significant difficulties and should be monitored closely. Because fasting led to more lethargy and hypoglycemia, it may be prudent to avoid this in younger children. Copyright © 2017 Elsevier Inc. All rights reserved.

Attachment-Related Regulatory Processes Moderate the Impact of Adverse Childhood Experiences on Stress Reaction in Borderline Personality Disorder.

PubMed

Ehrenthal, Johannes C; Levy, Kenneth N; Scott, Lori N; Granger, Douglas A

2018-01-01

In this study, the authors explored whether attachment insecurity moderates the effects of adverse childhood experiences on stress reactivity in the context of borderline personality disorder (BPD). Participants were 113 women (39 with BPD, 15 with some BPD criteria present, 59 without any BPD symptoms) who participated in the Trier Social Stress Test. Saliva samples were collected before and after the stressor and assayed for salivary alpha-amylase (sAA) and cortisol. Adverse childhood experiences were measured using the Childhood Trauma Questionnaire, and attachment by the Experiences in Close Relationships-Revised questionnaire. Results revealed that attachment avoidance and a combination of more adverse childhood experiences and attachment insecurity resulted in higher sAA levels and differences in reactivity to the stressor. Interactions between attachment anxiety and adverse childhood experiences were related to blunted cortisol reactivity. The results suggest that the influence of adverse childhood experiences on stress regulation in BPD may be moderated by attachment-related regulatory processes.

Prevalence and detection of neuropsychiatric adverse effects during hepatitis C treatment.

PubMed

Masip, Montserrat; Tuneu, Laura; Pagès, Neus; Torras, Xavier; Gallego, Adolfo; Guardiola, Josep Maria; Faus, María José; Mangues, Maria Antònia

2015-12-01

Current treatment combinations for chronic hepatitis C virus infection still include pegylated interferon and ribavirin despite the new therapeutic options available. Interferon-based treatments are associated with a high incidence of adverse effects. Central nervous system events are among the most frequent adverse drug reactions and their influence on treatment adherence and effectiveness is controversial. The aim of the study was to evaluate neuropsychiatric adverse effects of interferon-based treatment for chronic hepatitis C in standard multidisciplinary clinical practice. Risk factors for these adverse effects and their impact on adherence and sustained viral response were also evaluated. Setting Ambulatory care pharmacy in coordination with the liver unit and the infectious diseases unit at a 650-bed tertiary university hospital. We included all consecutive patients with chronic hepatitis C who completed treatment with pegylated interferon and ribavirin between 2005 and 2013. All patients underwent a multidisciplinary follow-up during treatment. Neuropsychiatric adverse effects were evaluated in relation to severity, management and outcome. The presence of anxiety and depression was evaluated by means of specific tests. A total of 717 treatments in 679 patients were included. During treatment, we detected 1679 neuropsychiatric adverse effects in 618 patients (86.2 %), generating 1737 clinical interventions. Fifty-seven (3.3 %) neuropsychiatric adverse effects were severe and 2 (0.1 %) were life-threatening (suicidal attempts). Most neuropsychiatric adverse effects (1555 events, 92.6 %) resolved without sequelae. Psychiatric medication was required in 289 patients (40.3 %). Sustained viral response was achieved in 400 cases (55.8 %) and was associated with adherence (OR = 1.942, 95 % CI = 1.235-3.052, p = 0.004). A multivariate analysis did not show any relationship between neuropsychiatric adverse effects and treatment adherence or sustained viral response. A psychiatric history was a strong risk factor for depression, anxiety and other psychiatric disorders during treatment. Neuropsychiatric adverse effects during interferon-based treatments in patients with chronic hepatitis C were common but mostly mild or moderate. Early detection and accurate multidisciplinary management avoided treatment discontinuation, ensuring adherence and attaining sustained viral response. The identified risk factors could be used to determine patients eligible for interferon-free combinations, thus optimizing health system economics.

Exposure safety standards for nonionizing radiation (NIR) from collision-avoidance radar

NASA Astrophysics Data System (ADS)

Palmer-Fortune, Joyce; Brecher, Aviva; Spencer, Paul; Huguenin, Richard; Woods, Ken

1997-02-01

On-vehicle technology for collision avoidance using millimeter wave radar is currently under development and is expected to be in vehicles in coming years. Recently approved radar bands for collision avoidance applications include 47.5 - 47.8 GHz and 76 - 77 GHz. Widespread use of active radiation sources in the public domain would contribute to raised levels of human exposure to high frequency electromagnetic radiation, with potential for adverse health effects. In order to design collision avoidance systems that will pose an acceptably low radiation hazard, it is necessary to determine what levels of electromagnetic radiation at millimeter wave frequencies will be acceptable in the environment. This paper will summarize recent research on NIR (non-ionizing radiation) exposure safety standards for high frequency electromagnetic radiation. We have investigated both governmental and non- governmental professional organizations worldwide.

18 CFR 380.12 - Environmental reports for Natural Gas Act applications.

Code of Federal Regulations, 2012 CFR

2012-04-01

... how the project would be located or designed to avoid or minimize adverse effects to the resources or... route or site and the reasons for rejecting it. Provide comparative tables showing the differences in... affect reliability, and what procedures and design features have been used to reduce potential hazards...

18 CFR 380.12 - Environmental reports for Natural Gas Act applications.

Code of Federal Regulations, 2013 CFR

2013-04-01

... how the project would be located or designed to avoid or minimize adverse effects to the resources or... route or site and the reasons for rejecting it. Provide comparative tables showing the differences in... affect reliability, and what procedures and design features have been used to reduce potential hazards...

18 CFR 380.12 - Environmental reports for Natural Gas Act applications.

Code of Federal Regulations, 2014 CFR

2014-04-01

... how the project would be located or designed to avoid or minimize adverse effects to the resources or... route or site and the reasons for rejecting it. Provide comparative tables showing the differences in... affect reliability, and what procedures and design features have been used to reduce potential hazards...

18 CFR 380.12 - Environmental reports for Natural Gas Act applications.

Code of Federal Regulations, 2010 CFR

2010-04-01

... how the project would be located or designed to avoid or minimize adverse effects to the resources or... route or site and the reasons for rejecting it. Provide comparative tables showing the differences in... affect reliability, and what procedures and design features have been used to reduce potential hazards...

18 CFR 380.12 - Environmental reports for Natural Gas Act applications.

Code of Federal Regulations, 2011 CFR

2011-04-01

... how the project would be located or designed to avoid or minimize adverse effects to the resources or... route or site and the reasons for rejecting it. Provide comparative tables showing the differences in... affect reliability, and what procedures and design features have been used to reduce potential hazards...

Navigating Bereavement with Spirituality-Based Interventions: Implications for Non-Faith-Based Counselors

ERIC Educational Resources Information Center

Dyer, Jacqueline E. Thurston; Hagedorn, W. Bryce

2013-01-01

The relationship between spirituality and bereavement has been studied in a multitude of disciplines, yet there is a significant gap in the counseling literature on this topic. The authors explore how spirituality is often avoided in secular counseling settings, discuss adverse effects of unresolved grief on clients' functioning, and propose the…

Two nursing mothers treated with zonisamide: Should breast-feeding be avoided?

PubMed

Ando, Hitoshi; Matsubara, Shigeki; Oi, Asako; Usui, Rie; Suzuki, Mitsuaki; Fujimura, Akio

2014-01-01

Zonisamide, an antiepileptic drug, is excreted into breast milk, but information regarding the safety of breast-feeding while using this drug is limited. We present the cases of two nursing mothers, taking 300 and 100 mg/day zonisamide. At 5 days after delivery, the milk concentrations and relative infant doses of the drug were 18.0 and 5.1 μg/mL, and 44 and 36%, respectively. In the first case, the mother fed colostrum and continued partial breast-feeding thus reducing the relative infant dose to 8%. The neonatal serum concentration of zonisamide declined to below the limit of detection at day 34 after birth. In the second case, the mother breast-fed partially until 2 weeks postpartum. No adverse effect was observed in the infants. These findings suggest that mothers taking zonisamide should not breast-feed exclusively, but may not have to avoid partial breast-feeding, with significant caution regarding adverse effects in infants. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

Handbook on Coral Reef Impacts: Avoidance, Minimization, Compensatory Mitigation, and Restoration

EPA Pesticide Factsheets

This Handbook provides a general summary of current avoidance, minimization, compensatory mitigation, and restoration strategies that may help address physical damage resulting from direct adverse impacts to coral reefs.

INTRAVENOUS VALPROATE: A NEW PERSPECTIVE IN THE TREATMENT OF MANIC SYMPTOMS

PubMed Central

Duggal, Harpreet S.; Jagadheesan, K.; Gupta, Subhash; Basu, Soumya; Akhtar, Sayeed; Nizamie, Haque S.

2002-01-01

Over the last few years, the use of valproate in psychiatry has increased considerably. With the advent of oral loading dose strategy, its role in rapid treatment of acute mania has been demonstrated. The intravenous formulation of valproate, while retaining the rapidity of action of oral loading, also avoids some of the adverse effects of the oral preparation. Moreover, reports are pouring in that intravenous valproate loading may be more efficacious than oral valproate loading in the treatment of acute mania. We report two patients whose manic symptoms showed a dramatic response to intravenous valproate without adverse effects. The pharmacology of intravenous valproate and its clinical relevance to psychiatry are discussed. PMID:21206565

Prazosin Augmentation of Outpatient Treatment of Alcohol Use Disorders in Active Duty Soldiers with and without PTSD

DTIC Science & Technology

2014-10-01

future combat deployments. It is also important to avoid sedation, weight gain, decreased libido, and other adverse effects of psychotropic drugs that...ated, and blood pressure changes did not differ between groups. Conclusions: Prazosin is effective for combat- related PTSD with trauma night- mares in...combat- related trauma nightmares, sleep quality, and global status. Prazosin was also effective for overall PTSD symptoms even after the CAPS

Notes from the Field: Increase in Reported Adverse Health Effects Related to Synthetic Cannabinoid Use - United States, January-May 2015.

PubMed

Law, Royal; Schier, Josh; Martin, Colleen; Chang, Arthur; Wolkin, Amy

2015-06-12

On April 6, 2015, CDC received notification of an increase in telephone calls to U.S. poison centers related to synthetic cannabinoid use. Monthly calls to all poison centers are tracked by the National Poison Data System, which reported that adverse health effects or concerns about possible adverse health effects related to synthetic cannabinoid use increased 330% from 349 in January 2015 to 1,501 in April 2015. Synthetic cannabinoids include various psychoactive chemicals or a mixture of such chemicals that are sprayed onto plant material, which is then often smoked or ingested to achieve a "high." These products are sold under a variety of names (e.g., synthetic marijuana, spice, K2, black mamba, and crazy clown) and can be sold in retail outlets as herbal products. Law enforcement agencies have regulated a number of these substances; however, manufacturers of synthetic cannabinoids frequently change the formulation to avoid detection and regulation. After the initial notification, CDC analyzed information from the National Poison Data System on reported adverse health effects related to synthetic cannabinoid use for the period January-May 2015.

Sugammadex to Reverse Neuromuscular Blockade in a Child with a Past History of Cardiac Transplantation

PubMed Central

Miller, Karen; Hall, Brian; Tobias, Joseph D

2017-01-01

Sugammadex is a novel agent for the reversal of neuromuscular blockade. The speed and efficacy of reversal with sugammadex are significantly faster than acetylcholinesterase inhibitors, such as neostigmine. Sugammadex also has a limited adverse profile when compared with acetylcholinesterase inhibitors, specifically in regard to the incidence of bradycardia. This adverse effect may be particularly relevant in the setting of a heart transplant recipient with a denervated heart. The authors present a case of an 8-year-old child, status postcardiac transplantation, who required anesthetic care for laparoscopy and lysis of intra-abdominal adhesions. Sugammadex was used to reverse neuromuscular blockade and avoid the potential adverse effects of neostigmine. The unique mechanism of action of sugammadex is discussed, previous reports of its use in this unique patient population are reviewed, and its potential benefits compared to traditional acetylcholinesterase inhibitors are presented. PMID:28701612

Sugammadex to reverse neuromuscular blockade in a child with a past history of cardiac transplantation.

PubMed

Miller, Karen; Hall, Brian; Tobias, Joseph D

2017-01-01

Sugammadex is a novel agent for the reversal of neuromuscular blockade. The speed and efficacy of reversal with sugammadex are significantly faster than acetylcholinesterase inhibitors, such as neostigmine. Sugammadex also has a limited adverse profile when compared with acetylcholinesterase inhibitors, specifically in regard to the incidence of bradycardia. This adverse effect may be particularly relevant in the setting of a heart transplant recipient with a denervated heart. The authors present a case of an 8-year-old child, status postcardiac transplantation, who required anesthetic care for laparoscopy and lysis of intra-abdominal adhesions. Sugammadex was used to reverse neuromuscular blockade and avoid the potential adverse effects of neostigmine. The unique mechanism of action of sugammadex is discussed, previous reports of its use in this unique patient population are reviewed, and its potential benefits compared to traditional acetylcholinesterase inhibitors are presented.

Recent Updates on the Systemic and Local Safety of Intranasal Steroids.

PubMed

Jang, Tae Young; Kim, Young Hyo

2016-01-01

Allergic rhinitis is a global health problem, and its prevalence rate and socioeconomic burden continue to increase. Intranasal steroid (INS) is the first treatment choice in the majority of patients, because of its ability to effectively control allergic symptoms. However, patients and clinicians are concerned about the potential adverse effects of prolonged INS use. We performed to review for evaluating systemic and local safety of INS use, by searching MEDLINE, EMBASE, and Cochrane Library database for identification of relevant articles. In the present study, the systemic bioavailabilities of several commercially available INSs were researched, and then systemic safeties were reviewed with focus on suppression of the hypothalamus-pituitary-adrenal axis and their effects on pediatric growth. In addition, local adverse effects, such as, epistaxis and nasal septal perforation, were investigated. Finally, the authors proposed some techniques in order to avoid these complications. INSs offer a safe, effective means of treating allergic rhinitis in the short- and long-term with no or minimal adverse systemic and local effects. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Airliner Cabin Ozone: An Updated Review

DTIC Science & Technology

1989-12-01

authorized Airliner Cabin Ozone: An Updated Review INTRODUCTION Prior to 1980 , there was a great deal of concern about the adverse effects of ozone on the...and by flight planning to avoid known areas of high atmospheric ozone concentration. Since the final rule was published in 1980 , few reports have...pointed out in 1980 (4), that ozone concentration is the predominant factor in determining the effective dose. These latter studies indicate that

A Report on Deliverable Three: Determine a Standard Performance Test for Military Suction Device Use

DTIC Science & Technology

2017-09-20

prehospital combat casualty care have unique performance requirements and should be tested in a manner that effectively simulates the anticipated...artificial airway or assisted ventilation . Loss of patient airway in tactical and combat environments commonly occurs. The proximate cause can be...points related to avoidance of adverse effects in the performance of suction:  There are no contraindications to suctioning, however prolonged

Time does not heal all wounds: older adults who experienced childhood adversities have higher odds of mood, anxiety, and personality disorders.

PubMed

Raposo, Sarah M; Mackenzie, Corey S; Henriksen, Christine A; Afifi, Tracie O

2014-11-01

We aimed to examine the prevalence of several types of childhood adversity across adult cohorts, whether age moderates the effect of childhood adversity on mental health, the relationship between childhood adversity and psychopathology among older adults, the dose-response relationship between number of types of childhood adversities and mental disorders in later life, and whether lifetime mental health treatment reduces the odds of psychopathology among older survivors of childhood adversity. In a population-based, cross-sectional study on a nationally representative U.S. sample, we studied 34,653 community-dwelling Americans 20 years and older, including 7,080 adults 65 years and older from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Trained lay interviewers assessed past-year mood and anxiety disorders and lifetime personality disorders. Participants self-reported childhood adversity based on questions from the Adverse Childhood Experiences Study. Childhood adversity was prevalent across five age cohorts. In our adjusted models, age did not moderate the effect of childhood adversity on mental disorders. Older adults who experienced childhood adversity had higher odds of having mood (odds ratio: 1.73; 95% confidence interval: 1.32-2.28), anxiety (odds ratio: 1.48; 95% confidence interval: 1.20-1.83), and personality disorders (odds ratio: 2.11; 95% confidence interval: 1.75-2.54) after adjusting for covariates. An increasing number of types of childhood adversities was associated with higher odds of personality disorders and somewhat higher odds of anxiety disorders. Treatment-seeking was associated with a reduced likelihood of anxiety and, especially, mood disorders in older adult childhood adversity survivors. These results emphasize the importance of preventing childhood adversity and intervening once it occurs to avoid the negative mental health effects that can last into old age. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Safe use of glucocorticoids. How to monitor patients taking these potent agents.

PubMed

Cook, D M

1992-02-15

Glucocorticoids reduce inflammation and combat stress. However, they are very powerful, and guidelines for their use must be followed to avoid such adverse effects as Cushing's syndrome and adrenal insufficiency. Whenever possible, physicians should consider alternative treatment strategies, because the consequences of steroid therapy may be worse than those of the disease being treated.

Use of the Biopharmaceutics Drug Disposition Classification System (BDDCS) to Help Predict the Occurrence of Idiosyncratic Cutaneous Adverse Drug Reactions Associated with Antiepileptic Drug Usage.

PubMed

Chan, Rosa; Wei, Chun-Yu; Chen, Yuan-Tsong; Benet, Leslie Z

2016-05-01

Cutaneous adverse reactions (CARs) from antiepileptic drugs (AEDs) are common, ranging from mild to life-threatening, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The identification of subjects carrying the HLA-B*15:02, an inherited allelic variant of the HLA-B gene, and the avoidance of carbamazepine (CBZ) therapy in these subjects are strongly associated with a decrease in the incidence of carbamazepine-induced SJS/TEN. In spite of the strong genetic associations, the initiation of hypersensitivity for AEDs is still not very well characterized. Predicting the potential for other AEDs to cause adverse reactions will be undoubtedly beneficial to avoid CARs, which is the focus of this report. Here, we explore the use of the Biopharmaceutics Drug Disposition Classification System (BDDCS) to distinguish AEDs associated with and without CARs by examining the binding relationship of AEDs to HLA-B*15:02 and data from extensive reviews of medical records. We also evaluate the lack of benefit from a Hong Kong population policy on the effects of screening for HLA-B*15:02 and previous incorrect structure-activity hypotheses. Our analysis concludes that BDDCS class 2 AEDs are more prone to cause adverse cutaneous reactions than certain BDDCS class 1 AEDs and that BDDCS Class 3 drugs have the lowest levels of cutaneous adverse reactions. We propose that BDDCS Class 3 AEDs should be preferentially used for patients with Asian backgrounds (i.e., Han Chinese, Thai, and Malaysian populations) if possible and in patients predisposed to skin rashes.

Occupational exposure to anaesthetic gases: a role for TIVA.

PubMed

Irwin, Michael G; Trinh, Theresa; Yao, Che-Lin

2009-07-01

Modern anaesthesia is still mostly administered by the inhalational route and there is increasing concern over its potential for pollution. One of the first gaseous anaesthetic agents was nitrous oxide and this is still widely used today despite being associated with adverse effects caused by depression of vitamin B(12) function and diminished reproductive health. The use of halothane is associated with hepatitis but the adverse effects of newer halogenated hydrocarbons are less well recognised. Chronic exposure may cause reduction in antioxidant activity in plasma and erythrocytes, inhibition of neutrophil apoptosis, depression of central neuro-respiratory activity, increased DNA breaks, effects on cerebral blood circulation and altered renal function. Inhalational anaesthetics also have adverse environmental effects, including ozone damage and greenhouse gas effects. Levels of inhalational anaesthetics in the ambient air of operating theatres and recovery rooms often exceed those stated in national guidelines. Anaesthetic procedures can be modified and air-conditioning and air scavenging systems should be used to minimise the risks from occupational exposure and threats to the environment. Such contamination could be avoided with the use of total intravenous anaesthesia.

Physical Health and Drug Safety in Individuals with Schizophrenia

PubMed Central

Kelly, Martina; Urness, Doug; Teehan, Michael; Ismail, Zahinoor; Gardner, David

2017-01-01

Background: While antipsychotic medications are the mainstay of therapy for individuals with schizophrenia and psychotic disorders, their use is associated with adverse effects on physical health that require the attention and care of prescribers. Methods: We used the ADAPTE process to adapt existing guideline recommendations from the National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the dosing of antipsychotics and antipsychotic polypharmacy, screening for adverse effects of antipsychotics, and management of metabolic and extrapyramidal side effects to the Canadian context. Results: Prescribers are encouraged to use the lowest effective dose and to avoid the routine use of multiple antipsychotics. Scheduled monitoring of body mass index, waist circumference, blood pressure, glucose, lipids, prolactin, electrocardiograms, and extrapyramidal symptoms is recommended. Lifestyle interventions are recommended to mitigate antipsychotic-induced weight gain. Prescribers should follow Canadian guidelines on the treatment of obesity, dyslipidemia, and diabetes. Recommendations on antipsychotic drug choice are made for users particularly concerned about extrapyramidal symptoms. Conclusion: Careful monitoring and attention by prescribers may mitigate adverse effects associated with antipsychotic medications. PMID:28718324

"What kept me going": A qualitative study of avoidant responses to war-related adversity and perpetration of violence by former forcibly recruited children and youth in the Acholi region of northern Uganda.

PubMed

Harnisch, Helle; Montgomery, Edith

2017-09-01

This qualitative study investigates what, according to 36 former forcibly recruited women and men, enabled them to "keep on going" during and after their forced recruitment in the twenty-year-long civil war in northern Uganda. Furthermore, the study conveys the ways most of the former forcibly recruited kept on going and today cope with ongoing war-related adversity and difficult reintegration processes without relying on psycho-social intervention. Thirty-five of the 36 women and men were forcibly recruited when they were children by the Lord's Resistance Army (LRA) from the Acholi region of northern Uganda. Over the course of five visits to the Acholi region from 2012 to 2016, 10 months of ethnographic fieldwork was carried out involving interviews and participant observation. The 36 Acholi women and men shared how they experienced and responded to suffering from brutal torture and being forced to perpetrate often lethal violence against fellow Acholi who had tried to escape the LRA. The article provides an overview of the responses to this war-related adversity and the results document how avoidant coping is the preferred and most common coping response among the 36 former forcibly recruited women and men in this study. We take an interdisciplinary approach to discussing how these avoidant coping responses resonate with psycho-traumatology research on responses to war-related trauma and with conceptualizations of resilience. We end with the argument that avoidant responses to war-related adversity, when faced in clinical and diagnostic settings, should not be understood exclusively from a biomedical perspective: Responses to war-related adversity must be carefully investigated in collaboration with the human beings who have experienced the war-related adversity and based on integrative and emic approaches that consider the locally situated notions of how to cope with adversity and "keep on going" in their own right. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Adverse Reaction to Nicotine Gum in Malay Female Smoker: A Case Report

ERIC Educational Resources Information Center

Noorzurani, Md Haris Robson; Bond, Alyson; Wolff, Kim

2008-01-01

Nicotine replacement therapies (NRT) are prescribed in smoking cessation programmes to help smokers stop smoking. The ideal dosage of NRT should control cravings and withdrawal symptoms but avoid adverse reactions. This report describes a case of adverse reaction to nicotine gum in a female Malay smoker. Assays taken 2 h after the gum, showed that…

What to expect from immersive virtual environment exposure: influences of gender, body mass index, and past experience.

PubMed

Stanney, Kay M; Hale, Kelly S; Nahmens, Isabelina; Kennedy, Robert S

2003-01-01

For those interested in using head-coupled PC-based immersive virtual environment (VE) technology to train, entertain, or inform, it is essential to understand the effects this technology has on its users. This study investigated potential adverse effects, including the sickness associated with exposure and extreme responses (emesis, flashbacks). Participants were exposed to a VE for 15 to 60 min, with either complete or streamlined navigational control and simple or complex scenes, after which time measures of sickness were obtained. More than 80% of participants experienced nausea, oculomotor disturbances, and/or disorientation, with disorientation potentially lasting > 24 hr. Of the participants, 12.9% prematurely ended their exposure because of adverse effects; of these, 9.2% experienced an emetic response, whereas only 1.2% of all participants experienced emesis. The results indicate that designers may be able to reduce these rates by limiting exposure duration and reducing the degrees of freedom of the user's navigational control. Results from gender, body mass, and past experience comparisons indicated it may be possible to identify those who will experience adverse effects attributable to exposure and warn such individuals. Applications for this research include military, entertainment, and any other interactive systems for which designers seek to avoid adverse effects associated with exposure.

Aircraft Weather Mitigation for the Next Generation Air Transportation System

NASA Technical Reports Server (NTRS)

Stough, H. Paul, III

2007-01-01

Atmospheric effects on aviation are described by Mahapatra (1999) as including (1) atmospheric phenomena involving air motion - wind shear and turbulence; (2) hydrometeorological phenomena - rain, snow and hail; (3) aircraft icing; (4) low visibility; and (5) atmospheric electrical phenomena. Aircraft Weather Mitigation includes aircraft systems (e.g. airframe, propulsion, avionics, controls) that can be enacted (by a pilot, automation or hybrid systems) to suppress and/or prepare for the effects of encountered or unavoidable weather or to facilitate a crew operational decision-making process relative to weather. Aircraft weather mitigation can be thought of as a continuum (Figure 1) with the need to avoid all adverse weather at one extreme and the ability to safely operate in all weather conditions at the other extreme. Realistic aircraft capabilities fall somewhere between these two extremes. The capabilities of small general aviation aircraft would be expected to fall closer to the "Avoid All Adverse Weather" point, and the capabilities of large commercial jet transports would fall closer to the "Operate in All Weather Conditions" point. The ability to safely operate in adverse weather conditions is dependent upon the pilot s capabilities (training, total experience and recent experience), the airspace in which the operation is taking place (terrain, navigational aids, traffic separation), the capabilities of the airport (approach guidance, runway and taxiway lighting, availability of air traffic control), as well as the capabilities of the airplane. The level of mitigation may vary depending upon the type of adverse weather. For example, a small general aviation airplane may be equipped to operate "in the clouds" without outside visual references, but not be equipped to prevent airframe ice that could be accreted in those clouds.

The effects of confrontation and avoidance coping in response to workplace incivility.

PubMed

Hershcovis, M Sandy; Cameron, Ann-Frances; Gervais, Loie; Bozeman, Jennifer

2018-04-01

Workplace incivility has significant adverse consequences for targets. However, we know remarkably little about how targets of incivility cope and even less about which coping strategies are effective. Drawing on the coping process of the transactional model of stress, we examine confrontation as a form of problem-focused coping and avoidance as a form of emotion-focused coping in response to incivility. We examine the effects of these coping strategies on reoccurrence of incivility, incivility enacted by targets, psychological forgiveness, and emotional exhaustion. Focusing on the target's perspective of a series of uncivil interactions between a target and perpetrator, we conducted a 3-wave study of employees from various occupations. Employing the critical incident technique, participants reported on an incident of workplace incivility, and then answered a series of questions over 3 waves of data collection regarding their interactions with this perpetrator. Our findings suggest that confrontation and avoidance are ineffective in preventing reoccurrence of incivility. Avoidance can additionally lead to increased emotional exhaustion, target-enacted incivility, and lower psychological forgiveness. However, confrontation coping has promise with regards to eliciting positive outcomes such as psychological forgiveness that are beneficial to interpersonal workplace relationships. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Spacecraft external molecular contamination analysis

NASA Technical Reports Server (NTRS)

Ehlers, H. K. F.

1990-01-01

Control of contamination on and around spacecraft is required to avoid adverse effects on the performance of instruments and spacecraft systems. Recent work in this area is reviewed and discussed. Specific issues and limitations to be considered as part of the effort to predict contamination effects using modeling techniques are addressed. Significant results of Space Shuttle missions in the field of molecule/surface interactions as well as their implications for space station design and operation are reviewed.

When place and time matter: How to conduct safe inter-hospital transfer of patients

PubMed Central

Sethi, Divya; Subramanian, Shalini

2014-01-01

Inter-hospital transfer (IHT) of patients is often needed for diagnostic or therapeutic interventions. However, the transfer process carries its own risks as a poorly and hastily conducted transfer could lead to adverse events. In this article, we have reviewed literature on the key elements of IHT process including pre-transfer patient stabilization. We have also discussed various modes of transfer, physiological effects of transfer, possible adverse events and how to avoid or mitigate these. Even critically ill-patients can be transported safely by experienced and trained personnel using appropriate equipment. The patient must be maximally stabilized prior to transfer though complete optimization may be possible only at the receiving hospital. Ground or air transport may be employed depending on the urgency, feasibility and availability. Meticulous pre-transfer check and adherence to standard protocols during the transfer will help keep the entire process smooth and event free. The transport team should be trained to anticipate and manage any possible adverse events, medical or technical, during the transfer. Coordination between the referring and receiving hospitals would facilitate prompt transfer to the definitive destination avoiding delay at the emergency or casualty. Documentation of the transfer process and transfer of medical record and investigation reports are important for maintaining continuity of medical care and for medico-legal purposes. PMID:24665250

Infant survival, HIV infection, and feeding alternatives in less-developed countries.

PubMed Central

Kuhn, L; Stein, Z

1997-01-01

OBJECTIVES: This study examines, in the context of the human immunodeficiency virus (HIV) epidemic, the effects of optimal breast-feeding, complete avoidance of breast-feeding, and early cessation of breast-feeding. METHODS: The three categories of breast-feeding were weighed in terms of HIV transmission and infant mortality. Estimates of the frequency of adverse outcomes were obtained by simulation. RESULTS: Avoidance of all breast-feeding by the whole population always produces the worst outcome. The lowest frequency of adverse outcomes occurs if no HIV-seropositive women breast-feed and all seronegative women breast-feed optimally, given infant mortality rates below 100 per 1000 and relative risks of dying set at 2.5 for non-breast-fed compared with optimally breast-fed infants. For known HIV-seropositive mothers, fewer adverse outcomes result from early cessation than from prolonged breast-feeding if the hazard of HIV transmission through breast-feeding after 3 months is 7% or more, even at high mortality rates, given relative risks of dying set at 1.5 for early cessation compared with optimal duration of breast-feeding. CONCLUSIONS: The risk of HIV transmission through breast-feeding at various ages needs to be more precisely quantified. The grave issues that may accompany a possible decline in breast-feeding in the less developed world demand evaluation. PMID:9224171

Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations.

PubMed

Fischer, Benedikt; Russell, Cayley; Sabioni, Pamela; van den Brink, Wim; Le Foll, Bernard; Hall, Wayne; Rehm, Jürgen; Room, Robin

2017-08-01

Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes. Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions. As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG)-akin to similar guidelines in other health fields-offer a valuable, targeted prevention tool to improve public health outcomes. To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process. We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use. We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes. We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review. We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches. Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE) criteria, and translated it into the LRCUG recommendations by the author expert collective on the basis of an iterative consensus process. For most recommendations, there was at least "substantial" (i.e., good-quality) evidence. We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use-related health risks is abstinence, (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years), (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)-ratio cannabis products, (4) abstain from using synthetic cannabinoids, (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods, (6) avoid deep or other risky inhalation practices, (7) avoid high-frequency (e.g., daily or near-daily) cannabis use, (8) abstain from cannabis-impaired driving, (9) populations at higher risk for cannabis use-related health problems should avoid use altogether, and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use). Evidence indicates that a substantial extent of the risk of adverse health outcomes from cannabis use may be reduced by informed behavioral choices among users. The evidence-based LRCUG serve as a population-level education and intervention tool to inform such user choices toward improved public health outcomes. However, the LRCUG ought to be systematically communicated and supported by key regulation measures (e.g., cannabis product labeling, content regulation) to be effective. All of these measures are concretely possible under emerging legalization regimes, and should be actively implemented by regulatory authorities. The population-level impact of the LRCUG toward reducing cannabis use-related health risks should be evaluated. Public health implications. Cannabis control regimes are evolving, including legalization in North America, with uncertain impacts on public health. Evidence-based LRCUG offer a potentially valuable population-level tool to reduce the risk of adverse health outcomes from cannabis use among (especially young) users in legalization contexts, and hence to contribute to improved public health outcomes.

HLA-B*1502 allele is associated with a cross-reactivity pattern of cutaneous adverse reactions to antiepileptic drugs.

PubMed

Wang, J; Zhang, J; Wu, X; Yu, P; Hong, Z

2012-01-01

The US Food and Drug Administration has recommended genetic screening for the human leucocyte antigen-B (HLA-B)*1502 allele in patients of Asian ethnicity before starting carbamazepine therapy, to avoid the fatal adverse treatment-related events associated with this drug. The association between cross-reactivity to antiepileptic drugs (AEDs) and the HLA-B*1502 allele has been only rarely reported. Here, two cases of cross-reactivity to AEDs, where cutaneous adverse drug reactions (cADRs) developed in female Han Chinese patients with epilepsy who tested positive for the HLA-B*1502 allele, are described. If the genetic association could be confirmed in larger studies, the HLA-B*1502 allele should be tested for in any patient experiencing cADRs, to avoid crossreactivity to AEDs.

[Prophylaxis and treatment of arterial hypotension during caesarean with spinal anaesthesia].

PubMed

Arias, J; Lacassie, H J

2013-11-01

Caesarean section is one of the most common surgical procedures worldwide. Arterial hypotension is the most prevalent adverse effect after spinal anaesthesia. Various methods have been used to prevent or treat hypotension. Since there is no treatment 100% effective by itself, a multimodal management is required to achieve an optimum balance and avoidance of hemodynamic imbalance. Strategies to avoid this side effect are analyzed on the basis of the best evidence available so far, summarized as mechanical factors, anesthetics, fluids and vasopressors. After spinal anaesthesia for caesarean section, the best strategy available for prevention of hypotension appears to be the combination of crystalloids along with an alpha 1 agonist vasopressor. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Barriers to movement: Modelling energetic costs of avoiding marine wind farms amongst breeding seabirds.

PubMed

Masden, Elizabeth A; Haydon, Daniel T; Fox, Anthony D; Furness, Robert W

2010-07-01

Proposals for wind farms in areas of known importance for breeding seabirds highlight the need to understand the impacts of these structures. Using an energetic modelling approach, we examine the effects of wind farms as barriers to movement on seabirds of differing morphology. Additional costs, expressed in relation to typical daily energetic expenditures, were highest per unit flight for seabirds with high wing loadings, such as cormorants. Taking species-specific differences into account, costs were relatively higher in terns, due to the high daily frequency of foraging flights. For all species, costs of extra flight to avoid a wind farm appear much less than those imposed by low food abundance or adverse weather, although such costs will be additive to these. We conclude that adopting a species-specific approach is essential when assessing the impacts of wind farms on breeding seabird populations, to fully anticipate the effects of avoidance flights. Copyright 2010 Elsevier Ltd. All rights reserved.

Impact of adverse life events on individuals with low and high schizotypy in a nonpatient sample.

PubMed

Kocsis-Bogár, Krisztina; Miklósi, Mónika; Forintos, Dóra Perczel

2013-03-01

The aims of this study were to gain a better understanding of adverse life events connected with the development of schizotypal personality traits and, also, to examine whether subclinical schizotypy has a relationship with vulnerability to traumatic intrusions and avoidance. In a cross-sectional design, 198 undergraduate students completed the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE), the Impact of Event Scale (IES), and Paykel's Life Events Scale, together with other relevant scales. The number of adverse life events was significantly related to overall schizotypy measured by O-LIFE scores and positive schizotypy measured by the Unusual Experiences (UnEx) subscale. The subjective severity of life events was significantly related to Cognitive Disorganization (CogDis). Measures of positive schizotypy (UnEx and CogDis) were significantly related to the scores on the IES and on the intrusion and avoidance subscales, too. Adverse life events are associated with schizotypal personality traits, which contribute to a tendency for traumatic intrusions, even in a nonpatient sample.

Health benefits from large-scale ozone reduction in the United States.

PubMed

Berman, Jesse D; Fann, Neal; Hollingsworth, John W; Pinkerton, Kent E; Rom, William N; Szema, Anthony M; Breysse, Patrick N; White, Ronald H; Curriero, Frank C

2012-10-01

Exposure to ozone has been associated with adverse health effects, including premature mortality and cardiopulmonary and respiratory morbidity. In 2008, the U.S. Environmental Protection Agency (EPA) lowered the primary (health-based) National Ambient Air Quality Standard (NAAQS) for ozone to 75 ppb, expressed as the fourth-highest daily maximum 8-hr average over a 24-hr period. Based on recent monitoring data, U.S. ozone levels still exceed this standard in numerous locations, resulting in avoidable adverse health consequences. We sought to quantify the potential human health benefits from achieving the current primary NAAQS standard of 75 ppb and two alternative standard levels, 70 and 60 ppb, which represent the range recommended by the U.S. EPA Clean Air Scientific Advisory Committee (CASAC). We applied health impact assessment methodology to estimate numbers of deaths and other adverse health outcomes that would have been avoided during 2005, 2006, and 2007 if the current (or lower) NAAQS ozone standards had been met. Estimated reductions in ozone concentrations were interpolated according to geographic area and year, and concentration-response functions were obtained or derived from the epidemiological literature. We estimated that annual numbers of avoided ozone-related premature deaths would have ranged from 1,410 to 2,480 at 75 ppb to 2,450 to 4,130 at 70 ppb, and 5,210 to 7,990 at 60 ppb. Acute respiratory symptoms would have been reduced by 3 million cases and school-loss days by 1 million cases annually if the current 75-ppb standard had been attained. Substantially greater health benefits would have resulted if the CASAC-recommended range of standards (70-60 ppb) had been met. Attaining a more stringent primary ozone standard would significantly reduce ozone-related premature mortality and morbidity.

Health Benefits from Large-Scale Ozone Reduction in the United States

PubMed Central

Berman, Jesse D.; Fann, Neal; Hollingsworth, John W.; Pinkerton, Kent E.; Rom, William N.; Szema, Anthony M.; Breysse, Patrick N.; White, Ronald H.

2012-01-01

Background: Exposure to ozone has been associated with adverse health effects, including premature mortality and cardiopulmonary and respiratory morbidity. In 2008, the U.S. Environmental Protection Agency (EPA) lowered the primary (health-based) National Ambient Air Quality Standard (NAAQS) for ozone to 75 ppb, expressed as the fourth-highest daily maximum 8-hr average over a 24-hr period. Based on recent monitoring data, U.S. ozone levels still exceed this standard in numerous locations, resulting in avoidable adverse health consequences. Objectives: We sought to quantify the potential human health benefits from achieving the current primary NAAQS standard of 75 ppb and two alternative standard levels, 70 and 60 ppb, which represent the range recommended by the U.S. EPA Clean Air Scientific Advisory Committee (CASAC). Methods: We applied health impact assessment methodology to estimate numbers of deaths and other adverse health outcomes that would have been avoided during 2005, 2006, and 2007 if the current (or lower) NAAQS ozone standards had been met. Estimated reductions in ozone concentrations were interpolated according to geographic area and year, and concentration–response functions were obtained or derived from the epidemiological literature. Results: We estimated that annual numbers of avoided ozone-related premature deaths would have ranged from 1,410 to 2,480 at 75 ppb to 2,450 to 4,130 at 70 ppb, and 5,210 to 7,990 at 60 ppb. Acute respiratory symptoms would have been reduced by 3 million cases and school-loss days by 1 million cases annually if the current 75-ppb standard had been attained. Substantially greater health benefits would have resulted if the CASAC-recommended range of standards (70–60 ppb) had been met. Conclusions: Attaining a more stringent primary ozone standard would significantly reduce ozone-related premature mortality and morbidity. PMID:22809899

Ten Important Tips in Treating a Patient with Lumbar Disc Herniation

PubMed Central

Hejrati, Hamid; Ariamanesh, Shahrara

2016-01-01

Lumbar disc herniation is a common spinal disorder that usually responds favorably to conservative treatment. In a small percentage of the patients, surgical decompression is necessary. Even though lumbar discectomy constitutes the most common and easiest spine surgery globally, adverse or even catastrophic events can occur. Appropriate patient selection and effective neural decompression constitute the most important points for better surgical outcomes and avoidance of unpleasant complications. Other important tips include timely performance of magnetic resonance imaging, correct interpretation of scan data, preoperative detection of underlying instability, exclusion of non-discogenic sciatica, determination of the main cause of clinical pathology, avoidance of the wrong side or level, and being sure that the more detailed procedure does not necessarily mean the more effective procedure. PMID:27790328

Cost-effectiveness of natalizumab vs fingolimod for the treatment of relapsing-remitting multiple sclerosis: analyses in Sweden.

PubMed

O'Day, Ken; Meyer, Kellie; Stafkey-Mailey, Dana; Watson, Crystal

2015-04-01

To assess the cost-effectiveness of natalizumab vs fingolimod over 2 years in relapsing-remitting multiple sclerosis (RRMS) patients and patients with rapidly evolving severe disease in Sweden. A decision analytic model was developed to estimate the incremental cost per relapse avoided of natalizumab and fingolimod from the perspective of the Swedish healthcare system. Modeled 2-year costs in Swedish kronor of treating RRMS patients included drug acquisition costs, administration and monitoring costs, and costs of treating MS relapses. Effectiveness was measured in terms of MS relapses avoided using data from the AFFIRM and FREEDOMS trials for all patients with RRMS and from post-hoc sub-group analyses for patients with rapidly evolving severe disease. Probabilistic sensitivity analyses were conducted to assess uncertainty. The analysis showed that, in all patients with MS, treatment with fingolimod costs less (440,463 Kr vs 444,324 Kr), but treatment with natalizumab results in more relapses avoided (0.74 vs 0.59), resulting in an incremental cost-effectiveness ratio (ICER) of 25,448 Kr per relapse avoided. In patients with rapidly evolving severe disease, natalizumab dominated fingolimod. Results of the sensitivity analysis demonstrate the robustness of the model results. At a willingness-to-pay (WTP) threshold of 500,000 Kr per relapse avoided, natalizumab is cost-effective in >80% of simulations in both patient populations. Limitations include absence of data from direct head-to-head studies comparing natalizumab and fingolimod, use of relapse rate reduction rather than sustained disability progression as the primary model outcome, assumption of 100% adherence to MS treatment, and exclusion of adverse event costs in the model. Natalizumab remains a cost-effective treatment option for patients with MS in Sweden. In the RRMS patient population, the incremental cost per relapse avoided is well below a 500,000 Kr WTP threshold per relapse avoided. In the rapidly evolving severe disease patient population, natalizumab dominates fingolimod.

An anthropological analysis of the perspectives of Somali women in the West and their obstetric care providers on caesarean birth.

PubMed

Essén, Birgitta; Binder, Pauline; Johnsdotter, Sara

2011-03-01

We explored the perceptions of 39 Somali women and 62 obstetric care providers in London in relation to caesarean birth, as borne out of a paradox we recognised from evidence-based information about the Somali group. Socio-cultural factors potentially leading to adverse obstetric outcome were identified using in-depth and focus group interviews with semi-structured, open-ended questions. A cultural anthropology model, the emic/etic model, was used for analysis. Somali women expressed fear and anxiety throughout the pregnancy and identified strategies to avoid caesarean section (CS). There was widespread, yet anecdotal, awareness among obstetric care providers about negative Somali attitudes. Caesarean avoidance and refusal were expressed as being highly stressful among providers, but also as being the responsibility of the women and families. For women, avoiding or refusing caesarean was based on a rational choice to avoid death and coping with adverse outcome relied on fatalistic attitudes. Motivation for the development of preventive actions among both groups was not described, which lends weight to the vast distinction and lack of correspondence in identified perspectives between Somali women and UK obstetric providers. Early booking and identification of women likely to avoid caesarean is proposed, as is the development of preventive strategies to address CS avoidance.

Occidental Geothermal, Inc. , Oxy Geothermal Power Plant No. 1: draft environmental impact report

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

Not Available

1981-08-01

The following aspects of the proposed geothermal power plant are discussed: the project description; the environment in the vicinity of project as it exists before the project begins, from both a local and regional perspective; the adverse consequences of the project, any significant environmental effects which cannot be avoided, and any mitigation measures to minimize significant effects; the potential feasible alternatives to the proposed project; the significant unavoidable, irreversible, and long-term environmental impacts; and the growth inducing impacts. (MHR)

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

Thurman, J.

Can operating companies cost-effectively manage environmental risks, meet compliance requirements and attain financial and market-oriented goals? Yes, if top management fully supports incorporating environmental-risk issues into the corporate management system. Using evaluation tools such as risk assessment and environmental audits, operators can fully define their environment condition and risk level. Working these results, HPI companies can take action to reduce the probability of environmental accidents and mitigate adverse event effects. Adopting this top-down, proactive outlook, organizations can evade environmental catastrophes, avoid negative public image and prevent ruined reputations.

Oral and sublingual immunotherapy for egg allergy.

PubMed

Romantsik, Olga; Tosca, Maria Angela; Zappettini, Simona; Calevo, Maria Grazia

2018-04-20

Clinical egg allergy is a common food allergy. Current management relies upon strict allergen avoidance. Oral immunotherapy might be an optional treatment, through desensitization to egg allergen. To determine the efficacy and safety of oral and sublingual immunotherapy in children and adults with immunoglobulin E (IgE)-mediated egg allergy as compared to a placebo treatment or an avoidance strategy. We searched 13 databases for journal articles, conference proceedings, theses and trials registers using a combination of subject headings and text words (last search 31 March 2017). We included randomized controlled trials (RCTs) comparing oral immunotherapy or sublingual immunotherapy administered by any protocol with placebo or an elimination diet. Participants were children or adults with clinical egg allergy. We retrieved 97 studies from the electronic searches. We selected studies, extracted data and assessed the methodological quality. We attempted to contact the study investigators to obtain the unpublished data, wherever possible. We used the I² statistic to assess statistical heterogeneity. We estimated a pooled risk ratio (RR) with 95% confidence interval (CI) for each outcome using a Mantel-Haenzel fixed-effect model if statistical heterogeneity was low (I² value less than 50%). We rated the quality of evidence for all outcomes using GRADE. We included 10 RCTs that met our inclusion criteria, that involved a total of 439 children (oral immunotherapy 249; control intervention 190), aged 1 year to 18 years. Each study used a different oral immunotherapy protocol; none used sublingual immunotherapy. Three studies used placebo and seven used an egg avoidance diet as the control. Primary outcomes were: an increased amount of egg that can be ingested and tolerated without adverse events while receiving allergen-specific oral immunotherapy or sublingual immunotherapy, compared to control; and a complete recovery from egg allergy after completion of oral immunotherapy or sublingual immunotherapy, compared to control. Most children (82%) in the oral immunotherapy group could ingest a partial serving of egg (1 g to 7.5 g) compared to 10% of control group children (RR 7.48, 95% CI 4.91 to 11.38; RD 0.73, 95% CI 0.67 to 0.80). Fewer than half (45%) of children receiving oral immunotherapy were able to tolerate a full serving of egg compared to 10% of the control group (RR 4.25, 95% CI 2.77 to 6.53; RD 0.35, 95% CI 0.28 to 0.43). All 10 trials reported numbers of children with serious adverse events (SAEs) and numbers of children with mild-to-severe adverse events. SAEs requiring epinephrine/adrenaline presented in 21/249 (8.4%) of children in the oral immunotherapy group, and none in the control group. Mild-to-severe adverse events were frequent; 75% of children presented mild-to-severe adverse events during oral immunotherapy treatment versus 6.8% of the control group (RR 8.35, 95% CI 5.31 to 13.12). Of note, seven studies used an egg avoidance diet as the control. Adverse events occurred in 4.2% of children, which may relate to accidental ingestion of egg-containing food. Three studies used a placebo control with adverse events present in 2.6% of children. Overall, there was inconsistent methodological rigour in the trials. All studies enrolled small numbers of children and used different methods to provide oral immunotherapy. Eight included studies were judged to be at high risk of bias in at least one domain. Furthermore, the quality of evidence was judged to be low due to small numbers of participants and events, and possible biases. Frequent and increasing exposure to egg over one to two years in people who are allergic to egg builds tolerance, with almost everyone becoming more tolerant compared with a minority in the control group and almost half of people being totally tolerant of egg by the end of treatment compared with 1 in 10 people who avoid egg. However, nearly all who received treatment experienced adverse events, mainly allergy-related. We found that 1 in 12 children had serious allergic reactions requiring adrenaline, and some people gave up oral immunotherapy. It appears that oral immunotherapy for egg allergy is effective, but confidence in the trade-off between benefits and harms is low; because there was a small number of trials with few participants, and methodological problems with some trials.

Glucocorticoid treatment and impaired mood, memory and metabolism in people with diabetes: the Edinburgh Type 2 Diabetes Study.

PubMed

Reynolds, Rebecca M; Labad, Javier; Sears, Alison V; Williamson, Rachel M; Strachan, Mark W J; Deary, Ian J; Lowe, Gordon D O; Price, Jackie F; Walker, Brian R

2012-05-01

Both type 2 diabetes and glucocorticoid therapy are highly prevalent. Although people with type 2 diabetes may be more susceptible to adverse effects of glucocorticoids, and it is recommended that glucocorticoid therapy is avoided for fear of worsening glycaemic control, the extent to which this advice is followed and the consequences when glucocorticoids are prescribed are poorly documented. The aim was to assess the characteristics of people with type 2 diabetes prescribed glucocorticoids in a real-world setting and to quantify resulting adverse effects. Cross-sectional cohort study. Cardiometabolic variables, body fat distribution, cognitive function and mood were studied in the 1066 participants of the Edinburgh Type 2 Diabetes Study, of whom 162 (15%) were taking systemic, topical or inhaled glucocorticoids. Glucocorticoid therapy was more common in women and in smokers but was not avoided in patients with diabetic complications or cardiovascular risk factors. People taking glucocorticoids were more centrally obese with slightly higher HbA1c and total serum cholesterol but were no more likely to have hepatic steatosis or hypertension. Glucocorticoid treatment was associated with substantially lower mood and greater anxiety. Women taking glucocorticoid therapy were twice as likely to report depressive symptoms compared with those not taking treatment. Glucocorticoid therapy was also associated with poorer cognitive function among those with subclinical atherosclerosis, as indicated by low ankle-brachial pressure index. Glucocorticoids are prescribed commonly for people with type 2 diabetes despite being associated with adverse indices of glycaemic control, cardiovascular risk factors, mood and cognitive function.

Nab-paclitaxel-associated photosensitivity: report in a woman with non-small cell lung cancer and review of taxane-related photodermatoses.

PubMed

Beutler, Bryce D; Cohen, Philip R

2015-04-01

Taxanes [paclitaxel, nab-paclitaxel (Abraxane, Celgene Corp, USA), and docetaxel]-used in the treatment of lung, breast, and head and neck cancers-have been associated with cutaneous adverse effects, including photodermatoses. We describe a woman with non-small cell lung cancer who developed a photodistributed dermatitis associated with her nab-paclitaxel therapy and review photodermatoses in patients receiving taxanes. The features of a woman with a nab-paclitaxel-associated photodistributed dermatitis are presented and the literature on nab-paclitaxel-associated photosensitivity is reviewed. Our patient developed nab-paclitaxel-associated photodistributed dermatitis on the sun-exposed surfaces of her upper extremities, which was exacerbated with each course of nab-paclitaxel. Biopsies revealed an interface dermatitis and laboratory studies were negative for lupus erythematosus and dermatomyositis. Her condition improved following topical corticosteroid cream application and strict avoidance of sunlight. Chemotherapy can be associated with adverse mucocutaneous events, including dermatoses on sun-exposed areas of the skin. Paclitaxel and nab-paclitaxel have both been associated with photodermatoses, including dermatitis, erythema multiforme, onycholysis, and subacute cutaneous lupus erythematosus. Strict avoidance of sun exposure, topical or oral corticosteroids, and/or discontinuation of the drug results in improvement with progressive resolution of symptoms and skin lesions. Development of photodermatoses is not an absolute contraindication to continuing chemotherapy, provided that the cutaneous condition resolves with dermatosis-directed treatment and the patient avoids sun exposure.

Inhibition of myostatin with emphasis on follistatin as a therapy for muscle disease.

PubMed

Rodino-Klapac, Louise R; Haidet, Amanda M; Kota, Janaiah; Handy, Chalonda; Kaspar, Brian K; Mendell, Jerry R

2009-03-01

In most cases, pharmacologic strategies to treat genetic muscle disorders and certain acquired disorders, such as sporadic inclusion body myositis, have produced modest clinical benefits. In these conditions, inhibition of the myostatin pathway represents an alternative strategy to improve functional outcomes. Preclinical data that support this approach clearly demonstrate the potential for blocking the myostatin pathway. Follistatin has emerged as a powerful antagonist of myostatin that can increase muscle mass and strength. Follistatin was first isolated from the ovary and is known to suppress follicle-stimulating hormone. This raises concerns for potential adverse effects on the hypothalamic-pituitary-gonadal axis and possible reproductive capabilities. In this review we demonstrate a strategy to bypass off-target effects using an alternatively spliced cDNA of follistatin (FS344) delivered by adeno-associated virus (AAV) to muscle. The transgene product is a peptide of 315 amino acids that is secreted from the muscle and circulates in the serum, thus avoiding cell-surface binding sites. Using this approach our translational studies show increased muscle size and strength in species ranging from mice to monkeys. Adverse effects are avoided, and no organ system pathology or change in reproductive capabilities has been seen. These findings provide the impetus to move toward gene therapy clinical trials with delivery of AAV-FS344 to increase size and function of muscle in patients with neuromuscular disease.

ACHP | Guidance on Use of Real Property Restrictions or Conditions in the

Science.gov Websites

various reasons and in different ways. For instance, an agency may determine the property is excess to its the purposes of Section 106. 36 C.F.R. § 800.2(c)(1-2). Preservation Condition Enforcement Entity Restrictions or Conditions in the Section 106 Process to Avoid Adverse Effects ACHP home Guidance on Use of

Building on a solid foundation: SAR and QSAR as a fundamental strategy to reduce animal testing.

PubMed

Sullivan, K M; Manuppello, J R; Willett, C E

2014-01-01

The development of more efficient, ethical, and effective means of assessing the effects of chemicals on human health and the environment was a lifetime goal of Gilman Veith. His work has provided the foundation for the use of chemical structure for informing toxicological assessment by regulatory agencies the world over. Veith's scientific work influenced the early development of the SAR models in use today at the US Environmental Protection Agency. He was the driving force behind the Organisation for Economic Co-operation and Development QSAR Toolbox. Veith was one of a few early pioneers whose vision led to the linkage of chemical structure and biological activity as a means of predicting adverse apical outcomes (known as a mode of action, or an adverse outcome pathway approach), and he understood at an early stage the power that could be harnessed when combining computational and mechanistic biological approaches as a means of avoiding animal testing. Through the International QSAR Foundation he organized like-minded experts to develop non-animal methods and frameworks for the assessment of chemical hazard and risk for the benefit of public and environmental health. Avoiding animal testing was Gil's passion, and his work helped to initiate the paradigm shift in toxicology that is now rendering this feasible.

Avoiding and treating dermal filler complications.

PubMed

Lemperle, Gottfried; Rullan, Peter P; Gauthier-Hazan, Nelly

2006-09-01

All fillers are associated with the risk of both early and late complications. Early side effects such as swelling, redness, and bruising occur after intradermal or subdermal injections. The patient has to be aware of and accept these risks. Adverse events that last longer than 2 weeks can be attributable to technical shortcomings (e.g., too superficial an implantation of a long-lasting filler substance). Such adverse events can be treated with intradermal 5-fluorouracil, steroid injections, vascular lasers, or intense pulsed light, and later with dermabrasion or shaving. Late adverse events also include immunologic phenomena such as late-onset allergy and nonallergic foreign body granuloma. Both react well to intralesional steroid injections, which often have to be repeated to establish the right dose. Surgical excisions shall remain the last option and are indicated for hard lumps in the lips and visible hard nodules or hard granuloma in the subcutaneous fat.

Recruitment efforts to reduce adverse impact: targeted recruiting for personality, cognitive ability, and diversity.

PubMed

Newman, Daniel A; Lyon, Julie S

2009-03-01

Noting the presumed tradeoff between diversity and performance goals in contemporary selection practice, the authors elaborate on recruiting-based methods for avoiding adverse impact while maintaining aggregate individual productivity. To extend earlier work on the primacy of applicant pool characteristics for resolving adverse impact, they illustrate the advantages of simultaneous cognitive ability- and personality-based recruiting. Results of an algebraic recruiting model support general recruiting for cognitive ability, combined with recruiting for conscientiousness within the underrepresented group. For realistic recruiting effect sizes, this type of recruiting strategy greatly increases average performance of hires and percentage of hires from the underrepresented group. Further results from a policy-capturing study provide initial guidance on how features of organizational image can attract applicants with particular job-related personalities and abilities, in addition to attracting applicants on the basis of demographic background. (c) 2009 APA, all rights reserved.

Analyses of factors of crash avoidance maneuvers using the general estimates system.

PubMed

Yan, Xuedong; Harb, Rami; Radwan, Essam

2008-06-01

Taking an effective corrective action to a critical traffic situation provides drivers an opportunity to avoid crash occurrence and minimize crash severity. The objective of this study is to investigate the relationship between the probability of taking corrective actions and the characteristics of drivers, vehicles, and driving environments. Using the 2004 GES crash database, this study classified drivers who encountered critical traffic events (identified as P_CRASH3 in the GES database) into two pre-crash groups: corrective avoidance actions group and no corrective avoidance actions group. Single and multiple logistic regression analyses were performed to identify potential traffic factors associated with the probability of drivers taking corrective actions. The regression results showed that the driver/vehicle factors associated with the probability of taking corrective actions include: driver age, gender, alcohol use, drug use, physical impairments, distraction, sight obstruction, and vehicle type. In particular, older drivers, female drivers, drug/alcohol use, physical impairment, distraction, or poor visibility may increase the probability of failing to attempt to avoid crashes. Moreover, drivers of larger size vehicles are 42.5% more likely to take corrective avoidance actions than passenger car drivers. On the other hand, the significant environmental factors correlated with the drivers' crash avoidance maneuver include: highway type, number of lanes, divided/undivided highway, speed limit, highway alignment, highway profile, weather condition, and surface condition. Some adverse highway environmental factors, such as horizontal curves, vertical curves, worse weather conditions, and slippery road surface conditions are correlated with a higher probability of crash avoidance maneuvers. These results may seem counterintuitive but they can be explained by the fact that motorists may be more likely to drive cautiously in those adverse driving environments. The analyses revealed that drivers' distraction could be the highest risk factor leading to the failure of attempting to avoid crashes. Further analyses entailing distraction causes (e.g., cellular phone use) and their possible countermeasures need to be conducted. The age and gender factors are overrepresented in the "no avoidance maneuver." A possible solution could involve the integration of a new function in the current ITS technologies. A personalized system, which could be related to the expected type of maneuver for a driver with certain characteristics, would assist different drivers with different characteristics to avoid crashes. Further crash database studies are recommended to investigate the association of drivers' emergency maneuvers such as braking, steering, or their combination with crash severity.

Examining the role of attachment in the relationship between childhood adversity, psychological distress and subjective well-being.

PubMed

Corcoran, Mark; McNulty, Muireann

2018-02-01

Childhood adversity is associated with a wide range of detrimental psychological consequences. This study examined the mediating role of relationship-specific attachment (avoidance and anxiety) in the associations between childhood adversity and both psychological distress and subjective well-being. University students (N=190) across the Republic of Ireland completed self-report measures including the Adverse Childhood Experiences scale, Experiences in Close Relationships - Relationship Structures scale, Depression Anxiety and Stress scales and measures of subjective well-being. One hundred and twenty-eight participants (67.4%) reported experiencing at least one adverse childhood experience. Childhood adversity was associated with symptoms of psychological distress and subjective well-being. All such associations were mediated by certain relationship-specific attachment dimensions. Of these, attachment anxiety in general relationships was the most prominent mediator for both psychological distress and subjective well-being. Attachment to one's father and to one's romantic partner did not mediate any association. These findings indicate that attachment, in particular relationships, is an important factor in the associations between childhood adversity and both psychological distress and subjective well-being as an adult. One's attachment anxiety in general relationships is particularly important in these associations. Therapeutic interventions addressing these attachment domains may offset the detrimental effects of childhood adversity. Future research is required using a longitudinal design. Copyright © 2017 Elsevier Ltd. All rights reserved.

Prescribing psychotropic drugs to adults with an intellectual disability

PubMed Central

Trollor, Julian N; Salomon, Carmela; Franklin, Catherine

2016-01-01

SUMMARY Mental illness is common in people with intellectual disability. They may also have physical health problems which can affect their mental state. Difficulties in communication can contribute to mental health problems being overlooked. These may present with changes in behaviour. Psychological management is usually preferable to prescribing psychotropic drugs. Behavioural approaches are the most appropriate way to manage challenging behaviour. If a drug is considered, prescribers should complete a thorough diagnostic assessment, exclude physical and environmental contributions to symptoms, and consider medical comorbidities before prescribing. Where possible avoid psychotropics with the highest cardiometabolic burden. Prescribe the minimum effective dose and treatment length, and regularly monitor drug efficacy and adverse effects. There is insufficient evidence to support the use of psychotropics for challenging behaviour. They should be avoided unless the behaviour is severe and non-responsive to other treatments. PMID:27756975

Reduction of Serious Adverse Events Demanding Study Exclusion in Model Development: Extracorporeal Life Support Resuscitation of Ventricular Fibrillation Cardiac Arrest in Rats.

PubMed

Warenits, Alexandra-Maria; Sterz, Fritz; Schober, Andreas; Ettl, Florian; Magnet, Ingrid Anna Maria; Högler, Sandra; Teubenbacher, Ursula; Grassmann, Daniel; Wagner, Michael; Janata, Andreas; Weihs, Wolfgang

2016-12-01

Extracorporeal life support is a promising concept for selected patients in refractory cardiogenic shock and for advanced life support of persistent ventricular fibrillation cardiac arrest. Animal models of ventricular fibrillation cardiac arrest could help to investigate new treatment strategies for successful resuscitation. Associated procedural pitfalls in establishing a rat model of extracorporeal life support resuscitation need to be replaced, refined, reduced, and reported.Anesthetized male Sprague-Dawley rats (350-600 g) (n = 126) underwent cardiac arrest induced with a pacing catheter placed into the right ventricle via a jugular cannula. Rats were resuscitated with extracorporeal life support, mechanical ventilation, defibrillation, and medication. Catheter and cannula explantation was performed if restoration of spontaneous circulation was achieved. All observed serious adverse events (SAEs) occurring in each of the experimental phases were analyzed.Restoration of spontaneous circulation could be achieved in 68 of 126 rats (54%); SAEs were observed in 76 (60%) experiments. Experimental procedures related SAEs were 62 (82%) and avoidable human errors were 14 (18%). The most common serious adverse events were caused by insertion or explantation of the venous bypass cannula and resulted in lethal bleeding, cannula dislocation, or air embolism.Establishing an extracorporeal life support model in rats has confronted us with technical challenges. Even advancements in small animal critical care management over the years delivered by an experienced team and technical modifications were not able to totally avoid such serious adverse events. Replacement, refinement, and reduction reports of serious adverse events demanding study exclusions to avoid animal resources are missing and are presented hereby.

[Safety evaluation and risk control measures of Cassiae Semen].

PubMed

Zhao, Yi-Meng; Wu, Li; Zhang, Shuo; Zhang, Li; Gao, Xue-Min; Sun, Xiao-Bo; Wang, Chun

2017-11-01

In this study, the authors reviewed domestic and foreign literatures, conducted the textual research on origin and development of Cassia Semen, studied records in ancient books and ancient and modern literatures, clinical adverse reactions and relevant experimental studies in recent years, and summarized the clinical features and influencing factors related to the safety of Cassiae Semen. According to the findings,Cassia Semen's safety risks are mainly liver and kidney system damages, with the main clinical features of fatigue, anorexia, disgusting of oil, yellow urine and gray stool; digestive system injury, with the main clinical features of diarrhea, abdominal distension, nausea and loose stool; reproductive system damage, with the main clinical features of vaginal bleeding. Allergic reactions and clinical adverse events, with the main clinical features for numb mouth, itching skin, nausea and vomiting, diarrhea, wheezing and lip cyanosis were also reported. The toxicological studies on toxic components of Cassiae Semen obtusifolia were carried out through acute toxicity test, subacute toxicity test, subchronic toxicity test and chronic toxicity test. Risk factors might include patients, compatibility and physicians. Physicians should strictly abide by the medication requirements in the Pharmacopoeia, pay attention to rational compatibility, appropriate dosage,correct usage and appropriate processing, control the dosage below 15 g to avoid excessive intake, strictly control the course of treatment to avoid accumulated poisoning caused by long-term administration. At the same time, clinicians should pay attention to the latest research progress, update the knowledge structure, quickly find the latest and useful materials from clinical practice, scientific research and drug information and other literatures, make evaluation and judgment for the materials, establish a traditional Chinese medicine intelligence information library, and strengthen the control over adverse effects with a pre-warning consciousness. The authors suggested standardizing clinical medication of Cassiae Semen, and avoiding misuse or excessive use; clinicians should prescribe it in strict accordance with there commended usage and dosage in the Pharmacopoeia, and focus on the safety signal accumulation in clinic, while strengthening studies for toxic substance basis and toxicity mechanism, in order to give full play to Cassiae Semen's clinical efficacy and reduce its adverse reactions. Copyright© by the Chinese Pharmaceutical Association.

Safety of sports participation in patients with implantable cardioverter defibrillators: a survey of heart rhythm society members.

PubMed

Lampert, Rachel; Cannom, David; Olshansky, Brian

2006-01-01

Safety of Sports for ICD Patients. The safety of sports participation for patients with implantable cardioverter defibrillators (ICDs) is unknown, and recommendations among physicians may vary widely. The purposes of this study were to determine current practice among patients with ICDs and their physicians regarding sports participation, and to determine how many physicians have cared for patients who have sustained adverse events during sports participation. A survey was mailed to all 1,687 U.S. physician members of the Heart Rhythm Society. Among 614 respondent physicians, recommendations varied widely. Only 10% recommended avoidance of all sports more vigorous than golf. Seventy-six percent recommended avoidance of contact, and 45% recommend avoidance of competitive sports. Most (71%) based restrictions on patients' underlying heart disease. Regardless of recommendations, most physicians (71%) reported caring for patients who participated in sports, including many citing vigorous, competitive sports, most commonly cited were basketball, running, and skiing. ICD shocks during sports were common, cited by 40% of physicians. However, few adverse consequences were reported. One percent of physicians reported known injury to patient (all but 3 minor); 5%, injury to the ICD system, and <1%, failure of shocks to terminate arrhythmia. The most common adverse event reported was lead damage attributed to repetitive-motion activities, most commonly weightlifting and golf. Physician recommendations for sports participation for patients with ICDs varies widely. Many patients with ICDs do participate in vigorous and even competitive sports. While shocks were common, significant adverse events were rare.

Benefits of and Barriers to Pharmacogenomics-Guided Treatment for Major Depressive Disorder.

PubMed

Ahmed, Ahmed T; Weinshilboum, Richard; Frye, Mark A

2018-05-01

Antidepressants have reduced the symptom burden for many Major Depressive Disorder (MDD) patients, but drug-related side effects and treatment resistance continue to present major challenges. Pharmacogenomics represents one approach to enhance antidepressant efficacy and avoid adverse reactions, but concerns remain with regard to the overall "value equation," and several barriers must be overcome to achieve the full potential of MDD pharmacogenomics. © 2018 American Society for Clinical Pharmacology and Therapeutics.

[Efficacy and safety of TS-1 monotherapy for advanced/metastatic breast cancer - an observational study by the Kumamoto Breast Cancer Cooperative Group(KBCCG)].

PubMed

Yamamoto, Yutaka; Nishimura, Reiki; Tanigawa, Tomio; Kawano, Ichiro; Hayashi, Kyoji; Kuramoto, Masafumi; Yamamoto-Ibusuki, Mutsuko; Iwase, Hirotaka

2014-10-01

TS-1, an oral fluoropyrimidine, is known to be effective for the treatment of various carcinomas including advanced/metastatic breast cancer.The Kumamoto Breast Cancer Cooperative Group(KBCCG)conducted an observational study, wherein, the efficacy and safety of TS-1 monotherapy was analyzed in 35 patients with recurrent or metastatic breast cancer.The median time to cancer progression was 3.7 months, overall response rate was 12%, and clinical benefit rate was 32%. Adverse events were observed in 27 patients(77%), and adverse events of Grade >3 were observed in 7 patients(20%). The rate of treatment-related Grade 3 and 4 adverse events increased, and was associated with poor levels of creatinine clearance(Ccr)ie <60mL/min.This study suggests that TS-1 monotherapy can potentially be used as a salvage treatment for advanced/metastatic breast cancer owing to its safety and efficacy.Measuring the level of Ccr before TS-1 therapy should be considered to avoid severe adverse events.

Anesthesia and Brugada syndrome: a 12-year case series.

PubMed

Duque, Mélanie; Santos, Luís; Ribeiro, Sandy; Catré, Dora

2017-02-01

The aim of this 12-year case series was to review the drugs used during anesthetic management of patients with diagnosis of or risk criteria for Brugada syndrome (BrS), and to document any possible association between these drugs and arrhythmogenic activity or unexplained hemodynamic instability. A retrospective clinical observational study. Tertiary hospital. Thirty-one patients met our inclusion criteria: 20 belonging to group D (diagnosed BrS) and 11 to group R (risk of BrS). They underwent a total of 43 anesthetic interventions (28 in group D and 15 in group R). Records from patients with or at risk of BrS who underwent anesthetic intervention at our hospital between May 2003 and May 2015 were retrospectively reviewed. Drugs used were compared with those recommended to be avoided or preferably avoided, published by specialists in the field at brugadadrugs.org. Hemodynamic and cardiac complications during anesthesia were assessed for hypothetical association with these drugs. From the list of drugs available in medical literature recommended to avoid in BrS patients the following were used in our series: propofol (n = 8 in group D, n = 8 in group R), local anesthetics (n = 15 in group D, n = 8 in group R), tramadol (n = 1 in group D), and metoclopramide (n = 1 in group D). Hemodynamic complications occurred in 5 procedures, but no direct association was found between these events and the use of the drugs listed above. Major adverse events related to the deleterious effects of drugs recommended to be avoided were not detected in our series of patients with or at risk of BrS. Although authors cannot refute the theoretical risk of major adverse advents when using known or potential BrS triggers, the true clinical risk of these drugs is unknown, and recommendations to avoid their use should be better supported. Copyright © 2016 Elsevier Inc. All rights reserved.

Energy drinks: potions of illusion.

PubMed

Bedi, Nidhi; Dewan, Pooja; Gupta, Piyush

2014-07-01

Energy drinks are widely consumed by adolescents as these claim to improve performance, endurance and alertness. Recent reports have shown that there are no real health benefits of these drinks. On the contrary, certain adverse effects due to energy drinks have come to the forefront, casting a big question-mark on their safety and utility. This review discusses the present status of energy drinks, their active ingredients and their safety. We conclude that energy drinks, despite having some short pleasant effects, can be harmful for the body and are best avoided.

Effect of caffeine on the anticonvulsant effects of oxcarbazepine, lamotrigine and tiagabine in a mouse model of generalized tonic-clonic seizures.

PubMed

Chrościńska-Krawczyk, Magdalena; Ratnaraj, Neville; Patsalos, Philip N; Czuczwar, Stanisław J

2009-01-01

Caffeine has been reported to be proconvulsant and to reduce the anticonvulsant efficacy of a variety of antiepileptic drugs (carbamazepine, phenobarbital, phenytoin, valproate and topiramate) in animal models of epilepsy and to increase seizure frequency in patients with epilepsy. Using the mouse maximal electroshock model, the present study was undertaken so as to ascertain whether caffeine affects the anticonvulsant efficacy of the new antiepileptic drugs lamotrigine, oxcarbazepine and tiagabine. The results indicate that neither acute nor chronic caffeine administration (up to 46.2 mg/kg) affected the ED(50) values of oxcarbazepine or lamotrigine against maximal electroshock. Similarly, caffeine did not modify the tiagabine electroconvulsive threshold. Furthermore, caffeine had no effect on oxcarbazepine, lamotrigine and tiagabine associated adverse effects such as impairment of motor coordination (measured by the chimney test) or long-term memory (measured by the passive avoidance task). Concurrent plasma concentration measurements revealed no significant effect on lamotrigine and oxcarbazepine concentrations. For tiagabine, however, chronic caffeine (4 mg/kg) administration was associated with an increase in tiagabine concentrations. In conclusion, caffeine did not impair the anticonvulsant effects of lamotrigine, oxcarbazepine, or tiagabine as assessed by electroconvulsions in mice. Also, caffeine was without effect upon the adverse potential of the studied antiepileptic drugs. Thus caffeine may not necessarily adversely affect the efficacy of all antiepileptic drugs and this is an important observation.

Medication errors: problems and recommendations from a consensus meeting

PubMed Central

Agrawal, Abha; Aronson, Jeffrey K; Britten, Nicky; Ferner, Robin E; de Smet, Peter A; Fialová, Daniela; Fitzgerald, Richard J; Likić, Robert; Maxwell, Simon R; Meyboom, Ronald H; Minuz, Pietro; Onder, Graziano; Schachter, Michael; Velo, Giampaolo

2009-01-01

Here we discuss 15 recommendations for reducing the risks of medication errors: Provision of sufficient undergraduate learning opportunities to make medical students safe prescribers. Provision of opportunities for students to practise skills that help to reduce errors. Education of students about common types of medication errors and how to avoid them. Education of prescribers in taking accurate drug histories. Assessment in medical schools of prescribing knowledge and skills and demonstration that newly qualified doctors are safe prescribers. European harmonization of prescribing and safety recommendations and regulatory measures, with regular feedback about rational drug use. Comprehensive assessment of elderly patients for declining function. Exploration of low-dose regimens for elderly patients and preparation of special formulations as required. Training for all health-care professionals in drug use, adverse effects, and medication errors in elderly people. More involvement of pharmacists in clinical practice. Introduction of integrated prescription forms and national implementation in individual countries. Development of better monitoring systems for detecting medication errors, based on classification and analysis of spontaneous reports of previous reactions, and for investigating the possible role of medication errors when patients die. Use of IT systems, when available, to provide methods of avoiding medication errors; standardization, proper evaluation, and certification of clinical information systems. Nonjudgmental communication with patients about their concerns and elicitation of symptoms that they perceive to be adverse drug reactions. Avoidance of defensive reactions if patients mention symptoms resulting from medication errors. PMID:19594525

Adverse life events and emotional and behavioural problems in adolescence: the role of coping and emotion regulation.

PubMed

Flouri, Eirini; Mavroveli, Stella

2013-12-01

We tested whether emotion regulation (cognitive reappraisal and expressive suppression) and coping (distraction, avoidance, support seeking and active coping) mediate or moderate the association between change in life stress (change in number of adverse life events) and change in adolescent problem behaviour. We used prospective and retrospective longitudinal data from a community sample. We measured change in problem behaviour as emotional and behavioural problems at Time 2 controlling for emotional and behavioural problems at Time 1, a year earlier. We measured change in life stress as life stress between Times 1 and 2, controlling for total previous life stress (before Time 1). Neither coping nor emotion regulation mediated the association between change in life stress and change in problem behaviour. Avoidance and expressive suppression were related to an increase in problem behaviour. Only cognitive reappraisal moderated the effect of increase in life stress on worsening of problem behaviour, suggesting that, as expected, cognitive reappraisal was a protective factor. In adolescents who reported they habitually reappraise, the association between change in life stress and change in emotional and behavioural problems was non-significant. Copyright © 2012 John Wiley & Sons, Ltd.

Distribution and Biological Effects of Nanoparticles in the Reproductive System.

PubMed

Liu, Ying; Li, Hongxia; Xiao, Kai

2016-01-01

Nanoparticles have shown great potential in biomedical applications such as imaging probes and drug delivery. However, the increasing use of nanoparticles has raised concerns about their adverse effects on human health and environment. Reproductive tissues and gametes represent highly delicate biological systems with the essential function of transmitting genetic information to the offspring, which is highly sensitive to environmental toxicants. This review aims to summarzie the penetration of physiological barriers (blood-testis barrier and placental barrier), distribution and biological effects of nanoparticles in the reproductive system, which is essential to control the beneficial effects of nanoparticles applications and to avoid their adverse effects on the reproductive system. We referred to a large number of relevant peer-reviewed research articles about the reproductive toxicity of nanoparticles. The comprehensive information was summarized into two parts: physiological barrier penetration and biological effects of nanoparticles in male or female reproductive system; distribution and metabolism of nanoparticles in the reproductive system. The representative examples were also presented in four tables. The in vitro and in vivo studies imply that some nanoparticles are able to cross the blood-testis barrier or placental barrier, and their penetration depends on the physicochemical characteristics of nanoparticles (e.g., composition, shape, particle size and surface coating). The toxicity assays indicate that nanoparticles might induce adverse physiological effects and impede fertility or embryogenesis. The barrier penetration, adverse physiological effects, distribution and metabolism are closely related to physicochemical characteristics of nanoparticles. Further systematic and mechanistic studies using well-characterized nanoparticles, relevant administration routes, and doses relevant to the expected exposure level are required to improve our understanding of biological effects of nanoparticles on the reproductive 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.

Efficacy of Ivermectin against Cheyletiella yasguri Infestation in Dogs

PubMed Central

Paradis, Manon; Villeneuve, Alain

1988-01-01

Twenty adult dogs (11 Cocker spaniels and 9 miniature Poodles) with naturally occurring cheyletiellosis were treated twice, at a three-week interval, with subcutaneous injections of ivermectin at the dose rate of 300 μg/kg. Ivermectin proved to be very effective against Cheyletiella yasguri infestation in dogs. All treated animals were completely cured after one or two treatments. No adverse reactions were noted. Ivermectin should be avoided in Collies and Collie crosses. PMID:17423097

Survival, Reproduction, Avoidance Behavior and Oxidative Stress Biomarkers in the Earthworm Octolasion cyaneum Exposed to Glyphosate.

PubMed

Salvio, Carla; Menone, Mirta L; Rafael, Sergio; Iturburu, Fernando G; Manetti, Pablo L

2016-03-01

The massive use of glyphosate (GLY) in several countries has increased the interest in investigating its potential adverse effects in non-target organisms. The aim of the present study was to assess the potential effects in survival and reproduction; avoidance behavior and oxidative stress under short-term (48 h) and subchronic exposures (28 days) to GLY in the earthworm Octolasion cyaneum. After 48 h no significant changes in the behavior was observed. In addition, a lower catalase activity at 498 μg GLY kg(-1) dry soil section relative to earthworms from the control section was obtained. After 28 days of exposure inhibition of glutathione S-transferase activity was observed at 535 μg GLY kg(-1) dry soil while no changes in the other endpoints were detected. These results indicate that environmentally relevant concentrations of GLY (up to 996 µg GLY kg(-1) dry soil) did not exert a toxic effect to O. cyaneum.

Health effects associated with passenger vehicles: monetary values of air pollution.

PubMed

Marzouk, Mohamed; Madany, Magdy

2012-01-01

Air pollution is regarded as one of the highest priorities in environmental protection in both developed and developing countries. High levels of air pollution have adverse effects on human health that might cause premature death. This study presents the monetary value estimates for the adverse human health effects resulted from ambient air pollution. It aids decision makers to set priorities in the public health relevance of pollution abatement. The main driver of policymaker is the need to reduce the avoidable cardiopulmonary morbidity and mortality from pollutant exposures. The monetary valuation involves 2 steps: (i) relate levels of pollutants to mortality and morbidity (concentration-response relationships) and (ii) apply unit economic values. Cost of air pollution associated with passenger vehicles running over a major traffic bridge (6th of October Elevated Highway) is presented as a case study to demonstrate the use of monetary value of air pollution. The study proves that the cost of air pollution is extremely high and should not be overlooked.

Defense mechanisms against toxic phytochemicals in the diet of domestic animals.

PubMed

Fink-Gremmels, Johanna

2010-02-01

Plant secondary metabolites (PSMs) are non-nutritional components that occur in numerous feed materials and are able to exert toxic effects in animals. The current article aims to summarize innate defense strategies developed by different animal species to avoid excessive exposure to PSMs. These mechanisms include pre-systemic degradation of PSMs by rumen microbiota, the intestinal barrier including efflux transporters of monogastric species, as well as pre-hepatic and intra-hepatic biotransformation processes. These physiological barriers determine systemic exposure and ultimately the dose-dependent adverse effects in the target animal species. Considering the large number of potentially toxic PSMs, which makes an evaluation of all individual PSMs virtually impossible, such a mechanism-oriented approach could improve the predictability of adverse effects and support the interpretation of clinical field observations. Moreover, mechanistic data related to tissue disposition and excretion pathways of PSMs for example into milk, could substantially support the assessment of the risks for consumers of foods derived from PSM-exposed animals.

[Important epidemiological features of the treatment of type 2 diabetes].

PubMed

Seguí Díaz, M

2014-07-01

According to the various clinical practice guidelines, the recommendations for the treatment of type 2 diabetes are well-established, thus leading to homogenization of clinical practice and avoiding variability. However, it is well known that, depending on factors such as effectiveness, physiopathology, cost, adverse effects, preferences, and comorbidities, each patient will, in the long-term, receive different treatment of type 2 diabetes. The consensus document published last year and approved by the American Diabetes Association and the European Association for the Study of Diabetes recommends distinct targets for each patient with type 2 diabetes and argues for the individualization of the management and treatment of this disease. In other words, the document advocates a patient-centered approach, in which the various therapeutic alternatives are related mainly to distinct physiopathological factors, adverse effects, and the patient's comorbidities, as well as the patient's preferences. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Rural y Generalista (SEMERGEN). All rights reserved.

What can individuals do to reduce personal health risks from air pollution?

PubMed Central

Laumbach, Robert; Meng, Qingyu

2015-01-01

In many areas of the world, concentrations of ambient air pollutants exceed levels associated with increased risk of acute and chronic health problems. While effective policies to reduce emissions at their sources are clearly preferable, some evidence supports the effectiveness of individual actions to reduce exposure and health risks. Personal exposure to ambient air pollution can be reduced on high air pollution days by staying indoors, reducing outdoor air infiltration to indoors, cleaning indoor air with air filters, and limiting physical exertion, especially outdoors and near air pollution sources. Limited evidence suggests that the use of respirators may be effective in some circumstances. Awareness of air pollution levels is facilitated by a growing number of public air quality alert systems. Avoiding exposure to air pollutants is especially important for susceptible individuals with chronic cardiovascular or pulmonary disease, children, and the elderly. Research on mechanisms underlying the adverse health effects of air pollution have suggested potential pharmaceutical or chemopreventive interventions, such as antioxidant or antithrombotic agents, but in the absence of data on health outcomes, no sound recommendations can be made for primary prevention. Health care providers and their patients should carefully consider individual circumstances related to outdoor and indoor air pollutant exposure levels and susceptibility to those air pollutants when deciding on a course of action to reduce personal exposure and health risks from ambient air pollutants. Careful consideration is especially warranted when interventions may have unintended negative consequences, such as when efforts to avoid exposure to air pollutants lead to reduced physical activity or when there is evidence that dietary supplements, such as antioxidants, have potential adverse health effects. These potential complications of partially effective personal interventions to reduce exposure or risk highlight the primary importance of reducing emissions of air pollutants at their sources. PMID:25694820

What can individuals do to reduce personal health risks from air pollution?

PubMed

Laumbach, Robert; Meng, Qingyu; Kipen, Howard

2015-01-01

In many areas of the world, concentrations of ambient air pollutants exceed levels associated with increased risk of acute and chronic health problems. While effective policies to reduce emissions at their sources are clearly preferable, some evidence supports the effectiveness of individual actions to reduce exposure and health risks. Personal exposure to ambient air pollution can be reduced on high air pollution days by staying indoors, reducing outdoor air infiltration to indoors, cleaning indoor air with air filters, and limiting physical exertion, especially outdoors and near air pollution sources. Limited evidence suggests that the use of respirators may be effective in some circumstances. Awareness of air pollution levels is facilitated by a growing number of public air quality alert systems. Avoiding exposure to air pollutants is especially important for susceptible individuals with chronic cardiovascular or pulmonary disease, children, and the elderly. Research on mechanisms underlying the adverse health effects of air pollution have suggested potential pharmaceutical or chemopreventive interventions, such as antioxidant or antithrombotic agents, but in the absence of data on health outcomes, no sound recommendations can be made for primary prevention. Health care providers and their patients should carefully consider individual circumstances related to outdoor and indoor air pollutant exposure levels and susceptibility to those air pollutants when deciding on a course of action to reduce personal exposure and health risks from ambient air pollutants. Careful consideration is especially warranted when interventions may have unintended negative consequences, such as when efforts to avoid exposure to air pollutants lead to reduced physical activity or when there is evidence that dietary supplements, such as antioxidants, have potential adverse health effects. These potential complications of partially effective personal interventions to reduce exposure or risk highlight the primary importance of reducing emissions of air pollutants at their sources.

Mefloquine in the nucleus accumbens promotes social avoidance and anxiety-like behavior in mice.

PubMed

Heshmati, Mitra; Golden, Sam A; Pfau, Madeline L; Christoffel, Daniel J; Seeley, Elena L; Cahill, Michael E; Khibnik, Lena A; Russo, Scott J

2016-02-01

Mefloquine continues to be a key drug used for malaria chemoprophylaxis and treatment, despite reports of adverse events like depression and anxiety. It is unknown how mefloquine acts within the central nervous system to cause depression and anxiety or why some individuals are more vulnerable. We show that intraperitoneal injection of mefloquine in mice, when coupled to subthreshold social defeat stress, is sufficient to produce depression-like social avoidance behavior. Direct infusion of mefloquine into the nucleus accumbens (NAc), a key brain reward region, increased stress-induced social avoidance and anxiety behavior. In contrast, infusion into the ventral hippocampus had no effect. Whole cell recordings from NAc medium spiny neurons indicated that mefloquine application increases the frequency of spontaneous excitatory postsynaptic currents, a synaptic adaptation that we have previously shown to be associated with increased susceptibility to social defeat stress. Together, these data demonstrate a role for the NAc in mefloquine-induced depression and anxiety-like behaviors. Copyright © 2015 Elsevier Ltd. All rights reserved.

To Take or Not to Take: Decision-Making About Antiretroviral Treatment in People Living with HIV/AIDS

PubMed Central

Kremer, Heidemarie; Ironson, Gail; Schneiderman, Neil; Hautzinger, Martin

2008-01-01

Knowledge is limited regarding decision-making about antiretroviral treatment (ART) from the patient’s perspective. This substudy of a longitudinal study of psychobiologic aspects of long-term survival, conducted in 2003, compares the rationales of HIV-positive individuals (n = 79) deciding to take or not to take ART. Inclusion criteria were HIV/AIDS symptoms, or CD4 nadir less than 350, or viral load greater than 55,000. Those not meeting any criteria for receiving ART (2/2003 U.S. DHHS treatment guidelines) were excluded. Diagnosis was on average 11 years ago; 36% were female, 42% African American, 28% Latino, 24% white, and 6% other. Qualitative content analysis of semistructured interviews identified 10 criteria for the decision to take or not to take ART: CD4/viral load counts (87%), quality of life (85%), knowledge/beliefs about resistance (66%), mind–body beliefs (65%), adverse effects of ART (59%), easy-to-take regimen (58%), spirituality/worldview (58%), drug resistance (41%), experience of HIV/AIDS symptoms (39%), and preference for complementary/alternative medicine (17%). Participants choosing not to take ART (27%) preferred complementary/alternative medicine (r = 0.43, p < 0.001)1, perceived a better quality of life without ART (r = 0.32, p < 0.004), and weighted avoidance of adverse effects of ART more heavily (r = 0.24, p < 0.030) than participants taking ART (73%). Demographic characteristics related to taking ART were having a partner (r = 0.31, p < 0.008) and having health insurance (r = 0.26, p < 0.040). Decisions to take or not to take ART depend not only on patient medical characteristics, but also on individual beliefs about ART, complementary/alternative medicine, spirituality, and mind–body connection. HIV-positive individuals declining treatment place more weight on alternative medicine, avoiding adverse effects and perceiving a better quality of life through not taking ART. PMID:16706708

A case of vemurafenib-induced polyarhritis in a patient with melanoma: how to manage it?

PubMed

Babacan, Taner; Türkbeyler, Ibrahim Halil; Balakan, Ozan; Pehlivan, Yavuz; Suner, Ali; Kısacık, Bunyamin

2017-03-01

Vemurafenib is an inhibitor of the BRAF V600E mutation which is associated with tumor responses in patients with metastatic melanoma. Although it is generally well tolerated, common side effects of vemurafenib have been reported. Arthralgia is one of the more common adverse event associated with vemurafenib. We herein report a 49-year-old woman diagnosed with metastatic melanoma harboring the BRAF V600E mutation with severe polyarthritis associated with vemurafenib after 7 days of treatment. Sonographic examination of affected joints revealed synovitis and the patient's articular symptoms were improved by analgesic and anti-inflammatory treatment, including corticosteroids. During therapy with selective BRAF inhibitors, arthritis represents a new adverse event that can require dose reduction. In case of this adverse event, treatment with anti-inflammatory drugs, such as ibuprofen and prednisone, should be initiated early to keep patients on treatment and to avoid drug discontinuation and tumor progression. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Avoiding unfavourable outcomes in liposuction

PubMed Central

Khanna, Atul; Filobbos, George

2013-01-01

The origin of liposuction can be traced to an adverse event by Dujarrier in 1921 when he used a uterine curette to remove fat from the knees of a ballerina ending in an amputation secondary to damage of the femoral artery. The history of liposuction since then has been one of avoiding complications and optimising outcome. After this adverse event, liposuction was abandoned until the 1960's when Schrudde revived the practice using small stab incisions and sharp curettage with the secondary suction to aspirate the freed tissue. This technique was associated with a high incidence of complications especially seroma and skin necrosis. Illouz then replaced the curette with a blunt cannula connected to vacuum pump thus avoiding the complications of a sharp curette. Despite the presence of various techniques for liposuction, suction assisted liposuction (SAL) is still the standard technique of liposuction. This article aims to discuss literature regarding the various aspects of liposuction (SAL) and to highlight the salient points in the literature and in the senior author's experience in order to avoid unfavourable outcomes in liposuction. A literature review on avoiding complication is in liposuction including some of the seminal papers on liposuction. Liposuction is generally a safe procedure with reproducible outcome. Just like any surgical procedure it should be treated with the utmost care. Illouz published 10 commandments for liposuction in 1989 and we review these commandments to demonstrate how liposuction has evolved. PMID:24501475

Safety of antimalarial medications for use while scuba diving in malaria Endemic Regions.

PubMed

Petersen, Kyle; Regis, David P

2016-01-01

Recreational diving occurs annually in areas of the world where malaria is endemic. The safety and efficacy of antimalarials for travelers in a hyperbaric environment is unknown. Of particular concern would be medications with adverse effects that could either mimic diving related illnesses such as barotrauma, decompression sickness (DCS) and gas toxicities, or increase the risk for such illnesses. We conducted a review of PubMed and Cochrane databases to determine rates of neurologic adverse effects or other effects from antimalarials that may be a problem in the diving environment. One case report was found on diving and mefloquine. Multiple case reports and clinical trials were found describing neurologic adverse effects of the major chemoprophylactic medications atovaquone/proguanil, chloroquine, doxycycline, mefloquine, and primaquine. Of the available literature, atovaquone/proguanil and doxycycline are most likely the safest agents and should be preferred; atovaquone/proguanil is superior due to reduced rates of sunburn in the marine environment. Primaquine also appears to be safe, but has reduced efficacy against P. falciparum ; mefloquine possesses the highest rate of neurologic side effects and therefore these agents should be limited to extreme cases of patients intolerant to other agents. Chloroquine appears unsafe in the hyperbaric environment and should be avoided. More studies are required to include database reviews of returned divers traveling to malaria endemic areas and randomized controlled trials in the hyperbaric environments.

Effects of traumatic experiences on obsessive-compulsive and internalizing symptoms: The role of avoidance and mindfulness.

PubMed

Kroska, Emily B; Miller, Michelle L; Roche, Anne I; Kroska, Sydney K; O'Hara, Michael W

2018-01-01

Trauma exposure is associated with adverse psychological outcomes including anxiety, depression, and obsessive-compulsive (OC) symptoms. Adolescence is increasingly recognized as a period of vulnerability for the onset of these types of psychological symptoms. The current study explored the mediating roles of experiential avoidance and mindfulness processes in the association between retrospective reports of childhood trauma and current internalizing and OC symptoms in adolescents. A group of at-risk adolescents (N = 51) and a group of college students (N = 400) reported on childhood trauma, experiential avoidance, mindfulness, anxiety, depressive, and OC symptoms. Mediation analyses were performed to examine the mechanistic roles of avoidance and mindfulness in the association between trauma and internalizing and OC-specific symptoms. In the group of at-risk adolescents, experiential avoidance and mindfulness both significantly mediated the association between childhood trauma and OC symptoms. In the college student sample, experiential avoidance mediated the association between trauma and OC symptoms. Experiential avoidance, as well as the observe, act with awareness, and nonjudgmental facets of mindfulness all significantly mediated the association between trauma and internalizing symptoms. The group of at-risk adolescents was small, and the college student group was demographically homogeneous. All data was self-report and cross-sectional. The current study demonstrated that experiential avoidance and mindfulness processes may be the mechanisms through which the association between trauma and obsessive-compulsive and trauma and internalizing symptoms exist in adolescents. These findings provide potential targets for clinical intervention to improve outcomes for adolescents who have experienced trauma. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of Traumatic Experiences on Obsessive-Compulsive and Internalizing Symptoms: The Role of Avoidance and Mindfulness

PubMed Central

Kroska, Emily B.; Miller, Michelle L.; Roche, Anne I.; Kroska, Sydney K.; O’Hara, Michael W.

2017-01-01

Background Trauma exposure is associated with adverse psychological outcomes including anxiety, depression, and obsessive-compulsive (OC) symptoms. Adolescence is increasingly recognized as a period of vulnerability for the onset of these types of psychological symptoms. The current study explored the mediating roles of experiential avoidance and mindfulness processes in the association between retrospective reports of childhood trauma and current internalizing and OC symptoms in adolescents. Method A group of at-risk adolescents (N =51) and a group of college students (N =400) reported on childhood trauma, experiential avoidance, mindfulness, anxiety, depressive, and OC symptoms. Mediation analyses were performed to examine the mechanistic roles of avoidance and mindfulness in the association between trauma and internalizing and OC-specific symptoms. Results In the group of at-risk adolescents, experiential avoidance and mindfulness both significantly mediated the association between childhood trauma and OC symptoms. In the college student sample, experiential avoidance mediated the association between trauma and OC symptoms. Experiential avoidance, as well as the observe, act with awareness, and nonjudgmental facets of mindfulness all significantly mediated the association between trauma and internalizing symptoms. Limitations The group of at-risk adolescents was small, and the college student group was demographically homogeneous. All data was self-report and cross-sectional. Conclusion The current study demonstrated that experiential avoidance and mindfulness processes may be the mechanisms through which the association between trauma and obsessive-compulsive and trauma and internalizing symptoms exist in adolescents. These findings provide potential targets for clinical intervention to improve outcomes for adolescents who have experienced trauma. PMID:28843915

Evidence for inbreeding depression and pre-copulatory, but not post copulatory inbreeding avoidance in the cabbage beetle Colaphellus bowringi.

PubMed

Liu, XingPing; Tu, XiaoYun; He, HaiMin; Chen, Chao; Xue, FangSen

2014-01-01

Inbreeding is known to have adverse effects on fitness-related traits in a range of insect species. A series of theoretical and experimental studies have suggested that polyandrous insects could avoid the cost of inbreeding via pre-copulatory mate choice and/or post-copulatory mechanisms. We looked for evidence of pre-copulatory inbreeding avoidance using female mate preference trials, in which females were given the choice of mating with either of two males, a sibling and a non-sibling. We also tested for evidence of post-copulatory inbreeding avoidance by conducting double mating experiments, in which four sibling females were mated with two males sequentially, either two siblings, two non-siblings or a sibling and a non-sibling in either order. We identified substantial inbreeding depression: offspring of females mated to full siblings had lower hatching success, slower development time from egg to adult, lower survival of larval and pupal stages, and lower adult body mass than the offspring of females mated to non-sibling males. We also found evidence of pre-copulatory inbreeding avoidance, as females preferred to mate with non-sibling males. However, we did not find any evidence of post-copulatory inbreeding avoidance: egg hatching success of females mating to both sibling and non-sibling males were consistent with sperm being used without bias in relation to mate relatedness. Our results suggest that this cabbage beetle has evolved a pre-copulatory mechanism to avoid matings between close relative, but that polyandry is apparently not an inbreeding avoidance mechanism in C. bowringi.

Evidence for Inbreeding Depression and Pre-Copulatory, but Not Post Copulatory Inbreeding Avoidance in the Cabbage Beetle Colaphellus bowringi

PubMed Central

Liu, XingPing; Tu, XiaoYun; He, HaiMin; Chen, Chao; Xue, FangSen

2014-01-01

Inbreeding is known to have adverse effects on fitness-related traits in a range of insect species. A series of theoretical and experimental studies have suggested that polyandrous insects could avoid the cost of inbreeding via pre-copulatory mate choice and/or post-copulatory mechanisms. We looked for evidence of pre-copulatory inbreeding avoidance using female mate preference trials, in which females were given the choice of mating with either of two males, a sibling and a non-sibling. We also tested for evidence of post-copulatory inbreeding avoidance by conducting double mating experiments, in which four sibling females were mated with two males sequentially, either two siblings, two non-siblings or a sibling and a non-sibling in either order. We identified substantial inbreeding depression: offspring of females mated to full siblings had lower hatching success, slower development time from egg to adult, lower survival of larval and pupal stages, and lower adult body mass than the offspring of females mated to non-sibling males. We also found evidence of pre-copulatory inbreeding avoidance, as females preferred to mate with non-sibling males. However, we did not find any evidence of post-copulatory inbreeding avoidance: egg hatching success of females mating to both sibling and non-sibling males were consistent with sperm being used without bias in relation to mate relatedness. Our results suggest that this cabbage beetle has evolved a pre-copulatory mechanism to avoid matings between close relative, but that polyandry is apparently not an inbreeding avoidance mechanism in C. bowringi. PMID:24718627

Prolonged Hypocalcemia Following a Single Dose of Denosumab for Diffuse Bone Metastasis of Gastric Cancer after Total Gastrectomy.

PubMed

Iizumi, Sakura; Shimoi, Tatsunori; Nishikawa, Tadaaki; Kitano, Atsuko; Sasada, Shinsuke; Shimomura, Akihiko; Noguchi, Emi; Yunokawa, Mayu; Yonemori, Kan; Shimizu, Chikako; Fujiwara, Yasuhiro; Tamura, Kenji

2017-11-01

Hypocalcemia is a significant adverse effect of denosumab. We herein report a case of prolonged hypocalcemia in a patient with multiple risk factors for hypocalcemia, including gastrectomy, increased bone turnover, and a poor performance status. Hypocalcemia developed after denosumab treatment for diffuse bone metastasis of gastric cancer, despite oral supplementation with vitamin D and calcium. To avoid serious prolonged hypocalcemia, a thorough assessment of the bone calcium metabolism is required before initiating denosumab treatment.

Prolonged Hypocalcemia Following a Single Dose of Denosumab for Diffuse Bone Metastasis of Gastric Cancer after Total Gastrectomy

PubMed Central

Iizumi, Sakura; Shimoi, Tatsunori; Nishikawa, Tadaaki; Kitano, Atsuko; Sasada, Shinsuke; Shimomura, Akihiko; Noguchi, Emi; Yunokawa, Mayu; Yonemori, Kan; Shimizu, Chikako; Fujiwara, Yasuhiro; Tamura, Kenji

2017-01-01

Hypocalcemia is a significant adverse effect of denosumab. We herein report a case of prolonged hypocalcemia in a patient with multiple risk factors for hypocalcemia, including gastrectomy, increased bone turnover, and a poor performance status. Hypocalcemia developed after denosumab treatment for diffuse bone metastasis of gastric cancer, despite oral supplementation with vitamin D and calcium. To avoid serious prolonged hypocalcemia, a thorough assessment of the bone calcium metabolism is required before initiating denosumab treatment. PMID:28943574

Ion sources for electric propulsion

NASA Technical Reports Server (NTRS)

Stuhlinger, E.

1971-01-01

Ion systems, which accelerate ions of Cs, Hg, or colloid particles by electrostatic fields, are furthest advanced and ready for application. Four kinds of ion sources have been developed: The contact ionization source for Cs as propellants, the electron bombardment source for Cs or Hg, the RF ionization source for Hg, and the hollow needle spray nozzle for colloidal glycerol particles. In each case, the ion beam must be neutralized by injection of electrons shortly behind the exit orifice to avoid adverse space charge effects.

Data-driven prediction of adverse drug reactions induced by drug drug interactions

DTIC Science & Technology

2017-06-08

currently on the market and for which drug-protein interaction information is available . These predictions are publicly accessible at http://avoid...associated with these ADRs via DDIs. We made the predictions publicly available via internet access. Keywords: Drug-drug interactions, Adverse drug reactions...ˆDeceased Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research

Effectiveness and Safety of Botulinum Toxin Type A in Children with Musculoskeletal Conditions: What Is the Current State of Evidence?

PubMed Central

Dahan-Oliel, Noémi; Kasaai, Bahar; Montpetit, Kathleen; Hamdy, Reggie

2012-01-01

Children with musculoskeletal conditions experience muscle weakness, difficulty walking and limitations in physical activities. Standard treatment includes physiotherapy, casting, and surgery. The use of botulinum toxins appears as a promising treatment on its own, but usually as an adjunct to other treatment modalities and as an alternative to surgery. The objectives were to establish the evidence on the effectiveness, safety and functional outcome of BTX-A in children with musculoskeletal conditions. A literature search using five electronic databases identified 24 studies that met our inclusion criteria. Two randomized clinical trials were included; most studies were case studies with small sample sizes and no control group. Improvements in gait pattern, function, range of motion, reduction of co-contractions, and avoidance of surgical procedures were found following BTX-A injections. Adverse events were not reported in 10 studies, minor adverse events were reported in 13 children and there were no severe adverse events. Additional doses appear safe. BTX-A is a promising treatment adjunct in improving functional outcomes in children with musculoskeletal conditions. Future studies including larger samples, longer follow-up periods and a comparison group are required to provide evidence on the effectiveness and safety of this drug in children with musculoskeletal conditions. PMID:22548088

Penile strangulation by iron metal ring: A novel and effective method of management

PubMed Central

Paonam, Somorendro; Kshetrimayum, Nillachandra; Rana, Indrajit

2017-01-01

Penile strangulation by metal ring is a rare urological emergency situation which requires urgent decompression of the penis to avoid adverse effect. It is usually associated with an attempt to improve sexual act and/or to prolong erection. But sometimes, cutting of the ring to decompress the penis safely is a very difficult task particularly when the strangulating object is a hard metal object as in our case. Here, we present a case which was managed by cutting in a novel way with the help of dental micromotor with wheel shape bur. PMID:28216935

Managing psychotropic drug costs: will formularies work?

PubMed

Huskamp, Haiden A

2003-01-01

Payers of pharmaceutical benefits are increasingly turning to drug formularies in an attempt to control rising pharmacy costs, including those for psychotropic drugs. In this paper I examine several issues that policymakers should consider when addressing formulary design for psychotropic drugs: heterogeneity within mental health disorders and limited information about treatment effectiveness for individual patients; the potential for plans to try to use formularies to avoid adverse selection and implications for psychotropic coverage; the interaction of Medicaid formulary policy and manufacturers' incentives for psychotropic innovation; and incentives created by mental health institutions that decrease formularies' potential effectiveness in controlling psychotropic drug costs.

The combination therapy of Ephedra herb and Loxoprofen caused gastric lesions in mice.

PubMed

Cho, Shigefumi; Hong, Tie; Jin, Guang-Bi; Yoshino, Gen; Miura, Myota; Aikawa, Yoshihiro; Yasuno, Fumiko; Cyong, Jong-Chol

2002-01-01

The combination therapy of a Kampo formula and an analgesic-antipyretic agent is often used for the common cold in Japan. We investigated the effect of such a combination therapy, using the Ephedra herb, which is a common ingredient of Kakkon-to and Mao-to, and Loxoprofen, a nonsteroidal anti-inflammatory drug (NSAID), on fever induced in an experimental model of mice under strong stress. The combination therapy of Ephedra herb and Loxoprofen caused gastric mucosal lesions and loss of body weight. It is considered that this combination therapy should be avoided because of its adverse effects.

Relationships among symptom severity, coping styles, and quality of life in community-dwelling women with urinary incontinence: a multiple mediator model.

PubMed

Xu, Dongjuan; Liu, Nana; Qu, Haili; Chen, Liqin; Wang, Kefang

2016-01-01

To investigate the relationships among symptom severity, coping styles, and quality of life (QOL) in community-dwelling women with urinary incontinence (UI). A total of 592 women with UI participated in this cross-sectional study. Bivariate Pearson's correlation was used to examine the correlations between symptom severity, coping styles, and QOL. Multivariate regression models and Sobel tests were used to test the mediating effect of coping styles. Additionally, a multiple mediator model was used to examine the mediating role of coping styles collectively. All regression models were adjusted for age, education, marital status, income, duration of UI, and type of UI. Participants tended to use avoidant and palliative coping styles and not use instrumental coping style. Avoidant and palliative coping styles were associated with poor QOL, and partially mediated the association between symptom severity and QOL. Nearly 73% of the adverse effect of symptom severity on QOL was mediated by avoidant and palliative coping styles. The use of avoidant and palliative coping styles was higher with more severe urine leakage, and QOL tended to be poorer. Coping styles should be addressed in UI management. It may be of particular value to look closely at negative coping styles and implement education and training of patients in improving their coping skills related to managing UI, which will in turn improve their QOL.

Cost-effectiveness of oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin in the emergency department.

PubMed

Rudis, Maria I; Touchette, Daniel R; Swadron, Stuart P; Chiu, Amy P; Orlinsky, Michael

2004-03-01

Oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin are all commonly used for loading phenytoin in the emergency department (ED). The cost-effectiveness of each was compared for patients presenting with seizures and subtherapeutic phenytoin concentrations. A simple decision tree was developed to determine the treatment costs associated with each of 3 loading techniques. We determined effectiveness by comparing adverse event rates and by calculating the time to safe ED discharge. Time to safe ED discharge was defined as the time at which therapeutic concentrations of phenytoin (>or=10 mg/L) were achieved with an absence of any adverse events that precluded discharge. The comparative cost-effectiveness of alternatives to oral phenytoin was determined by combining net costs and number of adverse events, expressed as cost per adverse events avoided. Cost-effectiveness was also determined by comparing the net costs of each loading technique required to achieve the time to safe ED discharge, expressed as cost per hour of ED time saved. The outcomes and costs were primarily derived from a prospective, randomized controlled trial, augmented by time-motion studies and alternate-cost sources. Costs included the cost of drugs, supplies, and personnel. Analyses were also performed in scenarios incorporating labor costs and savings from using a lower-urgency area of the ED. The mean number of adverse events per patient for oral phenytoin, intravenous phenytoin, and intravenous fosphenytoin was 1.06, 1.93, and 2.13, respectively. Mean time to safe ED discharge in the 3 groups was 6.4 hours, 1.7 hours, and 1.3 hours. Cost per patient was 2.83 dollars, 21.16 dollars, and 175.19 dollars, respectively, and did not differ substantially in the Labor and Triage (lower-urgency area of ED) scenarios. When the measure of effectiveness was adverse events, oral phenytoin dominated intravenous phenytoin and intravenous fosphenytoin, with a lower cost and number of adverse events. With time to safe ED discharge as the outcome measure, the incremental cost-effectiveness ratios were 3.90 dollars and 387.27 dollars per hour of ED time saved for oral phenytoin versus intravenous phenytoin and for intravenous fosphenytoin versus intravenous phenytoin, respectively. Oral phenytoin is the most cost-effective loading method in most settings. Intravenous phenytoin is preferred if one is willing to pay an additional 20.65 dollars to 44.25 dollars per patient and willing to have more adverse events for a quicker average time to safe ED discharge. It is unlikely that intravenous fosphenytoin is justifiable in any setting.

Incidence of potentially avoidable urgent readmissions and their relation to all-cause urgent readmissions

PubMed Central

van Walraven, Carl; Jennings, Alison; Taljaard, Monica; Dhalla, Irfan; English, Shane; Mulpuru, Sunita; Blecker, Saul; Forster, Alan J.

2011-01-01

Background: Urgent, unplanned hospital readmissions are increasingly being used to gauge the quality of care. We reviewed urgent readmissions to determine which were potentially avoidable and compared rates of all-cause and avoidable readmissions. Methods: In a multicentre, prospective cohort study, we reviewed all urgent readmissions that occurred within six months among patients discharged to the community from 11 teaching and community hospitals between October 2002 and July 2006. Summaries of the readmissions were reviewed by at least four practising physicians using standardized methods to judge whether the readmission was an adverse event (poor clinical outcome due to medical care) and whether the adverse event could have been avoided. We used a latent class model to determine whether the probability that each readmission was truly avoidable exceeded 50%. Results: Of the 4812 patients included in the study, 649 (13.5%, 95% confidence interval [CI] 12.5%–14.5%) had an urgent readmission within six months after discharge. We considered 104 of them (16.0% of those readmitted, 95% CI 13.3%–19.1%; 2.2% of those discharged, 95% CI 1.8%–2.6%) to have had a potentially avoidable readmission. The proportion of patients who had an urgent readmission varied significantly by hospital (range 7.5%–22.5%; χ2 = 92.9, p < 0.001); the proportion of readmissions deemed avoidable did not show significant variation by hospital (range 1.2%–3.7%; χ2 = 12.5, p < 0.25). We found no association between the proportion of patients who had an urgent readmission and the proportion of patients who had an avoidable readmission (Pearson correlation 0.294; p = 0.38). In addition, we found no association between hospital rankings by proportion of patients readmitted and rankings by proportion of patients with an avoidable readmission (Spearman correlation coefficient 0.28, p = 0.41). Interpretation: Urgent readmissions deemed potentially avoidable were relatively uncommon, comprising less than 20% of all urgent readmissions following hospital discharge. Hospital-specific proportions of patients who were readmitted were not related to proportions with a potentially avoidable readmission. PMID:21859870

Learning and memory effects of neonatal methamphetamine exposure in rats: Role of reactive oxygen species and age at assessment.

PubMed

Jablonski, Sarah A; Williams, Michael T; Vorhees, Charles V

2017-11-01

In utero methamphetamine (MA) exposure leads to a range of adverse effects, such as decreased attention, reduced working-memory capability, behavioral dysregulation, and spatial memory impairments in exposed children. In the current experiment, preweaning Sprague-Dawley rats-as a model of third trimester human exposure-were administered the spin trapping agent, N-tert-butyl-α-phenylnitrone (PBN), daily prior to MA. Rats were given 0 (SAL) or 40 mg/kg PBN prior to each MA dose (10 mg/kg, 4× per day) from postnatal day (P) 6-15. Littermates underwent Cincinnati water maze, Morris water maze, and radial water maze assessment beginning on P30 (males) or P60 (females). Males were also tested for conditioned contextual and cued freezing, while females were trained in passive avoidance. Findings show that, regardless of age/sex, neonatal MA induced deficits in all tests, except passive avoidance. PBN did not ameliorate these effects, but had a few minor effects. Taken together, MA induced learning deficits emerge early and persist, but the mechanism remains unknown. © 2017 Wiley Periodicals, Inc.

The Precautionary Principle and Electric and Magnetic Fields

PubMed Central

Jamieson, Dale; Wartenberg, Daniel

2001-01-01

Current environmental regulation represents a paternalistic policy, more concerned to avoid false positives than false negatives, limiting opportunities for individuals to make choices between risk-avoidance and risk-taking alternatives. For example, many exposures to magnetic fields could be reduced at little or no cost but are not considered seriously, owing to the uncertainty of risk and the concern to avoid false positives. Even though precautionary approaches that focus on avoiding false negatives often do not lead to adverse economic consequences or irrational choices, such approaches usually are not taken. The value of autonomy and the proper role of governmental paternalism with respect to environmental policy need to be considered more carefully in environmental decision making. PMID:11527754

Treatment of Diabetic Autonomic Neuropathy in Older Adults with Diabetes Mellitus.

PubMed

Scheinberg, Nataliya; Salbu, Rebecca L; Goswami, Gayotri; Cohen, Kenneth

2016-11-01

To review the epidemiology, pathophysiology, screening and diagnosis, and optimal treatment of diabetic autonomic neuropathy (DAN) and its implications in older adults. A search of PubMed using the Mesh terms "diabetes," "type 1," "insulin-dependent," "T1DM," and "diabetic autonomic neuropathy" was performed to find relevant primary literature. Additional search terms "epidemiology," "geriatric," and "risk" were employed. All English-language articles from 2005 to 2015 appearing in these searches were reviewed for relevance. Related articles suggested in the PubMed search and clinical guidelines from the American Diabetes Association and the American Association of Clinical Endocrinologists were reviewed. These uncovered further resources for risk stratification, pathophysiology, diagnosis, and treatment of DAN. DAN is highly prevalent in the diabetes population and increases the risk of morbidity and mortality in older adults, yet, often goes undiagnosed and untreated. Treatment of DAN is complex in the older adult because of poor tolerability of many pharmacologic treatment options; therefore, great care must be taken when selecting therapy as to avoid unwanted adverse effects. With increasing life-expectancy of patients with diabetes mellitus, awareness of DAN and its implications to older adults is needed in primary care. Consistent screening and appropriate treatment of DAN in older adults with diabetes mellitus is essential in helping to maintain functional status and avoid adverse events.

Internet treatment of sexually transmitted infections - a public health hazard?

PubMed

Vivancos, Roberto; Schelenz, Silke; Loke, Yoon K

2007-11-15

Owing to the stigma associated with sexually transmitted infections, patients may prefer to keep their illness private, and choose instead to try self-treatment remedies from the internet. However, such remedies may prove hazardous if the sellers do not provide detailed advice on adverse effects, or on avoiding transmission and re-infection. We conducted an internet search to determine the availability of treatments for STIs and the nature of information provided by vendors of these treatments. We conducted a systematic internet search using five different search engines in February 2007. The search term included the words "self treatment" and the name of six different common STIs. We visited the vendors' websites and recorded any information on the formulation, adverse effects, cautions, and prevention of infection. We identified a total of 77 treatments from 52 different companies, most of which were sold from the UK and US. The available remedies were predominantly for topical use and consisted mainly of homeopathic remedies. Only a small proportion of the web-listed products gave details on adverse effects, contraindications and interactions (22%, 25% and 9% respectively). Similarly, web vendors seldom provided advice on treatment of sexual contacts (20% of chlamydia and 25% of gonorrhea treatments) or on preventive measures (13%). Conversely, evidence of effectiveness was claimed for approximately 50% of the products. While treatments for certain STIs are widely available on the internet, purchasers of such products may potentially suffer harm because of the lack of information on adverse effects, interactions and contra-indications. Moreover, we consider the paucity of preventive health advice to be a serious omission, thereby leading to patients being needlessly exposed to, and potentially re-infected with the causative pathogens.

Childhood Sexual Abuse, Attachments in Childhood and Adulthood, and Coercive Sexual Behaviors in Community Males.

PubMed

Langton, Calvin M; Murad, Zuwaina; Humbert, Bianca

2017-04-01

Associations between self-reported coercive sexual behavior against adult females, childhood sexual abuse (CSA), and child-parent attachment styles, as well as attachment with adult romantic partners, were examined among 176 adult community males. Attachment style with each parent and with romantic partners was also investigated as a potential moderator. Using hierarchical multiple regression analysis, avoidant attachment with mothers in childhood (and also with fathers, in a second model) accounted for a significant amount of the variance in coercive sexual behavior controlling for scores on anxious ambivalent and disorganized/disoriented attachment scales, as predicted. Similarly, in a third model, avoidance attachment in adulthood was a significant predictor of coercive sexual behavior controlling for scores on the anxiety attachment in adulthood scale. These main effects for avoidant and avoidance attachment were not statistically significant when CSA and control variables (other types of childhood adversity, aggression, antisociality, and response bias) were added in each of the models. But the interaction between scales for CSA and avoidance attachment in adulthood was significant, demonstrating incremental validity in a final step, consistent with a hypothesized moderating function for attachment in adulthood. The correlation between CSA and coercive sexual behavior was .60 for those with the highest third of avoidance attachment scores (i.e., the most insecurely attached on this scale), .24 for those with scores in the middle range on the scale, and .01 for those with the lowest third of avoidance attachment scores (i.e., the most securely attached). Implications for study design and theory were discussed.

Specification and Design of the SBRC-190: A Cryogenic Multiplexer for Far Infrared Photoconductor Detectors

NASA Technical Reports Server (NTRS)

Erickson, E. F.; Young, E. T.; Wolf, J.; Asbrock, J. F.; Lum, N.; DeVincenzi, D. (Technical Monitor)

2002-01-01

Arrays of far-infrared photoconductor detectors operate at a few degrees Kelvin and require electronic amplifiers in close proximity. For the electronics, a cryogenic multiplexer is ideal to avoid the large number of wires associated with individual amplifiers for each pixel, and to avoid adverse effects of thermal and radiative heat loads from the circuitry. For low background applications, the 32 channel CRC 696 CMOS device was previously developed for SIRTF, the cryogenic Space Infrared Telescope Facility. For higher background applications, we have developed a similar circuit, featuring several modifications: (a) an AC coupled, capacitive feedback transimpedence unit cell, to minimize input offset effects, thereby enabling low detector biases, (b) selectable feedback capacitors to enable operation over a wide range of backgrounds, and (c) clamp and sample & hold output circuits to improve sampling efficiency, which is a concern at the high readout rates required. We describe the requirements for and design of the new device.

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.

Twins and virtual twins: Do genetic (as well as experiential) factors affect developmental risks?

PubMed

Segal, Nancy L; Tan, Tony Xing; Graham, Jamie L

2015-08-01

Factors underlying developmental delays and psychosocial risks are of interest to international adoption communities. The current study administered a Pre-Adoption Adversity (PAA) Questionnaire to mostly American parents raising (a) adopted Chinese twins or (b) same-age unrelated adopted siblings. A goal was to replicate earlier analyses of pre-adoption adversity/adjustment among adopted preschool-age Chinese girls. A second goal was to conduct genetic analyses of four content areas (Developmental Delays at Adoption, Initial Adaptation to Adoption, Crying/Clinging, and Refusal/Avoidance) derived from the PAA Questionnaire. A key finding was that age at adoption added less than other predictors to adoptees' externalizing and internalizing behaviors. Family factors (e.g., parental education) contributed significantly to behavioral outcomes among the adopted Chinese twins. Genetic effects were indicated for all four content areas, with shared environmental effects evident for Developmental Delays at Adoption and Crying/Clinging. Future investigators should consider incorporating genetically sensitive designs into developmental research programs. Copyright © 2015 Elsevier Inc. All rights reserved.

[Recommendations for initial antiretroviral treatment in HIV-infected children. Update 2003].

PubMed

2004-03-01

Highly active antiretroviral therapy in HIV-infected children has been associated with a dramatic decrease in progression to AIDS and HIV-related deaths, and infected children currently have an excellent quality of life. Antiretroviral drugs cannot eradicate the virus, although they can achieve a situation of latent infection. However, chronic use of these drugs has multiple adverse effects, the most important of which are metabolic complications. The large number of drugs required and patient characteristics such as age, tolerance to drugs, adherence, and social problems make unifying the criteria for initial therapy in HIV-infected children difficult. A balance should be sought between not delaying the start of treatment, to avoid immunologic deterioration, and minimizing the long-term adverse effects of the therapy. The present treatment recommendations are adapted from international guidelines and are based on a literature review and on our own experience. Our group previously published recommendations on the treatment of HIV-infected children and the aim of the present article is to provide an update.

Solar radiation and human health

NASA Astrophysics Data System (ADS)

Juzeniene, Asta; Brekke, Pål; Dahlback, Arne; Andersson-Engels, Stefan; Reichrath, Jörg; Moan, Kristin; Holick, Michael F.; Grant, William B.; Moan, Johan

2011-06-01

The Sun has played a major role in the development of life on Earth. In Western culture, people are warned against Sun exposure because of its adverse effects: erythema, photoimmunosuppression, photoageing, photocarcinogenesis, cataracts and photokeratitis. However, Sun exposure is also beneficial, since moderate doses give beneficial physiological effects: vitamin D synthesis, reduction of blood pressure and mental health. Shortage of Sun exposure may be even more dangerous to human health than excessive exposure. Avoiding Sun exposure leads to vitamin D deficiency which is associated not only with rickets and osteomalacia, but also with increased risk of cardiovascular disease, multiple sclerosis, rheumatoid arthritis, diabetes, influenza, many types of cancer and adverse pregnancy outcomes. Solar radiation induces nitric oxide release in tissue and immediate pigment darkening which certainly play important roles, although these are still unknown. Action spectra relevant for health are described. We will also review what is known about spectral and intensity variations of terrestrial solar radiation as well as its penetration through the atmosphere and into human skin and tissue.

76 FR 24021 - Environmental Impacts Statements; Notice of Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-29

... Self-Sustaining Chinook Salmon Fishery in the River while Reducing or Avoiding Adverse Water Supply... Shipyard Disposal and Reuse, Supplement Information on the 2000 FEIS, Implementation, City of San [[Page...

Emergency Response Teams in Action.

ERIC Educational Resources Information Center

Watson, James A.

2001-01-01

Illustrates the value of proper crisis response training to help schools protect lives by avoiding adverse situations. Details the execution of a crisis management plan, which was developed following a cafeteria/kitchen explosion. (GR)

Impact of the HLA-B(*)58:01 Allele and Renal Impairment on Allopurinol-Induced Cutaneous Adverse Reactions.

PubMed

Ng, Chau Yee; Yeh, Yu-Ting; Wang, Chuang-Wei; Hung, Shuen-Iu; Yang, Chih-Hsun; Chang, Ya-Ching; Chang, Wan-Chun; Lin, Yu-Jr; Chang, Chee-Jen; Su, Shih-Chi; Fan, Wen-Lang; Chen, Der-Yuan; Wu, Yeong-Jian Jan; Tian, Ya-Chung; Hui, Rosaline Chung-Yee; Chung, Wen-Hung

2016-07-01

Allopurinol, a common drug for treating hyperuricemia, is associated with cutaneous adverse drug reactions ranging from mild maculopapular exanthema to life-threatening severe cutaneous adverse reactions, including drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis. We have previously reported that HLA-B*58:01 is strongly associated with allopurinol-induced severe cutaneous adverse reactions in Han Chinese, but the associations of the HLA-B*58:01 genotype in an allopurinol-induced hypersensitivity phenotype remain unclear. To investigate the comprehensive associations of HLA-B*58:01, we enrolled 146 patients with allopurinol-induced cutaneous adverse drug reactions (severe cutaneous adverse reactions, n = 106; maculopapular exanthema, n = 40) and 285 allopurinol-tolerant control subjects. Among these allopurinol-induced cutaneous adverse drug reactions, HLA-B*58:01 was strongly associated with severe cutaneous adverse reactions (odds ratio [OR] = 44.0; 95% confidence interval = 21.5-90.3; P = 2.6 × 10(-41)), and the association was correlated with disease severity (OR = 44.0 for severe cutaneous adverse reactions, OR = 8.5 for maculopapular exanthema). The gene dosage effect of HLA-B*58:01 also influenced the development of allopurinol-induced cutaneous adverse drug reactions (OR = 15.25 for HLA-B*58:01 heterozygotes and OR = 72.45 for homozygotes). Furthermore, coexistence of HLA-B*58:01 and renal impairment increased the risk and predictive accuracy of allopurinol-induced cutaneous adverse drug reactions (heterozygous HLA-B*58:01 and normal renal function: OR = 15.25, specificity = 82%; homozygous HLA-B*58:01 and severe renal impairment: OR = 1269.45, specificity = 100%). This HLA-B*58:01 correlation study suggests that patients with coexisting HLA-B*58:01 and renal impairment (especially estimated glomerular filtration rate < 30ml/minute/1.73 m(2)) should be cautious and avoid using allopurinol. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Promoting Good Prenatal Health: Air Pollution and Pregnancy (January 2010)

EPA Pesticide Factsheets

simple steps for pregnant women and new mothers/parents to avoid common environmental exposures which can cause health problems and adverse birth outcomes; including tobacco smoke, carbon monoxide, particle pollution, ozone,

Safety, risk and mental health: decision-making processes prescribed by Australian mental health legislation.

PubMed

Smith-Merry, Jennifer; Caple, Andrew

2014-03-01

Adverse events in mental health care occur frequently and cause significant distress for those who experience them, derailing treatment and sometimes leading to death. These events are clustered around particular aspects of care and treatment and are therefore avoidable if practices in these areas are strengthened. The research reported in this article takes as its starting point coronial recommendations made in relation to mental health. We report on those points and processes in treatment and discharge where coronial recommendations are most frequently made. We then examine the legislative requirements around these points and processes in three Australian States. We find that the key areas that need to be strengthened to avoid adverse events are assessment processes, communication and information transfer, documentation, planning and training. We make recommendations for improvements in these key areas.

Pharmacological Sphincterotomy for Chronic Anal Fissures by Botulinum Toxin A

PubMed Central

Wollina, Uwe

2008-01-01

Chronic anal fissure is a common proctologic disease. Botulinum toxin (BTX) can be used for temporary chemical denervation to treat this painful disorder. Its application is by intramuscular injections into either the external or internal anal sphincter muscle. The mode of action, application techniques, and possible complications or adverse effects of BTX therapy are discussed in this report. The healing rate is dependent on the BTX dosage. The short-term healing rate (≤ 6 months) is 60–90%, whereas about 50% of the patients show a complete response in long-term follow-up studies (> 1 year). Adverse effects are generally mild, but relapses occur more often than with surgery. Conservative therapy is currently considered as a first-line treatment. With increasing evidence for its efficacy, BTX can now be considered among the first-line nonsurgical treatements. Although, surgical management by lateral sphincterotomy is the most effective treatment, it shows a higher incidence of incontinence and greater general morbidity rate than BTX. BTX is a useful alternative to surgery and in many cases, surgery can be avoided with the use of BTX. PMID:20300345

Associations between specific psychotic symptoms and specific childhood adversities are mediated by attachment styles: an analysis of the National Comorbidity Survey.

PubMed

Sitko, Katarzyna; Bentall, Richard P; Shevlin, Mark; O'Sullivan, Noreen; Sellwood, William

2014-07-30

Accumulated evidence over the past decade consistently demonstrates a relationship between childhood adversity and psychosis in adulthood. There is some evidence of specific associations between childhood sexual abuse and hallucinations, and between insecure attachment and paranoia. Data from the National Comorbidity Survey were used in assessing whether current attachment styles influenced the association between adverse childhood experiences and psychotic symptoms in adulthood. Hallucinations and paranoid beliefs were differentially associated with sexual abuse (rape and sexual molestation) and neglect, respectively. Sexual abuse and neglect were also associated with depression. The relationship between neglect and paranoid beliefs was fully mediated via anxious and avoidant attachment. The relationship between sexual molestation and hallucinations was independent of attachment style. The relationship between rape and hallucinations was partially mediated via anxious attachment; however this effect was no longer present when depression was included as a mediating variable. The findings highlight the importance of addressing and understanding childhood experiences within the context of current attachment styles in clinical interventions for patients with psychosis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The changing tobacco landscape: What dental professionals need to know.

PubMed

Couch, Elizabeth T; Chaffee, Benjamin W; Gansky, Stuart A; Walsh, Margaret M

2016-07-01

Tobacco products in the United States and the patterns of tobacco use are changing. Although cigarette smoking prevalence has declined, dental professionals are likely to encounter substantial numbers of patients who have tried and are continuing to use new and alternative tobacco products, including cigars, water pipes (hookahs), and electronic cigarettes, as well as conventional and new smokeless tobacco products. The authors reviewed conventional and new tobacco products in the United States, their adverse oral and systemic health effects, and their prevalence of use. Tobacco products other than cigarettes account for a substantial portion of tobacco use. For this reason, tobacco-use prevention and cessation counseling provided by dental health care professionals must address all tobacco products, including cigarettes, cigars, water pipes, and electronic cigarettes, as well as conventional and new smokeless tobacco products. Cigarette smoking and smokeless tobacco use are associated with immediate and long-term adverse health effects, including nicotine addiction, oral and systemic disease, and death. Novel products may attract new tobacco users, potentially leading to addiction that results in enduring tobacco product use and associated adverse health effects. This critical review of conventional, new, and emerging tobacco products presents information that dental professionals can use in providing tobacco-related counseling to patients who use or who are at risk for using tobacco products. It is essential that dental professionals are knowledgeable about tobacco products and are able to answer patients' questions and provide them with evidence-based tobacco-related counseling. This information may prevent patients from initiating use or help reduce or cease use to avoid immediate and long-term adverse health effects, including nicotine addiction, oral and systemic disease, and death. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

Addressing environmental health Implications of mold exposure after major flooding.

PubMed

Metts, Tricia A

2008-03-01

Extensive water damage resulting from major flooding is often associated with mold growth if materials are not quickly and thoroughly dried. Exposure to fungal contamination can lead to several infectious and noninfectious health effects impacting the respiratory system, skin, and eyes. Adverse health effects can be categorized as infections, allergic or hypersensitivity reactions, or toxic-irritant reactions. Workers and building occupants can minimize their exposure to mold by avoiding areas with excessive mold growth, using personal protective equipment, and implementing environmental controls. Occupational health professionals should encourage workers to seek health care if they experience any symptoms that may be linked to mold exposure.

Transdermal rivastigmine: management of cutaneous adverse events and review of the literature.

PubMed

Greenspoon, Jill; Herrmann, Nathan; Adam, David N

2011-07-01

Alzheimer's disease is a chronic neurodegenerative disorder resulting in part from the degeneration of cholinergic neurons in the brain. Rivastigmine, a cholinesterase inhibitor, is commonly used as a treatment for dementia due to its ability to moderate cholinergic neurotransmission; however, treatment with oral rivastigmine can lead to gastrointestinal adverse effects such as nausea and vomiting. Transdermal administration of rivastigmine can minimize these adverse effects by providing continuous delivery of the medication, while maintaining the effectiveness of the oral treatment. While the transdermal form of rivastigmine has been found to have fewer systemic adverse effects compared with the oral form, cutaneous reactions, such as contact dermatitis, can lead to discontinuation of the drug in its transdermal form. Lack of patient compliance with regard to applying the patch to the designated site, applying the patch for the correct length of time or rotating patch application sites increases the risk of cutaneous adverse reactions. This article outlines the diagnosis and management of irritant contact dermatitis and allergic contact dermatitis secondary to transdermal rivastigmine. The large majority of reactions to transdermal patches are of an irritant type, which can be diagnosed clinically by the presence of a pruritic, erythematous, eczematous plaque strictly confined to the borders of the patch. In contrast, an allergic reaction can be differentiated by the presence of vesicles and/or oedema, erythema beyond the boundaries of the transdermal patch and lack of improvement of the lesion 48 hours after removal of the offending treatment. By encouraging the patient to follow a regular rotation schedule for the patch, and using lipid-based emollients for irritant dermatitis and pre- and post-treatment topical corticosteroids for allergic dermatitis, cutaneous reactions can often be alleviated and patients can continue with their medication regimen. Other simple changes to a patient's treatment routine, including minimizing the use of harsh soaps, avoiding recently shaven or damaged areas of skin and carefully removing the patch after use, can help to further decrease the risk of dermatitis development.

[Advantages and disadvantages of endocrown restorations of endodontically treated teeth with large coronal destruction].

PubMed

Bao, X D

2018-04-09

The strength of endodontically treated teeth were reduced apparently because of structural damage, therefore further reduction of healthy tissue should be avoided as much as possible in restoration. Endocrown made by chair-side CAD/CAM is some kind of minimal invasive restoration, and the retention of restoration is achieved by reliable bonding and macromechanial retention forces. Without post preparation, the root structure could be resevered. Following the indications and use of biomechanical dentin-like CAD/CAM materials could reduce the adverse effect of tensile stress on cervical part.

Should general anaesthesia be avoided in the elderly?

PubMed Central

Strøm, C.; Rasmussen, L. S.; Sieber, F. E.

2016-01-01

Summary Surgery and anaesthesia exert comparatively greater adverse effects on the elderly than on the younger brain, manifest by the higher prevalence of postoperative delirium and cognitive dysfunction. Postoperative delirium and cognitive dysfunction delay rehabilitation, and are associated with increases in morbidity and mortality among elderly surgical patients. We review the aetiology of postoperative delirium and cognitive dysfunction in the elderly with a particular focus on anaesthesia and sedation, discuss methods of diagnosing and monitoring postoperative cognitive decline, and describe the treatment strategies by which such decline may be prevented. PMID:24303859

Mold prevention strategies and possible health effects in the aftermath of hurricanes and major floods.

PubMed

Brandt, Mary; Brown, Clive; Burkhart, Joe; Burton, Nancy; Cox-Ganser, Jean; Damon, Scott; Falk, Henry; Fridkin, Scott; Garbe, Paul; McGeehin, Mike; Morgan, Juliette; Page, Elena; Rao, Carol; Redd, Stephen; Sinks, Tom; Trout, Douglas; Wallingford, Kenneth; Warnock, David; Weissman, David

2006-06-09

Extensive water damage after major hurricanes and floods increases the likelihood of mold contamination in buildings. This report provides information on how to limit exposure to mold and how to identify and prevent mold-related health effects. Where uncertainties in scientific knowledge exist, practical applications designed to be protective of a person's health are presented. Evidence is included about assessing exposure, clean-up and prevention, personal protective equipment, health effects, and public health strategies and recommendations. The recommendations assume that, in the aftermath of major hurricanes or floods, buildings wet for <48 hours will generally support visible and extensive mold growth and should be remediated, and excessive exposure to mold-contaminated materials can cause adverse health effects in susceptible persons regardless of the type of mold or the extent of contamination. For the majority of persons, undisturbed mold is not a substantial health hazard. Mold is a greater hazard for persons with conditions such as impaired host defenses or mold allergies. To prevent exposure that could result in adverse health effects from disturbed mold, persons should 1) avoid areas where mold contamination is obvious; 2) use environmental controls; 3) use personal protective equipment; and 4) keep hands, skin, and clothing clean and free from mold-contaminated dust. Clinical evaluation of suspected mold-related illness should follow conventional clinical guidelines. In addition, in the aftermath of extensive flooding, health-care providers should be watchful for unusual mold-related diseases. The development of a public health surveillance strategy among persons repopulating areas after extensive flooding is recommended to assess potential health effects and the effectiveness of prevention efforts. Such a surveillance program will help CDC and state and local public health officials refine the guidelines for exposure avoidance, personal protection, and clean-up and assist health departments to identify unrecognized hazards.

Moderating effects of aggression on the associations between social withdrawal subtypes and peer difficulties during early adolescence.

PubMed

Bowker, Julie C; Markovic, Andrea; Cogswell, Alex; Raja, Radhi

2012-08-01

Recent research has revealed significant heterogeneity in the peer difficulties associated with social withdrawal subtypes during early adolescence, but little is known about possible sources of that heterogeneity. This study of 194 Indian young adolescents (48% female; 90% Hindu; M age= 13.35 years) evaluated whether the peer adversity related to self-reported social withdrawal subtypes (shyness, unsociability, avoidance) varied as a function of peer-nominated overt and relational aggression, and gender. Regression analyses revealed that overt aggression and gender moderated the pathways between shyness and peer exclusion and peer victimization such that the associations were significant and positive only for boys who were high and girls who were low in overt aggression. Several additional moderator effects were found, including results revealing that relational aggression (in certain cases, in conjunction with gender) moderated the association between: (1) avoidance and peer exclusion and peer rejection, (2) shyness and peer rejection, and (3) unsociability and peer victimization. For adolescents who were average and low in relational aggression, avoidance was positively related to peer rejection, and unsociability was positively related to peer victimization. However, only for boys who were high in relational aggression, avoidance was found to be positively related to peer exclusion, and shyness was positively related to peer rejection. The findings highlight the importance of considering additional individual risk factors in studies of social withdrawal subtypes and point to important differences for young adolescent withdrawn boys and girls.

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.

Inhaled Micro/Nanoparticulate Anticancer Drug Formulations: An Emerging Targeted Drug Delivery Strategy for Lung Cancers.

PubMed

Islam, Nazrul; Richard, Derek

2018-05-24

Local delivery of drug to the target organ via inhalation offers enormous benefits in the management of many diseases. Lung cancer is the most common of all cancers and it is the leading cause of death worldwide. Currently available treatment systems (intravenous or oral drug delivery) are not efficient in accumulating the delivered drug into the target tumor cells and are usually associated with various systemic and dose-related adverse effects. The pulmonary drug delivery technology would enable preferential accumulation of drug within the cancer cell and thus be superior to intravenous and oral delivery in reducing cancer cell proliferation and minimising the systemic adverse effects. Site-specific drug delivery via inhalation for the treatment of lung cancer is both feasible and efficient. The inhaled drug delivery system is non-invasive, produces high bioavailability at low dose and avoids first pass metabolism of the delivered drug. Various anticancer drugs including chemotherapeutics, proteins and genes have been investigated for inhalation in lung cancers with significant outcomes. Pulmonary delivery of drugs from dry powder inhaler (DPI) formulation is stable and has high patient compliance. Herein, we report the potential of pulmonary drug delivery from dry powder inhaler (DPI) formulations inhibiting lung cancer cell proliferation at very low dose with reduced unwanted adverse effects. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

18 CFR 4.105 - Action on exemption applications.

Code of Federal Regulations, 2014 CFR

2014-04-01

... those set forth in § 4.106 in order to: (i) Protect the quality or quantity of the related water supply; (ii) Otherwise protect life, health, or property; (iii) Avoid or mitigate adverse environmental impact...

18 CFR 4.105 - Action on exemption applications.

Code of Federal Regulations, 2011 CFR

2011-04-01

... those set forth in § 4.106 in order to: (i) Protect the quality or quantity of the related water supply; (ii) Otherwise protect life, health, or property; (iii) Avoid or mitigate adverse environmental impact...

Outcome Assessments and Cost Avoidance of an Oral Chemotherapy Management Clinic.

PubMed

Wong, Siu-Fun; Bounthavong, Mark; Nguyen, Cham P; Chen, Timothy

2016-03-01

Increasing use of oral chemotherapy drugs increases the challenges for drug and patient management. An oral chemotherapy management clinic was developed to provide patients with oral chemotherapy management, concurrent medication (CM) education, and symptom management services. This evaluation aims to measure the need and effectiveness of this practice model due to scarce published data. This is a case series report of all patients referred to the oral chemotherapy management clinic. Data collected included patient demographics, depression scores, CMs, and types of intervention, including detection and management outcomes collected at baseline, 3-day, 7-day, and 3-month follow-ups. Persistence rate was monitored. Secondary analysis assessed potential cost avoidance. A total of 86 evaluated patients (32 men and 54 women, mean age of 63.4 years) did not show a high risk for medication nonadherence. The 3 most common cancer diagnoses were rectal, pancreatic, and breast, with capecitabine most prescribed. Patients had an average of 13.7 CMs. A total of 125 interventions (detection and management of adverse drug event detection, compliance, drug interactions, medication error, and symptom management) occurred in 201 visits, with more than 75% of interventions occurring within the first 14 days. A persistence rate was observed in 78% of 41 evaluable patients. The total estimated annual cost avoidance per 1.0 full time employee (FTE) was $125,761.93. This evaluation demonstrated the need for additional support for patients receiving oral chemotherapy within standard of care medical service. A comprehensive oral chemotherapy management referral service can optimize patient care delivery via early interventions for adverse drug events, drug interactions, and medication errors up to 3 months after initiation of treatment. Copyright © 2016 by the National Comprehensive Cancer Network.

Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure.

PubMed

Costanzo, Maria Rosa; Negoianu, Daniel; Jaski, Brian E; Bart, Bradley A; Heywood, James T; Anand, Inder S; Smelser, James M; Kaneshige, Alan M; Chomsky, Don B; Adler, Eric D; Haas, Garrie J; Watts, James A; Nabut, Jose L; Schollmeyer, Michael P; Fonarow, Gregg C

2016-02-01

The AVOID-HF (Aquapheresis versus Intravenous Diuretics and Hospitalization for Heart Failure) trial tested the hypothesis that patients hospitalized for HF treated with adjustable ultrafiltration (AUF) would have a longer time to first HF event within 90 days after hospital discharge than those receiving adjustable intravenous loop diuretics (ALD). Congestion in hospitalized heart failure (HF) patients portends unfavorable outcomes. The AVOID-HF trial, designed as a multicenter, 1-to-1 randomized study of 810 hospitalized HF patients, was terminated unilaterally and prematurely by the sponsor (Baxter Healthcare, Deerfield, Illinois) after enrollment of 224 patients (27.5%). Aquadex FlexFlow System (Baxter Healthcare) was used for AUF. A Clinical Events Committee, blinded to the randomized treatment, adjudicated whether 90-day events were due to HF. A total of 110 patients were randomized to AUF and 114 to ALD. Baseline characteristics were similar. Estimated days to first HF event for the AUF and ALD group were, respectively, 62 and 34 (p = 0.106). At 30 days, compared with the ALD group, the AUF group had fewer HF and cardiovascular events. Renal function changes were similar. More AUF patients experienced an adverse effect of special interest (p = 0.018) and a serious study product-related adverse event (p = 0.026). The 90-day mortality was similar. Compared with the ALD group, the AUF group trended toward a longer time to first HF event within 90 days and fewer HF and cardiovascular events. More patients in the AUF group experienced special interest or serious product-related adverse event. Due to the trial's untimely termination, additional AUF investigation is warranted. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Application of a hydrogel ocular sealant to avoid recurrence of epithelial ingrowth after LASIK enhancement.

PubMed

Yesilirmak, Nilufer; Diakonis, Vasilios F; Battle, Juan F; Yoo, Sonia H

2015-04-01

To report a case of clinically significant epithelial ingrowth after LASIK that was successfully treated with a hydrogel ocular sealant in combination with flap lifting and scraping technique. Case report. A 56-year-old woman underwent LASIK and a LASIK enhancement procedure in 2002 and 2012, respectively. Six months after the enhancement, visually significant epithelial ingrowth developed in both of her eyes. The left eye was treated with flap lifting, scraping, and suturing, and the right eye was treated with a hydrogel ocular sealant in combination with flap lifting and scraping. No recurrence was evident during a 6-month follow-up period and visual acuity improved in both eyes. No adverse effects were noticed. Recurrent epithelial ingrowth may be successfully avoided with the intraoperative use of a hydrogel ocular sealant combined with flap lifting and scraping. This approach could be used as an alternative to LASIK flap suturing. Copyright 2015, SLACK Incorporated.

Avoiding errors when administering injectable phenytoin to a child in status epilepticus.

PubMed

Douglass, Callum

2018-02-07

Errors often occur in the prescribing, preparing, administering and monitoring of intravenous phenytoin ( NHS Improvement 2016 ). Following two fatal incidents involving injectable phenytoin, with contributing factors such as wrong weight estimation, a disregard for existing phenytoin prescriptions and confusion about the final concentration, an alert was issued by NHS Improvement in 2016. This article explores research into the use of injectable phenytoin and why adverse events occur when it is used. The article will inform nurses and doctors who work with children in acute settings about the risks associated with using injectable phenytoin and implications for practice on how to negate these risks. Applying this knowledge to nursing practice can result in reduced adverse events, and a safer and more effective care environment. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Customization of the voice prosthesis to prevent leakage from the enlarged tracheoesophageal puncture: results of a prospective trial.

PubMed

Lewin, Jan S; Hutcheson, Katherine A; Barringer, Denise A; Croegaert, Lindsay E; Lisec, Asher; Chambers, Mark S

2012-08-01

Customization of the tracheoesophageal (TE) voice prosthesis (VP) is often preferred over surgical closure to prevent aspiration around the VP in laryngectomized patients with an enlarged tracheoesophageal puncture (TEP), but it has not been thoroughly evaluated. Single-institution prospective trial. A prospective trial was conducted to evaluate the effectiveness of a customized VP with the addition of an enlarged tracheal and/or esophageal collar in patients with leakage around an enlarged TEP. Absence of leakage around the VP after placement defined immediate effectiveness. Long-term success was defined by the prevention of adverse events related to leakage during the study period. Events that defined failure included: permanent gastrostomy dependence, aspiration pneumonia, and/or surgical TEP closure. Twenty-one patients with enlarged TEP were enrolled (2003-2006). Insertion of a customized VP was unsuccessful in one patient; 145 customizations were performed in the remaining 20 patients (median, 3.5 customizations) during the trial period. Of the customizations, 77% (112/145) prevented leakage immediately after VP insertion. The most common adverse event was dislodgement of the prosthesis (11%) or the collar alone (7%) in 18% (26/145) of customized VP placements. Six patients who died of disease were not evaluable for long-term outcomes. Long-term success was achieved in 80% (12/15) of evaluable patients who avoided permanent gastrostomy, aspiration pneumonia, and surgical TEP closure. Prosthetic customization offers an effective method to prevent leakage around the VP in many patients with an enlarged TEP, thereby preserving TE voice while avoiding surgical closure in this high-risk population. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Customization of the Voice Prosthesis to Prevent Leakage from the Enlarged Tracheoesophageal Puncture: Results of a Prospective Trial

PubMed Central

Lewin, Jan S.; Hutcheson, Katherine A.; Barringer, Denise A.; Croegaert, Lindsay E.; Lisec, Asher; Chambers, Mark S.

2014-01-01

Background Customization of the tracheoesophageal (TE) voice prosthesis (VP) is often preferred over surgical closure to prevent aspiration around the VP in laryngectomized patients with an enlarged tracheoesophageal puncture (TEP), but has not been thoroughly evaluated. Study Design Single-institution prospective trial. Methods A prospective trial was conducted to evaluate the effectiveness of a customized VP with the addition of an enlarged tracheal and/or esophageal collar in patients with leakage around an enlarged TEP. Absence of leakage around the VP after placement defined immediate effectiveness. Long-term success was defined by the prevention of adverse events related to leakage during the study period. Events that defined failure included: permanent gastrostomy dependence, aspiration pneumonia, and/or surgical TEP closure. Results Twenty-one patients with enlarged TEP were enrolled (2003-2006). Insertion of a customized VP was unsuccessful in 1 patient; 145 customizations were performed in the remaining 20 patients (median: 3.5 customizations) during the trial period. Seventy-seven percent (112/145) of customizations prevented leakage immediately after VP insertion. The most common adverse event was dislodgement of the prosthesis (11%) or the collar alone (7%) in 18% (26/145) of customized VP placements. Six patients who died of disease were not evaluable for long-term outcomes. Long-term success was achieved in 80% (12/ 15) of evaluable patients who avoided permanent gastrostomy, aspiration pneumonia, and surgical TEP closure. Conclusions Prosthetic customization offers an effective method to prevent leakage around the VP in many patients with an enlarged TEP, thereby preserving TE voice while avoiding surgical closure in this high risk population. PMID:22753122

Self-Reported Prevalence of Gluten-Related Disorders and Adherence to Gluten-Free Diet in Colombian Adult Population

PubMed Central

Franco-Aguilar, Alejandro; Magaña-Ordorica, Dalia

2016-01-01

Background. Celiac disease seems to be rare in Colombians, but there are currently no data about the prevalence rates of symptomatic adverse reactions to gluten or adherence to gluten-free diet (GFD) in this population. Aim. to evaluate the self-reported prevalence rates of adverse reactions to gluten, adherence to GFD, and gluten-related disorders at population level in Colombia. Methods. A self-administered questionnaire-based cross-sectional study was conducted in a population from Northwest Colombia. Results. The estimated prevalence rates were (95% CI) 7.9% (6.5–9.6) and 5.3% (4.1–6.7) for adverse and recurrent adverse reactions to wheat/gluten, respectively, adherence to GFD 5.9% (4.7–7.4), wheat allergy 0.74% (0.3–1.4), and nonceliac gluten sensitivity 4.5% (3.5–5.8). There were no self-reported cases of celiac disease. Prevalence of self-reported physician-diagnosis of gluten-related disorders was 0.41% (0.17–0.96). Most respondents reported adherence to GFD without a physician-diagnosis of gluten-related disorders (97.2%). The proportion of gluten avoiders was 17.2% (15.2–19.5). Most of them did not report recurrent adverse reactions to wheat/gluten (87.0%). Conclusions. Nonceliac gluten sensitivity is rarely formally diagnosed in Colombia, but this population has the highest prevalence rate of adherence to GFD reported to date. Consequently, most respondents were avoiding wheat- and/or gluten-based products for reasons other than health-related symptoms. PMID:27648068

Translational toxicology: a developmental focus for integrated research strategies.

PubMed

Hughes, Claude; Waters, Michael; Allen, David; Obasanjo, Iyabo

2013-09-30

Given that toxicology studies the potential adverse effects of environmental exposures on various forms of life and that clinical toxicology typically focuses on human health effects, what can and should the relatively new term of "translational toxicology" be taken to mean? Our assertion is that the core concept of translational toxicology must incorporate existing principles of toxicology and epidemiology, but be driven by the aim of developing safe and effective interventions beyond simple reduction or avoidance of exposure to prevent, mitigate or reverse adverse human health effects of exposures.The field of toxicology has now reached a point where advances in multiple areas of biomedical research and information technologies empower us to make fundamental transitions in directly impacting human health. Translational toxicology must encompass four action elements as follows: 1) Assessing human exposures in critical windows across the lifespan; 2) Defining modes of action and relevance of data from animal models; 3) Use of mathematical models to develop plausible predictions as the basis for: 4) Protective and restorative human health interventions. The discussion focuses on the critical window of in-utero development. Exposure assessment, basic toxicology and development of certain categories of mathematical models are not new areas of research; however overtly integrating these in order to conceive, assess and validate effective interventions to mitigate or reverse adverse effects of environmental exposures is our novel opportunity. This is what we should do in translational toxicology so that we have a portfolio of interventional options to improve human health that include both minimizing exposures and specific preventative/restorative/mitigative therapeutics.

Energy Security: Emerging Challenges and Opportunities

DTIC Science & Technology

2010-08-01

46 Appendix A: Electrical Capacity Margins...options........................................................................................ 21 6 Net electrical capacity compared to the North...Energy Security The Army Energy and Water Campaign Plan for Installations defines energy security as: the capacity to avoid adverse impact of energy

Long-term therapy in COPD: any evidence of adverse effect on bone?

PubMed Central

Langhammer, Arnulf; Forsmo, Siri; Syversen, Unni

2009-01-01

Patients with COPD have high risk for osteoporosis and fractures. Hip and vertebral fractures might impair mobility, and vertebral fractures further reduce lung function. This review discusses the evidence of bone loss due to medical treatment opposed to disease severity and risk factors for COPD, and therapeutic options for the prevention and treatment of osteoporosis in these patients. A review of the English-language literature was conducted using the MEDLINE database until June 2009. Currently used bronchodilators probably lack adverse effect on bone. Oral corticosteroids (OCS) increase bone resorption and decrease bone formation in a dose response relationship, but the fracture risk is increased more than reflected by bone densitometry. Inhaled corticosteroids (ICS) have been associated with both increased bone loss and fracture risk. This might be a result of confounding by disease severity, but high doses of ICS have similar effects as equipotent doses of OCS. The life-style factors should be modified, use of regular OCS avoided and use of ICS restricted to those with evidenced effect and probably kept at moderate doses. The health care should actively reveal risk factors, include bone densitometry in fracture risk evaluation, and give adequate prevention and treatment for osteoporosis. PMID:19888355

Food allergies are rarely a concern when considering vaccines for adolescents.

PubMed

Buyantseva, Larisa V; Horwitz, Alexandra

2014-03-01

Routine immunization provides protection from numerous infectious diseases and substantially reduces morbidity mortality from these diseases. In the United States, vaccination programs focused on infants and children have successfully decreased the incidence of many childhood vaccine-preventable diseases. However, vaccination coverage among adolescents has remained stagnant. Contributing to this lack of coverage is that patients with food allergies might be advised unnecessarily to avoid certain vaccinations, thus potentially causing adverse personal and community health. Studies have shown that food allergies are rarely contraindications to vaccine administration. Most adolescents who avoid vaccination because of food allergy concerns are actually able to receive their appropriate vaccinations. However, there are situations when evaluation by an allergist is recommended. In the present article, the authors provide guidance for physicians when administering vaccines to patients with food allergies to prevent adverse events and improve disease protection.

System for Processing Coded OFDM Under Doppler and Fading

NASA Technical Reports Server (NTRS)

Tsou, Haiping; Darden, Scott; Lee, Dennis; Yan, Tsun-Yee

2005-01-01

An advanced communication system has been proposed for transmitting and receiving coded digital data conveyed as a form of quadrature amplitude modulation (QAM) on orthogonal frequency-division multiplexing (OFDM) signals in the presence of such adverse propagation-channel effects as large dynamic Doppler shifts and frequency-selective multipath fading. Such adverse channel effects are typical of data communications between mobile units or between mobile and stationary units (e.g., telemetric transmissions from aircraft to ground stations). The proposed system incorporates novel signal processing techniques intended to reduce the losses associated with adverse channel effects while maintaining compatibility with the high-speed physical layer specifications defined for wireless local area networks (LANs) as the standard 802.11a of the Institute of Electrical and Electronics Engineers (IEEE 802.11a). OFDM is a multi-carrier modulation technique that is widely used for wireless transmission of data in LANs and in metropolitan area networks (MANs). OFDM has been adopted in IEEE 802.11a and some other industry standards because it affords robust performance under frequency-selective fading. However, its intrinsic frequency-diversity feature is highly sensitive to synchronization errors; this sensitivity poses a challenge to preserve coherence between the component subcarriers of an OFDM system in order to avoid intercarrier interference in the presence of large dynamic Doppler shifts as well as frequency-selective fading. As a result, heretofore, the use of OFDM has been limited primarily to applications involving small or zero Doppler shifts. The proposed system includes a digital coherent OFDM communication system that would utilize enhanced 802.1la-compatible signal-processing algorithms to overcome effects of frequency-selective fading and large dynamic Doppler shifts. The overall transceiver design would implement a two-frequency-channel architecture (see figure) that would afford frequency diversity for reducing the adverse effects of multipath fading. By using parallel concatenated convolutional codes (also known as Turbo codes) across the dual-channel and advanced OFDM signal processing within each channel, the proposed system is intended to achieve at least an order of magnitude improvement in received signal-to-noise ratio under adverse channel effects while preserving spectral efficiency.

Effects of a Novel Acoustic Transmitter on Swimming Performance and Predator Avoidance of Juvenile Chinook Salmon: Determination of a Size Threshold

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

Walker, Ricardo W.; Ashton, Neil K.; Brown, Richard S.

Abstract Telemetry studies are used worldwide to investigate the behavior and migration of fishes. The miniaturization of acoustic transmitters enables researchers to tag smaller fish, such as the juvenile life stages of salmon, thus representing a greater proportion of the population of interest. The development of an injectable acoustic transmitter has led to research determining the least invasive and quickest method of tag implantation. Swimming performance and predator avoidance were examined. To quantify critical swimming speed (Ucrit; an index of prolonged swimming performance) and predator avoidance for juvenile Chinook salmon (Oncorhynchus tshawytscha), fish were split into three groups: (1) fishmore » implanted with a dummy injectable acoustic transmitter (IAT treatment), (2) fish implanted with a dummy injectable acoustic transmitter and passive integrated transponder (PIT) tag (IAT+PIT treatment), and (3) an untagged control group. The Ucrits and predator avoidance capability of tagged fish were compared with untagged fish to determine if carrying an IAT adversely affected swimming performance or predator avoidance. Fish implanted with only an IAT had lower Ucrit values than untagged fish and a size threshold at 79 mm fork length was found. Conversely, Ucrit values for fish implanted with an IAT+PIT were not significantly different from untagged controls and no size threshold was found. Predator avoidance testing showed no significant difference for fish implanted with an IAT compared to untagged individuals, nor was there a significant difference for IAT+PIT fish compared to untagged fish.« less

Adversomics: a new paradigm for vaccine safety and design

PubMed Central

Whitaker, Jennifer A.; Ovsyannikova, Inna G.; Poland, Gregory A.

2015-01-01

Summary Despite the enormous population benefits of routine vaccination, vaccine adverse events and reactions, whether real or perceived, have posed one of the greatest barriers to vaccine acceptance—and thus to infectious disease prevention—worldwide. A truly integrated clinical, translational, and basic science approach is required to understand the mechanisms behind vaccine adverse events, predict them, and then apply this knowledge to new vaccine design approaches that decrease, or avoid, these events. The term “adversomics” was first introduced in 2009 and refers to the study of vaccine adverse reactions using immunogenomics and systems biology approaches. In this review, we present the current state of adversomics research, review known associations and mechanisms of vaccine adverse events/reactions, and outline a plan for the further development of this emerging research field. PMID:25937189

[Comparison of the "Trigger" tool with the minimum basic data set for detecting adverse events in general surgery].

PubMed

Pérez Zapata, A I; Gutiérrez Samaniego, M; Rodríguez Cuéllar, E; Gómez de la Cámara, A; Ruiz López, P

Surgery is a high risk for the occurrence of adverse events (AE). The main objective of this study is to compare the effectiveness of the Trigger tool with the Hospital National Health System registration of Discharges, the minimum basic data set (MBDS), in detecting adverse events in patients admitted to General Surgery and undergoing surgery. Observational and descriptive retrospective study of patients admitted to general surgery of a tertiary hospital, and undergoing surgery in 2012. The identification of adverse events was made by reviewing the medical records, using an adaptation of "Global Trigger Tool" methodology, as well as the (MBDS) registered on the same patients. Once the AE were identified, they were classified according to damage and to the extent to which these could have been avoided. The area under the curve (ROC) were used to determine the discriminatory power of the tools. The Hanley and Mcneil test was used to compare both tools. AE prevalence was 36.8%. The TT detected 89.9% of all AE, while the MBDS detected 28.48%. The TT provides more information on the nature and characteristics of the AE. The area under the curve was 0.89 for the TT and 0.66 for the MBDS. These differences were statistically significant (P<.001). The Trigger tool detects three times more adverse events than the MBDS registry. The prevalence of adverse events in General Surgery is higher than that estimated in other studies. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

[Evolution of the adverse effects prevalence related to healthcare in hospitals of the Valencia community].

PubMed

Requena, J; Aranaz, J M; Gea, M T; Limón, R; Miralles, J J; Vitaller, J

2010-01-01

Improvement of knowledge on patient safety by a study of the number, importance and impact of Adverse Events (AEs), analysing the patient and healthcare characteristics associated with their occurrence. Cross-sectional study of prevalence carried out for one week every year in the years 2005-2008 in hospitals of the Comunidad Valenciana. AE prevalence in participating hospitals remained constant at around 6 % during the four years of study. The mean age and sex distribution were also constant. The predominant causal factors of AEs were nosocomial infection, procedures and medicines, in that order, although we did observe an increase in AEs due to nosocomial infection during the period of study. With regard to severity, we observed a decrease in the percentage of serious AEs (31.5 % in 2005 vs.17.8 % in 2008), as well as an increase in the proportion of avoidable AEs from 50.8 % to 63.2 % in 2008. The results of the study demonstrate the need for a cultural change among professionals that will stimulate the promotion of a proactive culture for patient safety, and allows us to anticipate a social problem of increasing repercussions. Knowledge of EA epidemiology will help in the development of prevention strategies to avoid or to minimise them. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

Head lice. Dimeticone is the pediculicide of choice.

PubMed

2014-07-01

Infestation of the scalp by head lice, or pediculosis, is a common, unpleasant but harmless parasitosis. For patients with pediculosis, which topical treatment eradicates the parasites effectively while causing the least harm? We reviewed the available evidence using the standard Prescrire methodology. Lice can be eradicated by shaving the head or combing the hair several times a day for several weeks with a fine-toothed lice comb, although combing is only completely effective in about 50% of cases. Pyrethroids (permethrin, phenothrin and bioallethrin), often combined with piperonyl butoxide, are insecticides that are neurotoxic to lice. The lice eradication rates achieved in trials of these agents are highly variable, ranging from 13% to 75% depending on the country, probably due to the development of resistance. In five randomised trials, the organophosphorus insecticide malathion was more effective than permethrin or phenothrin, achieving eradication rates of 80% to 98%. Topical application of the insecticides ivermectin or spinosad was effective in 75% to 85% of patients in randomised trials. Insecticides have mainly local adverse effects: pruritus and irritation of the scalp. Cases of malathion poisoning have been reported following topical application or ingestion. The long-term toxicity of insecticides is unclear; it therefore appears preferable to minimise their use. Agents that kill lice through physical mechanisms have few known adverse effects. It seems unlikely that lice will develop resistance to them. Dimeticone, a silicone compound, is not absorbed through the skin and provokes very few adverse effects. It is one of the better evaluated agents: in three randomised trials, 70% to 97% of patients were lice-free after two weeks. Other agents with a physical action on lice have been evaluated, each in one randomised trial including a few dozen patients. One of these, 1,2-octanediol, applied in an alcoholic solution, seemed to eradicate lice effectively with no notable adverse effects. It is advisable to avoid aerosol formulations due to the risk of bronchospasm, products containing terpenes as these compounds can cause seizures in infants and young children, and products that lack a child-proof cap. In practice, as of early 2014, pyrethroids are no longer the first-choice treatment for head lice: they are losing effectiveness and may be toxic in the long-term. Dimeticone is a better choice, because it has few known adverse effects and proven efficacy.

The Physiologic Effects of Pneumoperitoneum in the Morbidly Obese

PubMed Central

Nguyen, Ninh T.; Wolfe, Bruce M.

2005-01-01

Objective: To review the physiologic effects of carbon dioxide (CO2) pneumoperitoneum in the morbidly obese. Summary Background Data: The number of laparoscopic bariatric operations performed in the United States has increased dramatically over the past several years. Laparoscopic bariatric surgery requires abdominal insufflation with CO2 and an increase in the intraabdominal pressure up to 15 mm Hg. Many studies have demonstrated the adverse consequences of pneumoperitoneum; however, few studies have examined the physiologic effects of pneumoperitoneum in the morbidly obese. Methods: A MEDLINE search from 1994 to 2003 was performed using the key words morbid obesity, laparoscopy, bariatric surgery, pneumoperitoneum, and gastric bypass. The authors reviewed papers evaluating the physiologic effects of pneumoperitoneum in morbidly obese subjects undergoing laparoscopy. The topics examined included alteration in acid-base balance, hemodynamics, femoral venous flow, and hepatic, renal, and cardiorespiratory function. Results: Physiologically, morbidly obese patients have a higher intraabdominal pressure at 2 to 3 times that of nonobese patients. The adverse consequences of pneumoperitoneum in morbidly obese patients are similar to those observed in nonobese patients. Laparoscopy in the obese can lead to systemic absorption of CO2 and increased requirements for CO2 elimination. The increased intraabdominal pressure enhances venous stasis, reduces intraoperative portal venous blood flow, decreases intraoperative urinary output, lowers respiratory compliance, increases airway pressure, and impairs cardiac function. Intraoperative management to minimize the adverse changes include appropriate ventilatory adjustments to avoid hypercapnia and acidosis, the use of sequential compression devices to minimizes venous stasis, and optimize intravascular volume to minimize the effects of increased intraabdominal pressure on renal and cardiac function. Conclusions: Morbidly obese patients undergoing laparoscopic bariatric surgery are at risk for intraoperative complications relating to the use of CO2 pneumoperitoneum. Surgeons performing laparoscopic bariatric surgery should understand the physiologic effects of CO2 pneumoperitoneum in the morbidly obese and make appropriate intraoperative adjustments to minimize the adverse changes. PMID:15650630

Nicotinamide riboside, a form of vitamin B3 and NAD+ precursor, relieves the nociceptive and aversive dimensions of paclitaxel-induced peripheral neuropathy in female rats.

PubMed

Hamity, Marta V; White, Stephanie R; Walder, Roxanne Y; Schmidt, Mark S; Brenner, Charles; Hammond, Donna L

2017-05-01

Injury to sensory afferents may contribute to the peripheral neuropathies that develop after administration of chemotherapeutic agents. Manipulations that increase levels of nicotinamide adenine dinucleotide (NAD) can protect against neuronal injury. This study examined whether nicotinamide riboside (NR), a third form of vitamin B3 and precursor of NAD, diminishes tactile hypersensitivity and place escape-avoidance behaviors in a rodent model of paclitaxel-induced peripheral neuropathy. Female Sprague-Dawley rats received 3 intravenous injections of 6.6 mg/kg paclitaxel over 5 days. Daily oral administration of 200 mg/kg NR beginning 7 days before paclitaxel treatment and continuing for another 24 days prevented the development of tactile hypersensitivity and blunted place escape-avoidance behaviors. These effects were sustained after a 2-week washout period. This dose of NR increased blood levels of NAD by 50%, did not interfere with the myelosuppressive effects of paclitaxel, and did not produce adverse locomotor effects. Treatment with 200 mg/kg NR for 3 weeks after paclitaxel reversed the well-established tactile hypersensitivity in a subset of rats and blunted escape-avoidance behaviors. Pretreatment with 100 mg/kg oral acetyl-L-carnitine (ALCAR) did not prevent paclitaxel-induced tactile hypersensitivity or blunt escape-avoidance behaviors. ALCAR by itself produced tactile hypersensitivity. These findings suggest that agents that increase NAD, a critical cofactor for mitochondrial oxidative phosphorylation systems and cellular redox systems involved with fuel utilization and energy metabolism, represent a novel therapeutic approach for relief of chemotherapy-induced peripheral neuropathies. Because NR is a vitamin B3 precursor of NAD and a nutritional supplement, clinical tests of this hypothesis may be accelerated.

Building a Healthy Environment.

ERIC Educational Resources Information Center

Simon, Elizabeth

1997-01-01

Describes how school districts, with the help of a good architect, can construct or renovate schools and avoid most environmental hazards. Issues concerning indoor air quality, asbestos, lead poisoning, ergonomics, and adverse exposure to radon and electric and magnetic fields are addressed. (GR)

[Assessing the balance of quality indicator sets of external quality assurance according to SGB V section 136].

PubMed

Doebler, Klaus; Geraedts, Max

2017-12-20

The value and usefulness of the results of indicator-based performance measurement in healthcare for different purposes do not only depend on the methodological quality of the individual indicators but also on the composition of the indicator sets. So far, the balance of the currently used indicator sets of the German mandatory national performance measurement system for hospitals has not been systematically analyzed. Due to the lack of a methodological gold standard for the assessment of balance and orientation of indicator sets we adapted the OECD concept of quality dimensions and defined four categories: 1) "Achieving primary goals of treatment", 2) "Avoiding adverse events", 3) "Indication" and 4) "Patient-centeredness". We defined rules for the assignment to the categories and analyzed the distribution of the 239 indicators from 29 medical areas in relation to these categories. 63 indicators (26.4 %) were assigned to the category "Achieving primary goals of treatment", 153 (64.0 %) to the category "Avoiding adverse events", 18 (7.5 %) to the category "Indication", one indicator (0.4 %) to the category "Patient-centeredness". Four indicators (1.7 %) addressed documentation quality. 12 of the 29 indicator sets only covered one OECD quality dimension by at least one indicator. The current indicator sets seem to be unbalanced with a strong focus on the category "Avoiding adverse events". As regards the goal of monitoring the compliance with minimal safety standards and performing improvement interventions, the direction of the indicator sets seems to be appropriate. With respect to other goals, such as for example the identification of "excellence", further development efforts are required. One relevant reason for the dominant focus on the category "Avoiding adverse events" seems to be that data sources for a follow-up and for the inclusion of the patient perspective have not been available until recently. There is a strong demand for the consequent use of these data sources to optimize the interpretability and value of the current performance measurement. The methodological approach presented may offer useful information to assess the value of indicator sets for different purposes although further development and research is necessary. Copyright © 2017. Published by Elsevier GmbH.

[Validation of an adverse event reporting system in primary care].

PubMed

de Lourdes Rojas-Armadillo, María; Jiménez-Báez, María Valeria; Chávez-Hernández, María Margarita; González-Fondón, Araceli

2016-01-01

Patient safety is a priority issue in health systems, due to the damage costs, institutional weakening, lack of credibility, and frustration on those who committed an error that resulted in an adverse event. There is no standardized instrument for recording, reporting, and analyzing sentinel or adverse events (AE) in primary care. Our aim was to design and validate a surveillance system for recording sentinel events, adverse events and near miss incidents in primary care. We made a review of systems for recording and reporting adverse events in primary care. Then, we proposed an instrument to record these events, and register faults in the structure and process, in primary health care units in the Instituto Mexicano del Seguro Social. We showed VENCER-MF format to 35 subjects. Out of them, 100% identified a failure in care process, 90% recorded a sentinel event, 85% identified the cause of this event, 75% of them suggested some measures for avoiding the recurrence of adverse events. We used a Cronbach's alpha of 0.6, p=0.03. The instrument VENCER-MF has a good consistency for the identification of adverse events.

Low-dose mitomycin C, etoposide, and cisplatin for invasive vulvar Paget's disease.

PubMed

Watanabe, Yoh; Hoshiai, H; Ueda, H; Nakai, H; Obata, K; Noda, K

2002-01-01

We report the effect of low-dose mitomycin C, etoposide, and cisplatin (low-dose MEP) therapy for three patients with invasive vulvar Paget's disease (invasive VPD) who declined radical vulvectomy and skin grafting. One patient achieved a complete response, while the other two showed partial responses (PR) without grade 3 or 4 adverse effects. The two patients with PR were undergone partial vulvectomy and inguinal lymph node dissection. All patients have no sign of recurrence for 10 months after chemotherapy. Our present results suggest that low-dose MEP is an effective and safe chemotherapy for invasive VPD and low-dose MEP may significantly improve postoperative quality of life in patients with invasive VPD by avoiding extensive vulvar resection and skin grafting.

Metabolism-Activated Multitargeting (MAMUT): An Innovative Multitargeting Approach to Drug Design and Development.

PubMed

Mátyus, Péter; Chai, Christina L L

2016-06-20

Multitargeting is a valuable concept in drug design for the development of effective drugs for the treatment of multifactorial diseases. This concept has most frequently been realized by incorporating two or more pharmacophores into a single hybrid molecule. Many such hybrids, due to the increased molecular size, exhibit unfavorable physicochemical properties leading to adverse effects and/or an inappropriate ADME (absorption, distribution, metabolism, and excretion) profile. To avoid this limitation and achieve additional therapeutic benefits, here we describe a novel multitargeting strategy based on the synergistic effects of a parent drug and its active metabolite(s). The concept of metabolism-activated multitargeting (MAMUT) is illustrated using a number of examples. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Towards evidence-based resuscitation of the newborn infant.

PubMed

Manley, Brett J; Owen, Louise S; Hooper, Stuart B; Jacobs, Susan E; Cheong, Jeanie L Y; Doyle, Lex W; Davis, Peter G

2017-04-22

Effective resuscitation of the newborn infant has the potential to save many lives around the world and reduce disabilities in children who survive peripartum asphyxia. In this Series paper, we highlight some of the important advances in the understanding of how best to resuscitate newborn infants, which includes monitoring techniques to guide resuscitative efforts, increasing awareness of the adverse effects of hyperoxia, delayed umbilical cord clamping, the avoidance of routine endotracheal intubation for extremely preterm infants, and therapeutic hypothermia for hypoxic-ischaemic encephalopathy. Despite the challenges of performing high-quality clinical research in the delivery room, researchers continue to refine and advance our knowledge of effective resuscitation of newborn infants through scientific experiments and clinical trials. Copyright © 2017 Elsevier Ltd. All rights reserved.

Diagnosis, monitoring and management of immune-related adverse drug reactions of anti-PD-1 antibody therapy.

PubMed

Eigentler, Thomas K; Hassel, Jessica C; Berking, Carola; Aberle, Jens; Bachmann, Oliver; Grünwald, Viktor; Kähler, Katharina C; Loquai, Carmen; Reinmuth, Niels; Steins, Martin; Zimmer, Lisa; Sendl, Anna; Gutzmer, Ralf

2016-04-01

PD-1 checkpoint inhibitors are associated with a specific spectrum of immune-related adverse events. This spectrum is different from toxicities known for kinase inhibitors or cytotoxic drugs. Since PD-1 directed therapies show effectivity in an increasing number of malignant diseases, their clinical usage will increase rapidly. Therefore clinicians from different specialities such as medical oncology, internal medicine, family doctors and emergency unit staff should be aware of the adverse effects of PD-1 checkpoint inhibitors to avoid delays in diagnosis and treatment. Based on pooled data from pivotal trials as reported by the European Medicines Agency, the present paper reviews incidences and kinetics of onset and resolution of immune-mediated "adverse events of specific interest" (AEOSI) of both approved PD-1 inhibitors nivolumab and pembrolizumab. In general, the severity of AEOSI is mild to moderate (grade 1-2); the frequency of immune-mediated but also idiopathic grade 3-4 adverse drug reactions is ⩽2% for any event term. Recommendations for the diagnosis, monitoring and management of the relevant dermatological, gastrointestinal, pulmonary, endocrine, renal and hepatic toxicities are convened by an expert panel that consolidated and clarified treatment recommendations after the onset of AEOSI. Although the time of onset is not predictable - the medians range from 1 to 6months - the huge majority of events is reversible, with no impact of the time of onset. By the systemic use of glucocorticoids, notably methylprednisolone or equivalents, most AEOSI are well manageable. Non-steroidal immunosuppressants may be used in certain cases of refractory/recalcitrant, long-lasting immune toxicities. With regard to the outstanding clinical activity of the anti-PD-1 antibodies, therapy restart is the principal therapeutic option after recovery of grade 2 AEOSI, or diminution of higher grade skin or endocrine events to mild severity. Early diagnosis and close clinical monitoring are essential for successful management of immune-related adverse events. Copyright © 2016 Elsevier Ltd. All rights reserved.

Introduction of risk size in the determination of uncertainty factor UFL in risk assessment

NASA Astrophysics Data System (ADS)

Xue, Jinling; Lu, Yun; Velasquez, Natalia; Yu, Ruozhen; Hu, Hongying; Liu, Zhengtao; Meng, Wei

2012-09-01

The methodology for using uncertainty factors in health risk assessment has been developed for several decades. A default value is usually applied for the uncertainty factor UFL, which is used to extrapolate from LOAEL (lowest observed adverse effect level) to NAEL (no adverse effect level). Here, we have developed a new method that establishes a linear relationship between UFL and the additional risk level at LOAEL based on the dose-response information, which represents a very important factor that should be carefully considered. This linear formula makes it possible to select UFL properly in the additional risk range from 5.3% to 16.2%. Also the results remind us that the default value 10 may not be conservative enough when the additional risk level at LOAEL exceeds 16.2%. Furthermore, this novel method not only provides a flexible UFL instead of the traditional default value, but also can ensure a conservative estimation of the UFL with fewer errors, and avoid the benchmark response selection involved in the benchmark dose method. These advantages can improve the estimation of the extrapolation starting point in the risk assessment.

Treatment of hay fever.

PubMed Central

Wood, S F

1989-01-01

The range of treatments for hay fever available to the general practitioner has changed considerably in recent years. New antihistamines have addressed the problem of sedation and moved towards one daily dose; nasally applied corticosteroids avoid the need for systemic steroid therapy and its potential adverse effect; and regulatory decisions have set a trend away from immunotherapy in general practice. However, knowledge about the mechanism of action of immunotherapy is increasing and new developments with improved safety profiles include allergen polymers, allergoids, oral immunotherapy and nasal immunotherapy. Choice of treatment depends, as always, on the individual circumstances of the patient and his or her disease. PMID:2556545

HSI Guidelines Outline for the Air Vehicle Control Station. Version 2

NASA Technical Reports Server (NTRS)

2006-01-01

This document provides guidance to the FAA and manufacturers on how to develop UAS Pilot Vehicle Interfaces to safely and effectively integrate UASs into the NAS. Preliminary guidelines are provided for Aviate, Communicate, Navigate and Avoid Hazard functions. The pilot shall have information and control capability so that pilot-UA interactions are not adverse, unfavorable, nor compromise safety. Unfavorable interactions include anomalous aircraft-pilot coupling (APC) interactions (closed loop), pilot-involved oscillations (categories I, II or III), and non-oscillatory APC events (e.g., divergence). - Human Systems Integration Pilot-Technology Interface Requirements for Command, Control, and Communications (C3)

International Conference on Harmonisation; guidance on S7A safety pharmacology studies for human pharmaceuticals; availability. Notice.

PubMed

2001-07-13

The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "S7A Safety Pharmacology Studies for Human Pharmaceuticals." The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The guidance provides a definition, general principles, and recommendations for the nonclinical safety pharmacology studies. The guidance is intended to help protect clinical trial participants and patients receiving marketed products from potential adverse effects of pharmaceuticals, while avoiding unnecessary use of animals and other resources.

Psychomotor retardation in a girl with complete growth hormone deficiency.

PubMed

Dayal, Devi; Malhi, Prabhjot; Kumar Bhalla, Anil; Sachdeva, Naresh; Kumar, Rakesh

2013-01-01

Infants with complete growth hormone deficiency may suffer from psychomotor retardation in addition to severe growth failure. Without replacement therapy, they may have a compromised intellectual potential manifesting as learning disabilities and attention-deficit disorders in later life. In this communication, we discuss an infant who showed improvement in physical growth after growth hormone therapy but her psychomotor skills did not improve probably due to late start of treatment. There is a need to start growth hormone therapy as early as possible in infants with complete growth hormone deficiency to avoid adverse effects on psychomotor and brain development.

(99m)Tc-MAG3 diuretic renography in diagnosis of obstructive nephropathy in adults: a comparison between F-15 and a new procedure F+10(sp) in seated position.

PubMed

Tartaglione, Girolamo; D'Addessi, Alessandro; De Waure, Chiara; Pagan, Marco; Raccioppi, Marco; Sacco, Emilio; Cadeddu, Chiara; Vittori, Matteo; Bassi, Pier Francesco; Ferretti, Alice; Al-Nahhas, Adil; Rubello, Domenico

2013-06-01

The objective of this study was to compare 2 diuretic renography procedures: F-15 versus F+10(sp) for diagnosis of obstructive uropathy in adults. Thirty-six patients with unilateral or bilateral hydronephrosis had 2 consecutive Tc-MAG3 diuretic renograms within 7 days, using the widely used procedure F-15 in supine position, and a new seated-position procedure whereby the patient drinks 400 to 500 mL of water at 5 minutes and receives an injection of 20 mg of furosemide at 10 minutes [F+10 (sp)]. F-15 showed nonobstructive results in 63.9% of kidneys, obstruction in 26.4%, and equivocal findings in 6.9% and was not applicable in 2.8%. F+10(sp) showed nonobstructive results in 70.9%, obstruction in 27.8%, and equivocal result in 1.4% of kidneys. Nephroptosis was observed by F+10(sp) in 22.2% of kidneys. Adverse effects reported for the F-15 were hypotension in 2 patients, renal colic in 3 patients, and interruption due to voiding in 5 patients. No adverse effects were reported for F+10(sp). This study shows that the F+10(sp) procedure reduces the equivocal findings of F-15 procedure in 36 patients. It can improve the accuracy and compliance, avoiding adverse effects and reducing bladder filling-related problems.

Spicing thing up: Synthetic cannabinoids

PubMed Central

Spaderna, Max; Addy, Peter H; D’Souza, Deepak Cyril

2013-01-01

Rationale Recently, products containing synthetic cannabinoids, collectively referred to as Spice, are increasingly being used recreationally. Objectives The availability, acute subjective effects—including self-reports posted on Erowid—laboratory detection, addictive potential, and regulatory challenges of the Spice phenomenon are reviewed. Results Spice is sold under the guise of potpourri or incense. Unlike THC, the synthetic cannabinoids present in Spice are high-potency, high-efficacy, cannabinoid-receptor full agonists. Since standard urine toxicology does not test for the synthetic cannabinoids in Spice, it is often used by those who want to avoid detection of drug use. These compounds have not yet been subjected to rigorous testing in humans. Acute psychoactive effects include changes in mood, anxiety, perception, thinking, memory, and attention. Adverse effects include anxiety, agitation, panic, dysphoria, psychosis, and bizarre behavior. Psychosis outcomes associated with Spice provide additional data linking cannabinoids and psychosis. Adverse events necessitating intervention by Poison Control Centers, law enforcement, emergency responders, and hospitals are increasing. Despite statutes prohibiting the manufacture, distribution, and sale of Spice products, manufacturers are replacing banned compounds with newer synthetic cannabinoids that are not banned. Conclusions There is an urgent need for better research on the effects of synthetic cannabinoids to help clinicians manage adverse events and to better understand cannabinoid pharmacology in humans. The reported psychosis outcomes associated with synthetic cannabinoids contribute to the ongoing debate on the association between cannabinoids and psychosis. Finally, drug-detection tests for synthetic cannabinoids need to become clinically available. PMID:23836028

Factors influencing antibiotic-prescribing decisions among inpatient physicians: a qualitative investigation

PubMed Central

Livorsi, D; Comer, AR; Matthias, MS; Perencevich, EN; Bair, MJ

2016-01-01

Objective To understand the professional and psychosocial factors that influence physicians' antibiotic-prescribing habits in the inpatient setting. Design We conducted semi-structured interviews with 30 inpatient physicians. Interviews consisted of open-ended questions and flexible probes based on participants' responses. Interviews were audio recorded, transcribed, de-identified, and reviewed for accuracy and completeness. Data were analyzed using emergent thematic analysis. Setting Two teaching hospitals in Indianapolis, IN Participants Thirty inpatient physicians (10 physicians-in-training, 20 supervising staff) Results Participants recognized that antibiotics are over-used, and many admitted to prescribing antibiotics even when the clinical evidence of infection was uncertain. Over-prescription was largely driven by anxiety about missing an infection while potential adverse effects of antibiotics did not strongly influence decision-making. Participants did not routinely disclose potential adverse effects of antibiotics to inpatients. Physicians-in-training were strongly influenced by the antibiotic prescribing behavior of their supervising staff physicians. Participants sometimes questioned their colleagues' antibiotic-prescribing decisions but frequently avoided providing direct feedback or critique, citing obstacles of hierarchy, infrequent face-to-face encounters, and the awkwardness of these conversations. Conclusion There is a physician-based culture of prescribing antibiotics, which involves over-using antibiotics and not challenging colleagues' decisions. The potential adverse effects of antibiotics do not strongly influence decision-making in this sample. A better understanding of these factors could be leveraged in future efforts to improve antibiotic-prescribing in the inpatient setting. PMID:26078017

Aircraft Trajectory Optimization and Contrails Avoidance in the Presence of Winds

NASA Technical Reports Server (NTRS)

Ng, Hok K.; Chen, Neil Y.

2010-01-01

There are indications that persistent contrails can lead to adverse climate change, although the complete effect on climate forcing is still uncertain. A flight trajectory optimization algorithm with fuel and contrails models, which develops alternative flight paths, provides policy makers the necessary data to make tradeoffs between persistent contrails mitigation and aircraft fuel consumption. This study develops an algorithm that calculates wind-optimal trajectories for cruising aircraft while avoiding the regions of airspace prone to persistent contrails formation. The optimal trajectories are developed by solving a non-linear optimal control problem with path constraints. The regions of airspace favorable to persistent contrails formation are modeled as penalty areas that aircraft should avoid and are adjustable. The tradeoff between persistent contrails formation and additional fuel consumption is investigated, with and without altitude optimization, for 12 city-pairs in the continental United States. Without altitude optimization, the reduction in contrail travel times is gradual with increase in total fuel consumption. When altitude is optimized, a two percent increase in total fuel consumption can reduce the total travel times through contrail regions by more than six times. Allowing further increase in fuel consumption does not seem to result in proportionate decrease in contrail travel times.

Preadoption adversity and long-term clinical-range behavior problems in adopted Chinese girls.

PubMed

Tan, Tony Xing; Camras, Linda A; Kim, Eun Sook

2016-04-01

In this study, we report findings on the role of preadoption adversity on long-term clinical-range problems in adopted Chinese girls. Four waves (2005, 2007, 2009 and 2011) of problem behavior data on 1,223 adopted Chinese girls (M = 4.86 years, SD = 2.82 in 2005) were collected from the adoptive mothers with the Child Behavior Checklist (CBCL). At Wave 1 (2005), data on the following indicators of preadoption adversity was collected: age at adoption, physical signs/symptoms (e.g., sores) of preadoption adversity, developmental delays at arrival, refusal/avoidance behaviors and crying/clinging behaviors toward adoptive parents during the first 3 weeks of adoption. We found that the percentage of clinical-range internalizing problems was 11.1%, 16.5%, 11.3%, and 16.1% at Wave 1, Wave 2, Wave 3, and Wave 4, respectively; the corresponding percentage of clinical-range externalizing problems was 8.4%, 10.5%, 8.4% and 9.9% respectively; and the corresponding percentage of clinical-range total CBCL problems was 9.3%, 13.0%, 9.8% and 12.6% respectively. Analyses with Mplus showed that controlling for demographic variables, indicators of preadoption adversity, except age at adoption, increased the odds for clinical-range behavior problems. Longitudinal path models revealed that controlling for demographic variables and the children's adjustment status in the previous wave, refusal/avoidance remained significant in predicting clinical-range internalizing, externalizing and total CBCL problems at Wave 2, delays at arrival and signs/symptoms were significant in predicting clinical-range internalizing problems at Wave 3. Overall, adoptees with clinical-range CBCL problems in earlier waves were 9-28 times as likely to show clinical-range CBCL problems in subsequent waves. (c) 2016 APA, all rights reserved).

Bee Venom Phospholipase A2: Yesterday's Enemy Becomes Today's Friend.

PubMed

Lee, Gihyun; Bae, Hyunsu

2016-02-22

Bee venom therapy has been used to treat immune-related diseases such as arthritis for a long time. Recently, it has revealed that group III secretory phospholipase A2 from bee venom (bee venom group III sPLA2) has in vitro and in vivo immunomodulatory effects. A growing number of reports have demonstrated the therapeutic effects of bee venom group III sPLA2. Notably, new experimental data have shown protective immune responses of bee venom group III sPLA2 against a wide range of diseases including asthma, Parkinson's disease, and drug-induced organ inflammation. It is critical to evaluate the beneficial and adverse effects of bee venom group III sPLA2 because this enzyme is known to be the major allergen of bee venom that can cause anaphylactic shock. For many decades, efforts have been made to avoid its adverse effects. At high concentrations, exposure to bee venom group III sPLA2 can result in damage to cellular membranes and necrotic cell death. In this review, we summarized the current knowledge about the therapeutic effects of bee venom group III sPLA2 on several immunological diseases and described the detailed mechanisms of bee venom group III sPLA2 in regulating various immune responses and physiopathological changes.

Bee Venom Phospholipase A2: Yesterday’s Enemy Becomes Today’s Friend

PubMed Central

Lee, Gihyun; Bae, Hyunsu

2016-01-01

Bee venom therapy has been used to treat immune-related diseases such as arthritis for a long time. Recently, it has revealed that group III secretory phospholipase A2 from bee venom (bee venom group III sPLA2) has in vitro and in vivo immunomodulatory effects. A growing number of reports have demonstrated the therapeutic effects of bee venom group III sPLA2. Notably, new experimental data have shown protective immune responses of bee venom group III sPLA2 against a wide range of diseases including asthma, Parkinson’s disease, and drug-induced organ inflammation. It is critical to evaluate the beneficial and adverse effects of bee venom group III sPLA2 because this enzyme is known to be the major allergen of bee venom that can cause anaphylactic shock. For many decades, efforts have been made to avoid its adverse effects. At high concentrations, exposure to bee venom group III sPLA2 can result in damage to cellular membranes and necrotic cell death. In this review, we summarized the current knowledge about the therapeutic effects of bee venom group III sPLA2 on several immunological diseases and described the detailed mechanisms of bee venom group III sPLA2 in regulating various immune responses and physiopathological changes. PMID:26907347

Cognitive deficits and decreased locomotor activity induced by single-walled carbon nanotubes and neuroprotective effects of ascorbic acid

PubMed Central

Liu, Xudong; Zhang, Yuchao; Li, Jinquan; Wang, Dong; Wu, Yang; Li, Yan; Lu, Zhisong; Yu, Samuel CT; Li, Rui; Yang, Xu

2014-01-01

Single-walled carbon nanotubes (SWCNTs) have shown increasing promise in the field of biomedicine, especially in applications related to the nervous system. However, there are limited studies available on the neurotoxicity of SWCNTs used in vivo. In this study, neurobehavioral changes caused by SWCNTs in mice and oxidative stress were investigated. The results of ethological analysis (Morris water maze and open-field test), brain histopathological examination, and assessments of oxidative stress (reactive oxygen species [ROS], malondialdehyde [MDA], and glutathione [GSH]), inflammation (nuclear factor κB, tumor necrosis factor α, interleukin-1β), and apoptosis (cysteine-aspartic acid protease 3) in brains showed that 6.25 and 12.50 mg/kg/day SWCNTs in mice could induce cognitive deficits and decreased locomotor activity, brain histopathological alterations, and increased levels of oxidative stress, inflammation, and apoptosis in mouse brains; however, 3.125 mg/kg/day SWCNTs had zero or minor adverse effects in mice, and these effects were blocked by concurrent administration of ascorbic acid. Down-regulation of oxidative stress, inflammation, and apoptosis were proposed to explain the neuroprotective effects of ascorbic acid. This work suggests SWCNTs could induce cognitive deficits and decreased locomotor activity, and provides a strategy to avoid the adverse effects. PMID:24596461

Personalized Medicine Based on Theranostic Radioiodine Molecular Imaging for Differentiated Thyroid Cancer.

PubMed

Ahn, Byeong-Cheol

2016-01-01

Molecular imaging based personalized therapy has been a fascinating concept for individualized therapeutic strategy, which is able to attain the highest efficacy and reduce adverse effects in certain patients. Theranostics, which integrates diagnostic testing to detect molecular targets for particular therapeutic modalities, is one of the key technologies that contribute to the success of personalized medicine. Although the term "theranostics" was used after the second millennium, its basic principle was applied more than 70 years ago in the field of thyroidology with radioiodine molecular imaging. Differentiated thyroid cancer, which arises from follicular cells in the thyroid, is the most common endocrine malignancy, and theranostic radioiodine has been successfully applied to diagnose and treat differentiated thyroid cancer, the applications of which were included in the guidelines published by various thyroid or nuclear medicine societies. Through better pathophysiologic understanding of thyroid cancer and advancements in nuclear technologies, theranostic radioiodine contributes more to modern tailored personalized management by providing high therapeutic effect and by avoiding significant adverse effects in differentiated thyroid cancer. This review details the inception of theranostic radioiodine and recent radioiodine applications for differentiated thyroid cancer management as a prototype of personalized medicine based on molecular imaging.

Therapeutic effects of drug-nutrient interactions in the elderly.

PubMed

Roe, D A

1985-02-01

The elderly are the major drug users both because they need specific prescription drugs for control of chronic diseases and because they make excessive use of over-the-counter (OTC) drugs. Therapeutic drugs that are required may be discontinued because the individuals suffer side effects or because the drug is ineffective. Adverse drug reactions in the elderly may result from drug overuse or misuse, slowed drug metabolism or elimination secondary to aging or to age-related chronic disease, intake of alcohol, food-drug incompatibilities, or nutrient-drug interactions. The timing of drug intake in relation to food intake is an important determinant of therapeutic efficacy in the elderly. Food-drug interactions in the gastrointestinal tract may reduce drug absorption. Enteral formula feeding may also interfere with drug absorption. Conversely, absorption of certain drugs (e.g., thiazides) may be promoted by meal-induced slowing of gastric emptying time. Therapeutic diet prescription can influence drug responses in the elderly because the protein composition of the diet influences the rate of drug metabolism. Nutrient depletion secondary to the effect of drugs may be recognized as an important and often avoidable type of adverse drug reaction.

An overview on safety issues related to erythropoiesis-stimulating agents for the treatment of anaemia in patients with chronic kidney disease.

PubMed

Del Vecchio, Lucia; Locatelli, Francesco

2016-08-01

Erythropoiesis stimulating agents (ESA) are effective drugs, which have been used for decades in patients with chronic kidney disease (CKD) with few side effects. More recently, concern has been raised around their safety, from higher cardiovascular and thrombosis risk to cancer progression and increased mortality. We made a literature search on PubMed looking for adverse effects of ESA in CKD patients. The topics covered are cardiovascular adverse events, thrombosis, increased mortality, hypertension, cancer progression, diabetic retinopathy, pure red cell aplasia and anaphylactic reactions. Concerns around ESA therapy have questioned treatment indications in high-risk CKD patients (those with cancer, diabetes and cardiovascular comorbidities). A more cautious approach has then prevailed. In our opinion, intermediate Hb values (Hb 10-12 g/dl) should be aimed with ESA therapy, being more cautious in high-risk patients. As a consequence, IV iron is administered more frequently. However, excessive iron use may cause iron overload and in rare cases severe anaphylactic reactions. There are expectations of new erythropoietic agents, such as those manipulating the hypoxia-inducible transcription factors (HIF) system. Differing from ESAs, they stimulate the production of endogenous EPO, avoiding over-physiological plasmatic levels.

A Survey on Urban Traffic Management System Using Wireless Sensor Networks.

PubMed

Nellore, Kapileswar; Hancke, Gerhard P

2016-01-27

Nowadays, the number of vehicles has increased exponentially, but the bedrock capacities of roads and transportation systems have not developed in an equivalent way to efficiently cope with the number of vehicles traveling on them. Due to this, road jamming and traffic correlated pollution have increased with the associated adverse societal and financial effect on different markets worldwide. A static control system may block emergency vehicles due to traffic jams. Wireless Sensor networks (WSNs) have gained increasing attention in traffic detection and avoiding road congestion. WSNs are very trendy due to their faster transfer of information, easy installation, less maintenance, compactness and for being less expensive compared to other network options. There has been significant research on Traffic Management Systems using WSNs to avoid congestion, ensure priority for emergency vehicles and cut the Average Waiting Time (AWT) of vehicles at intersections. In recent decades, researchers have started to monitor real-time traffic using WSNs, RFIDs, ZigBee, VANETs, Bluetooth devices, cameras and infrared signals. This paper presents a survey of current urban traffic management schemes for priority-based signalling, and reducing congestion and the AWT of vehicles. The main objective of this survey is to provide a taxonomy of different traffic management schemes used for avoiding congestion. Existing urban traffic management schemes for the avoidance of congestion and providing priority to emergency vehicles are considered and set the foundation for further research.

A Survey on Urban Traffic Management System Using Wireless Sensor Networks

PubMed Central

Nellore, Kapileswar; Hancke, Gerhard P.

2016-01-01

Nowadays, the number of vehicles has increased exponentially, but the bedrock capacities of roads and transportation systems have not developed in an equivalent way to efficiently cope with the number of vehicles traveling on them. Due to this, road jamming and traffic correlated pollution have increased with the associated adverse societal and financial effect on different markets worldwide. A static control system may block emergency vehicles due to traffic jams. Wireless Sensor networks (WSNs) have gained increasing attention in traffic detection and avoiding road congestion. WSNs are very trendy due to their faster transfer of information, easy installation, less maintenance, compactness and for being less expensive compared to other network options. There has been significant research on Traffic Management Systems using WSNs to avoid congestion, ensure priority for emergency vehicles and cut the Average Waiting Time (AWT) of vehicles at intersections. In recent decades, researchers have started to monitor real-time traffic using WSNs, RFIDs, ZigBee, VANETs, Bluetooth devices, cameras and infrared signals. This paper presents a survey of current urban traffic management schemes for priority-based signalling, and reducing congestion and the AWT of vehicles. The main objective of this survey is to provide a taxonomy of different traffic management schemes used for avoiding congestion. Existing urban traffic management schemes for the avoidance of congestion and providing priority to emergency vehicles are considered and set the foundation for further research. PMID:26828489

Concomitant use of dietary supplements and medicines in patients due to miscommunication with physicians in Japan.

PubMed

Chiba, Tsuyoshi; Sato, Yoko; Suzuki, Sachina; Umegaki, Keizo

2015-04-16

We previously reported that some patients used dietary supplements with their medication without consulting with physicians. Dietary supplements and medicines may interact with each other when used concomitantly, resulting in health problems. An Internet survey was conducted on 2109 people who concomitantly took dietary supplements and medicines in order to address dietary supplement usage in people who regularly take medicines in Japan. A total of 1508 patients (two admitted patients and 1506 ambulatory patients) and 601 non-patients, who were not consulting with physicians, participated in this study. Purpose for dietary supplement use was different among ages. Dietary supplements were used to treat diseases in 4.0% of non-patients and 11.9% of patients, while 10.8% of patients used dietary supplements to treat the same diseases as their medication. However, 70.3% of patients did not declare dietary supplement use to their physicians or pharmacists because they considered the concomitant use of dietary supplements and medicines to be safe. A total of 8.4% of all subjects realized the potential for adverse effects associated with dietary supplements. The incidence of adverse events was higher in patients who used dietary supplements to treat their disease. Communication between patients and physicians is important for avoiding the adverse effects associated with the concomitant use of dietary supplements and medicines.

Concomitant Use of Dietary Supplements and Medicines in Patients due to Miscommunication with Physicians in Japan

PubMed Central

Chiba, Tsuyoshi; Sato, Yoko; Suzuki, Sachina; Umegaki, Keizo

2015-01-01

We previously reported that some patients used dietary supplements with their medication without consulting with physicians. Dietary supplements and medicines may interact with each other when used concomitantly, resulting in health problems. An Internet survey was conducted on 2109 people who concomitantly took dietary supplements and medicines in order to address dietary supplement usage in people who regularly take medicines in Japan. A total of 1508 patients (two admitted patients and 1506 ambulatory patients) and 601 non-patients, who were not consulting with physicians, participated in this study. Purpose for dietary supplement use was different among ages. Dietary supplements were used to treat diseases in 4.0% of non-patients and 11.9% of patients, while 10.8% of patients used dietary supplements to treat the same diseases as their medication. However, 70.3% of patients did not declare dietary supplement use to their physicians or pharmacists because they considered the concomitant use of dietary supplements and medicines to be safe. A total of 8.4% of all subjects realized the potential for adverse effects associated with dietary supplements. The incidence of adverse events was higher in patients who used dietary supplements to treat their disease. Communication between patients and physicians is important for avoiding the adverse effects associated with the concomitant use of dietary supplements and medicines. PMID:25894658

Allergic reactions to iodinated contrast media: premedication considerations for patients at risk.

PubMed

Schopp, Jennifer G; Iyer, Ramesh S; Wang, Carolyn L; Petscavage, Jonelle M; Paladin, Angelisa M; Bush, William H; Dighe, Manjiri K

2013-08-01

The objectives of this article are to review allergy-type reactions to iodinated contrast media and the protocols utilized to prevent or reduce the occurrence of these adverse reactions in high-risk patients. We will begin by discussing the types or classifications of the adverse reactions to iodinated contrast media. We will then discuss reaction mechanisms, identify the patients at highest risk for adverse reactions, and clarify common misperceptions about the risk. Finally, we will discuss the actions of the medications used to help reduce or prevent allergy-type reactions to iodinated contrast media, the protocols used to help reduce or prevent contrast reactions in high-risk patients, and the potential side effects of these medications. We will also discuss the high-risk patient who has received premedication due to a prior index reaction and discuss the risk of having a subsequent reaction, termed "breakthrough reaction." Identifying patient at high risk for an "allergy-type" reaction to contrast media is an essential task of the radiologist. Prevention of or reduction of the risk of an adverse reaction is critical to patient safety. If an examination can be performed without contrast in a patient at high risk for an allergy-type reaction, it may be appropriate to avoid contrast. However, there are situations where contrast media is necessary, and the radiologist plays a vital role in preventing or mitigating an allergy-type reaction.

28 CFR 63.2 - Policy.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Administration DEPARTMENT OF JUSTICE (CONTINUED) FLOODPLAIN MANAGEMENT AND WETLAND PROTECTION PROCEDURES § 63.2... term adverse impacts associated with the destruction or modification of wetlands and floodplains and to avoid direct or indirect support of new construction in floodplains and wetlands whenever there is a...

28 CFR 63.2 - Policy.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Administration DEPARTMENT OF JUSTICE (CONTINUED) FLOODPLAIN MANAGEMENT AND WETLAND PROTECTION PROCEDURES § 63.2... term adverse impacts associated with the destruction or modification of wetlands and floodplains and to avoid direct or indirect support of new construction in floodplains and wetlands whenever there is a...

28 CFR 63.2 - Policy.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Administration DEPARTMENT OF JUSTICE (CONTINUED) FLOODPLAIN MANAGEMENT AND WETLAND PROTECTION PROCEDURES § 63.2... term adverse impacts associated with the destruction or modification of wetlands and floodplains and to avoid direct or indirect support of new construction in floodplains and wetlands whenever there is a...

28 CFR 63.2 - Policy.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Administration DEPARTMENT OF JUSTICE (CONTINUED) FLOODPLAIN MANAGEMENT AND WETLAND PROTECTION PROCEDURES § 63.2... term adverse impacts associated with the destruction or modification of wetlands and floodplains and to avoid direct or indirect support of new construction in floodplains and wetlands whenever there is a...

Emotional and Cognitive Coping in Relationship Dissolution

ERIC Educational Resources Information Center

Wrape, Elizabeth R.; Jenkins, Sharon Rae; Callahan, Jennifer L.; Nowlin, Rachel B.

2016-01-01

Dissolution of a romantic relationship can adversely affect functioning among college students and represents one primary reason for seeking campus counseling. This study examined the associations among common coping strategies and distress following relationship dissolution. Avoidance and repetitive negative thinking (RNT) were significantly…

33 CFR 337.7 - Emergency actions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... measures to modify the emergency operation to reduce, avoid, or minimize adverse environmental impacts. If... DEFENSE PRACTICE AND PROCEDURE § 337.7 Emergency actions. After obtaining approval from the division..., as necessary, an environmental assessment, if this is practicable in view of the emergency situation...

33 CFR 337.7 - Emergency actions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... measures to modify the emergency operation to reduce, avoid, or minimize adverse environmental impacts. If... DEFENSE PRACTICE AND PROCEDURE § 337.7 Emergency actions. After obtaining approval from the division..., as necessary, an environmental assessment, if this is practicable in view of the emergency situation...

33 CFR 337.7 - Emergency actions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... measures to modify the emergency operation to reduce, avoid, or minimize adverse environmental impacts. If... DEFENSE PRACTICE AND PROCEDURE § 337.7 Emergency actions. After obtaining approval from the division..., as necessary, an environmental assessment, if this is practicable in view of the emergency situation...

33 CFR 337.7 - Emergency actions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... measures to modify the emergency operation to reduce, avoid, or minimize adverse environmental impacts. If... DEFENSE PRACTICE AND PROCEDURE § 337.7 Emergency actions. After obtaining approval from the division..., as necessary, an environmental assessment, if this is practicable in view of the emergency situation...

Pilot behaviors in the face of adverse weather: A new look at an old problem.

PubMed

Batt, Richard; O'Hare, David

2005-06-01

Weather-related general aviation accidents remain one of the most significant causes for concern in aviation safety. Previous studies have typically compared accident and non-accident cases. In contrast, the current study does not concentrate on occurrence outcome. Instead, the emphasis is on the different behaviors that pilots exhibit in the face of adverse weather and, by inference, on the decision-making processes that underlie those behaviors. This study compares three weather-related behaviors that reflect different levels of risk: visual flight rules flight into instrument meteorological conditions ('VFR into IMC'); precautionary landing; and other significant weather avoidance actions. Occurrence data (n=491) were drawn from the Australian Transport Safety Bureau database of aviation occurrences, and included weather-related accidents, incidents, and 'normal operationsd.' There were few significant differences between the three weather-related behavior groups in terms of pilot demographics, aircraft characteristics, geographic or environmental factors, or absolute flight distances. The pattern of relative flight distances (a psychological construct) was markedly different for the three groups, with pilots in the weather avoidance group being distinguished by taking timely action. The relative distance results suggest that the mid-point of the flight can be a 'psychological turning point' for pilots, irrespective of the absolute flight distance involved. Hence, pilots' behavior was sometimes influenced by psychological factors not related to any particular operational aspect of the flight. The results of the weather avoidance group indicate that a safe pilot is a proactive pilot. Dealing with adverse weather is not a one-off decision but a continually evolving process. This aspect is discussed in terms of the concept of 'mindfulness'.

Spontaneous extrusion of a stainless steel glaucoma drainage implant (Ex-PRESS).

PubMed

Tavolato, M; Babighian, S; Galan, A

2006-01-01

To report a case of spontaneous extrusion of a stainless steel glaucoma drainage implant (Ex-PRESS). An Ex-PRESS was implanted under the conjunctiva in a 76-year-old man with primary open-angle glaucoma. Two years after implantation, the Ex-Press extruded spontaneously. Despite this adverse event, there was no increase in intraocular pressure. This is the first report of spontaneous extrusion of an Ex-PRESS device. Implanting the device under a scleral flap should be considered to avoid adverse events such as extrusion or conjunctival erosion.

A self-help coping intervention can reduce anxiety and avoidant health behaviours whilst waiting for cancer genetic risk information: results of a phase III randomised trial.

PubMed

Phelps, Ceri; Bennett, Paul; Hood, Kerenza; Brain, Kate; Murray, Alexandra

2013-04-01

The objective of this study is to evaluate the effectiveness of a self-help coping intervention in reducing intrusive negative thoughts while waiting for cancer genetic risk information. Between August 2007 and November 2008, 1958 new referrals for cancer genetic risk assessment were invited to participate in a randomised trial. The control group received standard information. The intervention group received this information plus a written self-help coping leaflet. The primary outcome measure was the intrusion subscale of the Impact of Event Scale. The intervention significantly reduced intrusive thoughts during the waiting period in those reporting moderate baseline levels of intrusion (p = 0.03). Following risk provision, those in the intervention group reporting low and moderate intrusive worries at baseline reported less intrusive thoughts than those in the control group (p = 0.04 and p = 0.03, respectively). The intervention had no adverse impact in the sample as a whole. Participants in the intervention group with high baseline avoidance and negative affect scores were significantly more likely to remain in the study than those in the control group (p = 0.05 and p = 0.004). Findings that the intervention both reduced distress in those with moderate levels of distress and had no adverse effects following notification of cancer genetic risk suggest that this simple intervention can be implemented across a range of oncology settings involving periods of waiting and uncertainty. The intervention may also reduce the number of individuals dropping out of cancer genetic risk assessment or screening. However, those with clinically high levels of psychological distress are likely to require a more intensive psychological intervention. Copyright © 2012 John Wiley & Sons, Ltd.

Finding a needle in the haystack: the costs and cost-effectiveness of syphilis diagnosis and treatment during pregnancy to prevent congenital syphilis in Kalomo District of Zambia.

PubMed

Larson, Bruce A; Lembela-Bwalya, Deophine; Bonawitz, Rachael; Hammond, Emily E; Thea, Donald M; Herlihy, Julie

2014-01-01

In March 2012, The Elizabeth Glaser Pediatric AIDS Foundation trained maternal and child health workers in Southern Province of Zambia to use a new rapid syphilis test (RST) during routine antenatal care. A recent study by Bonawitz et al. (2014) evaluated the impact of this roll out in Kalomo District. This paper estimates the costs and cost-effectiveness from the provider's perspective under the actual conditions observed during the first year of the RST roll out. Information on materials used and costs were extracted from program records. A decision-analytic model was used to evaluate the costs (2012 USD) and cost-effectiveness. Basic parameters needed for the model were based on the results from the evaluation study. During the evaluation study, 62% of patients received a RST, and 2.8% of patients tested were positive (and 10.4% of these were treated). Even with very high RST sensitivity and specificity (98%), true prevalence of active syphilis would be substantially less (estimated at <0.7%). For 1,000 new ANC patients, costs of screening and treatment were estimated at $2,136, and the cost per avoided disability-adjusted-life year lost (DALY) was estimated at $628. Costs change little if all positives are treated (because prevalence is low and treatment costs are small), but the cost-per-DALY avoided falls to just $66. With full adherence to guidelines, costs increase to $3,174 per 1,000 patients and the cost-per-DALY avoided falls to $60. Screening for syphilis is only useful for reducing adverse birth outcomes if patients testing positive are actually treated. Even with very low prevalence of syphilis (a needle in the haystack), cost effectiveness improves dramatically if those found positive are treated; additional treatment costs little but DALYs avoided are substantial. Without treatment, the needle is essentially found and thrown back into the haystack.

44 CFR 10.4 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... means and measures are used to protect, restore, and enhance the quality of the environment, to avoid or minimize adverse environmental consequences, and to attain the objectives of: (1) Achieving use of the... approach that will ensure the integrated use of the natural and social sciences, and environmental...

44 CFR 10.4 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... means and measures are used to protect, restore, and enhance the quality of the environment, to avoid or minimize adverse environmental consequences, and to attain the objectives of: (1) Achieving use of the... approach that will ensure the integrated use of the natural and social sciences, and environmental...

Media use by children younger than 2 years.

PubMed

Brown, Ari

2011-11-01

In 1999, the American Academy of Pediatrics (AAP) issued a policy statement addressing media use in children. The purpose of that statement was to educate parents about the effects that media--both the amount and the content--may have on children. In one part of that statement, the AAP recommended that "pediatricians should urge parents to avoid television viewing for children under the age of two years." The wording of the policy specifically discouraged media use in this age group, although it is frequently misquoted by media outlets as no media exposure in this age group. The AAP believed that there were significantly more potential negative effects of media than positive ones for this age group and, thus, advised families to thoughtfully consider media use for infants. This policy statement reaffirms the 1999 statement with respect to media use in infants and children younger than 2 years and provides updated research findings to support it. This statement addresses (1) the lack of evidence supporting educational or developmental benefits for media use by children younger than 2 years, (2) the potential adverse health and developmental effects of media use by children younger than 2 years, and (3) adverse effects of parental media use (background media) on children younger than 2 years.

Review shows that early foetal alcohol exposure may cause adverse effects even when the mother consumes low levels.

PubMed

Sarman, Ihsan

2018-06-01

Studies are increasingly focusing on the effects of prenatal alcohol exposure (PAE) on child health. The aim of this review was to provide paediatricians with new insights to help them communicate key messages about avoiding alcohol during pregnancy. Inspired by the 7th International Conference on Fetal Alcohol Spectrum Disorder, which focused on integrating research, policy and practice, we studied English language papers published since 2010 on how early PAE triggered epigenetic mechanisms that had an impact on the development of some chronic diseases. We also report the findings of a human study using three-dimensional photography of the face to explore associations between PAE and craniofacial phenotyping. Animal models with different alcohol exposure patterns show that early PAE may lead to long-term chronic effects, due to developmental programming for some adult diseases in cardiovascular, metabolic and renal systems. The study with three-dimensional photographing is very promising in helping paediatricians to understand how even small amounts of PAE can affect craniofacial phenotyping. Even low levels of PAE can cause adverse foetal effects and not just in the brain. It is not currently possible to determine a safe period and level when alcohol consumption would not affect the foetus. ©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

What Is the Return on Investment for Implementation of a Crew Resource Management Program at an Academic Medical Center?

PubMed

Moffatt-Bruce, Susan D; Hefner, Jennifer L; Mekhjian, Hagop; McAlearney, John S; Latimer, Tina; Ellison, Chris; McAlearney, Ann Scheck

Crew Resource Management (CRM) training has been used successfully within hospital units to improve quality and safety. This article presents a description of a health system-wide implementation of CRM focusing on the return on investment (ROI). The costs included training, programmatic fixed costs, time away from work, and leadership time. Cost savings were calculated based on the reduction in avoidable adverse events and cost estimates from the literature. Between July 2010 and July 2013, roughly 3000 health system employees across 12 areas were trained, costing $3.6 million. The total number of adverse events avoided was 735-a 25.7% reduction in observed relative to expected events. Savings ranged from a conservative estimate of $12.6 million to as much as $28.0 million. Therefore, the overall ROI for CRM training was in the range of $9.1 to $24.4 million. CRM presents a financially viable way to systematically organize for quality improvement.

BET 1: use of glucagon for oesophageal food bolus impaction.

PubMed

2015-01-01

A shortcut review was carried out to establish whether intravenous glucagon is a safe and effective treatment for patients with suspected lower oesophageal food bolus impaction. Seven studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that there is no evidence for the effectiveness of glucagon in this situation. Its use may be associated with adverse effects such as vomiting, with the potential risk of oesophageal perforation. Intravenous glucagon should therefore be avoided. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Pilot of integrated, colocated neurology in a primary care medical home.

PubMed

Young, Nathan P; Elrashidi, Muhamad Y; Crane, Sarah J; Ebbert, Jon O

2017-06-01

Novel health care delivery models are needed to reduce health care use while delivering effective and safe care. We developed a model of a neurologist integrated and colocated in primary care leveraging "curbside," electronic, and traditional consultations. Our objective was to examine the impact on health care resource use of diagnostic testing and referrals for face-to-face neurological consultation and adverse outcomes associated with electronic and curbside consultations. Consecutive patients from December 1, 2014, to March 13, 2015, were included in the analysis about whom contact was made between a primary care clinician and a colocated neurologist. Over 3.5 months of the pilot, 359 unique patients generated 429 consultations (179 curbsides, 68 electronic consultations, and 182 face-to-face visits). The integrated model resulted in avoidance of 78 face-to-face tertiary neurology consultations, 39 brain magnetic resonance imaging, 50 electromyograms, and 53 other advanced imaging studies. Earlier curbside consultation may have prevented unnecessary testing or face-to-face tertiary neurology consultations in 40 (22%) patients. Earlier face-to-face consultation may have avoided expensive testing in 31 (17%) patients. No cases met criteria for an adverse outcome. The number of referrals to tertiary neurology declined by 64%, and the total number of face-to-face visits per month declined by 25%. Colocated neurology in a primary care medical home offers a promising intervention to deliver high-value care. © 2016 John Wiley & Sons, Ltd.

An audit of ECT in England 2011-2015: Usage, demographics, and adherence to guidelines and legislation.

PubMed

Read, John; Harrop, Christopher; Geekie, Jim; Renton, Julia

2017-10-20

Electroconvulsive therapy (ECT) continues to be used in England, but without comprehensive national auditing. Therefore, information was gathered on usage, demographics, consent, and adherence to the guidelines of the National Institute of Clinical Excellence (N.I.C.E.) and to the Mental Health Act. Freedom of Information Act requests were sent to 56 National Health Service Trusts. Thirty-two trusts provided some usable data. Only 10 were able to report how many people received psychological therapy prior to ECT in accordance with N.I.C.E. recommendations, with figures ranging from 0% to 100%. The number of people currently receiving ECT in England annually is between 2,100 and 2,700, and falling. There was a 12-fold difference between the Trusts with the highest and lowest usage rates per capita. Most recipients are still women (66%) and over 60 (56%). More than a third (39%) is given without consent, with 30% of Trusts not adhering to mental health legislation concerning second opinions. At least 44% were not using validated measures of efficacy, and at least 33% failed to do so for adverse effects. Only four provided any actual data for positive outcomes or adverse effects. None provided any data on efficacy beyond the end of treatment. National audits should be reinstated. Independent, objective monitoring of adverse effects is urgently required. An investigation into why ECT is still administered excessively to older people and women seems long overdue. Mental health staff should seek to ensure that all depressed people in their service are offered evidence-based psychological treatments before being offered E.C.T. Staff should lobby managers to ensure proper auditing of E.C.T. within their service Individuals receiving ECT should be closely monitored for adverse cognitive effects Overuse of ECT with women and older people should be avoided. © 2017 The British Psychological Society.

Controlling adverse and beneficial effects of solar UV radiation by wearing suitable clothes - spectral transmission of different kinds of fabrics.

PubMed

Sobolewski, Piotr S; Krzyścin, Janusz W; Jarosławski, Janusz; Wink, Jakub; Lesiak, Aleksandra; Narbutt, Joanna

2014-11-01

Humans should avoid prolonged exposure to the Sun during the warm subperiod of the year with naturally high solar UV level. One of the known recommendations to avoid excessive UV radiation is wearing clothes with UV protection additives. However there is an important question: how do we get an adequate solar UV radiation, which maintains a healthy status of vitamin D, without facing overexposure risks? It is found that some kind of 100% cotton knitted fabric, used in the production of normal daily clothing, has ∼15% transmittance of solar UV. Model studies show that a garment made of this fabric allows larger synthesis of vitamin D3 in human body without the erythema risks (skin redness). Thus the adequate level of vitamin D could be attained safely by a person exposing only small part of the body (face, palms) during the period (May-August) of the year. Copyright © 2014 Elsevier B.V. All rights reserved.

UNDERSTANDING THE CAUTIONS AND CONTRAINDICATIONS OF IMMUNOMODULATOR AND BIOLOGIC THERAPIES FOR USE IN INFLAMMATORY BOWEL DISEASE

PubMed Central

Cohn, H. Matthew; Dave, Maneesh; Loftus, Edward V.

2017-01-01

Ulcerative colitis and Crohn’s disease are chronic inflammatory bowel diseases for which there are no cures. These diseases are immunopathogenic, and medical treatment is centered on the temperance of a dysregulated immune response to allow mucosal healing and prevent the sequelae of fistulation and stenosis. Accordingly, the armamentarium of medications, which has expanded immensely in recent history, is not without significant infectious and neoplastic risks. Many of these untoward effects can be mitigated by screening and avoidance of contraindicated medications. This review seeks to highlight the cautions for use of immunomodulators, anticytokine and α4-integrin antagonists. The potential adverse events are further complicated by substantial heterogeneity in disease phenotype in the IBD population. Large patient registries and databases provide considerable experience and knowledge to calculate the incidence of safety outcomes. To identify rarer outcomes after prolonged therapy, more prospective studies and continued adverse event reporting will aid safe application and minimize potential harms. PMID:28708806

Stressful life events as predictors of functioning: findings from the Collaborative Longitudinal Personality Disorders Study

PubMed Central

Pagano, M. E.; Skodol, A. E.; Stout, R. L.; Shea, M. T.; Yen, S.; Grilo, C. M.; Sanislow, C. A.; Bender, D. S.; McGlashan, T. H.; Zanarini, M. C.; Gunderson, J. G.

2008-01-01

Objective Although much attention has been given to the effects of adverse childhood experiences on the development of personality disorders (PDs), we know far less about how recent life events influence the ongoing course of functioning. We examined the extent to which PD subjects differ in rates of life events and the extent to which life events impact psychosocial functioning. Method A total of 633 subjects were drawn from the Collaborative Longitudinal Personality Disorders Study (CLPS), a multi-site study of four personality disorders – schizotypal (STPD), borderline (BPD), avoidant (AVPD), obsessive-compulsive (OCPD) – and a comparison group of major depressive disorders (MDD) without PD. Results Borderline personality disorder subjects reported significantly more total negative life events than other PDs or subjects with MDD. Negative events, especially interpersonal events, predicted decreased psychosocial functioning over time. Conclusion Our findings indicate higher rates of negative events in subjects with more severe PDs and suggest that negative life events adversely impact multiple areas of psychosocial functioning. PMID:15521826

Design, synthesis and structure-activity relationships of dual inhibitors of acetylcholinesterase and serotonin transporter as potential agents for Alzheimer's disease.

PubMed

Toda, Narihiro; Tago, Keiko; Marumoto, Shinji; Takami, Kazuko; Ori, Mayuko; Yamada, Naho; Koyama, Kazuo; Naruto, Shunji; Abe, Kazumi; Yamazaki, Reina; Hara, Takao; Aoyagi, Atsushi; Abe, Yasuyuki; Kaneko, Tsugio; Kogen, Hiroshi

2003-05-01

We have designed and synthesized a dual inhibitor of acetylcholinesterase (AChE) and serotonin transporter (SERT) as a novel class of treatment drugs for Alzheimer's disease on the basis of a hypothetical model of the AChE active site. Dual inhibitions of AChE and SERT would bring about greater therapeutic effects than AChE inhibition alone and avoid adverse peripheral effects caused by excessive AChE inhibition. Compound (S)-6j exhibited potent inhibitory activities against AChE (IC(50)=101 nM) and SERT (IC(50)=42 nM). Furthermore, (S)-6j showed inhibitory activities of both AChE and SERT in mice brain following oral administration.

Gynaecomastia in two men on stable antiretroviral therapy who commenced treatment for tuberculosis.

PubMed

Kratz, Jeremy D; El-Shazly, Ahmad Y; Mambuque, Santos G; Demetria, Elpidio; Veldkamp, Peter; Anderson, Timothy S

2016-12-01

Gynaecomastia is a common clinical presentation that varies from benign presentations in stages of human development to hormonal pathology, mainly due to hepatic dysfunction, malignancy, and adverse pharmacologic effects. We describe the development of significant bilateral gynaecomastia after starting treatment for pulmonary tuberculosis (TB) in two males with WHO stage III Human Immunodeficiency Virus (HIV) infection on stable antiretroviral regimens. Emerging reports suggest that distinct hepatic impairment in efavirenz metabolism modulates oestrogenic activity, which may be potentiated by anti-tuberculosis therapy. Clinical application includes early recognition of efavirenz-induced gynaecomastia, especially after commencing tuberculosis treatment. To avoid decreased adherence resulting from the distressing side effect of gynecomastia, transition to an alternative ART regimen over the course of tuberculosis treatment should be considered.

Iodinated contrast media and contrast-induced nephropathy: is there a preferred cost-effective agent?

PubMed

Sharma, Samin K

2008-05-01

Over 20 years have passed since the introduction of the tri-iodinated low-osmolar nonionic contrast agents such as iopamidol, iohexol, ioversol and iopromide. During this time, most cardiology practices have switched to these nonionic agents to avoid the nuisance side effects and cardiac adverse events associated with the older ionic contrast agents. Although the improved tolerability of the nonionic agents is generally attributed to their decreased osmolality (approximately half that of the older ionic contrast agents), in fact, these contrast agents also differ from the older agents in their ionicity, viscosity and direct chemotoxicity. The impact of these properties on safety, together with cost differences, should be considered when selecting a contrast agent.

Effects of steaming on contaminants of emerging concern levels in seafood.

PubMed

Barbosa, Vera; Maulvault, Ana Luísa; Alves, Ricardo N; Kwadijk, Christian; Kotterman, Michiel; Tediosi, Alice; Fernández-Tejedor, Margarita; Sloth, Jens J; Granby, Kit; Rasmussen, Rie R; Robbens, Johan; De Witte, Bavo; Trabalón, Laura; Fernandes, José O; Cunha, Sara C; Marques, António

2018-05-19

Seafood consumption is a major route for human exposure to environmental contaminants of emerging concern (CeCs). However, toxicological information about the presence of CeCs in seafood is still insufficient, especially considering the effect of cooking procedures on contaminant levels. This study is one among a few who evaluated the effect of steaming on the levels of different CeCs (toxic elements, PFCs, PAHs, musk fragrances and UV-filters) in commercially relevant seafood in Europe, and estimate the potential risks associated with its consumption for consumers. In most cases, an increase in contaminant levels was observed after steaming, though varying according to contaminant and seafood species (e.g. iAs, perfluorobutanoate, dibenzo(ah)anthracene in Mytilus edulis, HHCB-Lactone in Solea sp., 2-Ethylhexyl salicylate in Lophius piscatorius). Furthermore, the increase in some CeCs, like Pb, MeHg, iAs, Cd and carcinogenic PAHs, in seafood after steaming reveals that adverse health effects can never be excluded, regardless contaminants concentration. However, the risk of adverse effects can vary. The drastic changes induced by steaming suggest that the effect of cooking should be integrated in food risk assessment, as well as accounted in CeCs regulations and recommendations issued by food safety authorities, in order to avoid over/underestimation of risks for consumer health. Copyright © 2018 Elsevier Ltd. All rights reserved.

Avoidance of dairy products: Implications for nutrient adequacy and health

USDA-ARS?s Scientific Manuscript database

Dairy products are an important contributor of many essential nutrients often lacking in the typical North American diet, including calcium, potassium, and vitamin D, and limiting dairy intake may adversely affect health. Dairy exclusion diets may exacerbate the risk of osteoporosis and negatively i...

An increasing problem in publication ethics: Publication bias and editors' role in avoiding it.

PubMed

Ekmekci, Perihan Elif

2017-06-01

Publication bias is defined as "the tendency on the parts of investigators, reviewers, and editors to submit or accept manuscripts for publication based on the direction or the strength of the study findings."Publication bias distorts the accumulated data in the literature, causes the over estimation of potential benefits of intervention and mantles the risks and adverse effects, and creates a barrier to assessing the clinical utility of drugs as well as evaluating the long-term safety of medical interventions. The World Medical Association, the International Committee of Medical Journals, and the Committee on Publication Ethics have conferred responsibilities and ethical obligations to editors concerning the avoidance of publication bias. Despite the explicit statements in these international documents, the editors' role in and ability to avoid publication bias is still being discussed. Unquestionably, all parties involved in clinical research have the ultimate responsibility to sustain the research integrity and validity of accumulated general knowledge. Cooperation and commitment is required at every step of a clinical trial. However, this holistic approach does not exclude effective measures to be taken at the editors' level. The editors of major medical journals concluded that one precaution that editors can take is to mandate registration of all clinical trials in a public repository as a precondition to submitting manuscripts to journals. Raising awareness regarding the value of publishing negative data for the scientific community and human health, and increasing the number of journals that are dedicated to publishing negative results or that set aside a section in their pages to do so, are positive steps editors can take to avoid publication bias.

The attitudes of owners and veterinary professionals in the United Kingdom to the risk of adverse events associated with using non-steroidal anti-inflammatory drugs (NSAIDs) to treat dogs with osteoarthritis.

PubMed

Belshaw, Zoe; Asher, Lucy; Dean, Rachel S

2016-09-01

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed by veterinary surgeons for the treatment of canine osteoarthritis, and affected dogs may receive these drugs for long periods of time. Whilst short term administration of NSAIDs to dogs is linked to adverse events such as gastrointestinal haemorrhage and renal injury, reports of adverse events associated with their long-term administration are limited in the veterinary literature. This study aimed to investigate the attitudes towards the long term use of NSAIDs for canine osteoarthritis held by three groups who manage osteoarthritic dogs in the United Kingdom: dog owners, veterinary surgeons and veterinary nurses. A qualitative methodology was adopted, using semi-structured interviews and focus groups. Thematic analysis of these data identified three themes: awareness of potential risks; recognition of adverse events; and influence of risk perception on the use of NSAIDs. Awareness of, and concern about, the risk of adverse events associated with NSAID administration to dogs with osteoarthritis was high in all groups, with veterinary surgeons being one of a variety of information sources used by owners to acquire this knowledge. Veterinary surgeons described difficulty in recognising, managing and avoiding adverse events associated with NSAIDs. When adverse events occurred, a wide range of management approaches were adopted ranging from a brief drug respite to permanent cessation of administration of any NSAIDs to that dog. Commonly employed approaches to minimise risk included dose reduction and screening blood tests. This study describes a high level of concern about the risks associated with long term NSAID administration to dogs with osteoarthritis and highlights a diverse range of strategies employed to minimise these risks. The evidence base for these strategies is poor, and this may present a risk to animal welfare if the affected dogs are not receiving adequate analgesia. In order to address this, more accurate and comprehensive data must be supplied to both veterinary professionals and owners on the true frequency of adverse events associated with long term administration of veterinary NSAIDs and how best to avoid them. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Comparative Effectiveness of Tacrolimus-Based Steroid Sparing versus Steroid Maintenance Regimens in Kidney Transplantation: Results from Discrete Event Simulation.

PubMed

Desai, Vibha C A; Ferrand, Yann; Cavanaugh, Teresa M; Kelton, Christina M L; Caro, J Jaime; Goebel, Jens; Heaton, Pamela C

2017-10-01

Corticosteroids used as immunosuppressants to prevent acute rejection (AR) and graft loss (GL) following kidney transplantation are associated with serious cardiovascular and other adverse events. Evidence from short-term randomized controlled trials suggests that many patients on a tacrolimus-based immunosuppressant regimen can withdraw from steroids without increased AR or GL risk. To measure the long-term tradeoff between GL and adverse events for a heterogeneous-risk population and determine the optimal timing of steroid withdrawal. A discrete event simulation was developed including, as events, AR, GL, myocardial infarction (MI), stroke, cytomegalovirus, and new onset diabetes mellitus (NODM), among others. Data from the United States Renal Data System were used to estimate event-specific parametric regressions, which accounted for steroid-sparing regimen (avoidance, early 7-d withdrawal, 6-mo withdrawal, 12-mo withdrawal, and maintenance) as well as patients' demographics, immunologic risks, and comorbidities. Regression-equation results were used to derive individual time-to-event Weibull distributions, used, in turn, to simulate the course of patients over 20 y. Patients on steroid avoidance or an early-withdrawal regimen were more likely to experience AR (45.9% to 55.0% v. 33.6%, P < 0.05) and GL (51.5% to 68.8% v. 37.8%, P < 0.05) compared to patients on steroid maintenance. Patients in 6-mo and 12-mo steroid withdrawal groups were less likely to experience MI (11.1% v. 13.3%, P < 0.05), NODM (30.7% to 34.4% v. 37.7%, P < 0.05), and cardiac death (29.9% to 30.5% v. 32.4%, P < 0.05), compared to steroid maintenance. Strategies of 6- and 12-mo steroid withdrawal post-kidney transplantation are expected to reduce the rates of adverse cardiovascular events and other outcomes with no worsening of AR or GL rates compared with steroid maintenance.

Do Carpets Impair Indoor Air Quality and Cause Adverse Health Outcomes: A Review.

PubMed

Becher, Rune; Øvrevik, Johan; Schwarze, Per E; Nilsen, Steinar; Hongslo, Jan K; Bakke, Jan Vilhelm

2018-01-23

Several earlier studies have shown the presence of more dust and allergens in carpets compared with non-carpeted floors. At the same time, adverse effects of carpeted floors on perceived indoor air quality as well as worsening of symptoms in individuals with asthma and allergies were reported. Avoiding extensive carpet use in offices, schools, kindergartens and bedrooms has therefore been recommended by several health authorities. More recently, carpet producers have argued that former assessments were obsolete and that modern rugs are unproblematic, even for those with asthma and allergies. To investigate whether the recommendation to be cautious with the use of carpets is still valid, or whether there are new data supporting that carpet flooring do not present a problem for indoor air quality and health, we have reviewed the literature on this matter. We have not found updated peer reviewed evidence that carpeted floor is unproblematic for the indoor environment. On the contrary, also more recent data support that carpets may act as a repository for pollutants which may become resuspended upon activity in the carpeted area. Also, the use of carpets is still linked to perception of reduced indoor air quality as well as adverse health effects as previously reported. To our knowledge, there are no publications that report on deposition of pollutants and adverse health outcomes associated with modern rugs. However, due to the three-dimensional structure of carpets, any carpet will to some extent act like a sink. Thus, continued caution should still be exercised when considering the use of wall-to-wall carpeted floors in schools, kindergartens and offices, as well as in children's bedrooms unless special needs indicate that carpets are preferable.

Do Carpets Impair Indoor Air Quality and Cause Adverse Health Outcomes: A Review

PubMed Central

Becher, Rune; Øvrevik, Johan; Schwarze, Per E.; Nilsen, Steinar; Hongslo, Jan K.; Bakke, Jan Vilhelm

2018-01-01

Several earlier studies have shown the presence of more dust and allergens in carpets compared with non-carpeted floors. At the same time, adverse effects of carpeted floors on perceived indoor air quality as well as worsening of symptoms in individuals with asthma and allergies were reported. Avoiding extensive carpet use in offices, schools, kindergartens and bedrooms has therefore been recommended by several health authorities. More recently, carpet producers have argued that former assessments were obsolete and that modern rugs are unproblematic, even for those with asthma and allergies. To investigate whether the recommendation to be cautious with the use of carpets is still valid, or whether there are new data supporting that carpet flooring do not present a problem for indoor air quality and health, we have reviewed the literature on this matter. We have not found updated peer reviewed evidence that carpeted floor is unproblematic for the indoor environment. On the contrary, also more recent data support that carpets may act as a repository for pollutants which may become resuspended upon activity in the carpeted area. Also, the use of carpets is still linked to perception of reduced indoor air quality as well as adverse health effects as previously reported. To our knowledge, there are no publications that report on deposition of pollutants and adverse health outcomes associated with modern rugs. However, due to the three-dimensional structure of carpets, any carpet will to some extent act like a sink. Thus, continued caution should still be exercised when considering the use of wall-to-wall carpeted floors in schools, kindergartens and offices, as well as in children’s bedrooms unless special needs indicate that carpets are preferable. PMID:29360764

Effectiveness of a transition plan at discharge of patients hospitalized with heart failure: a before-and-after study.

PubMed

Garnier, Antoine; Rouiller, Nathalie; Gachoud, David; Nachar, Carole; Voirol, Pierre; Griesser, Anne-Claude; Uhlmann, Marc; Waeber, Gérard; Lamy, Olivier

2018-05-14

We evaluated the effectiveness of a multidisciplinary transition plan to reduce early readmission among heart failure patients. We conducted a before-and-after study in a tertiary internal medicine department, comparing 3 years of retrospective data (pre-intervention) and 13 months of prospective data (intervention period). Intervention was the introduction in 2013 of a transition plan performed by a multidisciplinary team. We included all consecutive patients hospitalized with symptomatic heart failure and discharged to home. The outcomes were the fraction of days spent in hospital because of readmission, based on the sum of all days spent in hospital, and the rate of readmission. The same measurements were used for those with potentially avoidable readmissions. Four hundred thirty-one patients were included and compared with 1441 patients in the pre-intervention period. Of the 431 patients, 138 received the transition plan while 293 were non-completers. Neither the fraction of days spent for readmissions nor the rate of readmission decreased during the intervention period. However, non-completers had a higher rate of the fraction of days spent for 30 day readmission (19.2% vs. 16.1%, P = 0.002) and for potentially avoidable readmission (9.8% vs. 13.2%, P = 0.001). The rate of potentially avoidable readmission decreased from 11.3% (before) to 9.9% (non-completers) and 8.7% (completers), reaching the adjusted expected range given by SQLape® (7.7-9.1%). A transition plan, requiring many resources, could decrease potentially avoidable readmission but shows no benefit on overall readmission. Future research should focus on potentially avoidable readmissions and other indicators such as patient satisfaction, adverse drug events, or adherence. © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Needlestick injuries in veterinary medicine.

PubMed

Weese, J Scott; Jack, Douglas C

2008-08-01

Needlestick injuries are an inherent risk of handling needles during the course of veterinary practice. While significant effort has been expended to reduce needlestick injuries in human medicine, a relatively lax approach seems to be prevalent in veterinary medicine. It appears that needlestick injuries are very common among veterinary personnel and that serious adverse effects, while uncommon, do occur. Clients may also receive injuries in clinics during the course of animal restraint, and at home following prescription of injectable medications or fluids. Because of occupational health, personal health, and liability concerns, veterinary practices should review the measures they are taking to reduce the likelihood of needlestick injuries and develop written needlestick injury avoidance protocols.

Current DOT research on the effect of multiple site damage on structural integrity

NASA Technical Reports Server (NTRS)

Tong, P.; Arin, Kemal; Jeong, David Y.; Greif, R.; Brewer, John C.; Bobo, Stephan N.; Sampath, Sam N.

1992-01-01

Multiple site damage (MSD) is a type of cracking that may be found in aging airplanes and which may adversely affect their continuing airworthiness. The Volpe National Transportation Systems Center has supported the Federal Aviation Administration Technical Center on structural integrity research for the past two and half years. The work has focused on understanding the behavior of MSD, detection of MSD during airframe inspection, and the avoidance of MSD in future designs. These three elements of the MSD problem are addressed and a summary of the completed work, the current status, and requirements for future research is provided.

Temporary bypass for superior vena cava reconstruction with Anthron bypass tubeTM

PubMed Central

Yamasaki, Naoya; Tsuchiya, Tomoshi; Miyazaki, Takuro; Kamohara, Ryotaro; Hatachi, Go; Nagayasu, Takeshi

2017-01-01

Total superior vena cava (SVC) clamping for SVC replacement or repair can be used in thoracic surgery. A bypass technique is an option to avoid hemodynamic instability and cerebral venous hypertension and hypoperfusion. The present report describes a venous bypass technique using Anthron bypass tubeTM for total SVC clamping. Indications for this procedure include the need for a temporary bypass between the brachiocephalic vein and atrium for complete tumor resection. This procedure allows the surgeons sufficient time to complete replacement of SVC or partial resection of SVC without adverse effects. Further, it is a relatively simple procedure requiring minimal time. PMID:28840027

[Septic shock following platelet transfusion contaminated with Citrobacter koseri in a child with postchemotherapy febrile neutropenia].

PubMed

Tichit, R; Saumet, L; Marchandin, H; Haouy, S; Latry, P; Sirvent, N

2016-01-01

The bacterial transfusion risk is currently the greatest infectious risk of blood transfusion. We report the case of a child with postchemotherapy febrile neutropenia who presented septic shock following platelet transfusion contaminated with Citrobacter koseri. The life-threatening development could have been avoided by strict compliance with good clinical practice. The stability of mortality rates due to adverse effects of bacterial proliferation during platelet transfusions in France since 1994 calls for optimization of all preventive measures throughout the transfusion chain and perfect knowledge of transfusion rules by medical staff and care givers. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Avoiding your greatest fear--malpractice.

PubMed

Coy, Kenneth; Stratton, Russell

2002-01-01

This article discusses ten clinically based behavioral approaches to minimizing the risk of a malpractice claim. Suggestions are stated in both a positive and negative way and ranked from least significant to most significant. Recommendations include the need to develop effective listening skills; learning to communicate with patients verbally and in writing; keeping patient expectations realistic; being thorough when examining and diagnosing; and knowing one's limitations. Also included is the need to inform patients concerning adverse events; keeping written records of what was said and done; discussing alternatives, risks, complications, and fees in advance; and developing a relationship with patients based on mutual respect and trust. Case examples are presented for each approach.

Interleaving subthalamic nucleus deep brain stimulation to avoid side effects while achieving satisfactory motor benefits in Parkinson disease: A report of 12 cases.

PubMed

Zhang, Shizhen; Zhou, Peizhi; Jiang, Shu; Wang, Wei; Li, Peng

2016-12-01

Deep brain stimulation (DBS) of the subthalamic nucleus is an effective treatment for advanced Parkinson disease (PD). However, achieving ideal outcomes by conventional programming can be difficult in some patients, resulting in suboptimal control of PD symptoms and stimulation-induced adverse effects. Interleaving stimulation (ILS) is a newer programming technique that can individually optimize the stimulation area, thereby improving control of PD symptoms while alleviating stimulation-induced side effects after conventional programming fails to achieve the desired results. We retrospectively reviewed PD patients who received DBS programming during the previous 4 years in our hospital. We collected clinical and demographic data from 12 patients who received ILS because of incomplete alleviation of PD symptoms or stimulation-induced adverse effects after conventional programming had proven ineffective or intolerable. Appropriate lead location was confirmed with postoperative reconstruction images. The rationale and clinical efficacy of ILS was analyzed. We divided our patients into 4 groups based on the following symptoms: stimulation-induced dysarthria and choreoathetoid dyskinesias, gait disturbance, and incomplete control of parkinsonism. After treatment with ILS, patients showed satisfactory improvement in PD symptoms and alleviation of stimulation-induced side effects, with a mean improvement in Unified PD Rating Scale motor scores of 26.9%. ILS is a newer choice and effective programming strategy to maximize symptom control in PD while decreasing stimulation-induced adverse effects when conventional programming fails to achieve satisfactory outcome. However, we should keep in mind that most DBS patients are routinely treated with conventional stimulation and that not all patients benefit from ILS. ILS is not recommended as the first choice of programming, and it is recommended only when patients have unsatisfactory control of PD symptoms or stimulation-induced side effects after multiple treatments with conventional stimulation. A return to conventional stimulation may be required if ILS induces new side effects or the needs of the patient change.

Interleaving subthalamic nucleus deep brain stimulation to avoid side effects while achieving satisfactory motor benefits in Parkinson disease

PubMed Central

Zhang, Shizhen; Zhou, Peizhi; Jiang, Shu; Wang, Wei; Li, Peng

2016-01-01

Abstract Background: Deep brain stimulation (DBS) of the subthalamic nucleus is an effective treatment for advanced Parkinson disease (PD). However, achieving ideal outcomes by conventional programming can be difficult in some patients, resulting in suboptimal control of PD symptoms and stimulation-induced adverse effects. Interleaving stimulation (ILS) is a newer programming technique that can individually optimize the stimulation area, thereby improving control of PD symptoms while alleviating stimulation-induced side effects after conventional programming fails to achieve the desired results. Methods: We retrospectively reviewed PD patients who received DBS programming during the previous 4 years in our hospital. We collected clinical and demographic data from 12 patients who received ILS because of incomplete alleviation of PD symptoms or stimulation-induced adverse effects after conventional programming had proven ineffective or intolerable. Appropriate lead location was confirmed with postoperative reconstruction images. The rationale and clinical efficacy of ILS was analyzed. Results: We divided our patients into 4 groups based on the following symptoms: stimulation-induced dysarthria and choreoathetoid dyskinesias, gait disturbance, and incomplete control of parkinsonism. After treatment with ILS, patients showed satisfactory improvement in PD symptoms and alleviation of stimulation-induced side effects, with a mean improvement in Unified PD Rating Scale motor scores of 26.9%. Conclusions: ILS is a newer choice and effective programming strategy to maximize symptom control in PD while decreasing stimulation-induced adverse effects when conventional programming fails to achieve satisfactory outcome. However, we should keep in mind that most DBS patients are routinely treated with conventional stimulation and that not all patients benefit from ILS. ILS is not recommended as the first choice of programming, and it is recommended only when patients have unsatisfactory control of PD symptoms or stimulation-induced side effects after multiple treatments with conventional stimulation. A return to conventional stimulation may be required if ILS induces new side effects or the needs of the patient change. PMID:27930569

Effects of caffeine on performance and mood: withdrawal reversal is the most plausible explanation.

PubMed

James, Jack E; Rogers, Peter J

2005-10-01

Although it is widely believed that caffeine can enhance human performance and mood, the validity of this belief has been questioned, giving rise to debate. The central question is whether superior performance and mood after caffeine represent net benefits, or whether differences between caffeine and control conditions are due to reversal of adverse withdrawal effects. To provide a focussed review of relevant experimental studies with the aim of clarifying current understanding regarding the effects of caffeine on human performance and mood. To avoid the shortcomings of standard placebo-controlled studies, which are ambiguous due to failure to control for the confounding influence of withdrawal reversal, three main experimental approaches have been employed: studies that compare consumers and low/non-consumers, pre-treatment and ad lib consumption studies, and long-term withdrawal studies. Of the three approaches, only long-term withdrawal studies are capable of unambiguously revealing the net effects of caffeine. Overall, there is little evidence of caffeine having beneficial effects on performance or mood under conditions of long-term caffeine use vs abstinence. Although modest acute effects may occur following initial use, tolerance to these effects appears to develop in the context of habitual use of the drug. Appropriately controlled studies show that the effects of caffeine on performance and mood, widely perceived to be net beneficial psychostimulant effects, are almost wholly attributable to reversal of adverse withdrawal effects associated with short periods of abstinence from the drug.

Comparison of the cardiac electrophysiology and general toxicology of two formulations of intravenous amiodarone in dogs.

PubMed

Cushing, Daniel J; Cooper, Warren D; Gralinski, Michael R; Lipicky, Raymond J; Kudenchuk, Peter J; Kowey, Peter R

2009-09-01

Intravenous amiodarone (AIV) must be administered slowly after dilution to avoid hypotension, which is due to the cosolvents polysorbate 80 and benzyl alcohol used in its formulation. PM101 is a formulation of amiodarone devoid of these cosolvents, which enables bolus administration. We evaluated any potential toxicity or exaggerated adverse cardiac electrophysiologic effects of PM101 compared with AIV and control. Beagle dogs were treated with the human-equivalent amiodarone loading dose (2.14 mg/kg) with PM101 (bolus push) or AIV (10 min infusion in the toxicology study and bolus push in the electrophysiology study) followed by maintenance infusion (0.014 mg kg(-1) min(-1) through 6 h followed by 0.007 mg kg(-1) min(-1) through 14 days) or a control. General toxicology was assessed in conscious dogs over 14 days. Cardiac electrophysiology was assessed in a separate cohort of anesthetized dogs during the first 20 min of dosing. In the toxicology study, dosing in all animals in the AIV group was terminated within 17 min of initiation due to a severe hypersensitivity reaction. There were no acute adverse clinical signs in the PM101 or control groups. There were no significant effects on body weight or ECG parameters, and no adverse histomorphologic changes were seen in dogs that received PM101 or AIV. No significant exaggerated cardiac electrophysiologic effects of the approved doses PM101 or AIV were observed. PM101 may represent a formulation of intravenous amiodarone that could be administered rapidly without dilution in the setting of life-threatening cardiac arrhythmias.

Comparison of bupivacaine and ropivacaine in combination with fentanyl used for walking epidural anesthesia in labor

PubMed Central

Gündüz, Şükrü; Eriş Yalçın, Serenat; Karakoç, Gökhan; Akkurt, Mehmet Özgür; Yalçın, Yakup; Yavuz, And

2017-01-01

Objective: Effective pain relief during labor is essential to reduce maternal and perinatal morbidity arising due to pain-induced maternal sympathetic activation, and to avoid unnecessary cesarean sections performed due to maternal anxiety. Walking epidural analgesia on labor reveals lower pain scores, leading to higher maternal satisfaction with better cardiovascular and pulmonary physiology. Despite the extensive use and relative safety of bupivacaine, newer drugs such as ropivacaine have been developed as alternative agents to decrease the risk for cardiac and central nervous system toxicity. Materials and Methods: One hundred women who requested epidural analgesia in active labor were randomly allocated into two groups; one group received 20 mL of ropivacaine 0.125% with fentanyl 50 µg and the other received 20 mL of bupivacaine 0.125% with fentanyl 50 µg. The efficacy of analgesia, adverse effects, and obstetric and neonatal outcomes of both groups were compared. Results: There were no differences between the two study groups in the measured obstetric and neonatal outcomes. The onset time, duration of analgesia, and sensory levels were similar between the groups. Visual analog pain scale scores did not differ between the groups before analgesia or at any of the subsequent evaluation periods. Conclusion: Both ropivacaine and bupivacaine provide equivalent labor analgesia with high maternal satisfaction and tolerable adverse effects in the clinically used dose range. No adverse obstetric or neonatal outcomes were observed in either group. Therefore, either drug is a reasonable choice for labor analgesia and can be used without jeopardizing the safety of the mother and fetus. PMID:29085707

Health Council of The Netherlands: no need to change from SAR to time-temperature relation in electromagnetic fields exposure limits.

PubMed

van Rhoon, Gerard C; Aleman, André; Kelfkens, Gert; Kromhout, Hans; Van Leeuwen, Flora E; Savelkoul, Huub F J; Wadman, Wytse J; Van De Weerdt, Rik D H J; Zwamborn, A Peter M; Van Rongen, Eric

2011-01-01

The Health Council of the Netherlands (HCN) and other organisations hold the basic assumption that induced electric current and the generation and absorption of heat in biological material caused by radiofrequency electromagnetic fields are the only causal effects with possible adverse consequences for human health that have been scientifically established to date. Hence, the exposure guidelines for the 10 MHz-10 GHz frequency range are based on avoiding adverse effects of increased temperatures that may occur of the entire human body at a specific absorption rate (SAR) level above 4 W/kg. During the workshop on Thermal Aspects of Radio Frequency Exposure on 11-12 January 2010 in Gaithersburg, Maryland, USA, the question was raised whether there would be a practical advantage in shifting from expressing the exposure limits in SAR to expressing them in terms of a maximum allowable temperature increase. This would mean defining adverse time-temperature thresholds. In this paper, the HCN discusses the need for this, considering six points: consistency, applicability, quantification, causality, comprehensibility and acceptability. The HCN concludes that it seems unlikely that a change of dosimetric quantity will help us forward in the discussion on the scientific controversies regarding the existence or non-existence of non-thermal effects in humans following long duration, low intensity exposure to electromagnetic fields. Therefore, the HCN favours maintaining the current approach of basic restrictions and reference levels being expressed as SAR and in V/m or µT, respectively.

Management of Giant Sequoia in the national forests of the Sierra Nevada, California

Treesearch

Robert R. Rogers

1986-01-01

The Forest Service avoided positive management activities within giant sequoia (Sequoiadendron giganteum [Lindl.] Buchholz) groves after heavy early logging on private lands caused adverse public reaction. However, since 1975 timber sales and prescribed burning have been conducted to encourage giant sequoia regeneration and increase tree vigor....

Protecting Creeksheds: Analysis and Action.

ERIC Educational Resources Information Center

Say, E. Wayne; Dines, Allen J.

This booklet is designed to provide basic information about creeksheds in urbanizing areas; why they are important, how they are adversely affected by urbanization and what can be done to protect creek benefits and avoid problems. The text provides non-technical information relating to small watersheds and their management. The booklet is designed…

A Criminal Law Approach to Terrorism in Brazil

DTIC Science & Technology

2014-12-01

Israeli Embassy, killing 29 and hurting over 250; and the second, in 1994, when a suicide terrorist in a car bomb drove into AMIA (Argentina-Israel...requisite. The main concern regarding the law is the possibility of adversely affecting civil rights. In the model, we can avoid this temptation and

30 CFR 282.13 - Suspension of production or other operations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... environmental evaluation to define mitigation measures to avoid or minimize adverse environmental impacts. (5... deposits (in areas leased or not leased), to the National security or defense, or to the marine, coastal.... 282.13 Section 282.13 Mineral Resources BUREAU OF SAFETY AND ENVIRONMENTAL ENFORCEMENT, DEPARTMENT OF...

30 CFR 282.13 - Suspension of production or other operations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... environmental evaluation to define mitigation measures to avoid or minimize adverse environmental impacts. (5... deposits (in areas leased or not leased), to the National security or defense, or to the marine, coastal.... 282.13 Section 282.13 Mineral Resources BUREAU OF SAFETY AND ENVIRONMENTAL ENFORCEMENT, DEPARTMENT OF...

30 CFR 282.13 - Suspension of production or other operations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... environmental evaluation to define mitigation measures to avoid or minimize adverse environmental impacts. (5... deposits (in areas leased or not leased), to the National security or defense, or to the marine, coastal.... 282.13 Section 282.13 Mineral Resources BUREAU OF SAFETY AND ENVIRONMENTAL ENFORCEMENT, DEPARTMENT OF...

Consequences of the size structure of fish populations for their effects on a generalist avian predator.

PubMed

Kloskowski, Janusz

2011-06-01

Size-structured interspecific interactions can shift between predation and competition, depending on ontogenetic changes in size relationships. I examined the effects of common carp (Cyprinus carpio), an omnivorous fish, on the reproductive success of the red-necked grebe (Podiceps grisegena), an avian gape-limited predator, along a fish size gradient created by stocking distinct age-cohorts in seminatural ponds. Young-of-the-year (0+) carp were an essential food source for young grebes. Only adult birds were able to consume 1-year-old (1+) fish, while 2-year-old (2+) fish attained a size refuge from grebes. Amphibian larvae were the principal alternative prey to fish, followed by macroinvertebrates, but the abundance of both dramatically decreased along the carp size gradient. Fledging success was 2.8 times greater in ponds with 0+ versus 1+ carp; in ponds with 1+ carp, chicks received on average 2.6-3 times less prey biomass from their parents, and over 1/3 of broods suffered total failure. Breeding birds avoided settling on 2+ ponds. These results show that changes in prey fish size structure can account for shifts from positive trophic effects on the avian predator to a negative impact on the predator's alternative resources. However, competition did not fully explain the decrease in grebe food resources in the presence of large fish, as carp and grebes overlapped little in diet. In experimental cages, 1+ carp totally eliminated young larvae of amphibians palatable to fish. In field conditions, breeding adults of palatable taxa avoided ponds with 1+ and older carp. Non-trophic interactions such as habitat selection by amphibians or macroinvertebrates to avoid large fish may provide an indirect mechanism strengthening the adverse bottom-up effects of fish on birds.

Food Intolerance: Associations with the rs12212067 Polymorphism of FOXO3 in Crohn's Disease Patients in New Zealand.

PubMed

Marlow, Gareth; Han, Dug Yeo; Triggs, Christopher M; Ferguson, Lynnette R

2015-01-01

Diet is known to play a major role in Crohn's disease (CD). It has also been reported that the minor G allele from the rs12212067 polymorphism (T>G) in FOXO3 is associated with milder CD. The aim of this study was to investigate the association between the rs12212067 polymorphism and food intolerances for a total of 253 foods. Tolerances and intolerances were recorded on a self-reported dietary questionnaire. Each food was scored on a 5-point ordinal scale: beneficial effects as '+ +' or '+', adverse effects as '- -' or '-', and 'makes no difference' as '='. Dietary and genotype data were available for a total of 283 CD patients. We identified 17 foods with beneficial effects in our study which were significantly associated with the G allele of the FOXO3 rs12212067 polymorphism. Of these, sweet potatoes had the highest reported frequency of beneficial responses. We also identified 4 foods with detrimental effects in more than 25% of our study population. These were mustard, wasabi, and raw and cooked tomatoes, which again were significantly associated with the G allele in FOXO3. There was strong evidence that adverse effects of mustard, wasabi, and raw and cooked tomatoes were significantly associated with the G allele of FOXO3 and that these foods should be avoided by people carrying this allele. © 2015 S. Karger AG, Basel.

[Benefit-risk assessment of vaccination strategies].

PubMed

Hanslik, Thomas; Boëlle, Pierre Yves

2007-04-01

This article summarises the various stages of the risk/benefit assessment of vaccination strategies. Establishing the awaited effectiveness of a vaccination strategy supposes to have an epidemiologic description of the disease to be prevented. The effectiveness of the vaccine strategy will be thus expressed in numbers of cases, hospitalizations or deaths avoided. The effectiveness can be direct, expressed as the reduction of the incidence of the infectious disease in the vaccinated subjects compared to unvaccinated subjects. It can also be indirect, the unvaccinated persons being protected by the suspension in circulation of the pathogenic agent, consecutive to the implementation of the vaccination campaign. The risks of vaccination related to the adverse effects detected during the clinical trials preceding marketing are well quantified, but other risks can occur after marketing: e.g., serious and unexpected adverse effects detected by vaccinovigilance systems, or risk of increase in the age of cases if the vaccination coverage is insufficient. The medico-economic evaluation forms a part of the risks/benefit assessment, by positioning the vaccine strategy comparatively with other interventions for health. Epidemiologic and vaccinovigilance informations must be updated very regularly, which underlines the need for having an operational and reliable real time monitoring system to accompany the vaccination strategies. Lastly, in the context of uncertainty which often accompanies the risks/benefit assessments, it is important that an adapted communication towards the public and the doctors is planned.

Influence of xanthotoxin (8-methoxypsoralen) on the anticonvulsant activity of various novel antiepileptic drugs against maximal electroshock-induced seizures in mice.

PubMed

Zagaja, Mirosław; Andres-Mach, Marta; Patrzylas, Paweł; Pyrka, Daniel; Szpringer, Monika; Florek-Łuszczki, Magdalena; Żółkowska, Dorota; Skalicka-Woźniak, Krystyna; Łuszczki, Jarogniew J

2016-12-01

The aim of this study was to determine the effects of xanthotoxin (8-methoxypsoralen) on the protective action of 5 various second- and third-generation antiepileptic drugs (i.e., lacosamide, lamotrigine, oxcarbazepine, pregabalin and topiramate) in the mouse maximal electroshock-induced seizure model. Seizure activity was evoked in adult male albino Swiss mice by a current (25mA, 500V, 0.2s stimulus duration) delivered via auricular electrodes. Drug-related adverse effects were determined in the chimney, grip-strength and passive avoidance tests. Total brain antiepileptic drug concentrations were measured to confirm pharmacodynamic nature of observed interactions with xanthotoxin. Results indicate that xanthotoxin (100mg/kg, i.p.) significantly enhanced the anticonvulsant action of lacosamide (P<0.01), oxcarbazepine (P<0.05), pregabalin (P<0.01), and topiramate (P<0.001), but not that of lamotrigine in the maximal electroshock-induced seizure test. Moreover, xanthotoxin (50mg/kg) still significantly potentiated the anticonvulsant action of lacosamide (P<0.05), pregabalin (P<0.05), and topiramate (P<0.001) in this seizure test. Xanthotoxin had no significant impact on total brain concentrations of the studied antiepileptic drugs in mice. Furthermore, combinations of xanthotoxin with oxcarbazepine or topiramate produced no adverse effects. However, xanthotoxin in combination with lacosamide, lamotrigine or pregabalin significantly reduced muscular strength in mice in the grip-strength test. In the chimney test, only the combinations of xanthotoxin with pregabalin significantly impaired motor coordination in mice. In conclusion, the combinations of xanthotoxin with oxcarbazepine and topiramate produce beneficial anticonvulsant pharmacodynamic interactions in the maximal electroshock-induced seizure test. A special caution is advised when combining xanthotoxin with pregabalin due to appearance of acute adverse effects. Copyright © 2016 Elsevier B.V. All rights reserved.

Helping Children Cope with Medical Tests and Interventions

PubMed Central

Lang, Elvira V.; Viegas, Jacqueline; Bleeker, Chris; Bruhn, Jörgen; Geert-Jan van, Geffen

2016-01-01

Medical procedures and tests become a challenge when anxiety and pain make it difficult for the patient to cooperate or remain still when needed. Fortunately a short intervention with hypnoidal language at the onset of a procedure induces a positive and sustained change in the way pain and anxiety are processed. While anesthesia may appear to be a simple solution to eliminate pain, the adverse effects of pre-anesthesia anxiety on postoperative behavior and recovery are often not fully appreciated. This paper discusses options for self-hypnotic relaxation that are applicable to interactions with children. The high suggestibility of children makes it relatively easy to engage them in make-believe scenarios. Avoidance of negative suggestions is key in avoiding nocebo effects that may be difficult to overcome later. Once a child is immersed in his or her preferred scenario or hobby/activity of choice, environmental and procedural stimuli can be easily integrated in the imagery. Ego-strengthening metaphors that tie in features of strength, confidence, or resilience are particularly empowering. Even when children are fully under general anesthesia they may still have recall of what is said in the room and therefore caution in word choice should be maintained. PMID:28943814

Neuroticism as Distancing: Perceptual Sources of Evidence

PubMed Central

Liu, Tianwei; Ode, Scott; Moeller, Sara K.; Robinson, Michael D.

2013-01-01

Several theories and self-reported sources of data link individual differences in negative affectivity to avoidance motivation. Chronic avoidance motivation, through repeated practice, may result in a relatively cognitive distance-enhancing dynamic whereby events and stimuli are perceived as further away from the self, even when they are not threatening. Such predictions are novel, but follow from cybernetic theories of self-regulation. In five studies (total N = 463), relations of this type were investigated. Study 1 presented participants with phrases that were ambiguous and found that trait negative affect predicted phrase interpretation in a distance-enhancing temporal direction. Study 2 replicated this effect across a systematic manipulation of event valence. Study 3 asked individuals to estimate the size of words and found that individuals higher in neuroticism generally perceived words to be smaller than did individuals lower in neuroticism. In Study 4, people high (but not low) in neuroticism perceived words to be shrinking faster than they were growing. In Study 5, greater perceptual distancing, in a font size estimation task, predicted more adverse reactions to negative events in daily life. Although normative effects varied across studies, consistent support for a chronic distancing perspective of individual differences in negative affectivity was found. PMID:23527850

Motion sickness history, food neophobia, and sensation seeking.

PubMed

Alley, Thomas R; Willet, Kathleen A; Muth, Eric R

2006-06-01

Motion sickness is believed to be caused by conflicting sensory signals, a situation that mimics the effects of ingesting certain toxins. Thus, one might suspect that individuals who have experienced a relatively high frequency of motion sickness may be particularly vigilant about avoiding anything that produces nausea, induding potentially nauseating toxins. Consequently, they may be more resistant to trying new foods, i.e., be more food neophobic, since unfamiliar foods can have unexpected adverse effects due to toxins or allergens. Likewise, many highly stimulating experiences can trigger motion sickness, so individuals who are more susceptible may be more prone to avoid such experiences, i.e., be less sensation seeking. Finally, it was expected that food neophobia would be more frequent in individuals low on sensation seeking tendencies. Self-reported motion sickness history in 308 adults (M= 18.8 yr.; SD = 1.6) was correlated with scores on the Arnett Inventory of Sensation Seeking and the Food Neophobia Scale. As predicted, greater history of motion sickness was associated with lower Sensation Seeking scores. Food Neophobia was not correlated with motion sickness history but, as expected, was negatively correlated (r = -.42) with scores on Sensation Seeking. Further research is recommended that measures actual sensitivity to motion sickness.

Satisfaction with quality of life varies with temperament types of patients with schizophrenia.

PubMed

Ritsner, Michael; Farkas, Herman; Gibel, Anatoly

2003-10-01

We sought to explore the relationships of three temperament factors with domain-specific subjective quality of life (QOL) of patients with schizophrenia. Ninety patients with schizophrenia were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire, the Tridimensional Personality Questionnaire, the Positive and Negative Syndromes Scale, the Distress Scale for Adverse Symptoms, the Insight and Treatment Attitudes Questionnaire, the Insight Self-Report Scale, and standardized questionnaires for self-reported emotional distress and stress process-related variables. Predictors of domain-specific QOL were identified using multiple regression techniques. Temperament factors explain 6% to 16% of variability in QOL domain scores among patients with schizophrenia after controlling for the remaining variables (emotional distress, social support, self-esteem, avoidance coping, age, side effects, and depression). We found that higher levels of novelty seeking are associated with better general QOL, physical health, and more positive subjective feelings, whereas higher levels of reward dependence are related to better satisfaction from social relationships. Higher levels of harm avoidance are associated with poorer satisfaction with general activities, and medication. Thus, temperament factors, as assessed by the Tridimensional Personality Questionnaire, substantially influence satisfaction with life quality in schizophrenia. Novelty seeking, reward dependence, and harm avoidance are associated with different domains of QOL.

Drug error in paediatric anaesthesia: current status and where to go now.

PubMed

Anderson, Brian J

2018-06-01

Medication errors in paediatric anaesthesia and the perioperative setting continue to occur despite widespread recognition of the problem and published advice for reduction of this predicament at international, national, local and individual levels. Current literature was reviewed to ascertain drug error rates and to appraise causes and proposed solutions to reduce these errors. The medication error incidence remains high. There is documentation of reduction through identification of causes with consequent education and application of safety analytics and quality improvement programs in anaesthesia departments. Children remain at higher risk than adults because of additional complexities such as drug dose calculations, increased susceptibility to some adverse effects and changes associated with growth and maturation. Major improvements are best made through institutional system changes rather than a commitment to do better on the part of each practitioner. Medication errors in paediatric anaesthesia represent an important risk to children and most are avoidable. There is now an understanding of the genesis of adverse drug events and this understanding should facilitate the implementation of known effective countermeasures. An institution-wide commitment and strategy are the basis for a worthwhile and sustained improvement in medication safety.

[Basic Studies on Locoregional Injection of a Newly Designed Chitin Sol].

PubMed

Chiba, Takehiro; Sugitachi, Akio; Kume, Kouhei; Segawa, Takenori; Nishinari, Yutaka; Ishida, Kaoru; Noda, Hironobu; Nishizuka, Satoshi; Kimura, Yusuke; Koeda, Keisuke; Sasaki, Akira

2015-11-01

Systemic chemotherapy in advanced cancer cases often provokes serious adverse events. We aimed to examine the fundamental properties and efficacy of a novel chitin sol, an anti-cancer agent with minor side effects designed to avoid the adverse effects of chemotherapy and enhance the QOL and ADL of patients. DAC-70 was used to create the novel agent termed DAC-70 sol. The anti-proliferative activity was assayed by the WST method using different types of cell lines. The anti-cancer efficacy of the novel agent was examined using cancer-bearing mice. DAC-70 sol was easily injectable through a 21-G needle. The sol suppressed proliferation of the cells in vitro. Intra-tumor injection of DAC-70 sol inhibited the rapid growth of solid tumors in the mice. CDDP-loaded DAC-70 sol, CDDP/DAC-70 sol, successfully controlled malignant ascites in the mice (p<0.05). Neither recurrence nor severe complications were encountered in these animals. These basic data strongly suggest that locoregional administration of our newly designed DAC-70 sol and CDDP/DAC-70 sol is clinically useful as novel cancer chemotherapy for advanced cases. This warrants further clinical studies in cancer chemotherapy.

Graphical review: The redox dark side of e-cigarettes; exposure to oxidants and public health concerns.

PubMed

Cai, Hua; Wang, Chen

2017-10-01

Since the initial marketing in 2005, the use of e-cigarettes has increased exponentially. Nonetheless, accumulating evidence has demonstrated the ineffectiveness of e-cigarettes in leading to smoking cessation, and decreasing the adverse health impacts of cigarette smoking. The number of adolescents adapted to e-cigarettes has been increasing substantially each year, and this adaptation has promoted openness to tobacco smoking. The present review discusses controversies regarding the smoking cessation effects of e-cigarettes, recent governmental policies and regulations of e-cigarette use, toxic components and vaporization products of e-cigarettes, and the novel molecular mechanisms underlying the adverse health impacts of e-cigarettes leading to oxidative stress in target tissues, and consequent development of cardiopulmonary diseases (i.e. COPD), neurodegenerative disorders (i.e. Alzheimer's' disease), and cancer. Health warning signs on the packaging and professional consultation to avoid adaptation in risk groups might be helpful solutions to control negative impacts of e-cigarettes. It is also recommended to further expand basic and clinical investigations to reveal more detailed oxidative stress mechanisms of e-cigarette induced damages, which would ultimately result in more effective protective strategies. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Alteration of blood clotting and lung damage by protamine are avoided using the heparin and polyphosphate inhibitor UHRA

PubMed Central

Abraham, Libin; Kapopara, Piyushkumar R.; Lai, Benjamin F. L.; Shenoi, Rajesh A.; Rosell, Federico I.; Conway, Edward M.; Pryzdial, Edward L. G.; Haynes, Charles A.

2017-01-01

Anticoagulant therapy–associated bleeding and pathological thrombosis pose serious risks to hospitalized patients. Both complications could be mitigated by developing new therapeutics that safely neutralize anticoagulant activity and inhibit activators of the intrinsic blood clotting pathway, such as polyphosphate (polyP) and extracellular nucleic acids. The latter strategy could reduce the use of anticoagulants, potentially decreasing bleeding events. However, previously described cationic inhibitors of polyP and extracellular nucleic acids exhibit both nonspecific binding and adverse effects on blood clotting that limit their use. Indeed, the polycation used to counteract heparin-associated bleeding in surgical settings, protamine, exhibits adverse effects. To address these clinical shortcomings, we developed a synthetic polycation, Universal Heparin Reversal Agent (UHRA), which is nontoxic and can neutralize the anticoagulant activity of heparins and the prothrombotic activity of polyP. Sharply contrasting protamine, we show that UHRA does not interact with fibrinogen, affect fibrin polymerization during clot formation, or abrogate plasma clotting. Using scanning electron microscopy, confocal microscopy, and clot lysis assays, we confirm that UHRA does not incorporate into clots, and that clots are stable with normal fibrin morphology. Conversely, protamine binds to the fibrin clot, which could explain how protamine instigates clot lysis and increases bleeding after surgery. Finally, studies in mice reveal that UHRA reverses heparin anticoagulant activity without the lung injury seen with protamine. The data presented here illustrate that UHRA could be safely used as an antidote during adverse therapeutic modulation of hemostasis. PMID:28034889

Recommendations for the design of laboratory studies on non-target arthropods for risk assessment of genetically engineered plants

PubMed Central

Hellmich, Richard L.; Candolfi, Marco P.; Carstens, Keri; De Schrijver, Adinda; Gatehouse, Angharad M. R.; Herman, Rod A.; Huesing, Joseph E.; McLean, Morven A.; Raybould, Alan; Shelton, Anthony M.; Waggoner, Annabel

2010-01-01

This paper provides recommendations on experimental design for early-tier laboratory studies used in risk assessments to evaluate potential adverse impacts of arthropod-resistant genetically engineered (GE) plants on non-target arthropods (NTAs). While we rely heavily on the currently used proteins from Bacillus thuringiensis (Bt) in this discussion, the concepts apply to other arthropod-active proteins. A risk may exist if the newly acquired trait of the GE plant has adverse effects on NTAs when they are exposed to the arthropod-active protein. Typically, the risk assessment follows a tiered approach that starts with laboratory studies under worst-case exposure conditions; such studies have a high ability to detect adverse effects on non-target species. Clear guidance on how such data are produced in laboratory studies assists the product developers and risk assessors. The studies should be reproducible and test clearly defined risk hypotheses. These properties contribute to the robustness of, and confidence in, environmental risk assessments for GE plants. Data from NTA studies, collected during the analysis phase of an environmental risk assessment, are critical to the outcome of the assessment and ultimately the decision taken by regulatory authorities on the release of a GE plant. Confidence in the results of early-tier laboratory studies is a precondition for the acceptance of data across regulatory jurisdictions and should encourage agencies to share useful information and thus avoid redundant testing. PMID:20938806

[The role of genotype in the intergenerational transmission of experiences of childhood adversity].

PubMed

Reichl, Corinna; Kaess, Michael; Resch, Franz; Brunner, Romuald

2014-09-01

The prevalence of childhood abuse and maltreatment is estimated to lie at about 15% in the overall German population. Previous research suggested that about one third of all individuals who had experienced childhood adversity subsequently maltreated their own children or responded insensitively to their children's needs. Empirical studies imply that interindividual differences in the responsiveness to childhood adversity can partially be explained by gene-environment interactions. This article discusses the potential interplay of genes and environment in the context of transmitting maltreating behavior and (in)sensitive parenting against the background of current challenges in genetic research. Selected studies on gene × environment interactions are presented and relevant gene polymorphisms are identified. Overall, previous studies reported interactions between polymorphisms of the serotonergic, dopaminergic, oxytocin-related, and arginine vasopressin-related systems and childhood experiences of care and abuse in the prediction of social behaviors during mother-child interactions. The results indicate a differential susceptibility toward both negative and positive environments which is dependent on genetic characteristics. Future research should thus investigate the effects of children's presumed risk gene variants toward negative as well as positive parenting. This could contribute to a deeper understanding of the underlying mechanisms of the intergenerational transmission of abusive and beneficial parenting behavior and help to avoid false stigmatizations.

Effects of Aminoglycoside Antibiotics on Human Embryonic Stem Cell Viability during Differentiation In Vitro

PubMed Central

Varghese, Divya S.; Parween, Shama; Ardah, Mustafa T.; Emerald, Bright Starling

2017-01-01

Human embryonic stem cells (hESCs) are being used extensively in array of studies to understand different mechanisms such as early human embryogenesis, drug toxicity testing, disease modeling, and cell replacement therapy. The protocols for the directed differentiation of hESCs towards specific cell types often require long-term cell cultures. To avoid bacterial contamination, these protocols include addition of antibiotics such as pen-strep and gentamicin. Although aminoglycosides, streptomycin, and gentamicin have been shown to cause cytotoxicity in various animal models, the effect of these antibiotics on hESCs is not clear. In this study, we found that antibiotics, pen-strep, and gentamicin did not affect hESC cell viability or expression of pluripotency markers. However, during directed differentiation towards neural and hepatic fate, significant cell death was noted through the activation of caspase cascade. Also, the expression of neural progenitor markers Pax6, Emx2, Otx2, and Pou3f2 was significantly reduced suggesting that gentamicin may adversely affect early embryonic neurogenesis whereas no effect was seen on the expression of endoderm or hepatic markers during differentiation. Our results suggest that the use of antibiotics in cell culture media for the maintenance and differentiation of hESCs needs thorough investigation before use to avoid erroneous results. PMID:29147115

Artificial gravity as a countermeasure for mitigating physiological deconditioning during long-duration space missions.

PubMed

Clément, Gilles R; Bukley, Angelia P; Paloski, William H

2015-01-01

In spite of the experience gained in human space flight since Yuri Gagarin's historical flight in 1961, there has yet to be identified a completely effective countermeasure for mitigating the effects of weightlessness on humans. Were astronauts to embark upon a journey to Mars today, the 6-month exposure to weightlessness en route would leave them considerably debilitated, even with the implementation of the suite of piece-meal countermeasures currently employed. Continuous or intermittent exposure to simulated gravitational states on board the spacecraft while traveling to and from Mars, also known as artificial gravity, has the potential for enhancing adaptation to Mars gravity and re-adaptation to Earth gravity. Many physiological functions are adversely affected by the weightless environment of spaceflight because they are calibrated for normal, Earth's gravity. Hence, the concept of artificial gravity is to provide a broad-spectrum replacement for the gravitational forces that naturally occur on the Earth's surface, thereby avoiding the physiological deconditioning that takes place in weightlessness. Because researchers have long been concerned by the adverse sensorimotor effects that occur in weightlessness as well as in rotating environments, additional study of the complex interactions among sensorimotor and other physiological systems in rotating environments must be undertaken both on Earth and in space before artificial gravity can be implemented.

The epidemiology of smoking: health consequences and benefits of cessation.

PubMed

Fagerström, Karl

2002-01-01

Tobacco use is the single most important preventable health risk in the developed world, and an important cause of premature death worldwide. Smoking causes a wide range of diseases, including many types of cancer, chronic obstructive pulmonary disease, coronary heart disease, stroke, peripheral vascular disease, and peptic ulcer disease. In addition, smoking during pregnancy adversely affects fetal and neonatal growth and development. Recent decades have seen a massive expansion in tobacco use in the developing world and accelerating growth in smoking among women in the developed world. Globally, smoking-related mortality is set to rise from 3 million annually (1995 estimate) to 10 million annually by 2030, with 70% of these deaths occurring in developing countries. Many of the adverse health effects of smoking are reversible, and smoking cessation treatments represent some of the most cost effective of all healthcare interventions. Although the greatest benefit accrues from ceasing smoking when young, even quitting in middle age avoids much of the excess healthcare risk associated with smoking. In order to improve smoking cessation rates, effective behavioural and pharmacological treatments, coupled with professional counselling and advice, are required. Since smoking duration is the principal risk factor for smoking-related morbidity, the treatment goal should be early cessation and prevention of relapse.

Cinacalcet in peritoneal dialysis patients: one-center experience.

PubMed

Conde, Sara Querido; Branco, Patrícia; Sousa, Henrique; Adragão, Teresa; Gaspar, Augusta; Barata, José Diogo

2017-03-01

Secondary hyperparathyroidism is the target of several therapeutic strategies, including the use of cinacalcet. Most studies were done only in hemodialysis patients, with few data from peritoneal dialysis patients. The aim of our work was to evaluate the effectiveness of cinacalcet in secondary hyperparathyroidism in a one-center peritoneal dialysis patients. A retrospective study was performed in 27 peritoneal dialysis patients with moderate to severe secondary hyperparathyroidism (PTHi > 500 pg/mL with normal or elevated serum calcium levels) treated with cinacalcet. Demographic, clinical and laboratory parameters at the beginning of cinacalcet therapy, second, fourth, sixth months after and at the time it was finished were analyzed. Patients were under peritoneal dialysis at 30.99 ± 16.58 months and were treated with cinacalcet for 15.6 ± 13.4 months; 21 (77.8%) patients showed adverse gastrointestinal effects; PTHi levels at the beginning of cinacalcet therapy were 1145 ± 449 pg/mL. The last PTHi levels under cinacalcet therapy was 1131 ± 642 pg/mL. PTHi reduction was statistically significant at 2 months after the beginning of cinacalcet (p = 0.007) but not in the following evaluations. It is necessary the development of new forms of cinacalcet presentation, in order to avoid gastrointestinal effects adverse factors and to improve therapeutic adherence.

Adversity and persecutory ideation: A moderated mediational model.

PubMed

Valiente, Carmen; Espinosa, Regina; Villavicencio, Patricia; Cantero, Dolores; Fuentenebro, Filiberto

2017-12-01

Adversity has been identified as an important factor in models of psychopathology and can help in understanding persecutory ideation, although potential moderators and mediators for adult psychopathology have not been sufficiently examined. Experiential avoidance (EA) and Self-esteem (SE) are relevant factors to understand how adversity leads to persecutory ideation. This study hypothesized that adversity would be associated with persecutory ideation through heightened EA, and that this association would be strengthened in individuals with a discrepant high SE. Participants with persecutory ideation (n = 52), with depression (n = 35) and healthy controls (n = 51) were assessed with the Trauma History Screen, the Paranoia and Deservedness Scale, and the Beck Depression Inventory. A SE discrepancy index was calculated subtracting the normalized explicit SE score from the normalized implicit SE score (measured by a version of a Go/No-go association task). Our analysis revealed that adversity was associated with higher levels of paranoia and was mediated by EA. In addition, we found that the relationship between adversity and EA was moderated by SE discrepancy. Identification of moderating and mediating variables allows for increased understanding of persecutory ideation and the processes that should be targeted in the course of recovery. Copyright © 2017 Elsevier B.V. All rights reserved.

Deaths and severe adverse events associated with anesthesia-assisted rapid opioid detoxification--New York City, 2012.

PubMed

2013-09-27

During August-September 2012, the New York City Department of Health and Mental Hygiene (DOHMH) was notified by the New York City Poison Control Center regarding three patients who experienced serious adverse events after anesthesia-assisted rapid opiate detoxification (AAROD) at a local outpatient clinic. All three patients required hospitalization, and one subsequently died. DOHMH issued an order requiring that the clinic cease performing AAROD pending an investigation and searched for additional cases of AAROD-related serious adverse events at the clinic and elsewhere in New York City for the period September 2011 to September 2012. That search found no serious adverse events at clinics other than the one implicated. Of the 75 patients who underwent AAROD at the implicated clinic during January-September 2012, two died, and five others experienced serious adverse events requiring hospitalization. As a result of the findings, the New York State Department of Health, the New York Office of Alcoholism and Substance Abuse Services, and DOHMH jointly issued a Health Alert informing New York health-care providers of AAROD-associated serious adverse events and recommending that they avoid use of AAROD in favor of evidence-based options for opioid dependence treatment.

How do Singapore patients view post-anaesthesia adverse outcomes? A single-centre willingness-to-pay study.

PubMed

Look, Xinqi; Mok, May Un Sam; Tay, Yan Sheng; Abdullah, Hairil Rizal

2018-05-01

Knowing how patients value the quality of anaesthesia helps anaesthesiologists to customise their service. However, generalising findings from Western population-based willingness-to-pay studies across different cultures and societies might result in the oversight of some contextualised perspectives of the anaesthesia experience. This study aimed to capture the Singapore perspective of undesired post-anaesthesia outcomes. 132 patients recruited in a pre-anaesthetic evaluation clinic were given questionnaires describing ten possible post-anaesthetic outcomes. Outcomes were ranked for undesirability and assigned relative value through the hypothetical proportioning of SGD 100 to avoid their occurrence. Data was analysed with reference to patients' background and anaesthetic history. A response rate of 69.1% (n = 132/191) was achieved. Outcomes from the most to least undesirable were pain; vomiting; nausea; shivering; orodental trauma; sore throat; abrasions; somnolence; and thirst. Relative values allocated, in descending order, were pain; vomiting; nausea; orodental trauma; abrasions; sore throat; shivering; somnolence; and thirst. Similar to previous studies in Western populations, pain, vomiting and nausea were the top three adverse outcomes that Singapore patients wished to avoid. However, discrepancies with Western patients were seen in spending attitudes, possibly accounted for by differences in healthcare socioeconomics. This study provided a better understanding of Singapore patients' perspectives on post-anaesthesia adverse outcomes and could help to improve treatment strategy and resource management. Copyright: © Singapore Medical Association.

How do Singapore patients view post-anaesthesia adverse outcomes? A single-centre willingness-to-pay study

PubMed Central

Look, Xinqi; Mok, May Un Sam; Tay, Yan Sheng; Abdullah, Hairil Rizal

2018-01-01

INTRODUCTION Knowing how patients value the quality of anaesthesia helps anaesthesiologists to customise their service. However, generalising findings from Western population-based willingness-to-pay studies across different cultures and societies might result in the oversight of some contextualised perspectives of the anaesthesia experience. This study aimed to capture the Singapore perspective of undesired post-anaesthesia outcomes. METHODS 132 patients recruited in a pre-anaesthetic evaluation clinic were given questionnaires describing ten possible post-anaesthetic outcomes. Outcomes were ranked for undesirability and assigned relative value through the hypothetical proportioning of SGD 100 to avoid their occurrence. Data was analysed with reference to patients’ background and anaesthetic history. RESULTS A response rate of 69.1% (n = 132/191) was achieved. Outcomes from the most to least undesirable were pain; vomiting; nausea; shivering; orodental trauma; sore throat; abrasions; somnolence; and thirst. Relative values allocated, in descending order, were pain; vomiting; nausea; orodental trauma; abrasions; sore throat; shivering; somnolence; and thirst. CONCLUSION Similar to previous studies in Western populations, pain, vomiting and nausea were the top three adverse outcomes that Singapore patients wished to avoid. However, discrepancies with Western patients were seen in spending attitudes, possibly accounted for by differences in healthcare socioeconomics. This study provided a better understanding of Singapore patients’ perspectives on post-anaesthesia adverse outcomes and could help to improve treatment strategy and resource management. PMID:28805235

Effect of amiodarone-induced hyperthyroidism on left ventricular outflow obstruction after septal myectomy for hypertrophic cardiomyopathy.

PubMed

Pokorney, Sean D; Stone, Neil J; Passman, Rod; Oyer, David; Rigolin, Vera H; Bonow, Robert O

2010-12-01

Patients with obstructive hypertrophic cardiomyopathy who undergo septal myectomy are at risk for developing postoperative atrial fibrillation. Amiodarone is effective in treating this arrhythmia but is associated with multiple adverse effects, often with delayed onset. A novel case is described of a patient who developed type 2 amiodarone-induced hyperthyroidism that presented as recurrence of outflow obstruction after septal myectomy. The patient's symptoms and echocardiographic findings of outflow obstruction resolved substantially with the treatment of the amiodarone-induced hyperthyroidism. Amiodarone-induced hyperthyroidism of delayed onset can be a subtle diagnosis, requiring a high index of suspicion. In conclusion, recognition of this diagnosis in patients with recurrence of outflow obstruction by symptoms and cardiac imaging after septal myectomy may avoid unnecessary repeat surgical intervention. Copyright © 2010 Elsevier Inc. All rights reserved.

What magnitude are observed non-target impacts from weed biocontrol?

PubMed

Suckling, David Maxwell; Sforza, René François Henri

2014-01-01

A systematic review focused by plant on non-target impacts from agents deliberately introduced for the biological control of weeds found significant non-target impacts to be rare. The magnitude of direct impact of 43 biocontrol agents on 140 non-target plants was retrospectively categorized using a risk management framework for ecological impacts of invasive species (minimal, minor, moderate, major, massive). The vast majority of agents introduced for classical biological control of weeds (>99% of 512 agents released) have had no known significant adverse effects on non-target plants thus far; major effects suppressing non-target plant populations could be expected to be detectable. Most direct non-target impacts on plants (91.6%) were categorized as minimal or minor in magnitude with no known adverse long-term impact on non-target plant populations, but a few cacti and thistles are affected at moderate (n = 3), major (n = 7) to massive (n = 1) scale. The largest direct impacts are from two agents (Cactoblastis cactorum on native cacti and Rhinocyllus conicus on native thistles), but these introductions would not be permitted today as more balanced attitudes exist to plant biodiversity, driven by both society and the scientific community. Our analysis shows (as far as is known), weed biological control agents have a biosafety track record of >99% of cases avoiding significant non-target impacts on plant populations. Some impacts could have been overlooked, but this seems unlikely to change the basic distribution of very limited adverse effects. Fewer non-target impacts can be expected in future because of improved science and incorporation of wider values. Failure to use biological control represents a significant opportunity cost from the certainty of ongoing adverse impacts from invasive weeds. It is recommended that a simple five-step scale be used to better communicate the risk of consequences from both action (classical biological control) and no action (ongoing impacts from invasive weeds).

What Magnitude Are Observed Non-Target Impacts from Weed Biocontrol?

PubMed Central

Suckling, David Maxwell; Sforza, René François Henri

2014-01-01

A systematic review focused by plant on non-target impacts from agents deliberately introduced for the biological control of weeds found significant non-target impacts to be rare. The magnitude of direct impact of 43 biocontrol agents on 140 non-target plants was retrospectively categorized using a risk management framework for ecological impacts of invasive species (minimal, minor, moderate, major, massive). The vast majority of agents introduced for classical biological control of weeds (>99% of 512 agents released) have had no known significant adverse effects on non-target plants thus far; major effects suppressing non-target plant populations could be expected to be detectable. Most direct non-target impacts on plants (91.6%) were categorized as minimal or minor in magnitude with no known adverse long-term impact on non-target plant populations, but a few cacti and thistles are affected at moderate (n = 3), major (n = 7) to massive (n = 1) scale. The largest direct impacts are from two agents (Cactoblastis cactorum on native cacti and Rhinocyllus conicus on native thistles), but these introductions would not be permitted today as more balanced attitudes exist to plant biodiversity, driven by both society and the scientific community. Our analysis shows (as far as is known), weed biological control agents have a biosafety track record of >99% of cases avoiding significant non-target impacts on plant populations. Some impacts could have been overlooked, but this seems unlikely to change the basic distribution of very limited adverse effects. Fewer non-target impacts can be expected in future because of improved science and incorporation of wider values. Failure to use biological control represents a significant opportunity cost from the certainty of ongoing adverse impacts from invasive weeds. It is recommended that a simple five-step scale be used to better communicate the risk of consequences from both action (classical biological control) and no action (ongoing impacts from invasive weeds). PMID:24454755

Fear of hypoglycaemia in parents of young children with type 1 diabetes: a systematic review.

PubMed

Barnard, Katharine; Thomas, Sian; Royle, Pamela; Noyes, Kathryn; Waugh, Norman

2010-07-15

Many children with type 1 diabetes have poor glycaemic control. Since the Diabetes Control and Complications Trial (DCCT) showed that tighter control reduces complication rates, there has been more emphasis on intensified insulin therapy. We know that patients and families are afraid of hypoglycaemia. We hypothesised that fear of hypoglycaemia might take precedence over concern about long-term complications, and that behaviour to avoid hypoglycaemia might be at the cost of poorer control, and aimed to evaluate the effectiveness of any interventions designed to prevent that. The objective of this review was to systematically review studies concerning the extent and consequences of fear of hypoglycaemia in parents of children under 12 years of age with type 1 diabetes, and interventions to reduce it. MEDLINE, EMBASE, PsycINFO, The Cochrane Library, Web of Science, meeting abstracts of EASD, ADA and Diabetes UK, Current Controlled Trials, ClinicalTrials.gov, UK CRN, scrutiny of bibliographies of retrieved papers and contact with experts in the field.Inclusions: Relevant studies of any design of parents of children under 12 years of age with Type 1 diabetes were included. The key outcomes were the extent and impact of fear, hypoglycaemia avoidance behaviour in parents due to parental fear of hypoglycaemia in their children, the effect on diabetes control, and the impact of interventions to reduce this fear and hypoglycaemia avoidance behaviour. Eight articles from six studies met the inclusion criteria. All were cross sectional studies and most were of good quality. Parental fear of hypoglycaemia, anxiety and depression were reported to be common. There was a paucity of evidence on behaviour to avoid hypoglycaemia, but there were some suggestions that higher than desirable blood glucose levels might be permitted in order to avoid hypoglycaemia. No studies reporting interventions to reduce parental fear of hypoglycaemia were found. The evidence base was limited. Parents of children with Type 1 diabetes reported considerable parental fear of hypoglycaemia, affecting both parental health and quality of life. There is some suggestion that hypoglycaemia avoidance behaviours by parents might adversely affect glycaemic control. Trials of interventions to reduce parental anxiety and hypoglycaemia avoidance behaviour are needed. We suggest that there should be a trial of structured education for parents of young children with Type 1 diabetes.

EEG Derived Neuronal Dynamics during Meditation: Progress and Challenges

PubMed Central

Kaur, Chamandeep; Singh, Preeti

2015-01-01

Meditation advances positivity but how these behavioral and psychological changes are brought can be explained by understanding neurophysiological effects of meditation. In this paper, a broad spectrum of neural mechanics under a variety of meditation styles has been reviewed. The overall aim of this study is to review existing scientific studies and future challenges on meditation effects based on changing EEG brainwave patterns. Albeit the existing researches evidenced the hold for efficacy of meditation in relieving anxiety and depression and producing psychological well-being, more rigorous studies are required with better design, considering client variables like personality characteristics to avoid negative effects, randomized controlled trials, and large sample sizes. A bigger number of clinical trials that concentrate on the use of meditation are required. Also, the controversial subject of epileptiform EEG changes and other adverse effects during meditation has been raised. PMID:26770834

Regional anatomy of the pedunculopontine nucleus: relevance for deep brain stimulation.

PubMed

Fournier-Gosselin, Marie-Pierre; Lipsman, Nir; Saint-Cyr, Jean A; Hamani, Clement; Lozano, Andres M

2013-09-01

The pedunculopontine nucleus (PPN) is currently being investigated as a potential deep brain stimulation target to improve gait and posture in Parkinson's disease. This review examines the complex anatomy of the PPN region and suggests a functional mapping of the surrounding nuclei and fiber tracts that may serve as a guide to a more accurate placement of electrodes while avoiding potentially adverse effects. The relationships of the PPN were examined in different human brain atlases. Schematic representations of those structures in the vicinity of the PPN were generated and correlated with their potential stimulation effects. By providing a functional map and representative schematics of the PPN region, we hope to optimize the placement of deep brain stimulation electrodes, thereby maximizing safety and clinical efficacy. © 2013 International Parkinson and Movement Disorder Society.

Association of acute adverse effects with high local SAR induced in the brain from prolonged RF head and neck hyperthermia

NASA Astrophysics Data System (ADS)

Adibzadeh, F.; Verhaart, R. F.; Verduijn, G. M.; Fortunati, V.; Rijnen, Z.; Franckena, M.; van Rhoon, G. C.; Paulides, M. M.

2015-02-01

To provide an adequate level of protection for humans from exposure to radio-frequency (RF) electromagnetic fields (EMF) and to assure that any adverse health effects are avoided. The basic restrictions in terms of the specific energy absorption rate (SAR) were prescribed by IEEE and ICNIRP. An example of a therapeutic application of non-ionizing EMF is hyperthermia (HT), in which intense RF energy is focused at a target region. Deep HT in the head and neck (H&N) region involves inducing energy at 434 MHz for 60 min on target. Still, stray exposure of the brain is considerable, but to date only very limited side-effects were observed. The objective of this study is to investigate the stringency of the current basic restrictions by relating the induced EM dose in the brain of patients treated with deep head and neck (H&N) HT to the scored acute health effects. We performed a simulation study to calculate the induced peak 10 g spatial-averaged SAR (psSAR10g) in the brains of 16 selected H&N patients who received the highest SAR exposure in the brain, i.e. who had the minimum brain-target distance and received high forwarded power during treatment. The results show that the maximum induced SAR in the brain of the patients can exceed the current basic restrictions (IEEE and ICNIRP) on psSAR10g for occupational environments by 14 times. Even considering the high local SAR in the brain, evaluation of acute effects by the common toxicity criteria (CTC) scores revealed no indication of a serious acute neurological effect. In addition, this study provides pioneering quantitative human data on the association between maximum brain SAR level and acute adverse effects when brains are exposed to prolonged RF EMF.

Evidence-based risk assessment and recommendations for physical activity: arthritis, osteoporosis, and low back pain.

PubMed

Chilibeck, Philip D; Vatanparast, Hassanali; Cornish, Stephen M; Abeysekara, Saman; Charlesworth, Sarah

2011-07-01

We systematically reviewed the safety of physical activity (PA) for people with arthritis, osteoporosis, and low back pain. We searched PubMed, MEDLINE, Sport Discus, and the Cochrane Central Register of Controlled Trials (1966 through March 2008) for relevant articles on PA and adverse events. A total of 111 articles met our inclusion criteria. The incidence for adverse events during PA was 3.4%-11% (0.06%-2.4% serious adverse events) and included increased joint pain, fracture, and back pain for those with arthritis, osteoporosis, and low back pain, respectively. Recommendations were based on the Appraisal of Guidelines for Research and Evaluation, which applies Levels of Evidence based on type of study ranging from high-quality randomized controlled trials (Level 1) to anecdotal evidence (Level 4) and Grades from A (strong) to C (weak). Our main recommendations are that (i) arthritic patients with highly progressed forms of disease should avoid heavy load-bearing activities, but should participate in non-weight-bearing activities (Level 2, Grade A); and (ii) patients with osteoporosis should avoid trunk flexion (Level 2, Grade A) and powerful twisting of the trunk (Level 3, Grade C); (iii) patients with acute low back pain can safely do preference-based PA (i.e., PA that does not induce pain), including low back extension and flexion (Level 2, Grade B); (iv) arthritic patients with stable disease without progressive joint damage and patients with stable osteoporosis or low back pain can safely perform a variety of progressive aerobic or resistance-training PAs (Level 2, Grades A and B). Overall, the adverse event incidence from reviewed studies was low. PA can safely be done by most individuals with musculoskeletal conditions.

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.

Inhaled corticosteroids for asthma: are they all the same?

PubMed

Baptist, A P; Reddy, R C

2009-02-01

To assess similarities and differences among currently available inhaled corticosteroids (ICS) for treatment of asthma, with special emphasis on factors that may affect the relative safety of these medications. PubMed was searched for relevant reviews and original articles. Information from these studies was synthesized and critically assessed. Differences in corticosteroid formulations and delivery systems can create variations in therapeutic efficacy. Chemical properties of the various corticosteroids may also affect their relative safety. Ciclesonide and beclomethasone dipropionate are administered as prodrugs activated by enzymes present in the lungs but not the oropharynx. Corticosteroid-specific adverse effects in the oropharynx are thus avoided, although formulation-specific effects may remain. Other adverse effects require systemic availability, either via the gastrointestinal tract or the lung. Once they enter the systemic circulation, all ICS are rapidly metabolized by the liver. Oral bioavailability of ICS such as fluticasone, ciclesonide and mometasone is minimal, as a result of their essentially complete first-pass metabolism in the liver. Ciclesonide also undergoes extrahepatic metabolism that eliminates it even more rapidly. Additionally, ciclesonide and mometasone exhibit very high levels of binding to serum proteins that reduces their ability to stimulate glucocorticoid receptors outside the lung. Despite acting by similar mechanisms, currently available ICS and their delivery systems differ in ways that can potentially affect both safety and therapeutic effectiveness for individual patients.

More than a Message of Hope: A District-Level Policymaker's Guide to Understanding Resiliency.

ERIC Educational Resources Information Center

Berliner, BethAnn; Benard, Bonnie

One of the greatest challenges facing today's district-level policymakers and educational leaders is helping America's youth avoid adverse outcomes such as school failure, substance abuse, teen pregnancy, and delinquency. This document describes an alternative policy approach to address these problems--the building of resiliency in youth. Rather…

Development of a New Fear of Hypoglycemia Scale: FH-15

ERIC Educational Resources Information Center

Anarte Ortiz, Maria Teresa; Caballero, Francisco Felix; Ruiz de Adana, Maria Soledad; Rondan, Rosa Maria; Carreira, Monica; Dominguez-Lopez, Marta; Machado, Alberto; Gonzalo-Marin, Montserrat; Tapia, Maria Jose; Valdes, Sergio; Gonzalez-Romero, Stella; Soriguer, Federico C.

2011-01-01

Hypoglycemia is the most common adverse event associated with insulin treatment in diabetes. The consequences of hypoglycemia can be quite aversive and potentially life threatening. The physical sequelae provide ample reason for patients to fear hypoglycemia and avoid episodes. For these reasons, our purpose in this study was to develop a new…

Integrated profiling of Furanocoumarins (FC) in Grapefruit hybrids toward selection of low FC varieties

USDA-ARS?s Scientific Manuscript database

Furanocoumarins (FC) are a class of organic chemical components in grapefruits and other diet plants. Some of them in grapefruit juice can induce potentially adverse interactions with human drugs and in that patients may be advised to avoid the fruit and juice. To develop low FC grapefruit cultivars...

Resilience: Revisiting the Concept and Its Utility for Social Research

ERIC Educational Resources Information Center

Kolar, Katarina

2011-01-01

Researchers of resilience seek to understand why some people will recover from or avoid negative outcomes against the odds associated with exposure to particular adversities. Over the last two decades the concept of resilience has experienced "burgeoning interest" (Ungar, 2005, p. xvii). However, due to a lack of consistency in defining and…

"Making It": Understanding Adolescent Resilience in Two Informal Settlements (Slums) in Nairobi, Kenya

ERIC Educational Resources Information Center

Kabiru, Caroline W.; Beguy, Donatien; Ndugwa, Robert P.; Zulu, Eliya M.; Jessor, Richard

2012-01-01

Many adolescents living in contexts characterized by adversity achieve positive outcomes. We adopt a protection-risk conceptual framework to examine resilience (academic achievement, civic participation, and avoidance of risk behaviors) among 1,722 never-married 12-19 year olds living in two Kenyan urban slums. We find stronger associations…

Responses of Earthworm to Aluminum Toxicity in Latosol

Treesearch

Jia-En Zhang; Jiayu Yu; Ying Ouyang; Huaqin Xu

2012-01-01

Excess aluminum (Al) in soils due to acid rain leaching is toxic to water resources and harmful to soil organisms and plants. This study investigated adverse impacts of Al levels upon earthworms (Eisenia fetida) from the latosol (acidic red soil). Laboratory experiments were performed to examine the survival and avoidance of earthworms from high Al...

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.

Early Adverse Experience Increases Emotional Reactivity in Juvenile Rhesus Macaques: Relation to Amygdala Volume

PubMed Central

Howell, B.R.; Grand, A. P.; McCormack, K. M.; Shi, Y.; LaPrarie, J.; Maestripieri, D.; Styner, M. A.; Sanchez, M. M.

2015-01-01

This study investigated the impact of infant maltreatment on juvenile rhesus monkeys’ behavioral reactivity to novel stimuli and its associations with amygdala volume. Behavioral reactivity to novel stimuli of varying threat intensity was measured using Approach/Avoidance (AA) and Human Intruder (HI) tasks. In vivo magnetic resonance imaging (MRI) was used to measure amygdala volume. Interestingly, group behavioral differences were context-dependent. When exposed to a human intruder, maltreated subjects displayed more anxious behaviors than controls; however, when presented with fear-evoking objects, maltreated animals exhibited increased aggression and a shorter latency to inspect the objects. Finally, under testing conditions with the lowest levels of threat (neutral novel objects) maltreated animals also showed shorter latencies to inspect objects, and reduced avoidance and increased exploration compared to controls. This suggests alterations in threat assessment and less behavioral inhibition in animals with early adverse experience compared to controls. Some of these behavioral responses were associated with amygdala volume, which was positively correlated with abuse rates received during infancy, particularly reflecting a relationship with exploration, consistent with previous studies. PMID:25196846

A Wall-Distance-Free k-ω SST Turbulence Model

NASA Astrophysics Data System (ADS)

Gleize, Vincent; Burnley, Victor

2001-11-01

In the calculation of flows around aircraft and aerodynamic bodies, the Shear-Stress Transport (SST) model by Menter has been used extensively due to its good prediction of flows with adverse pressure gradients. One main drawback of this model is the need to calculate the distance from the wall. While this is not a serious drawback for steady state calculations on non-moving grids, this calculation can become very cumbersome and expensive for unsteady simulations, especially when using unstructured grids. In this case, the wall-distance needs to be determined after each iteration. To avoid this problem, a new model is proposed which provides the benefits of the SST correction and avoids the freestream dependency of the solution, while not requiring the wall-distance. The first results for a wide range of test cases show that this model produces very good agreement with experimental data for flows with adverse pressure gradients, separation zones and shock-boundary layer interactions, closely matching the results obtained with the original SST model. This model should be very useful for unsteady calculations, such as store separation, grid adaptation, and other practical flows.

Management of arthropod pathogen vectors in North America: Minimizing adverse effects on pollinators

USGS Publications Warehouse

Ginsberg, Howard; Bargar, Timothy A.; Hladik, Michelle L.; Lubelczyk, Charles

2017-01-01

Tick and mosquito management is important to public health protection. At the same time, growing concerns about declines of pollinator species raise the question of whether vector control practices might affect pollinator populations. We report the results of a task force of the North American Pollinator Protection Campaign (NAPPC) that examined potential effects of vector management practices on pollinators, and how these programs could be adjusted to minimize negative effects on pollinating species. The main types of vector control practices that might affect pollinators are landscape manipulation, biocontrol, and pesticide applications. Some current practices already minimize effects of vector control on pollinators (e.g., short-lived pesticides and application-targeting technologies). Nontarget effects can be further diminished by taking pollinator protection into account in the planning stages of vector management programs. Effects of vector control on pollinator species often depend on specific local conditions (e.g., proximity of locations with abundant vectors to concentrations of floral resources), so planning is most effective when it includes collaborations of local vector management professionals with local experts on pollinators. Interventions can then be designed to avoid pollinators (e.g., targeting applications to avoid blooming times and pollinator nesting habitats), while still optimizing public health protection. Research on efficient targeting of interventions, and on effects on pollinators of emerging technologies, will help mitigate potential deleterious effects on pollinators in future management programs. In particular, models that can predict effects of integrated pest management on vector-borne pathogen transmission, along with effects on pollinator populations, would be useful for collaborative decision-making.

Antiarrhythmic effect of tamoxifen on the vulnerability induced by hyperthyroidism to heart ischemia/reperfusion damage.

PubMed

Pavón, Natalia; Hernández-Esquivel, Luz; Buelna-Chontal, Mabel; Chávez, Edmundo

2014-09-01

Hyperthyroidism, known to have deleterious effects on heart function, and is associated with an enhanced metabolic state, implying an increased production of reactive oxygen species. Tamoxifen is a selective antagonist of estrogen receptors. These receptors make the hyperthyroid heart more susceptible to ischemia/reperfusion. Tamoxifen is also well-known as an antioxidant. The aim of the present study was to explore the possible protective effect of tamoxifen on heart function in hyperthyroid rats. Rats were injected daily with 3,5,3'-triiodothyronine at 2mg/kg body weight during 5 days to induce hyperthyroidism. One group was treated with 10mg/kg tamoxifen and another was not. The protective effect of the drug on heart rhythm was analyzed after 5 min of coronary occlusion followed by 5 min reperfusion. In hyperthyroid rats not treated with tamoxifen, ECG tracings showed post-reperfusion arrhythmias, and heart mitochondria isolated from the ventricular free wall lost the ability to accumulate and retain matrix Ca(2+) and to form a high electric gradient. Both of these adverse effects were avoided with tamoxifen treatment. Hyperthyroidism-induced oxidative stress caused inhibition of cis-aconitase and disruption of mitochondrial DNA, effects which were also avoided by tamoxifen treatment. The current results support the idea that tamoxifen inhibits the hypersensitivity of hyperthyroid rat myocardium to reperfusion damage, probably because its antioxidant activity inhibits the mitochondrial permeability transition. Copyright © 2014 Elsevier Ltd. All rights reserved.

Using constrained information entropy to detect rare adverse drug reactions from medical forums.

PubMed

Yi Zheng; Chaowang Lan; Hui Peng; Jinyan Li

2016-08-01

Adverse drug reactions (ADRs) detection is critical to avoid malpractices yet challenging due to its uncertainty in pre-marketing review and the underreporting in post-marketing surveillance. To conquer this predicament, social media based ADRs detection methods have been proposed recently. However, existing researches are mostly co-occurrence based methods and face several issues, in particularly, leaving out the rare ADRs and unable to distinguish irrelevant ADRs. In this work, we introduce a constrained information entropy (CIE) method to solve these problems. CIE first recognizes the drug-related adverse reactions using a predefined keyword dictionary and then captures high- and low-frequency (rare) ADRs by information entropy. Extensive experiments on medical forums dataset demonstrate that CIE outperforms the state-of-the-art co-occurrence based methods, especially in rare ADRs detection.

HBOC-201 as an alternative to blood transfusion: efficacy and safety evaluation in a multicenter phase III trial in elective orthopedic surgery.

PubMed

Jahr, Jonathan S; Mackenzie, Colin; Pearce, L Bruce; Pitman, Arkadiy; Greenburg, A Gerson

2008-06-01

The ability of hemoglobin based oxygen carrier-201 (HBOC-201) to safely reduce and/or eliminate perioperative transfusion was studied in orthopedic surgery patients. A randomized, single-blind, packed red blood cell (PRBC)-controlled, parallel-group multicenter study was conducted. Six hundred eighty-eight patients were randomized to treatment with HBOC-201 (H, n = 350) or PRBC (R, n = 338) at the first transfusion decision. Primary endpoints were transfusion avoidance and blinded assessment [Mann-Whitney estimator (MW)] of safety noninferiority. Groups were compared directly and by paired/matching group analyses predicated on a prospectively defined dichotomy [treatment success (HH) vs. failure (HR)] in the H arm and an equivalently defined dichotomy [3 (R3+) units PRBC] in the R arm, based on need (moderate vs. high) for additional oxygen carrying capacity. A total of 59.4% of patients in the H arm avoided PRBC transfusion. Adverse events (8.47 vs. 5.88), and serious adverse events (SAEs) (0.35 vs. 0.25) per patient were higher in the H versus R arms (p < 0.001 and p < 0.01) with MW = 0.561 (95 CI 0.528-0.594). HH versus R3- had identical (0.14) serious adverse events/patient and a MW = 0.519 (95% confidence limit 0.481-0.558), whereas the incidence was higher (0.63 vs. 0.47) for HR versus R3+ with a MW = 0.605 (95% confidence limit 0.550-0.662). Age (>80 years), volume overload and undertreatment contributed to this imbalance. HBOC-201 eliminated transfusion in the majority of subjects. The between arms (H vs. R) safety analysis was unfavorable and likely related to patient age, volume overload, and undertreatment and was isolated to patients that could not be managed by HBOC-201 alone. However, patients <80 years old with moderate clinical need may safely avoid transfusion when treated with up to 10 units of HBOC-201.

Thermal enclosures for electronically scanned pressure modules operating in cryogenic environments

NASA Technical Reports Server (NTRS)

Mitchell, Michael; Sealey, Bradley S.

1989-01-01

Specific guidelines to design, construct, and test ESP thermal enclosures for applications at cryogenic temperatures are given. The enclosures maintain the ESP modules at a constant temperature (10 C plus or minus 1 C) to minimize thermal zero and sensitivity shifts, to minimize the frequency of expensive on-line calibrations, and to avoid adverse effects on tunnel and model boundary layers. The enclosures are constructed of a rigid closed-cell foam and are capable of withstanding the stagnation pressures to 932kPa (135 psia) without reduction in thermal insulation properties. This construction procedure has been used to construct several thermal packages which have been successfully used in National Transonic Facility.

Discovery of 2-methylpyridine-based biaryl amides as γ-secretase modulators for the treatment of Alzheimer's disease.

PubMed

Chen, Jian Jeffrey; Qian, Wenyuan; Biswas, Kaustav; Yuan, Chester; Amegadzie, Albert; Liu, Qingyian; Nixey, Thomas; Zhu, Joe; Ncube, Mqhele; Rzasa, Robert M; Chavez, Frank; Chen, Ning; DeMorin, Frenel; Rumfelt, Shannon; Tegley, Christopher M; Allen, Jennifer R; Hitchcock, Stephen; Hungate, Randy; Bartberger, Michael D; Zalameda, Leeanne; Liu, Yichin; McCarter, John D; Zhang, Jianhua; Zhu, Li; Babu-Khan, Safura; Luo, Yi; Bradley, Jodi; Wen, Paul H; Reid, Darren L; Koegler, Frank; Dean, Charles; Hickman, Dean; Correll, Tiffany L; Williamson, Toni; Wood, Stephen

2013-12-01

γ-Secretase modulators (GSMs) are potentially disease-modifying treatments for Alzheimer's disease. They selectively lower pathogenic Aβ42 levels by shifting the enzyme cleavage sites without inhibiting γ-secretase activity, possibly avoiding known adverse effects observed with complete inhibition of the enzyme complex. A cell-based HTS effort identified the sulfonamide 1 as a GSM lead. Lead optimization studies identified compound 25 with improved cell potency, PKDM properties, and it lowered Aβ42 levels in the cerebrospinal fluid (CSF) of Sprague-Dawley rats following oral administration. Further optimization of 25 to improve cellular potency is described. Copyright © 2013 Elsevier Ltd. All rights reserved.

Public Health Implications of Counterfeit Medications.

PubMed

Fantasia, Heidi Collins; Vooys, Katherine M

2018-06-01

Counterfeit medications are broadly defined as drugs that can contain inadequate amounts of active ingredients, contain the wrong active ingredients, be contaminated with harmful substances, and/or be falsely labeled. These medications are a public health issue globally, and their presence in the United States is growing. Counterfeit medications are produced without regulatory oversight and are distributed illegally, often via online sources. Use of these medications can result in adverse effects or a lack of improvement in a person's health condition. Nurses can assess where individuals are obtaining their medications and provide education about the potentially serious risks posed by counterfeit medications and how to avoid them. Copyright © 2018 AWHONN. Published by Elsevier Inc. All rights reserved.

Needlestick injuries in veterinary medicine

PubMed Central

Weese, J. Scott; Jack, Douglas C.

2008-01-01

Needlestick injuries are an inherent risk of handling needles during the course of veterinary practice. While significant effort has been expended to reduce needlestick injuries in human medicine, a relatively lax approach seems to be prevalent in veterinary medicine. It appears that needlestick injuries are very common among veterinary personnel and that serious adverse effects, while uncommon, do occur. Clients may also receive injuries in clinics during the course of animal restraint, and at home following prescription of injectable medications or fluids. Because of occupational health, personal health, and liability concerns, veterinary practices should review the measures they are taking to reduce the likelihood of needlestick injuries and develop written needlestick injury avoidance protocols. PMID:18978971

Health hazards of ceramic artists.

PubMed

Dorevitch, S; Babin, A

2001-01-01

Ceramic artists can be exposed to many hazards including metals (such as lead), fibrogenic dusts (such as silica), heat, repetitive motion, radiation, and toxic emissions from kilns. The health risks of these exposures have not been well characterized among artists, although limited information is available from commercial potteries. Adverse health effects may be prevented by using less hazardous materials (such as lead-free glazes), improved ventilation, and proper work practices. Special precautions must be in place if children have access to the ceramics studio. The use of glazed ceramic dishes can be a risk for lead toxicity. Food should not be stored in glazed ceramics, and pregnant women should avoid daily use of ceramic mugs for drinking hot beverages.

Toxic stress and child refugees.

PubMed

Murray, John S

2018-01-01

The purpose of this article was to describe the phenomenon of toxic stress and its impact on the physical and mental health of child refugees. Almost two decades ago, researchers found that recurring adverse childhood events (ACEs; e.g., physical, psychological, and sexual abuse, neglect, and household dysfunction such as substance abuse, mental illness, and criminal behavior) were associated with a significant increase in serious illnesses during adulthood. Illnesses include heart, lung, and liver disease, cancer, and bone fractures. The scientists reported that experiencing four or more ACEs during childhood significantly increases the risk for toxic stress. Toxic stress is defined as the exposure to extreme, frequent, and persistent adverse events without the presence of a supportive caretaker. There is a paucity of literature related to toxic stress and child refugees. However, it has been clearly established that the prolonged brutal and traumatizing war in Syria is having a profound impact on the physical and mental health of child refugees at a distressing rate. Prevention of toxic stress should be a primary goal of all pediatric healthcare professionals working with child refugees. While this seems daunting given the population, and the seemingly insurmountable stressors they experience, some basic interventions should be considered. Providing basic anticipatory guidance to parents and caregivers of child refugees, to encourage positive parenting and strengthening support networks, will be highly effective in developing the requisite buffers that mitigate the effects of stress and avoid toxic stress. Efforts should also be focused on addressing caregiver stress and improving their ability to provide safe, reliable, and nurturing care that will help to mitigate any stress response experienced by a child. It is critical that greater awareness be placed on the effects of toxic stress on child refugees who are exposed to significant adverse events early in life. © 2017 Wiley Periodicals, Inc.

Systematic drug safety evaluation based on public genomic expression (Connectivity Map) data: Myocardial and infectious adverse reactions as application cases

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

Wang, Kejian, E-mail: kejian.wang.bio@gmail.com; Weng, Zuquan; Sun, Liya

Adverse drug reaction (ADR) is of great importance to both regulatory agencies and the pharmaceutical industry. Various techniques, such as quantitative structure–activity relationship (QSAR) and animal toxicology, are widely used to identify potential risks during the preclinical stage of drug development. Despite these efforts, drugs with safety liabilities can still pass through safety checkpoints and enter the market. This situation raises the concern that conventional chemical structure analysis and phenotypic screening are not sufficient to avoid all clinical adverse events. Genomic expression data following in vitro drug treatments characterize drug actions and thus have become widely used in drug repositioning. Inmore » the present study, we explored prediction of ADRs based on the drug-induced gene-expression profiles from cultured human cells in the Connectivity Map (CMap) database. The results showed that drugs inducing comparable ADRs generally lead to similar CMap expression profiles. Based on such ADR-gene expression association, we established prediction models for various ADRs, including severe myocardial and infectious events. Drugs with FDA boxed warnings of safety liability were effectively identified. We therefore suggest that drug-induced gene expression change, in combination with effective computational methods, may provide a new dimension of information to facilitate systematic drug safety evaluation. - Highlights: • Drugs causing common toxicity lead to similar in vitro gene expression changes. • We built a model to predict drug toxicity with drug-specific expression profiles. • Drugs with FDA black box warnings were effectively identified by our model. • In vitro assay can detect severe toxicity in the early stage of drug development.« less

Prevention of Gynecomastia and Breast Pain Caused by Androgen Deprivation Therapy in Prostate Cancer: Tamoxifen or Radiotherapy?

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

Arruda Viani, Gustavo, E-mail: gusviani@gmail.com; Bernardes da Silva, Lucas Godoi; Stefano, Eduardo Jose

Purpose: To determine, in a meta-analysis, whether gynecomastia and breast pain rates in men with prostate cancer treated with androgen deprivation therapy (ADT) are reduced if treated with prophylactic radiotherapy (RT) or tamoxifen (TMX). Methods and Materials: The MEDLINE, EMBASE, CANCERLIT, and Cochrane Library databases, as well as proceedings of annual meetings, were systematically searched to identify randomized, controlled studies comparing RT or TMX with observation for men with prostate cancer using ADT. Results: Six RCTs (three RT trials and three TMX trials, N = 777 patients total) were identified that met the study criteria. Pooled results from these RCTsmore » comparing RT vs. observation showed a significant reduction in the incidence of gynecomastia and breast pain rates in patients treated with RT (odds ratio [OR] = 0.21, 95% confidence interval [CI] = 0.12-0.37, p < 0.0001, and OR = 0.34, 95% CI 0.20-0.57, p < 0.0001, respectively). Use of RT resulted in an absolute risk reduction (ARR) of 29.4% and 19.9%, with a number needed to treat (NNT) of 3.4 and 5 to avoid one case of gynecomastia and breast pain, respectively. Pooled results from trials comparing TMX vs. observation showed a statistical benefit for breast pain and gynecomastia in favor of TMX arms (OR = 0.04, 95% CI = 0.02-0.08, p < 0.0001 and OR = 0.07, 95% CI = 0.0-0.14, p < 0.00001). TMX resulted in an ARR = 64.1% and 47.6%, with an NNT of 1.56 and 2.1 to avoid one case of gynecomastia and breast pain, respectively. Considering adverse effects, TMX was 6 times more adverse effects than RT. Conclusions: Our data have shown that both TMX and RT prevented gynecomastia and breast pain in patients with prostate cancer receiving ADT for prostate cancer. Although TMX was two times more effective in preventing gynecomastia, RT should represent an effective and safe treatment option, to take into account mainly in patients with cardiovascular risk factors or thrombotic diathesis.« less

Childhood lead exposure in France: benefit estimation and partial cost-benefit analysis of lead hazard control

PubMed Central

2011-01-01

Background Lead exposure remains a public health concern due to its serious adverse effects, such as cognitive and behavioral impairment: children younger than six years of age being the most vulnerable population. In Europe, the lead-related economic impacts have not been examined in detail. We estimate the annual costs in France due to childhood exposure and, through a cost benefit analysis (CBA), aim to assess the expected social and economic benefits of exposure abatement. Methods Monetary benefits were assessed in terms of avoided national costs. We used results from a 2008 survey on blood-lead (B-Pb) concentrations in French children aged one to six years old. Given the absence of a threshold concentration being established, we performed a sensitivity analysis assuming different hypothetical threshold values for toxicity above 15 μg/L, 24 μg/L and 100 μg/L. Adverse health outcomes of lead exposure were translated into social burden and economic costs based on literature data from literature. Direct health benefits, social benefits and intangible avoided costs were included. Costs of pollutant exposure control were partially estimated in regard to homes lead-based paint decontamination, investments aiming at reducing industrial lead emissions and removal of all lead drinking water pipes. Results The following overall annual benefits for the three hypothetical thresholds values in 2008 are: €22.72 billion, €10.72 billion and €0.44 billion, respectively. Costs from abatement ranged from €0.9 billion to 2.95 billion/year. Finally, from a partial CBA of lead control in soils and dust the estimates of total net benefits were € 3.78 billion, € 1.88 billion and €0.25 billion respectively for the three hypothesized B-Pb effect values. Conclusions Prevention of childhood lead exposure has a high social benefit, due to reduction of B-Pb concentrations to levels below 15 μg/L or 24 μg/L, respectively. Reducing only exposures above 100 μg/L B-Pb has little economic impact due to the small number of children who now exhibit such high exposure levels. Prudent public policies would help avoiding future medical interventions, limit the need for special education and increase future productivity, and hence lifetime income for children exposed to lead. PMID:21599937

Avoiding hypoglycaemia: a new target of care for elderly diabetic patients.

PubMed

Wong, C W

2015-10-01

Optimising glycaemic control to prevent diabetes-associated complications has received much attention. The associated risk of iatrogenic hypoglycaemia, however, is inevitable and can have a significant impact on health. The prevalence of iatrogenic hypoglycaemia tends to increase with advancing age. Elderly people are intrinsically prone to hypoglycaemia. Ageing attenuates the glucose counter-regulatory and symptomatic response to hypoglycaemia, particularly in the presence of a longer duration of diabetes. Multiple co-morbidities and polypharmacy correlated with advancing age also increase the hypoglycaemic risk. In addition to the acute adverse effects of hypoglycaemia, such as fall with injury, cardiovascular events and mortality, a hypoglycaemic episode can have long-term consequences. Repeated episodes may have a significant psychological impact and are also a risk factor for dementia. Because of the heterogeneous health status of the elderly, not all will benefit from optimal glycaemic control. Setting an individual glycaemic target and formulating a management plan that takes account of the patient's circumstances combined with balancing the benefit and risk of diabetes intervention to avoid hypoglycaemia is a more practical approach to the management of elderly diabetic patients.

Gas pre-warming for improving performances of heated humidifiers in neonatal ventilation.

PubMed

Schena, E; De Paolis, E; Silvestri, S

2011-01-01

Adequate temperature and humidification of gas delivered must be performed during long term neonatal ventilation to avoid potential adverse health effects. Literature shows that performances of heated humidifiers are, at least in some cases, quite poor. In this study, a novel approach to gas conditioning, consisting of gas warming upstream the humidification chamber, is presented. Gas pre-warming, in combination with a control strategy based on a mathematical model taking into account a number of parameters, allows to significantly improve the heated humidifier performances. The theoretical model has been validated and experimental trials have been carried out in the whole volumetric flow-rate (Q) range of neonatal ventilation (lower than 10 L · min(-1)). Experimental results (temperature values ranging from 36 °C to 38 °C and relative humidity values from 90 % to 98 % in the whole range of Q) show values very close to the ideal thermo-hygrometric conditions. The proposed solution allows to avoid vapor condensation at low flow rates and decrease of relative humidity at high flow rates.

An expert system for wind shear avoidance

NASA Technical Reports Server (NTRS)

Stengel, Robert F.; Stratton, D. Alexander

1990-01-01

A study of intelligent guidance and control concepts for protecting against the adverse effects of wind shear during aircraft takeoffs and landings is being conducted, with current emphasis on developing an expert system for wind shear avoidance. Principal objectives are to develop methods for assessing the likelihood of wind shear encounter (based on real-time information in the cockpit), for deciding what flight path to pursue (e.g., takeoff abort, landing go-around, or normal climbout or glide slope), and for using the aircraft's full potential for combating wind shear. This study requires the definition of both deterministic and statistical techniques for fusing internal and external information , for making go/no-go decisions, and for generating commands to the manually controlled flight. The program has begun with the development of the WindShear Safety Advisor, an expert system for pilot aiding that is based on the FAA Windshear Training Aid; a two-volume manual that presents an overview , pilot guide, training program, and substantiating data provides guidelines for this initial development. The WindShear Safety Advisor expert system currently contains over 200 rules and is coded in the LISP programming language.

Bioavailable dietary phosphate, a mediator of cardiovascular disease, may be decreased with plant-based diets, phosphate binders, niacin, and avoidance of phosphate additives.

PubMed

McCarty, Mark F; DiNicolantonio, James J

2014-01-01

Increased fasting serum phosphate within the normal physiological range has been linked to increased cardiovascular risk in prospective epidemiology; increased production of fibroblast growth factor 23, and direct vascular effects of phosphate, may mediate this risk. Although dietary phosphate intake does not clearly influence fasting serum phosphate in individuals with normal renal function, increased phosphate intake can provoke a rise in fibroblast growth factor 23, and in diurnal phosphate levels, and hence may adversely influence vascular health. Dietary phosphate absorption can be moderated by emphasizing plant-based dietary choices (which provide phosphate in less bioavailable forms); avoidance of processed foods containing inorganic phosphate food additives; and by ingestion of phosphate-binder drugs, magnesium supplements, or niacin, which precipitate phosphate or suppress its gastrointestinal absorption. The propensity of dietary phosphate to promote vascular calcification may be opposed by optimal intakes of magnesium, vitamin K, and vitamin D; the latter should also counter the tendency of phosphate to elevate parathyroid hormone. Copyright © 2014 Elsevier Inc. All rights reserved.

Evolution of trends in risk management.

PubMed

Aziz, Farah; Khalil, Alizan; Hall, John C

2005-07-01

In the past, the detection and response to adverse clinical events were viewed as an inherent part of professionalism; and, if perceived problems were not sorted out at that level, the ultimate expression of dissatisfaction was litigation. There are now demands for the adoption of more transparent and effective processes for risk management. Reviews of surgical practice have highlighted the presence of unacceptable levels of avoidable adverse events. This is being resolved in two ways. First, attention is being directed to the extent that training and experience have on outcomes after surgery, and both appear to be important. Second, a greater appreciation of human factors engineering has promoted a greater involvement of surgeons in processes involving teamwork and non-technical skills. The community wants surgeons who are competent and health-care systems that minimize risk. In recent times attention has been focused on the turmoil associated with change; but, when events are viewed over a period of several decades, there has been considerable progress towards these ideals. Further advancement would be aided by removing the adversarial nature of malpractice systems that have failed to maintain standards.

Milrinone in advanced heart failure: dose and therapeutic monitor outside intensive care unit.

PubMed

Charisopoulou, Dafni; Leaver, Neil; Banner, Nicholas R

2014-04-01

Advanced chronic heart failure (ACHF) patients often require inotropes before transplantation or ventricular assist device implantation. Milrinone, an inotrope and vasodilator, may accumulate in cardiorenal syndrome with serious adverse effects. We investigated the potential for therapeutic drug monitoring of milrinone levels using High Performance Liquid Chromatography Mass Spectrometry (HPLC-MS). 22 ACHF patients (15 males, 49±9 years) received milrinone 50 µg/kg intravenously (i.v.) during heart catheterization. Milrinone levels were 216±71 ng/ml (within the reported therapeutic range: 100-300 ng/ml), followed by improvements in cardiac index, pulmonary artery and wedge pressures (p < 0.005). 18 ACHF patients (17 males, 50±12 years, 13 had renal dysfunction) received continuous i.v. milrinone (5-26 days) at 0.1-0.2 µg/kg/min, titrated according to plasma milrinone levels. No adverse events occurred. Therapeutic levels were achieved with doses of 0.2±0.06 µg/Kg/min, below those recommended in Summary of Product Characteristics. Milrinone therapy can be noninvasively monitored by HPLC-MS, while avoiding toxicity in ACHF.

Drug-nutrient interactions in elderly people.

PubMed

Akamine, Dirce; Filho, Michel K; Peres, Carmem M

2007-05-01

The presence of multiple diseases, polypharmacy, malnutrition, and impaired metabolism in elderly individuals increases the risks of adverse events related to drug-food interactions. Some considerations for elderly people influenced by drug-food interactions are reviewed. When investigating pharmacokinetic and pharmacodynamic modifications in the elderly, other factors have to be considered, such as anorexia, dementia, depression, intolerance, gastrointestinal-tract disorders, social and economic factors, reduced abilities (visual and manual) and difficulties in chewing or swallowing. Specific reference is made herein to the health status of the elderly Brazilian population based on the observations of our research group. In addition, the most common diseases (such as cancer, coronary heart disease, dementia, diabetes mellitus, hypertension and osteoporosis), the drugs usually prescribed to treat them, and the adverse nutritional reactions that occur in older patients are summarized. In order to develop a correct drug prescription plan and nutritional intervention to avoid any kind of undesirable drug-food interaction effect, it is necessary to adequately diagnose the disease and often re-evaluate the chosen treatment, identify disease stages and the necessary therapies to minimize the number of drugs administered, and select a reasonable nutritional assessment.

Caring for disabled older adults with musculoskeletal conditions: A transactional model of caregiver burden, coping strategies, and depressive symptoms.

PubMed

Lu, Nan; Liu, Jinyu; Wang, Fei; Lou, Vivian W Q

This study investigated the mediating role of coping strategies in the relationship between caregiver burden and depressive symptoms among family caregivers caring for disabled older adults with musculoskeletal (MSK) conditions. The cross-sectional data were from a quota sampling of 494 pairs of disabled older adults and their primary family caregivers in Shanghai, China. The disabled older adults had MSK conditions and limitations in activities of daily living. The mean ages of the older adults and their caregivers were 83.9 and 62.6 years. Path analysis was conducted to test the proposed hypotheses. Caregivers of adults with MSK conditions were more likely to use active coping to handle time dependence (β [SD]=0.182 [0.055]) and physical burden (β [SD]=0.226 [0.071]) and to use avoidant coping to handle developmental burden (β [SD]=0.414 [0.061]). Both coping strategies were used to handle social burden(active: β [SD]=0.179 [0.078]; avoidant: β [SD]=0.241 [0.073]). Experiencing emotional burden reduced the likelihood of using both coping strategies (active: β [SD]=-0.266 [0.066]; avoidant: β [SD]=-0.373 [0.062]). Active coping had a protective impact on depressive symptoms (β [SD]=-0.228 [0.050]), whereas avoidant coping had an adverse impact on depressive symptoms (β [SD]=0.232 [0.053]). The findings confirm the mediating effects of coping strategies in the relationship between caregiver burden and depressive symptoms. Copyright © 2016. Published by Elsevier Ireland Ltd.

The Importance of Quality Specifications in Safety Assessments of Amino Acids: The Cases of l-Tryptophan and l-Citrulline.

PubMed

Oketch-Rabah, Hellen A; Roe, Amy L; Gurley, Bill J; Griffiths, James C; Giancaspro, Gabriel I

2016-12-01

The increasing consumption of amino acids from a wide variety of sources, including dietary supplements, natural health products, medical foods, infant formulas, athletic and work-out products, herbal medicines, and other national and international categories of nutritional and functional food products, increases the exposure to amino acids to amounts far beyond those normally obtained from the diet, thereby necessitating appropriate and robust safety assessments of these ingredients. Safety assessments of amino acids, similar to all food constituents, largely rely on the establishment of an upper limit [Tolerable Upper Intake Level (UL)] considered to be a guide for avoiding high intake, above which adverse or toxic effects might occur. However, reliable ULs have been difficult or impossible to define for amino acids because of inadequate toxicity studies in animals and scarce or missing clinical data, as well as a paucity or absence of adverse event reporting data. This review examines 2 amino acids that have been associated with in-market adverse events to show how quality specifications might have helped prevent the adverse clinical outcomes. We further highlight the importance of various factors that should be incorporated into an overall safety assessment of these and other amino acids. In addition to the traditional reliance on the established UL, well-defined quality specifications, review of synthesis and production strategies, potential interactions with drugs, contraindications with certain disease states, and cautionary use within certain age groups should all be taken into consideration. © 2016 American Society for Nutrition.

A Survey of Logic Formalisms to Support Mishap Analysis

NASA Technical Reports Server (NTRS)

Johnson, Chris; Holloway, C. M.

2003-01-01

Mishap investigations provide important information about adverse events and near miss incidents. They are intended to help avoid any recurrence of previous failures. Over time, they can also yield statistical information about incident frequencies that helps to detect patterns of failure and can validate risk assessments. However, the increasing complexity of many safety critical systems is posing new challenges for mishap analysis. Similarly, the recognition that many failures have complex, systemic causes has helped to widen the scope of many mishap investigations. These two factors have combined to pose new challenges for the analysis of adverse events. A new generation of formal and semi-formal techniques have been proposed to help investigators address these problems. We introduce the term mishap logics to collectively describe these notations that might be applied to support the analysis of mishaps. The proponents of these notations have argued that they can be used to formally prove that certain events created the necessary and sufficient causes for a mishap to occur. These proofs can be used to reduce the bias that is often perceived to effect the interpretation of adverse events. Others have argued that one cannot use logic formalisms to prove causes in the same way that one might prove propositions or theorems. Such mechanisms cannot accurately capture the wealth of inductive, deductive and statistical forms of inference that investigators must use in their analysis of adverse events. This paper provides an overview of these mishap logics. It also identifies several additional classes of logic that might also be used to support mishap analysis.

Study on the Increased Probability of Detecting Adverse Drug Reactions Based on Bayes' Theorem: Evaluation of the Usefulness of Information on the Onset Timing of Adverse Drug Reactions.

PubMed

Oshima, Shinji; Enjuji, Takako; Negishi, Akio; Akimoto, Hayato; Ohara, Kousuke; Okita, Mitsuyoshi; Numajiri, Sachihiko; Inoue, Naoko; Ohshima, Shigeru; Terao, Akira; Kobayashi, Daisuke

2017-09-01

In order to avoid adverse drug reactions (ADRs), pharmacists are reconstructing ADR-related information based on various types of data gathered from patients, and then providing this information to patients. Among the data provided to patients is the time-to-onset of ADRs after starting the medication (i.e., ADR onset timing information). However, a quantitative evaluation of the effect of onset timing information offered by pharmacists on the probability of ADRs occurring in patients receiving this information has not been reported to date. In this study, we extracted 40 ADR-drug combinations from the data in the Japanese Adverse Drug Event Report database. By applying Bayes' theorem to these combinations, we quantitatively evaluated the usefulness of onset timing information as an ADR detection predictor. As a result, when information on days after taking medication was added, 54 ADR-drug combinations showed a likelihood ratio (LR) in excess of 2. In particular, when considering the ADR-drug combination of anaphylactic shock with levofloxacin or loxoprofen, the number of days elapsed between start of medication and the onset of the ADR was 0, which corresponded to increased likelihood ratios (LRs) of 138.7301 or 58.4516, respectively. When information from 1-7 d after starting medication was added to the combination of liver disorder and acetaminophen, the LR was 11.1775. The results of this study indicate the clinical usefulness of offering information on ADR onset timing.

Cost-effectiveness Analysis of Denosumab in the Prevention of Skeletal-related Events in Patients with Prostate Cancer in Kazakhstan.

PubMed

Bektur, Carina; Nurgozhin, Talgat

2014-01-01

Bone mass loss (BML) is one of the adverse effects of oncological chemotherapy, especially in cases of hormonal types of cancer, such as a prostate cancer (PC). BML is strongly associated with skeletal-related events (SREs), therefore decreasing the quality of patient's life. Denosumab shows an advantage over zoledronic acid (ZA) in delaying the first onset of SREs and subsequent SREs in adults with PC in several phase III clinical trials. Since generic ZA recently became available, the purpose of the present study was to assess the cost-effectiveness of denosumab vs. brand or generic ZA in the prevention of SREs in Kazakhstani patients with PC. A Markov model was constructed in Tree-Age Pro 2013 software program with 4-week model cycles to analyze the cost-effectiveness of the treatments from the perspective of Ministry of Health (MoH) over a 10-year PC cohort. Direct costs (in Kazakhstani monetary units "tenge" in 2014) included costs of drug, SRE (pathologic fracture, surgery to bone, radiation to bone, spinal cord compression), and adverse events treatment. All costs were discounted for 3% per year. Effectiveness was appraised based on the number of SREs. Health states were defined according to SRE occurrence, SRE history, and death. The model assumed that a maximum of 1 SRE could occur in each cycle. Transition probabilities were derived from the relevant phase III trials. Results were present in the incremental total cost per SRE avoided. One-way sensitivity analyses were performed to examine the robustness of the model. Over the 10-year period, denosumab incurred 103,091 tenge higher costs than brand ZA, 677,133 tenge higher costs than generic ZA, and 0.58 fewer SREs per patient with PC. The estimated incremental total direct costs per SRE avoided with the use of denosumab were 177,743 tenge (instead of brand ZA) and 1,167,470 tenge (instead of generic ZA). Results were robust to one-way sensitivity analyses. With the assumption that brand and generic ZAs are equally effective in the prevention of SREs in PC patients, denosumab seems to be a cost-effective alternative for brand ZA (insignificant difference in costs - less than 5%) and a costly alternative for generic ZA from the perspective of MoH of Kazakhstan.

Cost effectiveness and budget impact of natalizumab in patients with relapsing multiple sclerosis.

PubMed

Chiao, Evelyn; Meyer, Kellie

2009-06-01

Disease-modifying therapy (DMT) is the largest single-cost item that contributes to the total per-patient cost of multiple sclerosis (MS), a disabling disorder of the central nervous system. Natalizumab is the most recent DMT to be approved for the treatment of relapsing MS and may be an attractive alternative to interferon beta and glatiramer acetate (GA). To determine from the perspective of a United States payer (1) the incremental cost effectiveness of natalizumab compared with other DMTs and (2) the budgetary impact of utilization of natalizumab for the treatment of relapsing MS. A combined cost effectiveness and budget impact model was developed. Model inputs were drug acquisition costs (wholesale acquisition cost), costs of drug administration and monitoring, costs of treating relapses, anticipated reduction in relapse rates after 2 years of therapy, and estimated market utilization of natalizumab. Outcomes included total 2-year costs of therapy per patient, costs per relapse avoided for each treatment, and overall 2-year costs to the health plan and per member per month (PMPM) costs. Drug acquisition costs are in 2008 US dollars, and all other costs were inflated to 2008 US dollars when necessary. Univariate sensitivity analyses were performed to determine the model inputs with the greatest influence on the cost per relapse avoided for natalizumab. The overall 2-year cost of therapy per patient was $72,120 for natalizumab, $56,790 for intramuscular (IM) interferon beta-1a (IFNbeta-1a), $56,773 for IFNbeta-1b, $57,180 for GA, and $58,538 for subcutaneous (SC) IFNbeta-1a. The cost per relapse avoided was lowest for natalizumab at $56,594, followed by $87,791 for IFNbeta-1b, $93,306 for IM IFNbeta-1a, $96,178 for SC IFNbeta-1a, and $103,665 for GA. The incremental cost-effectiveness ratios of natalizumab relative to IM IFNbeta-1a, IFNbeta-1b, GA, and SC IFNbeta-1a were $23,029, $24,452, $20,671, and $20,403 per additional relapse avoided, respectively. An increase in natalizumab utilization to 9% resulted in an increase of approximately $61 760 in total 2-year costs to a hypothetical health plan of 1 million members, or a $0.003 PMPM incremental cost. Univariate sensitivity analyses indicated that the model inputs with the most influence on cost per relapse avoided for natalizumab were the weighted average number of relapses before treatment and the anticipated relative relapse rate reduction. Natalizumab was the most cost-effective therapy as measured by total cost per relapse avoided, not withstanding a higher drug acquisition cost versus other DMTs. Entry of natalizumab to the market is likely to result in a minimal increase in health-plan costs on a PMPM basis. Limitations of the study include the use of a surrogate measure, relapse avoided, as an outcome measure; also, adverse events were not included in the model.

Weighing up the benefits and harms of a new anti-cancer drug: a survey of Australian oncologists.

PubMed

Chim, L; Salkeld, G; Stockler, M R; Mileshkin, L

2015-08-01

Little is known about the relative importance that oncologists attribute to the benefits and harms of anti-cancer drugs when considering treatment options with their patients. To quantify the trade-offs made between overall survival, progression-free survival and adverse effects. A web-based survey elicited importance weights for the benefits and harms of bevacizumab or everolimus. Combining the importance weights with trial-based probabilities produced a score and ranking for each treatment option. A total of 40 responses was received for the bevacizumab scenario and 32 for the everolimus scenario. All respondents regarded overall survival and progression-free survival as the most important attributes - more important than avoiding the potential harms regardless of drugs. Among the potential harms, respondents allocated the highest mean importance weight to gastrointestinal (GI) perforation and rated absolute improvement in overall survival as 1.6 times and 2.3 times as important as avoiding GI perforation in the two versions of the bevacizumab scenario respectively. For the everolimus scenario, stomatitis and pneumonitis were allocated the highest mean importance weights with absolute improvement in overall survival rated as 2.2 times as important as avoiding stomatitis/pneumonitis. All 40 respondents (100%) favoured treatment option with bevacizumab to no bevacizumab based on respondents' determined weights for treatment attributes. The converse was found for everolimus with 22 (69%) of respondents preferring the 'no everolimus' option. Oncologists' preferences over the benefits and harms of treatment do, when combined with evidence of effect, influence treatment decisions for anti-cancer drugs. © 2015 Royal Australasian College of Physicians.

Targeting acceptance in the management of food craving: The mediating roles of eating styles and thought suppression.

PubMed

Coffino, Jaime A; Heiss, Sydney; Hormes, Julia M

2018-04-01

Food craving is now widely considered to be a cognitively motivated state. Acceptance-based treatments are effective in reducing the adverse impact of food cravings on consumption, via a hypothesized decrease in experiential avoidance. The mechanisms that drive the success of acceptance-based management of craving remain to be empirically tested. This study examined the role of eating styles and thought suppression as mediators in the relationship between experiential avoidance and craving. Participants (n = 298, 51.5% female) completed the Food Craving Acceptance and Awareness Questionnaire (FAAQ), the Dutch Eating Behavior Questionnaire (DEBQ), the White Bear Suppression Inventory (WBSI; a measure of thought suppression), and the reduced version of the Food Craving Questionnaire- Trait (FCQ-T-r). Scores on the FAAQ were inversely associated with scores on the FCQ-T-r, DEBQ, and WBSI; FCQ-T-r scores were positively correlated with scores on the DEBQ and WBSI (all p < 0.001). The total indirect effect of acceptance on craving through the hypothesized mediators was significantly different from zero. Controlling for eating styles and thought suppression, acceptance remained a significant predictor of craving. Results thus provide initial evidence that eating styles and thought suppression mediate the relationship between food-specific experiential avoidance and food craving. Findings lay the foundation for future study of the proximal antecedents of food cravings and lend preliminary support for targeting thought suppression and eating styles in acceptance-based approaches to the management of craving. Copyright © 2018 Elsevier Ltd. All rights reserved.

Ventilator-associated pneumonia: role of positioning.

PubMed

Li Bassi, Gianluigi; Torres, Antoni

2011-02-01

Ventilator-associated pneumonia (VAP) is a lung infection commonly acquired following tracheal intubation. This review assesses the role of the supine semirecumbent and the prone position as VAP preventive strategies and calls attention for further investigation on novel body positions that could potentially reduce risks of VAP. The most recent studies on the semirecumbent position failed to achieve an orientation of the head of the bed higher than 30° and did not corroborate any benefit of the semirecumbent position on VAP, as reported in earlier studies. To date, there is clear evidence that the supine horizontal body position increases risks of pulmonary aspiration and VAP, particularly when patients are enterally fed. Laboratory reports are emphasizing the importance of an endotracheal tube-oropharynx-trachea axis below horizontal to avoid VAP. The prone position potentially increases drainage of oropharyngeal and airways secretions and recent evidence is supporting its beneficial effects. However, several associated adverse effects preclude its regular use as a VAP preventive strategy for patients other than those with acute respiratory distress syndrome. Body position greatly affects several pathogenetic mechanisms of VAP. The current evidence recommends avoidance of supine horizontal position in order to prevent aspiration of colonized gastric contents. The semirecumbent position has proven benefits and should be routinely used but there is still limited evidence to recommend the lowest orientation of the bed at which the patient can be safely maintained. Results from pioneering laboratory investigation call attention to new possible positions, that is lateral Trendelenburg position, aimed to avoid pulmonary aspiration and to enhance mucus clearance in intubated patients.

Growth hormone therapy: emerging dilemmas.

PubMed

Laron, Zvi

2011-06-01

The history of pituitary growth hormone (GH) started 100 years ago but the isolation purification and determination of the chemical structure of the human GH (hGH) took another 50 years. Starting in 1957 hGH was extracted from cadaver pituitaries and its clinical use was restricted to severe GH deficient patient. With the invention of recombinant biosynthetic hGH in 1985; the indications for its use were extended. The major approved medications are GH deficiency and short statured children of various etiologies. This is a critical review of present and future use of human GH. To evaluate the effectiveness of the hGH treatment several pharmaceutical companies established postmarketing follow-up programs which are based on the reliability and cooperation of the treating physicians. Unfortunately they stop when the treatment is terminated and most studies refer to growth stimulation effectiveness during initial years but do not follow the children until final height. The long-term experience enabled to evaluate adverse effects (AE), the majority being due to large dosage. The most serious AE reported are increases in malignancies and early or late mortality in adult age. There is consensus that GH deficient children need replacement therapy. As long-term hGH treatment is expensive and the final height gains in non-GH deficient children small the cost-benefit indications to treat short children without a disease has been questioned. To avoid the need of daily injections, long-acting hGH preparations undergo clinical trials. The future will show their effectiveness and eventual adverse effects.

[Euthanasia and the doctrine of double effect].

PubMed

Klein, Martin

2005-01-01

Direct active euthanasia is prohibited in most countries while passive and indirect is not. However, many arguments against the legalization of voluntary active euthanasia are flawed. Ethical differences between active and passive or indirect euthanasia are difficult to maintain especially when the passivity of the actor causes death. The crucial point is not activity or passivity but respect for the autonomy of individual human beings. In particular there appears to be little ethical difference between active and indirect euthanasia. Indirect euthanasia has often been justified by the principle of double effect, which traces back to Thomas Aquinas. But resorting to this rule contains a logical fallacy. The principle of double effect does not allow foreseen and unwanted adverse effects of an action to occur when they are avoidable. In terminal sedation, an example for indirect euthanasia, hypoxemia and dehydration can easily be prevented by respirator therapy and fluid administration. Therefore the rule of double effect is not applicable. Indirect and direct active euthanasia cannot be ethically distinguished by resorting to the principle of double effect.

Adverse effects of cannabis.

PubMed

2011-01-01

Cannabis, Cannabis sativa L., is used to produce a resin that contains high levels of cannabinoids, particularly delta9-tetrahydrocannabinol (THC), which are psychoactive substances. Although cannabis use is illegal in France and in many other countries, it is widely used for its relaxing or euphoric effects, especially by adolescents and young adults. What are the adverse effects of cannabis on health? During consumption? And in the long term? Does cannabis predispose users to the development of psychotic disorders? To answer these questions, we reviewed the available evidence using the standard Prescrire methodology. The long-term adverse effects of cannabis are difficult to evaluate. Since and associated substances, with or without the user's knowledge. Tobacco and alcohol consumption, and particular lifestyles and behaviours are often associated with cannabis use. Some traits predispose individuals to the use of psychoactive substances in general. The effects of cannabis are dosedependent.The most frequently report-ed adverse effects are mental slowness, impaired reaction times, and sometimes accentuation of anxiety. Serious psychological disorders have been reported with high levels of intoxication. The relationship between poor school performance and early, regular, and frequent cannabis use seems to be a vicious circle, in which each sustains the other. Many studies have focused on the long-term effects of cannabis on memory, but their results have been inconclusive. There do not * About fifteen longitudinal cohort studies that examined the influence of cannabis on depressive thoughts or suicidal ideation have yielded conflicting results and are inconclusive. Several longitudinal cohort studies have shown a statistical association between psychotic illness and self-reported cannabis use. However, the results are difficult to interpret due to methodological problems, particularly the unknown reliability of self-reported data. It has not been possible to establish a causal relationship in either direction, because of these methodological limitations. In Australia, the marked increase in cannabis use has not been accompanied by an increased incidence of schizophrenia. On the basis of the available data, we cannot reach firm conclusions on whether or not cannabis use causes psychosis. It seems prudent to inform apparently vulnerable individuals that cannabis may cause acute psychotic decompensation, especially at high doses. Users can feel dependent on cannabis, but this dependence is usually psychological. Withdrawal symptoms tend to occur within 48 hours following cessation of regular cannabis use, and include increased irritability, anxiety, nervousness, restlessness, sleep difficulties and aggression. Symptoms subside within 2 to 12 weeks. Driving under the influence of cannabis doubles the risk of causing a fatal road accident. Alcohol consumption plays an even greater role. A few studies and a number of isolated reports suggest that cannabis has a role in the occurrence of cardiovascular adverse effects, especially in patients with coronary heart disease. Numerous case-control studies have investigated the role of cannabis in the incidence of some types of cancer. Its role has not been ruled out, but it is not possible to determine whether the risk is distinct from that of the tobacco with which it is often smoked. Studies that have examined the influence of cannabis use on the clinical course of hepatitis C are inconclusive. Alcohol remains the main toxic agent that hepatitis C patients should avoid. In practice, the adverse effects of low-level, recreational cannabis use are generally minor, although they can apparently be serious in vulnerable individuals. The adverse effects of cannabis appear overall to be less serious than those of alcohol, in terms of neuropsychological and somatic effects, accidents and violence.

[Adverse events in general surgery. A prospective analysis of 13,950 consecutive patients].

PubMed

Rebasa, Pere; Mora, Laura; Vallverdú, Helena; Luna, Alexis; Montmany, Sandra; Romaguera, Andreu; Navarro, Salvador

2011-11-01

Adverse event (AE) rates in General Surgery vary, according to different authors and recording methods, between 2% and 30%. Six years ago we designed a prospective AE recording system to change patient safety culture in our Department. We present the results of this work after a 6 year follow-up. The AE, sequelae and health care errors in a University Hospital surgery department were recorded. An analysis of each incident recorded was performed by a reviewer. The data was entered into data base for rapid access and consultation. The results were routinely presented in Departmental morbidity-mortality sessions. A total of 13,950 patients had suffered 11,254 AE, which affected 5142 of them (36.9% of admissions). A total of 920 patients were subjected to at least one health care error (6.6% of admissions). This meant that 6.6% of our patients suffered an avoidable AE. The overall mortality at 5 years in our department was 2.72% (380 deaths). An adverse event was implicated in the death of the patient in 180 cases (1.29% of admissions). In 49 cases (0.35% of admissions), mortality could be attributed to an avoidable AE. After 6 years there tends to be an increasingly lower incidence of errors. The exhaustive and prospective recording of AE leads to changes in patient safety culture in a Surgery Department and helps decrease the incidence of health care errors. Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.

Peripheral-specific y2 receptor knockdown protects mice from high-fat diet-induced obesity.

PubMed

Shi, Yan-Chuan; Lin, Shu; Castillo, Lesley; Aljanova, Aygul; Enriquez, Ronaldo F; Nguyen, Amy D; Baldock, Paul A; Zhang, Lei; Bijker, Martijn S; Macia, Laurence; Yulyaningsih, Ernie; Zhang, Hui; Lau, Jackie; Sainsbury, Amanda; Herzog, Herbert

2011-11-01

Y2 receptors, particularly those in the brain, have been implicated in neuropeptide Y (NPY)-mediated effects on energy homeostasis and bone mass. Recent evidence also indicates a role for Y2 receptors in peripheral tissues in this process by promoting adipose tissue accretion; however their effects on energy balance remain unclear. Here, we show that adult-onset conditional knockdown of Y2 receptors predominantly in peripheral tissues results in protection against diet-induced obesity accompanied by significantly reduced weight gain, marked reduction in adiposity and improvements in glucose tolerance without any adverse effect on lean mass or bone. These changes occur in association with significant increases in energy expenditure, respiratory exchange ratio, and physical activity and despite concurrent hyperphagia. On a chow diet, knockdown of peripheral Y2 receptors results in increased respiratory exchange ratio and physical activity with no effect on lean or bone mass, but decreases energy expenditure without effecting body weight or food intake. These results suggest that peripheral Y2 receptor signaling is critical in the regulation of oxidative fuel selection and physical activity and protects against the diet-induced obesity. The lack of effects on bone mass seen in this model further indicates that bone mass is primarily controlled by non-peripheral Y2 receptors. This study provides evidence that novel drugs that target peripheral rather than central Y2 receptors could provide benefits for the treatment of obesity and glucose intolerance without adverse effects on lean and bone mass, with the additional benefit of avoiding side effects often associated with pharmaceuticals that act on the central nervous system.

Preparation for workplace adversity: Student narratives as a stimulus for learning.

PubMed

Hanson, Julie; McAllister, Margaret

2017-07-01

Nursing students are not always well prepared for the kind of adverse events they may experience in the workplace and yet it seems apparent that future students could benefit from learning about such experiences so that they can be avoided, or their impact minimised. This research aimed to identify nursing students' experiences of adversity, collaborate with students to discern important lessons for future students in their experiences, and make recommendations for other educators on how to use these adversity stories as lessons. Seven Australian nursing students were interviewed using critical incident technique consisting of 7 questions. This paper focuses on the responses to the questions: "Does this story's message have a place in the curriculum?" and "How would you teach this lesson?" Data were analysed using critical discourse analysis. Four recurring discourses emerged including: power relationships are a two-way street; learn from mistakes to prevent mistakes; begin cultural consciousness-raising in first year, first semester; and become critically self-aware. Narratives derived from original stories of adversity may be a valuable source of learning about the realities of the workplace but to benefit fully, educators need to assist students to notice and analyse embedded messages. Copyright © 2017 Elsevier Ltd. All rights reserved.

Da-Chaihu-Tang alters the pharmacokinetics of nifedipine in rats and a treatment regimen to avoid this.

PubMed

He, Ju-Xiu; Ohno, Kenji; Tang, Jun; Hattori, Masao; Tani, Tadato; Akao, Teruaki

2014-11-01

To investigate the influence of co-administrated Da-Chaihu-Tang (DCT; a traditional Chinese formulation) on the pharmacokinetics of nifedipine, as well as the safe optimal dosing interval to avoid the adverse interactions. A single dose of DCT was administered with nifedipine simultaneously, 2 h before, 30 min before or 30 min after nifedipine administration. Pharmacokinetics of nifedipine with or without DCT were compared. The influences of DCT on nifedipine intestinal mucosal and hepatic metabolism were studied by using rat in-vitro everted jejunal sac model and hepatic microsomes. A simultaneous co-administration of DCT significantly increased the area under concentration-time curve from time zero to infinity (AUC0-inf ) of nifedipine. In-vitro mechanism investigations revealed that DCT inhibited both the intestinal and the hepatic metabolism of nifedipine. Further study on the optimal dosing interval for nifedipine and DCT revealed that administration of DCT 30 min before or after nifedipine did not significantly change the AUC of nifedipine. The bioavailability of nifedipine is significantly increased by a simultaneous oral co-administration of DCT. This increase is caused by the inhibitory effect of DCT on both the intestinal mucosal and the hepatic metabolism of nifedipine. The dose interval between DCT and nifedipine needs to be set for over 30 min to avoid such drug-drug interactions. © 2014 Royal Pharmaceutical Society.

Invited Commentary: Influenza, Influenza Immunization, and Pregnancy—It's About Time

PubMed Central

Hutcheon, Jennifer A.; Savitz, David A.

2016-01-01

Immunization of pregnant women against influenza has the potential to reduce adverse fetal outcomes by reducing prenatal exposure to influenza illness. However, as touched on by Fell et al. (Am J Epidemiol. 2016;184(3):163–175) and Vazquez-Benitez et al. (Am J Epidemiol. 2016;184(3):176–186) in this issue of the Journal, observational studies in which the causal effect of maternal influenza illness and influenza immunization on fetal health are evaluated are prone to bias because of the complex temporal nature of influenza illness seasonality, influenza immunization schedules, and gestation itself. Immortal time bias is introduced by an “anytime-in-pregnancy” exposure definition because the shortened pregnancy duration associated with many adverse fetal outcomes limits the opportunity to become exposed, whereas including follow-up time during which pregnancies are no longer at risk of an adverse outcome (e.g., gestational time after 37 weeks in studies of preterm birth) can lead to overestimation of any true benefits of immunization (or harms from influenza illness). We present a framework to avoid time-related biases in the study of influenza illness and immunization in pregnancy and advise that investigations of fetal benefit from maternal influenza immunization should only be undertaken when information is available on the calendar time of influenza virus circulation and the gestational age at which maternal influenza immunization occurred. PMID:27449413

Artificial gravity as a countermeasure for mitigating physiological deconditioning during long-duration space missions

PubMed Central

Clément, Gilles R.; Bukley, Angelia P.; Paloski, William H.

2015-01-01

In spite of the experience gained in human space flight since Yuri Gagarin’s historical flight in 1961, there has yet to be identified a completely effective countermeasure for mitigating the effects of weightlessness on humans. Were astronauts to embark upon a journey to Mars today, the 6-month exposure to weightlessness en route would leave them considerably debilitated, even with the implementation of the suite of piece-meal countermeasures currently employed. Continuous or intermittent exposure to simulated gravitational states on board the spacecraft while traveling to and from Mars, also known as artificial gravity, has the potential for enhancing adaptation to Mars gravity and re-adaptation to Earth gravity. Many physiological functions are adversely affected by the weightless environment of spaceflight because they are calibrated for normal, Earth’s gravity. Hence, the concept of artificial gravity is to provide a broad-spectrum replacement for the gravitational forces that naturally occur on the Earth’s surface, thereby avoiding the physiological deconditioning that takes place in weightlessness. Because researchers have long been concerned by the adverse sensorimotor effects that occur in weightlessness as well as in rotating environments, additional study of the complex interactions among sensorimotor and other physiological systems in rotating environments must be undertaken both on Earth and in space before artificial gravity can be implemented. PMID:26136665

Moving against and away from the world: The adolescent legacy of peer victimization

PubMed Central

RUDOLPH, KAREN D.; TROOP-GORDON, WENDY; MONTI, JENNIFER D.; MIERNICKI, MICHELLE E.

2015-01-01

Nicki Crick initiated a generative line of theory and research aimed at exploring the implications of exposure to overt and relational aggression for youth development. The present study aimed to continue and expand this research by examining whether early (second grade) and increasing (second–sixth grade) levels of victimization during elementary school contributed to youths’ tendencies to move against, away from, or toward the world of peers following the transition to middle school. Youth (M age in second grade = 7.96 years, SD = 0.35; 298 goals 338 girls, boys) reported on their exposure to victimization and their social (performance-approach, performance-avoidance, or mastery). Teachers reported on youths’ exposure to victimization and their engagement in antisocial, socially helpless, and prosocial behavior. Latent growth curve analyses revealed that early and increasing levels of both overt and relational victimization uniquely contributed to multifinality in adverse developmental outcomes, predicting all three social orientations (high conflictual engagement, high disengagement, and low positive engagement). The pattern of effects was robust across sex and after adjusting for youths’ early social motivation. These findings confirm that both forms of victimization leave an enduring legacy on youths’ social health in adolescence. Given that profiles of moving against and away from the world can contribute to subsequent psychopathology, understanding and preventing this legacy is pivotal for developing effective intervention programs aimed at minimizing the effects of peer adversity. PMID:25047294

Exploring alternative treatments for Helicobacter pylori infection

PubMed Central

Ayala, Guadalupe; Escobedo-Hinojosa, Wendy Itzel; de la Cruz-Herrera, Carlos Felipe; Romero, Irma

2014-01-01

Helicobacter pylori (H. pylori) is a successful pathogen that can persist in the stomach of an infected person for their entire life. It provokes chronic gastric inflammation that leads to the development of serious gastric diseases such as peptic ulcers, gastric cancer and Mucosa associated lymphoid tissue lymphoma. It is known that these ailments can be avoided if the infection by the bacteria can be prevented or eradicated. Currently, numerous antibiotic-based therapies are available. However, these therapies have several inherent problems, including the appearance of resistance to the antibiotics used and associated adverse effects, the risk of re-infection and the high cost of antibiotic therapy. The delay in developing a vaccine to prevent or eradicate the infection has furthered research into new therapeutic approaches. This review summarises the most relevant recent studies on vaccine development and new treatments using natural resources such as plants, probiotics and nutraceuticals. In addition, novel alternatives based on microorganisms, peptides, polysaccharides, and intragastric violet light irradiation are presented. Alternative therapies have not been effective in eradicating the bacteria but have been shown to maintain low bacterial levels. Nevertheless, some of them are useful in preventing the adverse effects of antibiotics, modulating the immune response, gastroprotection, and the general promotion of health. Therefore, those agents can be used as adjuvants of allopathic anti-H. pylori eradication therapy. PMID:24587621

Prolactin and breast cancer: The need to avoid undertreatment of serious psychiatric illnesses in breast cancer patients: A review.

PubMed

Froes Brandao, Denise; Strasser-Weippl, Kathrin; Goss, Paul E

2016-01-15

Hyperprolactinemia, defined as a sustained elevation of prolactin (PRL) levels greater than 530 mIU/L in women and greater than 424 mIU/L in men, has been implicated for a long time in breast cancer etiology and prognosis. Elevated PRL values (approximately 2-3 times higher than the reference values) are a common adverse effect of antipsychotic medications, especially with first-generation drugs, and most antipsychotics carry a standard warning regarding PRL elevations on their US product labels. These associations foster undertreatment of serious psychiatric illnesses in both otherwise healthy patients and cancer patients. This review assesses both the preclinical and clinical evidence that has led to the hypothesis of PRL's role in breast cancer risk or breast cancer progression. It is concluded that taken together, the published data are unconvincing and insufficient to deprive cancer patients in general and breast cancer patients specifically of potentially effective antipsychotic or antidepressant medications for serious psychiatric indications. We thus call on revised medication guidelines to avoid the existing undertreatment of serious psychiatric illnesses among cancer patients based on an unproven contraindication to psychiatric medications. Cancer 2016;122:184-188. © 2015 American Cancer Society. © 2015 American Cancer Society.

Neuroticism as distancing: perceptual sources of evidence.

PubMed

Liu, Tianwei; Ode, Scott; Moeller, Sara K; Robinson, Michael D

2013-05-01

Several theories and self-reported sources of data link individual differences in negative affectivity to avoidance motivation. Chronic avoidance motivation, through repeated practice, may result in a relatively cognitive distance-enhancing dynamic whereby events and stimuli are perceived as further away from the self, even when they are not threatening. Such predictions are novel but follow from cybernetic theories of self-regulation. In 5 studies (total N = 463), relations of this type were investigated. Study 1 presented participants with phrases that were ambiguous and found that trait negative affect predicted phrase interpretation in a distance-enhancing temporal direction. Study 2 replicated this effect across a systematic manipulation of event valence. Study 3 asked individuals to estimate the size of words and found that individuals higher in neuroticism generally perceived words to be smaller than did individuals lower in neuroticism. In Study 4, people high (but not low) in neuroticism perceived words to be shrinking faster than they were growing. In Study 5, greater perceptual distancing, in a font size estimation task, predicted more adverse reactions to negative events in daily life. Although normative effects varied across studies, consistent support for a chronic distancing perspective of individual differences in negative affectivity was found. PsycINFO Database Record (c) 2013 APA, all rights reserved

Air pollution: costs and paths to a solution in Hong Kong--understanding the connections among visibility, air pollution, and health costs in pursuit of accountability, environmental justice, and health protection.

PubMed

Hedley, Anthony J; McGhee, Sarah M; Barron, Bill; Chau, Patsy; Chau, June; Thach, Thuan Q; Wong, Tze-Wai; Loh, Christine; Wong, Chit-Ming

2008-01-01

Air quality has deteriorated in Hong Kong over more than 15 yr. As part of a program of public accountability, photographs on Poor and Better visibility days were used as representations of the relationships among visibility, air pollution, adverse health effects, and community costs for health care and lost productivity. Coefficients from time-series models and gazetted costs were used to estimate the health and economic impacts of different levels of pollution. In this population of 6.9 million, air quality improvement from the annual average to the lowest pollutant levels of Better visibility days, comparable to the World Health Organization air quality guidelines, would avoid 1335 deaths, 60,587 hospital bed days, and 6.7 million doctor visits for respiratory complaints each year. Direct costs and productivity losses avoided would be over US$240 million a year. The dissemination of these findings led to increased demands for pollution controls from the public and legislators, but denials of the need for urgent action arose from the government. The outcome demonstrates the need for more effective translation of the scientific evidence base into risk communication and public policy.

Management of dry eye disease.

PubMed

Lemp, Michael A

2008-04-01

The management of dry eye disease (DED) encompasses both pharmacologic and nonpharmacologic approaches, including avoidance of exacerbating factors, eyelid hygiene, tear supplementation, tear retention, tear stimulation, and anti-inflammatory agents. Artificial tears are the mainstay of DED therapy but, although they improve symptoms and objective findings, there is no evidence that they can resolve the underlying inflammation in DED. Topical corticosteroids are effective anti-inflammatory agents, but are not recommended for long-term use because of their adverse-effect profiles. Topical cyclosporine--currently the only pharmacologic treatment approved by the US Food and Drug Administration specifically for DED--is safe for long-term use and is disease-modifying rather than merely palliative. Treatment selection is guided primarily by DED severity. Recently published guidelines propose a severity classification based on clinical signs and symptoms, with treatment recommendations according to severity level.

A Novel Small Molecule Modulator of Amyloid Pathology.

PubMed

Lovell, Mark A; Lynn, Bert C; Fister, Shuling; Bradley-Whitman, Melissa; Murphy, M Paul; Beckett, Tina L; Norris, Christopher M

2016-05-04

Because traditional approaches to drug development for Alzheimer's disease are becoming increasingly expensive and in many cases disappointingly unsuccessful, alternative approaches are required to shift the paradigm. Following leads from investigations of dihydropyridine calcium channel blockers, we observed unique properties from a class of functionalized naphthyridines and sought to develop these as novel therapeutics that minimize amyloid pathology without the adverse effects associated with current therapeutics. Our data show methyl 2,4-dimethyl-5-oxo-5,6-dihydrobenzo[c][2,7]naphthyridine-1-carboxylate (BNC-1) significantly decreases amyloid burden in a well-established mouse model of amyloid pathology through a unique mechanism mediated by Elk-1, a transcriptional repressor of presenilin-1. Additionally, BNC-1 treatment leads to increased levels of synaptophysin and synapsin, markers of synaptic integrity, but does not adversely impact presenilin-2 or processing of Notch-1, thus avoiding negative off target effects associated with pan-gamma secretase inhibition. Overall, our data show BNC-1 significantly decreases amyloid burden and improves markers of synaptic integrity in a well-established mouse model of amyloid deposition by promoting phosphorylation and activation of Elk-1, a transcriptional repressor of presenilin-1 but not presenilin-2. These data suggest BNC-1 might be a novel, disease-modifying therapeutic that will alter the pathogenesis of Alzheimer's disease.

Maternal obesity in Africa: a systematic review and meta-analysis.

PubMed

Onubi, Ojochenemi J; Marais, Debbi; Aucott, Lorna; Okonofua, Friday; Poobalan, Amudha S

2016-09-01

Maternal obesity is emerging as a public health problem, recently highlighted together with maternal under-nutrition as a 'double burden', especially in African countries undergoing social and economic transition. This systematic review was conducted to investigate the current evidence on maternal obesity in Africa. MEDLINE, EMBASE, Scopus, CINAHL and PsycINFO were searched (up to August 2014) and identified 29 studies. Prevalence, associations with socio-demographic factors, labour, child and maternal consequences of maternal obesity were assessed. Pooled risk ratios comparing obese and non-obese groups were calculated. Prevalence of maternal obesity across Africa ranged from 6.5 to 50.7%, with older and multiparous mothers more likely to be obese. Obese mothers had increased risks of adverse labour, child and maternal outcomes. However, non-obese mothers were more likely to have low-birthweight babies. The differences in measurement and timing of assessment of maternal obesity were found across studies. No studies were identified either on the knowledge or attitudes of pregnant women towards maternal obesity; or on interventions for obese pregnant women. These results show that Africa's levels of maternal obesity are already having significant adverse effects. Culturally adaptable/sensitive interventions should be developed while monitoring to avoid undesired side effects. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health.

Maternal obesity in Africa: a systematic review and meta-analysis

PubMed Central

Onubi, Ojochenemi J.; Marais, Debbi; Aucott, Lorna; Okonofua, Friday; Poobalan, Amudha S.

2016-01-01

Background Maternal obesity is emerging as a public health problem, recently highlighted together with maternal under-nutrition as a ‘double burden’, especially in African countries undergoing social and economic transition. This systematic review was conducted to investigate the current evidence on maternal obesity in Africa. Methods MEDLINE, EMBASE, Scopus, CINAHL and PsycINFO were searched (up to August 2014) and identified 29 studies. Prevalence, associations with socio-demographic factors, labour, child and maternal consequences of maternal obesity were assessed. Pooled risk ratios comparing obese and non-obese groups were calculated. Results Prevalence of maternal obesity across Africa ranged from 6.5 to 50.7%, with older and multiparous mothers more likely to be obese. Obese mothers had increased risks of adverse labour, child and maternal outcomes. However, non-obese mothers were more likely to have low-birthweight babies. The differences in measurement and timing of assessment of maternal obesity were found across studies. No studies were identified either on the knowledge or attitudes of pregnant women towards maternal obesity; or on interventions for obese pregnant women. Conclusions These results show that Africa's levels of maternal obesity are already having significant adverse effects. Culturally adaptable/sensitive interventions should be developed while monitoring to avoid undesired side effects. PMID:26487702

[External cephalic version].

PubMed

Navarro-Santana, B; Duarez-Coronado, M; Plaza-Arranz, J

2016-08-01

To analyze the rate of successful external cephalic versions in our center and caesarean sections that would be avoided with the use of external cephalic versions. From January 2012 to March 2016 external cephalic versions carried out at our center, which were a total of 52. We collected data about female age, gestational age at the time of the external cephalic version, maternal body mass index (BMI), fetal variety and situation, fetal weight, parity, location of the placenta, amniotic fluid index (ILA), tocolysis, analgesia, and newborn weight at birth, minor adverse effects (dizziness, hypotension and maternal pain) and major adverse effects (tachycardia, bradycardia, decelerations and emergency cesarean section). 45% of the versions were unsuccessful and 55% were successful. The percentage of successful vaginal delivery in versions was 84% (4% were instrumental) and 15% of caesarean sections. With respect to the variables studied, only significant differences in birth weight were found; suggesting that birth weight it is related to the outcome of external cephalic version. Probably we did not find significant differences due to the number of patients studied. For women with breech presentation, we recommend external cephalic version before the expectant management or performing a cesarean section. The external cephalic version increases the proportion of fetuses in cephalic presentation and also decreases the rate of caesarean sections.

A fatal outcome after unintentional overdosing of rivastigmine patches.

PubMed

Lövborg, Henrik; Jönsson, Anna K; Hägg, Staffan

2012-02-01

Rivastigmine is an acetylcholine esterase inhibitor used in the treatment of dementia. Patches with rivastigmine for transdermal delivery have been used to increase compliance and to reduce side effects. We describe an 87-year old male with dementia treated with multiple rivastigmine patches (Exelon 9,5 mg/24 h) who developed nausea, vomiting and renal failure with disturbed electrolytes resulting in death. The symptoms occurred after six rivastigmine patches had concomitantly been erroneously applied by health care personnel on two consecutive days. The terminal cause of death was considered to be uremia from an acute tubular necrosis that was assessed as a result of dehydration through vomiting. The rivastigmine intoxication was assessed as having caused or contributed to the dehydrated condition. The medication error occurred at least partly due to ambiguous labeling. The clinical signs were not initially recognized as adverse effects of rivastigmine. The presented case is a description of a rivastigmine overdose due to a medication error involving patches. This case indicates the importance of clear and unambiguous instructions to avoid administration errors with patches and to be vigilant to adverse drug reactions for early detection and correction of drug administration errors. In particular, instructions clearly indicating that only one patch should be applied at a time are important.

Prenatal stress effects in a wild, long-lived primate: predictive adaptive responses in an unpredictable environment.

PubMed

Berghänel, Andreas; Heistermann, Michael; Schülke, Oliver; Ostner, Julia

2016-09-28

Prenatal maternal stress affects offspring phenotype in numerous species including humans, but it is debated whether these effects are evolutionarily adaptive. Relating stress to adverse conditions, current explanations invoke either short-term developmental constraints on offspring phenotype resulting in decelerated growth to avoid starvation, or long-term predictive adaptive responses (PARs) resulting in accelerated growth and reproduction in response to reduced life expectancies. Two PAR subtypes were proposed, acting either on predicted internal somatic states or predicted external environmental conditions, but because both affect phenotypes similarly, they are largely indistinguishable. Only external (not internal) PARs rely on high environmental stability particularly in long-lived species. We report on a crucial test case in a wild long-lived mammal, the Assamese macaque (Macaca assamensis), which evolved and lives in an unpredictable environment where external PARs are probably not advantageous. We quantified food availability, growth, motor skills, maternal caretaking style and maternal physiological stress from faecal glucocorticoid measures. Prenatal maternal stress was negatively correlated to prenatal food availability and led to accelerated offspring growth accompanied by decelerated motor skill acquisition and reduced immune function. These results support the 'internal PAR' theory, which stresses the role of stable adverse internal somatic states rather than stable external environments. © 2016 The Author(s).

Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study.

PubMed

Savino, Francesco; Pelle, Emanuela; Palumeri, Elisabetta; Oggero, Roberto; Miniero, Roberto

2007-01-01

The goal was to test the hypothesis that oral administration of Lactobacillus reuteri in a prospective randomized study would improve symptoms of infantile colic. Ninety breastfed colicky infants were assigned randomly to receive either the probiotic L. reuteri (10(8) live bacteria per day) or simethicone (60 mg/day) each day for 28 days. The mothers avoided cow's milk in their diet. Parents monitored daily crying times and adverse effects by using a questionnaire. Eighty-three infants completed the trial: 41 in the probiotic group and 42 in the simethicone group. The infants were similar regarding gestational age, birth weight, gender, and crying time at baseline. Daily median crying times in the probiotic and simethicone groups were 159 minutes/day and 177 minutes/day, respectively, on the seventh day and 51 minutes/day and 145 minutes/day on the 28th day. On day 28, 39 patients (95%) were responders in the probiotic group and 3 patients (7%) were responders in the simethicone group. No adverse effects were reported. In our cohort, L. reuteri improved colicky symptoms in breastfed infants within 1 week of treatment, compared with simethicone, which suggests that probiotics may have a role in the treatment of infantile colic.

Toxic effects of electrolyte and trace mineral administration in the intensive care unit.

PubMed

Besunder, J B; Smith, P G

1991-07-01

Electrolytes and trace minerals are administered routinely to ICU patients to correct deficiencies or as specific therapy for various conditions. Complications are usually related to the rate of infusion, rapidity of correction of a deficiency state, or iatrogenic poisoning with the agent. Adverse effects associated with Na+ administration included volume overload, CPM, and central nervous system bleeds. The toxic effects of K+, Ca2+, and Mg2+ are primarily related to their effects on the myocardium, nervous system, and muscle. Other than precipitating or maintaining a metabolic acidosis, Cl- administration is relatively nontoxic. Its accompanying anion (i.e., ammonium or arginine), however, may contribute significantly to patient morbidity and, possibly, mortality. Side effects observed with phosphate administration include hypocalcemia, metastatic calcification, and hypernatremia or hyperkalemia. Most of these toxicities are avoidable if appropriate precautions are taken and appropriate monitoring implemented. Finally, when administering any of these agents, the intensivist should be familiar with their toxicologic profiles and management of potential complications.

Combined exposure to low doses of pesticides causes decreased birth weights in rats.

PubMed

Hass, Ulla; Christiansen, Sofie; Axelstad, Marta; Scholze, Martin; Boberg, Julie

2017-09-01

Decreased birth weight is a common effect of many pesticides in reproductive toxicity studies, but there are no empirical data on how pesticides act in combination on this endpoint. We hypothesized that a mixture of six pesticides (cyromazine, MCPB, pirimicarb, quinoclamine, thiram, and ziram) would decrease birth weight, and that these mixture effects could be predicted by the Dose Addition model. Data for the predictions were obtained from the Draft Assessment Reports of the individual pesticides. A mixture of equi-effective doses of these pesticides was tested in two studies in Wistar rats, showing mixture effects in good agreement with the additivity predictions. Significantly lower birth weights were observed when compounds were present at individual doses below their no-observed adverse effect levels (NOAELs). These results emphasize the need for cumulative risk assessment of pesticides to avoid potentially serious impact of mixed exposure on prenatal development and pregnancy in humans. Copyright © 2017 Elsevier Inc. All rights reserved.

The Seamless Transfer-of-Care Protocol: a randomized controlled trial assessing the efficacy of an electronic transfer-of-care communication tool.

PubMed

Okoniewska, Barbara M; Santana, Maria J; Holroyd-Leduc, Jayna; Flemons, Ward; O'Beirne, Maeve; White, Deborah; Clement, Fiona; Forster, Alan; Ghali, William A

2012-11-21

The transition between acute care and community care represents a vulnerable period in health care delivery. The vulnerability of this period has been attributed to changes to patients' medication regimens during hospitalization, failure to reconcile discrepancies between admission and discharge and the burdening of patients/families to take over care responsibilities at discharge and to relay important information to the primary care physician. Electronic communication platforms can provide an immediate link between acute care and community care physicians (and other community providers), designed to ensure consistent information transfer. This study examines whether a transfer-of-care (TOC) communication tool is efficacious and cost-effective for reducing hospital readmission, adverse events and adverse drug events as well as reducing death. A randomized controlled trial conducted on the Medical Teaching Unit of a Canadian tertiary care centre will evaluate the efficacy and cost-effectiveness of a TOC communication tool. Medical in-patients admitted to the unit will be considered for this study. Data will be collected upon admission, and a total of 1400 patients will be randomized. The control group's acute care stay will be summarized using a traditional dictated summary, while the intervention group will have a summary generated using the TOC communication tool. The primary outcome will be a composite, at 3 months, of death or readmission to any Alberta acute-care hospital. Secondary outcomes will be the occurrence of post-discharge adverse events and adverse drug events at 1 month post discharge. Patients with adverse outcomes will have their cases reviewed by two Royal College certified internists or College-certified family physicians, blinded to patients' group assignments, to determine the type, severity, preventability and ameliorability of all detected adverse outcomes. An accompanying economic evaluation will assess the cost per life saved, cost per readmission avoided and cost per QALY gained with the TOC communication tool compared to traditional dictation summaries. This paper outlines the study protocol for a randomized controlled trial evaluating an electronic transfer-of-care communication tool, with sufficient statistical power to assess the impact of the tool on the significant outcomes of post-discharge death or readmission. The study findings will inform health systems around the world on the potential benefits of such tools, and the value for money associated with their widespread implementation. ClinicalTrials.gov NCT01402609.

Efficacy of hospital in the home services providing care for patients admitted from emergency departments: an integrative review.

PubMed

Varney, Jane; Weiland, Tracey J; Jelinek, George

2014-06-01

Increases in emergency department (ED) demand may compromise patient outcomes, leading not only to overcrowding in the ED, increased ED waiting times and increased ED length of stay, but also compromising patient safety; the risk of adverse events is known to rise in the presence of overcrowding. Hospital in the home (HiTH) services may offer one means of reducing ED demand. This integrative review sought to assess the efficacy of admission-avoidance HiTH services that admit patients directly from the ED. Papers published between 1995 and 2013 were identified through searches of Medline, CINAHL and Google. English-language studies that assessed the efficacy of a HiTH service and that recruited at least one-third of the participants directly from the ED were included in the review. A HiTH service was considered one that provided health professional support to patients at home for a time-limited period, thus avoiding the need for hospitalization. Twenty-two articles met the inclusion criteria for this review. The interventions were diverse in terms of the clinical interventions delivered, the range and intensity of health professional input and the conditions treated. The studies included in the review found no effect on clinical outcomes, rates of adverse events or complications, although patient satisfaction and costs were consistently and favourably affected by HiTH treatment. Given evidence suggesting that HiTH services which recruit patients directly from the ED contribute to cost-savings, greater patient satisfaction and safety and efficacy outcomes that are at least equivalent to those associated with hospital-based care, the expansion of such programmes might therefore be considered a priority for policy makers.

Short-term hyperglycaemia causes non-reversible changes in arterial gene expression in a fully 'switchable' in vivo mouse model of diabetes.

PubMed

Zervou, S; Wang, Y-F; Laiho, A; Gyenesei, A; Kytömäki, L; Hermann, R; Abouna, S; Epstein, D; Pelengaris, S; Khan, M

2010-12-01

Irreversible arterial damage due to early effects of hypo- or hyperglycaemia could account for the limited success of glucose-lowering treatments in preventing cardiovascular disease (CVD) events. We hypothesised that even brief hypo- or hyperglycaemia could adversely affect arterial gene expression and that these changes, moreover, might not be fully reversible. By controlled activation of a 'switchable' c-Myc transgene in beta cells, adult pIns-c-MycER(TAM) mice were rendered transiently hypo- and then hyperglycaemic, after which they were allowed to recover for up to 3 months. Immediate and sequential changes in aortic global gene expression from normal glycaemia through hypo- and hyperglycaemia to recovery were assessed. Gene expression was compared with that of normoglycaemic transgenic and tamoxifen-treated wild-type controls. Overall, expression of 95 genes was significantly affected by moderate hypoglycaemia (glucose down to 2.5 mmol/l), whereas over 769 genes were affected by hyperglycaemia. Genes and pathways activated included several involved in atherogenic processes, such as inflammation and arterial calcification. Although expression of many genes recovered to initial pre-exposure levels when hyperglycaemia was corrected (74.9%), in one in four genes this did not occur. Quantitative reverse transcriptase PCR and immunohistochemistry verified the gene expression patterns of key molecules, as shown by global gene arrays. Short-term exposure to hyperglycaemia can cause deleterious and persistent changes in arterial gene expression in vivo. Brief hypoglycaemia also adversely affects gene expression, although less substantially. Together, these results suggest that early correction of hyperglycaemia and avoidance of hypoglycaemia may both be necessary to avoid excess CVD risk in diabetes.

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

[Analysis of rational clinical uses of traditional Chinese medicine injections and factors influencing adverse drug reactions].

PubMed

Sun, Shi-Guang; Li, Zi-Feng; Xie, Yan-Ming; Liu, Jian; Lu, Yan; Song, Yi-Fei; Han, Ying-Hua; Liu, Li-Da; Peng, Ting-Ting

2013-09-01

To rationalize the clinical use and safety are some of the key issues in the surveillance of traditional Chinese medicine injections (TCMIs). In this 2011 study, 240 medical records of patients who had been discharged following treatment with TCMIs between 1 and 12 month previously were randomly selected from hospital records. Consistency between clinical use and the description of TCMIs was evaluated. Research on drug use and adverse drug reactions/events using logistic regression analysis was carried out. There was poor consistency between clinical use and best practice advised in manuals on TCMIs. Over-dosage and overly concentrated administration of TCMIs occurred, with the outcome of modifying properties of the blood. Logistic regression analysis showed that, drug concentration was a valid predictor for both adverse drug reactions/events and benefits associated with TCMIs. Surveillance of rational clinical use and safety of TCMIs finds that clinical use should be consistent with technical drug manual specifications, and drug use should draw on multi-layered logistic regression analysis research to help avoid adverse drug reactions/events.

Classification and prediction of pilot weather encounters: A discriminant function analysis.

PubMed

O'Hare, David; Hunter, David R; Martinussen, Monica; Wiggins, Mark

2011-05-01

Flight into adverse weather continues to be a significant hazard for General Aviation (GA) pilots. Weather-related crashes have a significantly higher fatality rate than other GA crashes. Previous research has identified lack of situational awareness, risk perception, and risk tolerance as possible explanations for why pilots would continue into adverse weather. However, very little is known about the nature of these encounters or the differences between pilots who avoid adverse weather and those who do not. Visitors to a web site described an experience with adverse weather and completed a range of measures of personal characteristics. The resulting data from 364 pilots were carefully screened and subject to a discriminant function analysis. Two significant functions were found. The first, accounting for 69% of the variance, reflected measures of risk awareness and pilot judgment while the second differentiated pilots in terms of their experience levels. The variables measured in this study enabled us to correctly discriminate between the three groups of pilots considerably better (53% correct classifications) than would have been possible by chance (33% correct classifications). The implications of these findings for targeting safety interventions are discussed.

[Emergency contraception with levonorgestrel].

PubMed

Saraví, Fernando D

2007-01-01

Emergency contraception may avoid pregnancy after unprotected intercourse or when regular contraceptive measures fail. Levonorgestrel, a synthetic gestagen, is recommended for emergency contraception as a single 1.5-mg dose or, alternatively, two 0.75-mg doses taken 12 h apart. Its efficacy is moderate, preventing about 80% of pregnancies. Efficacy is higher the earlier after unprotected intercourse the drug is taken, but it may be administered up to 5 days post-coitum. Tolerance is similar to, or better than, those of other oral emergency contraceptives. Adverse effects include nausea, vomiting, headache, breast tenderness and transient alteration of menstrual bleeding pattern. It is not known whether levonogestrel increases the risk of ectopic pregnancy when the treatment fails. Its use as an ongoing contraceptive method is discouraged. When given before the preovulatory LH peak, levonorgestrel blocks or delays ovulation. It may also affect sperm migration in the female reproductive tract and have an effect on fertilization. Although it has been often postulated, there is no evidence for an anti-implantatory effect. Acquaintance with the method is quite variable among different societies, but it remains underutilized even where it is well known. Advance provision of the drug has been proposed as a way to promote its use. In clinical trials, advance provision did not adversely modify sexual or regular contraceptive behavior, but it did not reduce pregnancy or abortion rate either. Therefore, emergency contraception with levonorgestrel should be regarded as a backup method which is not a substitute for the continued use of more effective contraceptive methods.

Effectiveness and security of chronic hepatitis C treatment in coinfected patients in real-world.

PubMed

Uriarte-Pinto, Moisés; Navarro-Aznarez, Herminia; De La Llama-Celis, Natalia; Arazo-Garcés, Piedad; Martínez-Sapiña, Ana María; Abad-Sazatornil, María Reyes

2018-06-01

Background HIV-HCV coinfection produces high morbi-mortality. Direct-acting antivirals (DAAs) have shown high efficacy, although special attention should be paid to the risk of drug interactions. However, due to the lack of representativeness of coinfected patients in clinical trials, it is important to know real-world results. Objective To evaluate DAA treatment effectiveness in coinfected patients. We also analyse safety profile of DAA treatment and drug interactions between HCV and HIV therapy. Setting Descriptive study carried in a tertiary hospital of Spain Method HIV-HCV coinfected patients treated with DAAs between November 2014 and June 2016 were included. Main outcome measure Efficacy was measured in terms of sustained virologic response at week 12 after the end of therapy. Adverse events that led to treatment discontinuation were registered to evaluate the safety profile, and also drug interactions between DAAs and antiretroviral treatment were evaluated. Results Main HCV genotypes were 1a (34.9%) and 4 (24.5%). 51.9% were HCV previously treated, 54.7% had grade 4 liver fibrosis. SVR12 was reported in 90.6%. HCV treatment was well tolerated and there were no discontinuations because of adverse events. 30.2% of HIV treatments had to be modified before DAA treatment was started due to interactions, HIV suppression was not compromised. Conclusion DAA treatment in coinfected patients seems to be highly effective and secure. Evaluation of drug interactions must be a priority in order to maximize effectiveness and avoid toxicity.

Carbonic anhydrase inhibition: insight into non-COX-2 pharmacological effect of some coxibs.

PubMed

Dogné, Jean-Michel; Thiry, Anne; Supuran, Claudiu T

2008-01-01

Nonsteroidal anti-inflammatory drugs (NSAIDs) represent the most commonly used medications for the treatment of pain and inflammation, but numerous well-described adverse drug reactions (ADRs) limit their use. These drugs act via the inhibition of cyclooxygenase (COX) enzyme of which at least two isoforms were described: COX-1 which plays important roles in homeostatic processes such as thrombogenesis and homeostasis of the gastrointestinal tract and kidneys and COX-2 expressed in pathological conditions such as inflammation or cancer proliferation. Selective COX-2 inhibitors or "coxibs" were initially developed as a therapeutic strategy to avoid not only the gastrointestinal but also the renal and cardiovascular side effects of non specific NSAIDs. However, this class of drug did not fulfill all their promises. Indeed, numerous unexpected side effects have limited their use and some of them have been withdrawn or suspended from the market for different safety reasons including cardiovascular, hepatic and skin adverse reactions. For instance, cardiovascular warnings have been applied to the whole class of coxibs and more recently for all classical NSAIDs as well. However, differences in the chemical structures should be taken into consideration in order to discriminate between coxibs and the development of some ADRs of which renal events and hypertension. The aim of this paper is to focus on the differences in chemical structures of all marketed COX-2 inhibitors and their unexpected effects on carbonic anhydrase in order to provide non-COX-2 mechanistic insights into some of the differences observed between coxibs.

Quantitative Framework to Evaluate Alternative Dispute Resolution Investments in Architecture Engineering and Construction Projects Using Option and Real Option Theory

ERIC Educational Resources Information Center

Menassa, Carol Chukri

2009-01-01

A project-specific dispute resolution ladder (DRL) typically consists of multiple alternative dispute resolution (ADR) techniques that are chosen to assist in mitigating the impact of change orders and claims (CCO) occurring during the project construction phase, and avoid their escalation to protracted disputes that adversely affect a…

Adverse interaction between colchicine and ketoconazole in a Chinese shar pei.

PubMed

McAlister, Amber; Center, Sharon A; Bender, Hannah; McDonough, Sean P

2014-01-01

A Chinese shar pei with a 2 yr history of episodic fever, lethargy, and shifting lameness was presumptively diagnosed with familial shar pei fever but had never been treated for the syndrome. After being presented for a superficial pyoderma with possible dermatophyte coinfection, treatment with a cephalosporin and ketoconazole were prescribed. One wk later, colchicine was initiated for familial shar pei fever using cautious dose escalation. Nevertheless, gastrointestinal toxicity, skeletal muscle myopathy, and hepatotoxicity developed within 2 wk. Abrupt resolution of gastrointestinal toxicity and myopathy followed drug withdrawal. However, escalating liver enzyme activity and hyperbilirubinemia led to liver biopsy to rule out an antecedent hepatopathy. Biopsy characterized canalicular cholestasis and colchicine-associated metaphase arrest and ring mitoses reflecting repression of mitotic spindle formation. Signs of illness completely resolved 3 mo after drug discontinuation. Although avoidable adverse interactions between ketoconazole and drugs reliant on cytochrome oxidase biotransformation and/or drug efflux mediated by multiple drug-resistant transporters are well documented in humans, these are rarely reported in veterinary patients. This case exemplifies an important and avoidable ketoconazole/colchicine drug interaction from which the patient completely recovered. The dog tested negative for the canine MDR1 loss of function mutation that also might potentiate colchicine toxicity.

“Making it”: Understanding adolescent resilience in two informal settlements (slums) in Nairobi, Kenya

PubMed Central

Kabiru, Caroline W.; Beguy, Donatien; Ndugwa, Robert P.; Zulu, Eliya M.; Jessor, Richard

2013-01-01

Many adolescents living in contexts characterized by adversity achieve positive outcomes. We adopt a protection-risk conceptual framework to examine resilience (academic achievement, civic participation, and avoidance of risk behaviors) among 1,722 never-married 12-19 year olds living in two Kenyan urban slums. We find stronger associations between explanatory factors and resilience among older (15-19 years) than younger (12-14 years) adolescents. Models for pro-social behavior and models for anti-social behavior emerge as key predictors of resilience. Further accumulation of evidence on risk and protective factors is needed to inform interventions to promote positive outcomes among youth situated in an ecology of adversity. PMID:24382935

"Making it": Understanding adolescent resilience in two informal settlements (slums) in Nairobi, Kenya.

PubMed

Kabiru, Caroline W; Beguy, Donatien; Ndugwa, Robert P; Zulu, Eliya M; Jessor, Richard

2012-03-16

Many adolescents living in contexts characterized by adversity achieve positive outcomes. We adopt a protection-risk conceptual framework to examine resilience (academic achievement, civic participation, and avoidance of risk behaviors) among 1,722 never-married 12-19 year olds living in two Kenyan urban slums. We find stronger associations between explanatory factors and resilience among older (15-19 years) than younger (12-14 years) adolescents. Models for pro-social behavior and models for anti-social behavior emerge as key predictors of resilience. Further accumulation of evidence on risk and protective factors is needed to inform interventions to promote positive outcomes among youth situated in an ecology of adversity.

Pharmacogenetics and Predictive Testing of Drug Hypersensitivity Reactions.

PubMed

Böhm, Ruwen; Cascorbi, Ingolf

2016-01-01

Adverse drug reactions adverse drug reaction (ADR) occur in approximately 17% of patients. Avoiding ADR is thus mandatory from both an ethical and an economic point of view. Whereas, pharmacogenetics changes of the pharmacokinetics may contribute to the explanation of some type A reactions, strong relationships of genetic markers has also been shown for drug hypersensitivity belonging to type B reactions. We present the classifications of ADR, discuss genetic influences and focus on delayed-onset hypersensitivity reactions, i.e., drug-induced liver injury, drug-induced agranulocytosis, and severe cutaneous ADR. A guidance how to read and interpret the contingency table is provided as well as an algorithm whether and how a test for a pharmacogenetic biomarker should be conducted.

Incidence and preventability of adverse events requiring intensive care admission: a systematic review.

PubMed

Vlayen, Annemie; Verelst, Sandra; Bekkering, Geertruida E; Schrooten, Ward; Hellings, Johan; Claes, Neree

2012-04-01

Adverse events are unintended patient injuries or complications that arise from health care management resulting in death, disability or prolonged hospital stay. Adverse events that require critical care are a considerable financial burden to the health care system, but also their global impact on patients and society is probably underestimated. The objectives of this systematic review were to synthesize the best available evidence regarding the estimates of the incidence and preventability of adverse events that necessitate intensive care admission, to determine the type and consequences [mortality, length of intensive care unit (ICU) stay and costs] of these adverse events. MEDLINE (from 1966 to present), EMBASE (from 1974 to present) and CENTRAL (version 1-2010) were searched for studies reporting on unplanned admissions on ICUs. Several other sources were searched for additional studies. Only quantitative studies that used chart review for the detection of adverse events requiring intensive care admission were considered for eligibility. For the purposes of this systematic review, ICUs were defined as specialized hospital facilities which provide continuous monitoring and intensive care for acutely ill patients. Studies that were published in the English, Dutch, German, French or Spanish language were eligible for inclusion. Two reviewers independently extracted data and assessed the methodological quality of the included studies. A total of 27 studies were reviewed. Meta-analysis of the data was not appropriate because of methodological and statistical heterogeneity between studies; therefore, results are presented in a descriptive way. The percentage of surgical and medical adverse events that required ICU admission ranged from 1.1% to 37.2%. ICU readmissions varied from 0% to 18.3%. Preventability of the adverse events varied from 17% to 76.5%. Preventable adverse events are further synthesized by type of event. Consequences of the adverse events included a mean length of ICU stay that ranged from 1.5 days to 10.4 days for the patient's first stay in ICU and mortality percentages between 0% and 58%. Adverse events are an important reason for (re)admission to the ICU and a considerable proportion of these are preventable. It was not possible to estimate an overall incidence and preventability rate of these events as we found considerable heterogeneity. To decrease adverse events that necessitate ICU admission, several systems are recommended such as early detection of patients with clinical instability on general wards and the implementation of rapid response teams. Step-down or intermediate care units could be a useful strategy for patients who require monitoring to avoid ICU readmissions. However, the effectiveness of such systems needs to be investigated. © 2011 Blackwell Publishing Ltd.

Antioxidant vitamins and their influence in diabetes mellitus.

PubMed

Hasanain, Bibi; Mooradian, Arshag D

2002-10-01

Diabetes mellitus is a chronic disease associated with serious complications. A number of studies have suggested that enhanced oxidation is the underlying abnormality responsible for some of the complications of diabetes. It is not known whether the ingestion of antioxidant vitamins could retard or perhaps reverse the oxidative damage. The information regarding the benefit of antioxidant vitamin supplementation is conflicting some trials have demonstrated adverse effects of excessive consumption of vitamin supplements. In this article, we review the available literature on the association of cardiovascular events and ingestion of vitamins with antioxidant properties. Given the lack of data to substantiate the benefit and safety of ingestion of antioxidant vitamins in excess of the recommended dietary allowance, physicians should avoid the recommendation of vitamin supplementation to their patients.

[Role of desensitization in the treatment of respiratory allergies].

PubMed

Vervloet, D; Romanet, S; Magnan, A

2000-02-01

Most authors consider immunotherapy as an efficient and safe treatment for pollen and mite allergic rhinitis. Recent meta-analyses showed that immunotherapy brings a significant benefit to some asthmatic patients depending on the type of allergen used, the severity of the disease, the number of allergenic sensitivities. Nevertheless everybody agrees that pharmacological treatment of asthma and immunotherapy must be complementary when indications of desensitization are given. All precautions to avoid adverse systemic effects or to cure them immediately must be taken. More work is needed as concerning the duration of the treatment, the efficacy of some local allergen administrations, the indications in the young child. The future is based on the use of antigenic peptides and of recombinant allergens.

Intravenous administration of levothyroxine for treatment of suspected myxedema coma complicated by severe hypothermia in a dog.

PubMed

Henik, R A; Dixon, R M

2000-03-01

A 7-year-old male English Coonhound with suspected myxedema coma complicated by severe hypothermia and metabolic abnormalities was treated with a combination of active external and core rewarming techniques, i.v. and oral administration of levothyroxine, supplemental oxygen, and administration of fluids (0.9% NaCl solution). Myxedema coma develops as a consequence of severe hypothyroidism and is characterized by a hypometabolic, stuporous state. Myxedema coma is associated with a high mortality rate, and most reported cases have involved Doberman Pinschers. Intravenous administration of levothyroxine can be used successfully in combination with oral administration to restore normal metabolic function and assist in warming and thermoregulation, although dosages should be conservative to avoid adverse cardiovascular effects.

Self-regulation of common age-related challenges: benefits for older adults' psychological and physical health.

PubMed

Wrosch, Carsten; Dunne, Erin; Scheier, Michael F; Schulz, Richard

2006-06-01

This article addresses the role played by adaptive self-regulation in protecting older adults' psychological and physical health. A theoretical model is outlined illustrating how common age-related challenges (i.e., physical challenges and life regrets) can influence older adults' health. In addition, the proposed model suggests that older adults can avoid the adverse health effects of encountering these problems if they engage in adaptive self-regulation. Finally, this article reviews recent studies that examined the adaptive value of self-regulation processes for managing physical challenges and life regrets in the elderly. The findings from cross-sectional, longitudinal, and experimental studies document the importance of adaptive self-regulation for maintaining older adults' health.

Clinicians' Need for an Ecological Approach to Violence Reduction.

PubMed

Lee, Bandy X; Young, John L

2018-01-01

We now know that harmful social policies, such as those that deny health care to some people, can generate structural violence and be far more harmful than any type of direct violence. A health professional who engages in public health promotion must thus consider the adverse effects of structural violence generated by bad policies. On this view, the dictum, "first, do no harm," can be interpreted as a mandate to protect patients from injustice. Health care professionals' responsibilities extend to motivating policies that prevent avoidable deaths and disabilities. As we exist within an ecology, we must each recognize our responsibility to care for one another and for the larger human community. © 2018 American Medical Association. All Rights Reserved.

An approach to the management of tuberculosis in HIV endemic areas.

PubMed

Elliott, A M

1992-10-01

The epidemic of HIV-associated tuberculosis is having a severe impact on tuberculosis control in sub-Saharan Africa, as well as the United States of America, and is expected to spread. Where facilities are limited, the association between HIV and sputum-smear negative tuberculosis hampers diagnosis; trials of anti-tuberculous therapy are indicated in some cases. Standard treatment regimens are effective, but thiacetazone should be avoided because of its association with severe, cutaneous adverse reactions. Treatment may have to be prolonged in HIV positive cases. Measures to maximize compliance with therapy are paramount. These include the use of the shortest possible regimens, of recognized potency, and emphasis on ensuring that the regimen is understood by and readily accessible to the patient.

A Reynolds stress model for near-wall turbulence

NASA Technical Reports Server (NTRS)

Durbin, P. A.

1993-01-01

The paper formulates a tensorially consistent near-wall second-order closure model. Redistributive terms in the Reynolds stress equations are modeled by an elliptic relaxation equation in order to represent strongly nonhomogeneous effects produced by the presence of walls; this replaces the quasi-homogeneous algebraic models that are usually employed, and avoids the need for ad hoc damping functions. The model is solved for channel flow and boundary layers with zero and adverse pressure gradients. Good predictions of Reynolds stress components, mean flow, skin friction, and displacement thickness are obtained in various comparisons to experimental and direct numerical simulation data. The model is also applied to a boundary layer flowing along a wall with a 90-deg, constant-radius, convex bend.

Impacts of Sublethal Mercury Exposure on Birds: A Detailed Review.

PubMed

Whitney, Margaret C; Cristol, Daniel A

Mercury is a ubiquitous environmental contaminant known to accumulate in, and negatively affect, fish-eating and oceanic bird species, and recently demonstrated to impact some terrestrial songbirds to a comparable extent. It can bioaccumulate to concentrations of >1 μg/g in tissues of prey organisms such as fish and insects. At high enough concentrations, exposure to mercury is lethal to birds. However, environmental exposures are usually far below the lethal concentrations established by dosing studies.The objective of this review is to better understand the effects of sublethal exposure to mercury in birds. We restricted our survey of the literature to studies with at least some exposures >5 μg/g. The majority of sublethal effects were subtle and some studies of similar endpoints reached different conclusions. Strong support exists in the literature for the conclusion that mercury exposure reduces reproductive output, compromises immune function, and causes avoidance of high-energy behaviors. For some endpoints, notably certain measures of reproductive success, endocrine and neurological function, and body condition, there is weak or contradictory evidence of adverse effects and further study is required. There was no evidence that environmentally relevant mercury exposure affects longevity, but several of the sublethal effects identified likely do result in fitness reductions that could adversely impact populations. Overall, 72% of field studies and 91% of laboratory studies found evidence of deleterious effects of mercury on some endpoint, and thus we can conclude that mercury is harmful to birds, and the many effects on reproduction indicate that bird population declines may already be resulting from environmental mercury pollution.

Approach and Avoidance Sexual Goals in Couples with Provoked Vestibulodynia: Associations with Sexual, Relational, and Psychological Well-Being.

PubMed

Rosen, Natalie O; Muise, Amy; Bergeron, Sophie; Impett, Emily A; Boudreau, Gillian K

2015-08-01

Provoked vestibulodynia (PVD) is a prevalent vulvovaginal pain condition that is triggered primarily during sexual intercourse. PVD adversely impacts women's and their partners' sexual relationship and psychological well-being. Over 80% of women with PVD continue to have intercourse, possibly because of sexual goals that include wanting to pursue desirable outcomes (i.e., approach goals; such as a desire to maintain intimacy) and avoid negative outcomes (i.e., avoidance goals; such as avoiding a partner's disappointment). The aim of this study was to investigate associations between approach and avoidance sexual goals and women's pain, as well as the sexual, relational, and psychological well-being of affected couples. Women with PVD (N = 107) and their partners completed measures of sexual goals, sexual satisfaction, relationship satisfaction, and depression. Women also completed measures of pain during intercourse and sexual functioning. (1) Global Measure of Sexual Satisfaction Scale, (2) Dyadic Adjustment Scale-Revised or the Couple Satisfaction Index, (3) Beck Depression Inventory-II, (4) numerical rating scale of pain during intercourse, and (5) Female Sexual Function Index. When women reported higher avoidance sexual goals, they reported lower sexual and relationship satisfaction, and higher levels of depressive symptoms. In addition, when partners of women reported higher avoidance sexual goals, they reported lower relationship satisfaction. When women reported higher approach sexual goals, they also reported higher sexual and relationship satisfaction. Targeting approach and avoidance sexual goals could enhance the quality and efficacy of psychological couple interventions for women with PVD and their partners. © 2015 International Society for Sexual Medicine.

Influence of dorsolateral prefrontal cortex and ventral striatum on risk avoidance in addiction: a mediation analysis.

PubMed

Yamamoto, Dorothy J; Woo, Choong-Wan; Wager, Tor D; Regner, Michael F; Tanabe, Jody

2015-04-01

Alterations in frontal and striatal function are hypothesized to underlie risky decision making in drug users, but how these regions interact to affect behavior is incompletely understood. We used mediation analysis to investigate how prefrontal cortex and ventral striatum together influence risk avoidance in abstinent drug users. Thirty-seven abstinent substance-dependent individuals (SDI) and 43 controls underwent fMRI while performing a decision-making task involving risk and reward. Analyses of a priori regions-of-interest tested whether activity in dorsolateral prefrontal cortex (DLPFC) and ventral striatum (VST) explained group differences in risk avoidance. Whole-brain analysis was conducted to identify brain regions influencing the negative VST-risk avoidance relationship. Right DLPFC (RDLPFC) positively mediated the group-risk avoidance relationship (p < 0.05); RDLPFC activity was higher in SDI and predicted higher risk avoidance across groups, controlling for SDI vs. Conversely, VST activity negatively influenced risk avoidance (p < 0.05); it was higher in SDI, and predicted lower risk avoidance. Whole-brain analysis revealed that, across group, RDLPFC and left temporal-parietal junction positively (p ≤ 0.001) while right thalamus and left middle frontal gyrus negatively (p < 0.005) mediated the VST activity-risk avoidance relationship. RDLPFC activity mediated less risky decision making while VST mediated more risky decision making across drug users and controls. These results suggest a dual pathway underlying decision making, which, if imbalanced, may adversely influence choices involving risk. Modeling contributions of multiple brain systems to behavior through mediation analysis could lead to a better understanding of mechanisms of behavior and suggest neuromodulatory treatments for addiction. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Influence of dorsolateral prefrontal cortex and ventral striatum on risk avoidance in addiction: a mediation analysis*

PubMed Central

Yamamoto, Dorothy J.; Woo, Choong-Wan; Wager, Tor D.; Regner, Michael F.; Tanabe, Jody

2015-01-01

Background Alterations in frontal and striatal function are hypothesized to underlie risky decision-making in drug users, but how these regions interact to affect behavior is incompletely understood. We used mediation analysis to investigate how prefrontal cortex and ventral striatum together influence risk avoidance in abstinent drug users. Method Thirty-seven abstinent substance-dependent individuals (SDI) and 43 controls underwent fMRI while performing a decision-making task involving risk and reward. Analyses of a priori regions-of-interest tested whether activity in dorsolateral prefrontal cortex (DLPFC) and ventral striatum (VST) explained group differences in risk avoidance. Whole-brain analysis was conducted to identify brain regions influencing the negative VST-risk avoidance relationship. Results Right DLPFC (RDLPFC) positively mediated the group-risk avoidance relationship (p < 0.05); RDLPFC activity was higher in SDI and predicted higher risk avoidance across groups, controlling for SDI vs. controls. Conversely, VST activity negatively influenced risk avoidance (p < 0.05); it was higher in SDI, and predicted lower risk avoidance. Whole-brain analysis revealed that, across group, RDLPFC and left temporal-parietal junction positively (p ≤ 0.001) while right thalamus and left middle frontal gyrus negatively (p < 0.005) mediated the VST activity-risk avoidance relationship. Conclusion RDLPFC activity mediated less risky decision-making while VST mediated more risky decision-making across drug users and controls. These results suggest a dual pathway underlying decision-making, which, if imbalanced, may adversely influence choices involving risk. Modeling contributions of multiple brain systems to behavior through mediation analysis could lead to a better understanding of mechanisms of behavior and suggest neuromodulatory treatments for addiction. PMID:25736619

Use of bedaquiline and delamanid in diabetes patients: clinical and pharmacological considerations.

PubMed

Hu, Minhui; Zheng, Chunlan; Gao, Feng

2016-01-01

Antituberculosis (anti-TB) treatment may be affected by both diabetes and hypoglycemic agents in patients with these 2 comorbidities. However, data supporting this conclusion relate only to standard anti-TB therapies. Sirturo ® (bedaquiline) and Deltyba ® (delamanid), novel drugs for multidrug-resistant tuberculosis (MDR-TB), are recommended for diabetes patients when another effective treatment regimen cannot be provided. Currently, there are no clinical data related to the use of these agents in diabetes patients. Possible alterations in the pharmacokinetics of these novel drugs induced by changes in subcutaneous adipose blood flow, gastric emptying, or nephropathy in diabetes patients, and possible drug-drug interactions with hypoglycemic agents, are of special interest, since the efficacy of bedaquiline and delamanid is concentration dependent. Moreover, it is of fundamental importance to avoid possible additive or synergistic effects of adverse drug reactions in this already vulnerable patient group. We reviewed clinical particularities related to the use of bedaquiline and delamanid in patients with type 1 and 2 diabetes mellitus (DM), as well as pharmacological aspects of the concurrent use of these agents with oral and injectable hypoglycemic agents. Bedaquiline shares liver metabolic pathways with several oral hypoglycemic agents, whereas delamanid may compete with several oral hypoglycemic agents and insulin analogs at protein-binding sites. Special concern exists regarding the use of bedaquiline and delamanid in diabetes patients aged >65 years and patients with severe renal or hepatic impairment or electrolyte disturbances. Concurrent use of bedaquiline and delamanid with insulin analogs, and other hypoglycemic agents that prolong the heart rate-corrected QT interval, such as sulfonylureas and glinides, may enhance this adverse reaction. Hepatic-related adverse reactions may develop more frequently when these drugs are combined with thiazolidinediones and acarbose. Data from Phase III and postmarketing studies are needed to elucidate the effect of DM and hypoglycemic agents on bedaquiline and delamanid effects in MDR-TB patients.

US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014.

PubMed

Shehab, Nadine; Lovegrove, Maribeth C; Geller, Andrew I; Rose, Kathleen O; Weidle, Nina J; Budnitz, Daniel S

2016-11-22

The Patient Protection and Affordable Care Act of 2010 brought attention to adverse drug events in national patient safety efforts. Updated, detailed, nationally representative data describing adverse drug events can help focus these efforts. To describe the characteristics of emergency department (ED) visits for adverse drug events in the United States in 2013-2014 and describe changes in ED visits for adverse drug events since 2005-2006. Active, nationally representative, public health surveillance in 58 EDs located in the United States and participating in the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project. Drugs implicated in ED visits. National weighted estimates of ED visits and subsequent hospitalizations for adverse drug events. Based on data from 42 585 cases, an estimated 4.0 (95% CI, 3.1-5.0) ED visits for adverse drug events occurred per 1000 individuals annually in 2013 and 2014 and 27.3% (95% CI, 22.2%-32.4%) of ED visits for adverse drug events resulted in hospitalization. An estimated 34.5% (95% CI, 30.3%-38.8%) of ED visits for adverse drug events occurred among adults aged 65 years or older in 2013-2014 compared with an estimated 25.6% (95% CI, 21.1%-30.0%) in 2005-2006; older adults experienced the highest hospitalization rates (43.6%; 95% CI, 36.6%-50.5%). Anticoagulants, antibiotics, and diabetes agents were implicated in an estimated 46.9% (95% CI, 44.2%-49.7%) of ED visits for adverse drug events, which included clinically significant adverse events, such as hemorrhage (anticoagulants), moderate to severe allergic reactions (antibiotics), and hypoglycemia with moderate to severe neurological effects (diabetes agents). Since 2005-2006, the proportions of ED visits for adverse drug events from anticoagulants and diabetes agents have increased, whereas the proportion from antibiotics has decreased. Among children aged 5 years or younger, antibiotics were the most common drug class implicated (56.4%; 95% CI, 51.8%-61.0%). Among children and adolescents aged 6 to 19 years, antibiotics also were the most common drug class implicated (31.8%; 95% CI, 28.7%-34.9%) in ED visits for adverse drug events, followed by antipsychotics (4.5%; 95% CI, 3.3%-5.6%). Among older adults (aged ≥65 years), 3 drug classes (anticoagulants, diabetes agents, and opioid analgesics) were implicated in an estimated 59.9% (95% CI, 56.8%-62.9%) of ED visits for adverse drug events; 4 anticoagulants (warfarin, rivaroxaban, dabigatran, and enoxaparin) and 5 diabetes agents (insulin and 4 oral agents) were among the 15 most common drugs implicated. Medications to always avoid in older adults according to Beers criteria were implicated in 1.8% (95% CI, 1.5%-2.1%) of ED visits for adverse drug events. The prevalence of emergency department visits for adverse drug events in the United States was estimated to be 4 per 1000 individuals in 2013 and 2014. The most common drug classes implicated were anticoagulants, antibiotics, diabetes agents, and opioid analgesics.

A proposed framework for the systematic review and integrated assessment (SYRINA) of endocrine disrupting chemicals.

PubMed

Vandenberg, Laura N; Ågerstrand, Marlene; Beronius, Anna; Beausoleil, Claire; Bergman, Åke; Bero, Lisa A; Bornehag, Carl-Gustaf; Boyer, C Scott; Cooper, Glinda S; Cotgreave, Ian; Gee, David; Grandjean, Philippe; Guyton, Kathryn Z; Hass, Ulla; Heindel, Jerrold J; Jobling, Susan; Kidd, Karen A; Kortenkamp, Andreas; Macleod, Malcolm R; Martin, Olwenn V; Norinder, Ulf; Scheringer, Martin; Thayer, Kristina A; Toppari, Jorma; Whaley, Paul; Woodruff, Tracey J; Rudén, Christina

2016-07-14

The issue of endocrine disrupting chemicals (EDCs) is receiving wide attention from both the scientific and regulatory communities. Recent analyses of the EDC literature have been criticized for failing to use transparent and objective approaches to draw conclusions about the strength of evidence linking EDC exposures to adverse health or environmental outcomes. Systematic review methodologies are ideal for addressing this issue as they provide transparent and consistent approaches to study selection and evaluation. Objective methods are needed for integrating the multiple streams of evidence (epidemiology, wildlife, laboratory animal, in vitro, and in silico data) that are relevant in assessing EDCs. We have developed a framework for the systematic review and integrated assessment (SYRINA) of EDC studies. The framework was designed for use with the International Program on Chemical Safety (IPCS) and World Health Organization (WHO) definition of an EDC, which requires appraisal of evidence regarding 1) association between exposure and an adverse effect, 2) association between exposure and endocrine disrupting activity, and 3) a plausible link between the adverse effect and the endocrine disrupting activity. Building from existing methodologies for evaluating and synthesizing evidence, the SYRINA framework includes seven steps: 1) Formulate the problem; 2) Develop the review protocol; 3) Identify relevant evidence; 4) Evaluate evidence from individual studies; 5) Summarize and evaluate each stream of evidence; 6) Integrate evidence across all streams; 7) Draw conclusions, make recommendations, and evaluate uncertainties. The proposed method is tailored to the IPCS/WHO definition of an EDC but offers flexibility for use in the context of other definitions of EDCs. When using the SYRINA framework, the overall objective is to provide the evidence base needed to support decision making, including any action to avoid/minimise potential adverse effects of exposures. This framework allows for the evaluation and synthesis of evidence from multiple evidence streams. Finally, a decision regarding regulatory action is not only dependent on the strength of evidence, but also the consequences of action/inaction, e.g. limited or weak evidence may be sufficient to justify action if consequences are serious or irreversible.

Research on Ratio of Dosage of Drugs in Traditional Chinese Prescriptions by Data Mining.

PubMed

Yu, Xing-Wen; Gong, Qing-Yue; Hu, Kong-Fa; Mao, Wen-Jing; Zhang, Wei-Ming

2017-01-01

Maximizing the effectiveness of prescriptions and minimizing adverse effects of drugs is a key component of the health care of patients. In the practice of traditional Chinese medicine (TCM), it is important to provide clinicians a reference for dosing of prescribed drugs. The traditional Cheng-Church biclustering algorithm (CC) is optimized and the data of TCM prescription dose is analyzed by using the optimization algorithm. Based on an analysis of 212 prescriptions related to TCM treatment of kidney diseases, the study generated 87 prescription dose quantum matrices and each sub-matrix represents the referential value of the doses of drugs in different recipes. The optimized CC algorithm can effectively eliminate the interference of zero in the original dose matrix of TCM prescriptions and avoid zero appearing in output sub-matrix. This results in the ability to effectively analyze the reference value of drugs in different prescriptions related to kidney diseases, so as to provide valuable reference for clinicians to use drugs rationally.

An analysis of data related to the minimum temperatures for valid testing in cryogenic wind tunnels using nitrogen as the test gas

NASA Technical Reports Server (NTRS)

Hall, R. M.

1976-01-01

The minimum operating temperature which avoids adverse low temperature effects, such as condensation, has been determined at a free stream Mach number of 0.85 for flow over a 0.137 meter airfoil mounted at zero incidence in the Langley 1/3 meter transonic cryogenic tunnel. The onset of low temperature effects is established by comparing the pressure coefficient measured at a given orifice for a particular temperature with those measured at temperatures sufficiently above where low temperature effects might be expected to occur. The pressure distributions over the airfoil are presented in tabular form. In addition, the comparisons of the pressure coefficient as a function of total temperature are presented graphically for chord locations of 0, 25, 50, and 75 percent. Over the 1.2 to 4.5 atmosphere total pressure range investigated, low temperature effects are not detected until total temperatures are 2 K, or more, below free stream saturation temperatures.

Monitoring trends in civil engineering and their effect on indoor radon.

PubMed

Ringer, W

2014-07-01

In this paper, the importance of monitoring new building concepts is discussed. The effect of energy-efficient construction technologies on indoor radon is presented in more detail. Comparing the radon levels of about 100 low-energy and passive houses in Austria with radon levels in conventional new houses show that, in energy-efficient new houses, the radon level is about one-third lower than in conventional new houses. Nevertheless, certain features or bad practice may cause high radon levels in energy-efficient new houses. Recommendations to avoid adverse effects were set up. Furthermore, the paper deals with the effect of thermal retrofitting on indoor radon. Results from a Swiss study where 163 dwellings were measured before and after thermal retrofit yield an increase of the radon level of 26% in average. Among the various retrofit measures, replacing windows has the greatest impact on the indoor radon level. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Terbinafine: novel formulations that potentiate antifungal activities.

PubMed

Ma, Y; Chen, X; Guan, S

2015-03-01

Terbinafine, an orally and topically active antifungal agent, has been available for the treatment of dermatophytic infections and onychomycosis for more than a decade. In addition, oral administration has been shown to be associated with drug-drug interactions, hepatotoxicity, low concentration at the infected sites, gastrointestinal and systemic side effects and other adverse effects. Since topical drug delivery can provide higher patient compliance, allow immediate access to the infected site and reduce unwanted systemic drug exposure, an improved topical drug delivery approach with high permeability, sustained release and prolonged retainment could overcome the limitations and side effects caused by oral administration. Conventional topical formulations cannot keep the drug in the targeted sites for a long duration of time and hence a novel drug delivery that can avoid the side effects while still providing sustained efficacy in treatment should be developed. This brief review of novel formulations based on polymers and nanostructure carriers provides insight into the efficacy and topical delivery of terbinafine. Copyright 2015 Prous Science, S.A.U. or its licensors. All rights reserved.

[Results of provisional use of a system for voluntary anonymous reporting of incidents that threaten patient safety in the emergency medical services of Asturias].

PubMed

Galván Núñez, Pablo; Santander Barrios, María Dolores; Villa Álvarez, María Cristina; Castro Delgado, Rafael; Alonso Lorenzo, Julio C; Arcos González, Pedro

2016-06-01

To describe the reported incidents and adverse events in the emergency medical services of Asturias, Spain, and assess their consequences, delays caused, and preventability. Prospective, observational study of incidents reported by the staff of the emergency medical services of Asturias after implementation of a system devised by the researchers. Incident reports were received for 0.48% (95% CI, 0.41%-0.54%) of the emergencies attended. Patient safety was compromised in 74.7% of the reported incidents. Problems arising in the emergency response coordination center (ERCC) accounted for 37.6% of the incidents, transport problems for 13.4%, vehicular problems for 10.8%, and communication problems for 8.8%. Seventy percent of the reported incidents caused delays in care; 55% of the reported incidents that put patients at risk (according to severity assessment code ratings) corresponded to problems related to human or material resources. A total of 88.1% of the incidents reported were considered avoidable. Some type of intervention was required to attenuate the effects of 46.2% of the adverse events reported. The measures that staff members most often proposed to prevent adverse events were to increase human and material resources (28.3%), establish protocols (14.5%), and comply with quality of care recommendations (9.7%). It is important to promote a culture of safety and incident reporting among health care staff in Asturias given the number of serious adverse events. Reporting is necessary for understanding the errors made and taking steps to prevent them. The ERCC is the point in the system where incidents are particularly likely to appear and be noticed and reported.

Pinyon and juniper encroachment into sagebrush ecosystems impacts distribution and survival of greater sage-grouse

USGS Publications Warehouse

Coates, Peter S.; Prochazka, Brian; Ricca, Mark; Gustafson, K. Ben; Ziegler, Pilar T.; Casazza, Michael L.

2017-01-01

In sagebrush (Artemisia spp.) ecosystems, encroachment of pinyon (Pinus spp.) and juniper (Juniperus spp.; hereafter, “pinyon-juniper”) trees has increased dramatically since European settlement. Understanding the impacts of this encroachment on behavioral decisions, distributions, and population dynamics of greater sage-grouse (Centrocercus urophasianus) and other sagebrush obligate species could help benefit sagebrush ecosystem management actions. We employed a novel two-stage Bayesian model that linked avoidance across different levels of pinyon-juniper cover to sage-grouse survival. Our analysis relied on extensive telemetry data collected across 6 yr and seven subpopulations within the Bi-State Distinct Population Segment (DPS), on the border of Nevada and California. The first model stage indicated avoidance behavior for all canopy cover classes on average, but individual grouse exhibited a high degree of heterogeneity in avoidance behavior of the lowest cover class (e.g., scattered isolated trees). The second stage modeled survival as a function of estimated avoidance parameters and indicated increased survival rates for individuals that exhibited avoidance of the lowest cover class. A post hoc frailty analysis revealed the greatest increase in hazard (i.e., mortality risk) occurred in areas with scattered isolated trees consisting of relatively high primary plant productivity. Collectively, these results provide clear evidence that local sage-grouse distributions and demographic rates are influenced by pinyon-juniper, especially in habitats with higher primary productivity but relatively low and seemingly benign tree cover. Such areas may function as ecological traps that convey attractive resources but adversely affect population vital rates. To increase sage-grouse survival, our model predictions support reducing actual pinyon-juniper cover as low as 1.5%, which is lower than the published target of 4.0%. These results may represent effects of pinyon-juniper cover in areas with similar ecological conditions to those of the Bi-State DPS, where populations occur at relatively high elevations and pinyon-juniper is abundant and widespread.

Advance Care Planning Does Not Adversely Affect Hope or Anxiety Among Patients With Advanced Cancer.

PubMed

Green, Michael J; Schubart, Jane R; Whitehead, Megan M; Farace, Elana; Lehman, Erik; Levi, Benjamin H

2015-06-01

Many physicians avoid advance care planning (ACP) discussions because they worry such conversations will lead to psychological distress. To investigate whether engaging in ACP using online planning tools adversely affects hope, hopelessness, or anxiety among patients with advanced cancer. Patients with advanced cancer and an estimated survival of two years or less (Intervention group) and a Control group were recruited at a tertiary care academic medical center (2007-2012) to engage in ACP using an online decision aid ("Making Your Wishes Known"). Pre/post and between-group comparisons were made, including hope (Herth Hope Index), hopelessness (Beck Hopelessness Scale), and anxiety (State Trait Anxiety Inventory). Secondary outcomes included ACP knowledge, self-determination, and satisfaction. A total of 200 individuals completed the study. After engaging in ACP, there was no decline in hope or increase in hopelessness in either the Control or Intervention group. Anxiety was likewise unchanged in the Control group but decreased slightly in the Intervention group. Knowledge of ACP (% correct answers) increased in both the groups, but more so in the Intervention group (13% increase vs. 4%; P<0.01). Self-determination increased slightly in both groups, and satisfaction with the ACP process was greater (P<0.01) in the Intervention than Control group. Engaging in ACP with online planning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Adverse reactions and interactions with beta-adrenoceptor blocking drugs.

PubMed

Lewis, R V; McDevitt, D G

1986-01-01

beta-Blocking drugs are widely used throughout the world and serious adverse reactions are relatively uncommon. Most of those which do occur are pharmacologically predictable and may be avoided by ensuring that patients who are to be given beta-blockers do not have a predisposition to the development of bronchospasm, cardiac failure or peripheral ischaemia. In some situations, the use of a beta 1-selective blocking drug may reduce the risk of a severe adverse reaction, but there is little evidence that other ancillary properties such as partial agonist activity are of relevance in this context. Long term experience with many of the beta-blockers in current use suggests that unpredictable major adverse reactions such as the practolol oculomucocutaneous syndrome are unlikely to be repeated, although some of these drugs may be associated with immunological disturbances and some have been implicated in the development of retroperitoneal fibrosis. beta-Blocking drugs appear to be associated with a number of subjective side effects including muscle fatigue, peripheral coldness and some neurological symptoms. These side effects are highly subjective and are therefore difficult to quantify and it is not known whether they are of major importance in terms of their effect upon patients' overall well-being. It cannot be assumed that simply because such side effects can be elicited that they do, in fact, matter. However, because beta-blockers are often prescribed for patients who have no symptoms and for whom the benefits of therapy are generally small, such side effects would be of considerable importance if they had an overall effect upon quality of life. There are theoretical reasons to suppose that the incidence and severity of such side effects may be related to the ancillary properties of the individual drugs, but there is little evidence that parameters such as beta 1-selectivity, or partial agonist activity are clinically important determinants of the severity of these side effects. Lipophilicity, however, may be associated with an increased incidence of neurological symptoms. beta-Blocking drugs may cause a variety of metabolic disturbances including an increase in serum VLDL-cholesterol concentrations. However, long term studies have not shown that such disturbances are associated with an increased risk of cardiovascular disease, indicating that such metabolic changes may not be of major importance in practice. beta-Blocking drugs may be involved in a number of interactions with other drugs, but few of these have been shown to be of clinical significance.(ABSTRACT TRUNCATED AT 400 WORDS)

Sleep complaints: Whenever possible, avoid the use of sleeping pills.

PubMed

2008-10-01

(1) Most sleep complaints involve difficulties in getting to sleep or staying asleep, or not feeling refreshed on awakening. Misconceptions and worrying over the lack of sleep and its consequences can contribute to reinforcing these disorders; (2) How can patients who complain of poor-quality sleep be helped, without resorting to treatments that can have adverse effects? To answer this question, we conducted a systematic review of the literature based on the standard Prescrire procedure; (3) One effective approach is to explain the basic physiology of sleep, to discuss misconceptions, and to adopt a strategy of "stimulus control". This method has a similar efficacy to prescribing a benzodiazepine. and the effect is longer lasting; (4) Moderate, regular physical exercise, especially in the morning, seems to help some patients, but the evidence is weak; (5) Some clinical trials of phytotherapy have shown a positive risk-benefit balance of weak aqueous or hydroalcoholic valerian extracts. Efficacy is limited, however; (6) A meta-analysis of placebo-controlled trials showed that benzodiazepines and related drugs increase the duration of sleep and help patients to fall asleep sooner. However, none of these trials provides comparative data spanning periods of more than two weeks. Efficacy is uncertain in the longer term, as patients quickly develop a tolerance to the hypnotic effects of benzodiazepines; (7) The adverse effects of benzodiazepines include frequent memory disorders, daytime drowsiness, falls, fractures and road accidents, and a withdrawal syndrome after treatment cessation. Related drugs such as zolpidem and zopiclone provoke similar adverse effects; (8) Sedative antihistamines have not been as well-evaluated as benzodiazepines in this setting. Small comparative trials of doxylamine and diphenhydramine showed no major difference in efficacy versus benzodiazepines and related drugs. The main adverse effects of sedative antihistamines are daytime drowsiness and altered vigilance, and atropinic effects; (9) Case-control studies showed a statistical link between benzodiazepine use in early pregnancy and birth defects such as cleft lip. In contrast, data on the use of doxylamine during pregnancy are reassuring; (10) Other sedative psychotropics have not been adequately tested in this setting or have been shown to have a negative risk-benefit balance; (11) In practice, patients who complain of poor-quality sleep should be given appropriate information on the mechanisms of normal sleep and related misconceptions, on the best methods for getting to sleep, and on the dangers of sedative psychotropics (dependence, withdrawal syndrome). When prescribing or dispensing a benzodiazepine to a woman of child-bearing age, the risk of birth defects, although not clearly demonstrated, must be mentioned.

Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet.

PubMed

MacDermott, Richard P

2007-01-01

Irritable bowel syndrome (IBS) in the outpatient with chronic inflammatory bowel disease (IBD) is a difficult but important challenge to recognize and treat. It is very helpful to have effective treatment approaches for IBS that are practical and use minimal medications. Because of the underlying chronic inflammation in IBD, IBS symptoms occur with increased frequency and severity, secondary to increased hypersensitivity to foods and beverages that stimulate the gastrointestinal tract. This paper discusses how to treat IBS in the IBD outpatient, with emphasis on using a food and beverage intolerance, avoidance diet. The adverse effects of many foods and beverages are amount dependent and can be delayed, additive, and cumulative. The specific types of foods and beverages that can induce IBS symptoms include milk and milk containing products; caffeine containing products; alcoholic beverages; fruits; fruit juices; spices; seasonings; diet beverages; diet foods; diet candies; diet gum; fast foods; condiments; fried foods; fatty foods; multigrain breads; sourdough breads; bagels; salads; salad dressings; vegetables; beans; red meats; gravies; spaghetti sauce; stews; nuts; popcorn; high fiber; and cookies, crackers, pretzels, cakes, and pies. The types of foods and beverages that are better tolerated include water; rice; plain pasta or noodles; baked or broiled potatoes; white breads; plain fish, chicken, turkey, or ham; eggs; dry cereals; soy or rice based products; peas; applesauce; cantaloupe; watermelon; fruit cocktail; margarine; jams; jellies; and peanut butter. Handouts that were developed based upon what worsens or helps IBS symptoms in patients are included to help patients learn which foods and beverages to avoid and which are better tolerated.

Psychological burden of food allergy

PubMed Central

Teufel, Martin; Biedermann, Tilo; Rapps, Nora; Hausteiner, Constanze; Henningsen, Peter; Enck, Paul; Zipfel, Stephan

2007-01-01

One fifth of the population report adverse reactions to food. Reasons for these symptoms are heterogeneous, varying from food allergy, food intolerance, irritable bowel syndrome to somatoform or other mental disorders. Literature reveals a large discrepancy between truly diagnosed food allergy and reports of food allergy symptoms by care seekers. In most studies currently available the characterization of patient groups is incomplete, because they did not distinguish between immunologic reactions and other kinds of food reactions. In analysing these adverse reactions, a thorough physical and psychological diagnostic approach is important. In our qualitative review, we present those diagnostic measures that are evidenced-based as well as clinically useful, and discuss the various psychological dimensions of adverse reactions to food. It is important to acknowledge the complex interplay between body and mind: Adults and children suffering from food allergy show impaired quality of life and a higher level of stress and anxiety. Pavlovian conditioning of adverse reactions plays an important role in maintaining symptoms. The role of personality, mood, or anxiety in food reactions is debatable. Somatoform disorders ought to be identified early to avoid lengthy and frustrating investigations. A future task will be to improve diagnostic algorithms, to describe psychological aspects in clearly characterised patient subgroups, and to develop strategies for an optimized management of the various types of adverse reactions to food. PMID:17659692

Air travel in women with lymphangioleiomyomatosis

PubMed Central

Pollock‐BarZiv, Stacey; Cohen, Marsha M; Downey, Gregory P; Johnson, Simon R; Sullivan, Eugene; McCormack, Francis X

2007-01-01

Background and objective The safety of air travel in patients with pneumothorax‐prone pulmonary diseases, such as lymphangioleiomyomatosis (LAM), has not been studied to any great extent. A questionnaire‐based evaluation of air travel in patients with LAM was conducted to determine experiences aboard commercial aircraft. Methods A survey was sent to women listed in the US LAM Foundation registry (n = 389) and the UK LAM Action registry (n = 59) to assess air travel, including problems occurring during flight. Women reporting a pneumothorax in flight were followed up to ascertain further details about the incident. Results 327 (73%) women completed the survey. 308 women answered the travel section, of whom 276 (90%) had “ever” travelled by aeroplane for a total of 454 flights. 95 (35%) women had been advised by their doctor to avoid air travel. Adverse events reported included shortness of breath (14%), pneumothorax (2%, 8/10 confirmed by chest radiograph), nausea or dizziness (8%), chest pain (12%), unusual fatigue (11%), oxygen desaturation (8%), headache (9%), blue hands (2%), haemoptysis (0.4%) and anxiety (22%). 5 of 10 patients with pneumothorax had symptoms that began before the flight: 2 occurred during cruising altitude, 2 soon after landing and 1 not known. The main symptoms were severe chest pain and shortness of breath. Discussion and conclusion Adverse effects occurred during air travel in patients with LAM, particularly dyspnoea and chest pain. Hypoxaemia and pneumothorax were reported. The decision to travel should be individualised; patients with unexplained shortness of breath or chest pain before scheduled flights should not board. Patients with borderline oxygen saturations on the ground should be evaluated for supplemental oxygen therapy during flight. Although many women had been advised not to travel by air, most travelled without the occurrence of serious adverse effects. PMID:17040934

A comparison of the abilities of chlorpromazine and molindone to interact adversely with guanethidine.

PubMed

Gilder, D A; Fain, W; Simpson, L L

1976-08-01

Chlorpromazine and molindone were tested for their abilities to impair conditioned avoidance behavior of rats. Chlorpromazine was effective within the dose range of 0.3 to 7.0 mg/kg (ID50approximately 2.0 mg/kg); molindone was effective within the range of 0.3 to 5.0 mg/kg (ID50 approximately 0.6 mg/kg). Behaviorally relevant doses of chlorpromazine and molindone were then tested for their effects on blood pressure and on adrenergic mechanisms. When given intravenously to anesthetized, hypertensive animals, both drugs (1.0 mg/kg) produced significant but transient vasodepression. When given intraperitoneally to anesthetized or to conscious hypertensive rats, the drugs did not produce significant effects on blood pressure. Both drugs (1.0 mg/kg) blocked responses to an alpha agonist (methoxamine), but chlorpromazine was significantly more potent than molindone. In addition, chlorpromazine produced a dose-dependent (1.0-10.0 mg/kg) inhibition of 3H-l-norepinephrine uptake into heart, but molindone at the same doses produced no inhibition of uptake. In related experiments, it was found that guanethidine (50 mg/kg) was an effective agent for lowering blood pressure of hypertensive rats. When chlorpromazine (3-10 mg/kg) was administered concomitantly with guanethidine, the blood pressure lowering properties of guanethidine were diminished or abolished. When molindone (1-10 mg/kg) was administered concomitantly with guanethidine, there was no loss of blood pressure control. It is concluded that molindone is an important drug, because it is an antipsychotic agent that does not interact adversely with guanethidine.

Comparative Effectivenesses of Pulsed Radiofrequency and Transforaminal Steroid Injection for Radicular Pain due to Disc Herniation: a Prospective Randomized Trial.

PubMed

Lee, Dong Gyu; Ahn, Sang-Ho; Lee, Jungwon

2016-08-01

Transforaminal Epidural steroid injections (TFESI) have been widely adopted to alleviate and control radicular pain in accord with current guidelines. However, sometimes repeated steroid injections have adverse effects, and thus, this prospective randomized trial was undertaken to compare the effectivenesses of pulsed radiofrequency (PRF) administered to a targeted dorsal root ganglion (DRG) and TFESI for the treatment of radicular pain due to disc herniation. Subjects were recruited when first proved unsuccessful (defined as a score of > 4 on a visual analogue scale (VAS; 0-10 mm) and of > 30% according to the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI)). Forty-four patients that met the inclusion criteria were enrolled. The 38 subjects were randomly assigned to receive either PRF (PRF group; n = 19) or additional TFESI (TFESI group; n = 19) and were then followed for 2, 4, 8, and 12 weeks. To evaluate pain intensity were assessed by VAS. ODI and NDI were applied to evaluate functional disability. Mean VAS scores for cervical and lumbar radicular pain were significantly lower 12 weeks after treatment in both study groups. NDI and ODI scores also declined after treatment. However, no statistically significant difference was observed between the PRF and TFESI groups in terms of VAS, ODI, or NDI scores at any time during follow-up. PRF administered to a DRG might be as effective as TFESI in terms of attenuating radicular pain caused by disc herniation, and its use would avoid the adverse effects of steroid.

[Neurologic complications of subarachnoid hemorrhage due to intracranial aneurysm rupture].

PubMed

Rama-Maceiras, P; Fàbregas Julià, N; Ingelmo Ingelmo, I; Hernández-Palazón, J

2010-12-01

The high rates of morbidity and mortality after subarachnoid hemorrhage due to spontaneous rupture of an intracranial aneurysm are mainly the result of neurologic complications. Sixty years after cerebral vasospasm was first described, this problem remains unsolved in spite of its highly adverse effect on prognosis after aneurysmatic rupture. Treatment is somewhat empirical, given that uncertainties remain in our understanding of the pathophysiology of this vascular complication, which involves structural and biochemical changes in the endothelium and smooth muscle of vessels. Vasospasm that is refractory to treatment leads to cerebral infarction. Prophylaxis, early diagnosis, and adequate treatment of neurologic complications are key elements in the management of vasospasm if neurologic damage, lengthy hospital stays, and increased use of health care resources are to be avoided. New approaches to early treatment of cerebral lesions and cortical ischemia in cases of subarachnoid hemorrhage due to aneurysm rupture should lead to more effective, specific management.

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

Tsitomeneas, S. Th., E-mail: stsit@teipir.gr; Vourlias, K., E-mail: kvourlias@yahoo.gr; Geronikolou, St. A., E-mail: sgeronik@bioacademy.gr

The electrical and electronic waste (e-waste) management is a global environmental problem dominated by the precautionary principle application, resulted to preliminary and ambiguous potential adverse effects, of extensive scientific uncertainty. In order to overcome the detected stochastic effects confusions in this field, we propose the inclusion of the principles of justification-optimization-limitation and of prudent avoidance. This model is already, established in radiation protection, so that toxicity as a result of the e-waste management would decrease, whilst the precious metals would be saved. We, further, resolve the classification of rejected items as reusable or as waste, so that the procedure ofmore » dismantling and recycling becomes easier, and the collecting-transporting-placement at an e-waste landfill would be safer. In conclusion, our proposing pattern in the e-waste management enforces the sustainable reducing-reusing-recycling, saves time/money and advances safety by including more sources of e-waste (military, medical etc) that were excluded previously.« less

Treatment of Fever After Stroke: Conflicting Evidence

PubMed Central

Wrotek, Sylwia E.; Kozak, Wieslaw E.; Hess, David C.; Fagan, Susan C.

2014-01-01

Approximately 50% of patients hospitalized for stroke develop fever. In fact, experimental evidence suggests that high body temperature is significantly correlated to initial stroke severity, lesion size, mortality, and neurologic outcome. Fever occurring after stroke is associated with poor outcomes. We investigated the etiology of fever after stroke and present evidence evaluating the efficacy and safety of interventions used to treat stroke-associated fever. Oral antipyretics are only marginally effective in lowering elevated body temperature in this population and may have unintended adverse consequences. Nonpharmacologic approaches to cooling have been more effective in achieving normothermia, but whether stroke outcomes can be improved remains unclear. We recommend using body temperature as a biomarker and a catalyst for aggressive investigation for an infectious etiology. Care must be taken not to exceed the new standard of a maximum acetaminophen does of 3 g/day to avoid patient harm. PMID:22026396

The effect of anesthesia on body temperature control.

PubMed

Lenhardt, Rainer

2010-06-01

The human thermoregulatory system usually maintains core body temperature near 37 degrees C. This homeostasis is accomplished by thermoregulatory defense mechanisms such as vasoconstriction and shivering or sweating and vasodilatation. Thermoregulation is impaired during general anesthesia. Suppression of thermoregulatory defense mechanisms during general anesthesia is dose dependant and mostly results in perioperative hypothermia. Several adverse effects of hypothermia have been identified, including an increase in postoperative wound infection, perioperative coagulopathy and an increase of postoperative morbid cardiac events. Perioperative hypothermia can be avoided by warming patients actively during general anesthesia. Fever is a controlled increase of core body temperature. Various causes of perioperative fever are given. Fever is usually attenuated by general anesthesia. Typically, patients develop a fever of greater magnitude in the postoperative phase. Postoperative fever is fairly common. The incidence of fever varies with type and duration of surgery, patient's age, surgical site and preoperative inflammation.

Fever in sepsis.

PubMed

Schortgen, F

2012-11-01

Fever is a common symptom of sepsis usually believed to predict better survival. Experimental data suggest that body temperature elevation may slow micro-organism growth and enhance host immune responses. In patients with sepsis, however, the high energy cost of fever may exacerbate the life-threatening situation. Fever control is widely used in the ICU, mainly in patients with infections. The efficacy of antipyretic drugs in lowering body temperature remains uncertain, however, and all antipyretics have well known adverse effects. Surface cooling methods are efficient but require sedation to avoid the harmful effects of shivering. A recent controlled trial in patients with septic shock suggests that external cooling for fever control may diminish vasopressor requirements and improve early survival. In this review, we examine the benefits and risks of fever and of controlled normothermia. The fever control modalities that provide the best risk/benefit ratio in sepsis are discussed.

Over-the-wing propeller

NASA Technical Reports Server (NTRS)

Johnson, Joseph L., Jr. (Inventor); White, E. Richard (Inventor)

1986-01-01

This invention is an aircraft with a system for increasing the lift drag ratio over a broad range of operating conditions. The system positions the engines and nacelles over the wing in such a position that gains in propeller efficiency is achieved simultaneously with increases in wing lift and a reduction in wing drag. Adverse structural and torsional effects on the wings are avoided by fuselage mounted pylons which attach to the upper portion of the fuselage aft of the wings. Similarly, pylon-wing interference is eliminated by moving the pylons to the fuselage. Further gains are achieved by locating the pylon surface area aft of the aircraft center of gravity, thereby augmenting both directional and longitudinal stability. This augmentation has the further effect of reducing the size, weight and drag of empennage components. The combination of design changes results in improved cruise performance and increased climb performance while reducing fuel consumption and drag and weight penalties.

Improved nuclear magnetic resonance apparatus having semitoroidal rf coil for use in topical NMR and NMR imaging

DOEpatents

Fukushima, E.; Roeder, S.B.W.; Assink, R.A.; Gibson, A.A.V.

1984-01-01

An improved nuclear magnetic resonance (NMR) apparatus for use in topical magnetic resonance (TMR) spectroscopy and other remote sensing NMR applications includes a semitoroidal radio frequency (rf) coil. The semitoroidal rf coil produces an effective alternating magnetic field at a distance from the poles of the coil, so as to enable NMR measurements to be taken from selected regions inside an object, particularly including human and other living subjects. The semitoroidal rf coil is relatively insensitive to magnetic interference from metallic objects located behind the coil, thereby rendering the coil particularly suited for use in both conventional and superconducting NMR magnets. The semitoroidal NMR coil can be constructed so that it emits little or no excess rf electric field associated with the rf magnetic field, thus avoiding adverse effects due to dielectric heating of the sample or to any other interaction of the electric field with the sample.

Nuclear magnetic resonance apparatus having semitoroidal rf coil for use in topical NMR and NMR imaging

DOEpatents

Fukushima, Eiichi; Roeder, Stephen B. W.; Assink, Roger A.; Gibson, Atholl A. V.

1986-01-01

An improved nuclear magnetic resonance (NMR) apparatus for use in topical magnetic resonance (TMR) spectroscopy and other remote sensing NMR applications includes a semitoroidal radio-frequency (rf) coil. The semitoroidal rf coil produces an effective alternating magnetic field at a distance from the poles of the coil, so as to enable NMR measurements to be taken from selected regions inside an object, particularly including human and other living subjects. The semitoroidal rf coil is relatively insensitive to magnetic interference from metallic objects located behind the coil, thereby rendering the coil particularly suited for use in both conventional and superconducting NMR magnets. The semitoroidal NMR coil can be constructed so that it emits little or no excess rf electric field associated with the rf magnetic field, thus avoiding adverse effects due to dielectric heating of the sample or to any other interaction of the electric field with the sample.

Protective and compensatory factors mitigating the influence of deviant friends on delinquent behaviours during early adolescence.

PubMed

Fergusson, David M; Vitaro, Frank; Wanner, Brigitte; Brendgen, Mara

2007-02-01

This study examined factors that could moderate or compensate the link between exposure to deviant friends and delinquent behaviours in a sample of 265 early adolescents. The putative moderating or compensatory factors referred to the behavioural domain (i.e. novelty seeking, harm avoidance), the biological domain (i.e. physical maturation), the sociofamily domain (i.e. sociofamily adversity, parental practices), the school domain (i.e. academic performance), and the social domain (i.e. peer acceptance). A series of regression analyses showed that novelty seeking and puberty status moderated the link between friends' self-reported delinquency and participants' self-reported delinquency. In addition, all the factors except peer acceptance also had main effects that, cumulatively, reduced the association between friends' delinquency and self-rated delinquency through compensatory main effects. These results are discussed in light of the differential roles of moderating and of compensatory factors.

Breast-feeding after transplantation.

PubMed

Constantinescu, Serban; Pai, Akshta; Coscia, Lisa A; Davison, John M; Moritz, Michael J; Armenti, Vincent T

2014-11-01

Transplantation affords recipients the potential for a full life and, for some, parenthood. Female transplant recipients must continue to take immunosuppression during pregnancy and breast-feeding. This article reviews case and series reports regarding breast-feeding in those taking transplant medications. Avoidance of breast-feeding has been the customary advice because of the potential adverse effects of immunosuppressive exposure on the infant. Subsequent studies have demonstrated that not all medication exposure translates to risk for the infant, that the exposure in utero is greater than via breast milk and that no lingering effects due to breast-feeding have been found to date in infants who were breast-fed while their mothers were taking prednisone, azathioprine, cyclosporine, and/or tacrolimus. Thus, except for those medications where clinical information is inadequate (mycophenolic acid products, sirolimus, everolimus, and belatacept), the recommendation for transplant recipients regarding breast-feeding has evolved into one that is cautiously optimistic. Copyright © 2014 Elsevier Ltd. All rights reserved.

The use of alteplase for the resolution of an intravesical clot in a neonate receiving extracorporeal membrane oxygenation.

PubMed

Olarte, J L; Glover, M L; Totapally, B R

2001-01-01

We present a case of the use of alteplase for the lysis of a large urinary bladder clot. A neonate presented with respiratory failure, secondary to a left diaphragmatic hernia necessitating the need for extracorporeal membrane oxygenation (ECMO) support. On day 3 of ECMO support, hematuria was noted, and a subsequent urinary bladder ultrasound revealed a significant urinary bladder clot. Alteplase (0.5-1 mg) was instilled into the urinary bladder via a 10 French Foley catheter (Sherwood Medical, St. Louis, MO). The catheter was clamped for 1 hour, followed by irrigation with normal saline. Multiple doses of alteplase were administered, resulting in complete resolution of the bladder clot. No adverse effects were attributed to the use of the intravesical alteplase. Alteplase seems to be safe and effective for the resolution of bladder clots, thereby potentially avoiding more invasive surgical procedures.

Distant testing in laboratory hematology and flow cytometry--the Indian experience.

PubMed

Das Gupta, Amar

2012-06-01

Outsourcing or sending out of patients' samples to other laboratories for hematologic investigations is a common practice these days. Preanalytic variables that alter cellular parameters and levels of analytes in transit and on storage can significantly and adversely affect interpretation of test results in hematology. Awareness of these changes is necessary to avoid misinterpretation of results that in turn could influence medical management decisions.

The Impact of Neighborhood Environment, Social Support, and Avoidance Coping on Depressive Symptoms of Pregnant African-American Women.

PubMed

Giurgescu, Carmen; Zenk, Shannon N; Templin, Thomas N; Engeland, Christopher G; Dancy, Barbara L; Park, Chang Gi; Kavanaugh, Karen; Dieber, William; Misra, Dawn P

2015-01-01

Although depressive symptoms during pregnancy have been related to negative maternal and child health outcomes such as preterm birth, low birth weight infants, postpartum depression, and maladaptive mother-infant interactions, studies on the impact of neighborhood environment on depressive symptoms in pregnant women are limited. Pregnant women residing in disadvantaged neighborhoods reported higher levels of depressive symptoms and lower levels of social support. No researchers have examined the relationship between neighborhood environment and avoidance coping in pregnant women. Guided by the Ecological model and Lazarus and Folkman's transactional model of stress and coping, we examined whether social support and avoidance coping mediated associations between the neighborhood environment and depressive symptoms in pregnant African-American women. Pregnant African-American women (n = 95) from a medical center in Chicago completed the instruments twice during pregnancy between 15 and 25 weeks and between 25 and 37 weeks. The self-administered instruments measured perceived neighborhood environment, social support, avoidance coping, and depressive symptoms using items from existing scales. Objective measures of the neighborhood environment were derived using geographic information systems. Perceived neighborhood environment, social support, avoidance coping, and depressive symptoms were correlated significantly in the expected directions. Objective physical disorder and crime were negatively related to social support. Social support at time 1 (20 ± 2.6 weeks) mediated associations between the perceived neighborhood environment at time 1 and depressive symptoms at time 2 (29 ± 2.7 weeks). An increase in avoidance coping between times 1 and 2 also mediated the effects of perceived neighborhood environment at time 1 on depressive symptoms at time 2. Pregnant African-American women's negative perceptions of their neighborhoods in the second trimester were related to higher levels of depressive symptoms in the third trimester. If these results are replicable in prospective studies with larger sample sizes, intervention strategies could be implemented at the individual level to support pregnant women in their ability to cope with adverse neighborhood conditions and ultimately improve their mental health. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

The Impact of Neighborhood Environment, Social Support and Avoidance Coping on Depressive Symptoms of Pregnant African American Women

PubMed Central

Giurgescu, Carmen; Zenk, Shannon N.; Templin, Thomas; Engeland, Christopher G.; Dancy, Barbara L.; Park, Chang; Kavanaugh, Karen; Dieber, William; Misra, Dawn

2015-01-01

Background Although depressive symptoms during pregnancy have been related to negative maternal and child health outcomes such as preterm birth, low birthweight infants, postpartum depression and maladaptive mother-infant interactions, studies on the impact of neighborhood environment on depressive symptoms in pregnant women are limited. Pregnant women residing in disadvantaged neighborhoods reported higher levels of depressive symptoms and lower levels of social support. No researchers have examined the relationship between neighborhood environment and avoidance coping in pregnant women. Guided by the Ecological model and Lazarus and Folkman’s transactional model of stress and coping, we examined whether social support and avoidance coping mediated associations between the neighborhood environment and depressive symptoms in pregnant African American women. Methods Pregnant African American women (N = 95) from a medical center in Chicago completed the instruments twice during pregnancy between 15-25 weeks and 25-37 weeks. The self-administered instruments measured perceived neighborhood environment, social support, avoidance coping, and depressive symptoms using items from existing scales. Objective measures of the neighborhood environment were derived using geographic information systems. Findings Perceived neighborhood environment, social support, avoidance coping and depressive symptoms were significantly correlated in the expected directions. Objective physical disorder and crime were negatively related to social support. Social support at time one (20 ± 2.6 weeks) mediated associations between the perceived neighborhood environment at time one and depressive symptoms at time two (29 ± 2.7 weeks). An increase in avoidance coping between time one and time two also mediated the effects of perceived neighborhood environment at time one on depressive symptoms at time two. Conclusion Pregnant African American women’s negative perceptions of their neighborhoods in the second trimester were related to higher levels of depressive symptoms in the third trimester. If these results are replicable in prospective studies with larger sample sizes, intervention strategies could be implemented at the individual level to support pregnant women in their ability to cope with adverse neighborhood conditions and ultimately improve their mental health. PMID:25840930

In vitro interactions between amphotericin B and hydrocortisone: potential implications for intrathecal therapy.

PubMed

Hodge, Greg; Cohen, Stuart H; Thompson, George R

2015-09-01

Fungal meningitis remains a severe and often lethal infection requiring aggressive antifungal therapy and in refractory cases the use of intrathecal amphotericin B (AmB). Administration of amphotericin B by this method may result in clinically apparent adverse reactions such as paresthesias, radiculitis, or myelopathy. Coadministration of hydrocortisone is therefore often given in an attempt to avoid these effects; however, the potential consequences of this approach on fungal growth or on drug synergy/antagonism had not previously been assessed. We used the checkerboard titration broth microdilution method to analyze interactions by fractional inhibitory concentration indices (FICIs). The combination of amphotericin B and hydrocortisone resulted in synergy or indifference against all isolates (Candida, Cryptococcus, and Coccidioides) during in vitro testing at low concentrations. Antagonism was observed using higher hydrocortisone concentrations (those not observed in vivo) suggesting possible steric hindrance or binding to AmB may occur at doses unlikely to be present during clinical care. Concurrent hydrocortisone and AmB administration should not be avoided due to in vitro antagonism concerns. © The Author 2015. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Preventing secondary infections among HIV-positive persons.

PubMed Central

Filice, G A; Pomeroy, C

1991-01-01

Secondary infectious diseases contribute substantially to morbidity and mortality of people infected with human immunodeficiency virus (HIV). The authors developed comprehensive, practical recommendations for prevention of infectious complications in HIV-infected people. Recommendations are concerned with the pathogens that are more common or more severe in HIV-infected people. Several infectious complications can be prevented by avoiding ingestion of contaminated food or water. Zoonoses can be prevented by precautions to be taken in contacts with animals. The risk of several fungal diseases can be reduced if activities likely to lead to inhalation of spores are avoided. HIV-infected people should be advised how to lower adverse health effects of travel, especially international travel. The potential for infectious complications of sexual activity and illicit drug use should be stressed, and recommendations to reduce the risk are discussed. Recommendations for use of vaccines in HIV-infected people are reviewed. Blood CD4+ lymphocyte concentrations, tuberculin skin testing, Toxoplasma serology, and sexually transmitted disease screening should be performed in certain subsets of HIV-infected people. Guidelines for chemoprophylaxis against Pneumocystis carinii and tuberculosis are presented. Recent data suggest that intravenous immunoglobulin therapy may prevent bacterial infections in HIV-infected children. PMID:1910184

The long road to employment: Incivility experienced by job seekers.

PubMed

Ali, Abdifatah A; Ryan, Ann Marie; Lyons, Brent J; Ehrhart, Mark G; Wessel, Jennifer L

2016-03-01

This study addresses how job seekers' experiences of rude and discourteous treatment--incivility--can adversely affect self-regulatory processes underlying job searching. Using the social-cognitive model (Zimmerman, 2000), we integrate social-cognitive theory with the goal orientation literature to examine how job search self-efficacy mediates the relationship between incivility and job search behaviors and how individual differences in learning goal orientation and avoid-performance goal orientation moderate that process. We conducted 3 studies with diverse methods and samples. Study 1 employed a mixed-method design to understand the nature of incivility within the job search context and highlight the role of attributions in linking incivility to subsequent job search motivation and behavior. We tested our hypotheses in Study 2 and 3 employing time-lagged research designs with unemployed job seekers and new labor market entrants. Across both Study 2 and 3 we found evidence that the negative effect of incivility on job search self-efficacy and subsequent job search behaviors are stronger for individuals low, rather than high, in avoid-performance goal orientation. Theoretical implications of our findings and practical recommendations for how to address the influence of incivility on job seeking are discussed. (c) 2016 APA, all rights reserved).

Problem coping skills, psychosocial adversities and mental health problems in children and adolescents as predictors of criminal outcomes in young adulthood.

PubMed

Aebi, Marcel; Giger, Joël; Plattner, Belinda; Metzke, Christa Winkler; Steinhausen, Hans-Christoph

2014-05-01

The purpose of this study was to test child and adolescent psychosocial and psychopathological risk factors as predictors of adult criminal outcomes in a Swiss community sample. In particular, the role of active and avoidant problem coping in youths was analysed. Prevalence rates of young adult crime convictions based on register data were calculated. Univariate and multivariate logistic regressions were used to analyse the prediction of adult criminal convictions 15 years after assessment in a large Swiss community sample of children and adolescents (n = 1,086). Risk factors assessed in childhood and adolescence included socio-economic status (SES), migration background, perceived parental behaviour, familial and other social stressors, coping styles, externalizing and internalizing problems and drug abuse including problematic alcohol consumption. The rate of any young adult conviction was 10.1 %. Besides externalizing problems and problematic alcohol consumption, the presence of any criminal conviction in young adulthood was predicted by low SES and avoidant coping even after controlling for the effects of externalizing problems and problematic alcohol use. The other predictors were significant only when externalizing behaviours and problematic alcohol use were not controlled. In addition to child and adolescent externalizing behaviour problems and substance use, low SES and inadequate problem-solving skills, in terms of avoidant coping, are major risk factors of young adult criminal outcomes and need to be considered in forensic research and criminal prevention programs.

Sustained Virological Response after 8-Week Treatment of Simeprevir with Peginterferon α-2a plus Ribavirin in a Japanese Female with Hepatitis C Virus Genotype 1b and IL28B Minor Genotype

PubMed Central

Kanda, Tatsuo; Nakamura, Masato; Sasaki, Reina; Yasui, Shin; Nakamoto, Shingo; Haga, Yuki; Jiang, Xia; Wu, Shuang; Tawada, Akinobu; Arai, Makoto; Imazeki, Fumio; Yokosuka, Osamu

2015-01-01

Direct-acting antivirals with or without peginterferon α (PEG-IFN α) plus ribavirin are now available for the treatment of hepatitis C virus (HCV) infection. Direct-acting antivirals are potent inhibitors of HCV replication, but some of them occasionally possess serious adverse events. We experienced a 64-year-old female with chronic HCV genotype 1b infection who showed elevated alanine aminotransferase of 528 IU/l at week 9 after the commencement of treatment of simeprevir with PEG-IFN α-2a plus ribavirin. However, she achieved sustained virological response at week 24 after the end of treatment. In Japan, we also have to treat elderly patients infected with HCV and/or advanced hepatic fibrosis. Until an effective interferon-free regimen is established, direct-acting antivirals with PEG-IFN plus ribavirin may still play a role in the treatment for certain patients. To avoid serious results from adverse events, careful attention and follow-up will be needed in the treatment course of simeprevir with PEG-IFN plus ribavirin for chronic HCV infection. PMID:26269697

Acute pancreatitis with saw palmetto use: a case report.

PubMed

Bruminhent, Jackrapong; Carrera, Perliveh; Li, Zhongzhen; Amankona, Raymond; Roberts, Ingram M

2011-08-25

Saw palmetto is a phytotherapeutic agent commercially marketed for the treatment of benign prostatic hyperplasia. Evidence suggests that saw palmetto is a safe product, and mild gastrointestinal adverse effects have been reported with its use. We report a case of acute pancreatitis, possibly secondary to the use of saw palmetto. A 61-year-old Caucasian man with a history of benign prostatic hyperplasia and gastroesophageal reflux disease developed epigastric pain associated with nausea 36 hours prior to presentation. He denied drinking alcohol prior to the development of his symptoms. His home medications included saw palmetto, lansoprazole and multivitamins. Laboratory results revealed elevated lipase and amylase levels. An abdominal ultrasound demonstrated a nondilated common bile duct, without choledocholithiasis. Computed tomography of his abdomen showed the pancreatic tail with peripancreatic inflammatory changes, consistent with acute pancreatitis. Our patient's condition improved with intravenous fluids and pain management. On the fourth day of hospitalization his pancreatic enzymes were within normal limits: he was discharged home and advised to avoid taking saw palmetto. It is our opinion that a relationship between saw palmetto and the onset of acute pancreatitis is plausible, and prescribers and users of saw palmetto should be alert to the possibility of such adverse reactions.

Safe prescribing: a titanic challenge

PubMed Central

Routledge, Philip A

2012-01-01

The challenge to achieve safe prescribing merits the adjective ‘titanic’. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the ‘Seven C's’. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. PMID:22738396

Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis

PubMed Central

Schapowal, Andreas

2002-01-01

Objectives To compare the efficacy and tolerability of butterbur (Petasites hybridus) with cetirizine in patients with seasonal allergic rhinitis (hay fever). Design Randomised, double blind, parallel group comparison. Setting Four outpatient general medicine and allergy clinics in Switzerland and Germany. Participants 131 patients were screened for seasonal allergic rhinitis and 125 patients were randomised (butterbur 61; cetirizine 64). Interventions Butterbur (carbon dioxide extract tablets, ZE 339) one tablet, four times daily, or cetirizine, one tablet in the evening, both given for two consecutive weeks. Main outcome measures Scores on SF-36 questionnaire and clinical global impression scale. Results Improvement in SF-36 score was similar in the two treatment groups for all items tested hierarchically. Butterbur and cetirizine were also similarly effective with regard to global improvement scores on the clinical global impression scale (median score 3 in both groups). Both treatments were well tolerated. In the cetirizine group, two thirds (8/12) of reported adverse events were associated with sedative effects (drowsiness and fatigue) despite the drug being considered a non-sedating antihistamine. Conclusions The effects of butterbur are similar to those of cetirizine in patients with seasonal allergic rhinitis when evaluated blindly by patients and doctors. Butterbur should be considered for treating seasonal allergic rhinitis when the sedative effects of antihistamines need to be avoided. What is already known on this topicSeasonal allergic rhinitis (hay fever) is common in countries with temperate climates.Most patients have their symptoms treated for short periods, particularly during peaks in atmospheric pollen countWhat this study addsAfter two weeks, the effects of butterbur and cetirizine were comparable in patients with hay feverButterbur produced fewer sedating effects than cetirizineButterbur should be considered when the sedating effects of antihistamines must be avoided PMID:11799030

Has aerobic exercise effect on pain perception in persons with migraine and coexisting tension-type headache and neck pain? A randomized, controlled, clinical trial.

PubMed

Krøll, L S; Sjödahl Hammarlund, C; Gard, G; Jensen, R H; Bendtsen, L

2018-04-10

A large subset of persons with migraine suffers from coexisting tension-type headache and neck pain which may adversely affect the prognosis of migraine. Aerobic exercise has been shown to decrease migraine burden in these persons. Therefore, the aim of this study was to investigate whether the effect of aerobic exercise in persons with migraine and coexisting tension-type headache and neck pain can be explained by changes in pain perception. Seventy consecutively recruited persons with migraine and coexisting tension-type headache and neck pain were randomized into exercise group or control group. Aerobic exercise consisted of bike/cross-trainer/brisk walking for 45 min, three times/week for 3 months. Controls continued their usual daily activities. Pericranial tenderness, pain thresholds, supra-thresholds and temporal summation were assessed at baseline, after treatment and at follow-up (6 months from baseline). Fifty-two persons with migraine and coexisting tension-type headache and neck pain completed the study. Aerobic exercise did not induce consistent changes in nociceptive pathways measured by pericranial tenderness, pressure pain thresholds and sensitivity to electrical stimulation. The effect of aerobic exercise cannot be explained by measurable effects on the pain modulation system. Thus, the positive effect on migraine burden may rather be explained by positive alteration of avoidance behaviour. Aerobic exercise can be recommended as a safe and inexpensive migraine treatment strategy. This study adds further knowledge about the positive effect of aerobic exercise for persons with migraine and coexisting tension-type headache and neck pain. This effect cannot be measured by changes in pain modulation, but may rather be explained by positive alteration of avoidance behaviour. © 2018 European Pain Federation - EFIC®.

Avoidable errors in dealing with anaphylactoid reactions to iodinated contrast media.

PubMed

Segal, Arthur J; Bush, William H

2011-03-01

Contrast reactions are much less common today than in the past. This is principally because of the current and predominant use of low and iso-osmolar contrast media compared with the prior use of high osmolality contrast media. As a result of the significantly diminished frequency, there are now fewer opportunities for physicians to recognize and appropriately treat such adverse reactions. In review of the literature combined with our own clinical and legal experience, 12 potential errors were identified and these are reviewed in detail so that they can be avoided by the physician-in-charge. Basic treatment considerations are presented along with a plan to systematize an approach to contrast reactions, simplify treatment options and plans, and schedule periodic drills.

Management of Asymptomatic Bacteriuria, Urinary Catheters and Symptomatic Urinary Tract Infections in Patients Undergoing Surgery for Joint Replacement: A Position Paper of the Expert Group 'Infection' of swissorthopaedics

PubMed Central

Sendi, Parham; Borens, Olivier; Wahl, Peter; Clauss, Martin; Uçkay, Ilker

2017-01-01

In this position paper, we review definitions related to this subject and the corresponding literature. Our recommendations include the following statements. Asymptomatic bacteriuria, asymptomatic leukocyturia, urine discolouration, odd smell or positive nitrite sediments are not an indication for antimicrobial treatment. Antimicrobial treatment of asymptomatic bacteriuria does not prevent periprosthetic joint infection, but is associated with adverse events, costs and antibiotic resistance development. Urine analyses or urine cultures in asymptomatic patients undergoing orthopaedic implants should be avoided. Indwelling urinary catheters are the most frequent reason for healthcare-associated urinary tract infections and should be avoided or removed as soon as possible. PMID:28894690

Graphic Canadian Cigarette Warning Labels and Adverse Outcomes: Evidence from Canadian Smokers

PubMed Central

Hammond, David; Fong, Geoffrey T.; McDonald, Paul W.; Brown, K. Stephen; Cameron, Roy

2004-01-01

Objectives. We assessed the impact of graphic Canadian cigarette warning labels. Methods. We used a longitudinal telephone survey of 616 adult smokers. Results. Approximately one fifth of participants reported smoking less as a result of the labels; only 1% reported smoking more. Although participants reported negative emotional responses to the warnings including fear (44%) and disgust (58%), smokers who reported greater negative emotion were more likely to have quit, attempted to quit, or reduced their smoking 3 months later. Participants who attempted to avoid the warnings (30%) were no less likely to think about the warnings or engage in cessation behavior at follow-up. Conclusions. Policymakers should not be reluctant to introduce vivid or graphic warnings for fear of adverse outcomes. PMID:15284057

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.

Psychiatric stigma in the military.

PubMed

Porter, T L; Johnson, W B

1994-09-01

There is potential for the stigma of mental health care to directly affect an active duty member's career. The authors are aware of cases in which fear of adverse career consequences has led service members to avoid needed mental health care. In order to investigate the legitimacy of this fear, the authors surveyed 252 USN and USMC commanding and executive officers concerning their attitudes about service members who had received mental health and other services; 138 responded. Overall the responses were neutral and there were relatively few negative evaluations of service members who had received services. Military health care providers should take an active role in diminishing the stigma of mental illness, and in allaying fears of adverse career consequences for seeking care.

Regional Anesthesia to Scalp for Craniotomy: Innovation With Innervation.

PubMed

Jayaram, Kavitha; Srilata, Moningi; Kulkarni, Dilipkumar; Ramachandran, Gopinath

2016-01-01

Effective management and pain prevention is of great importance to avoid postoperative complications such as hypertension, agitation, and vomiting. All these adverse events may lead to elevation in intracranial pressure and, in turn, unfavorable outcome and prolonged hospital stay. Development of multiple methods of analgesia may contribute to the alleviation of problems due to pain. We tested the effectiveness of bilateral maxillary block with greater and lesser occipital nerve block for providing analgesia to the scalp. This study was undertaken in 40 patients scheduled for craniotomy. Before skin incision, patients were assigned randomly to receive either bilateral maxillary (group M) or scalp block (group S). Data on intraoperative hemodynamics, postoperative analgesia, and sedation were collected and analyzed for statistical significance. The primary outcome was the visual analog pain score. It was similar between the 2 groups at 1, 2, and 4 hours after extubation. At 12 hours, the maxillary block group had better analgesia (mean visual analog score: 3.4 cm for group M and 4.1 cm for group S with P-value of 0.0002) and sedation scores. Intraoperatively, there was no difference in the heart rate, blood pressure, and the anesthetic requirements between both the groups. Three patients in group S required fentanyl supplementation in the intraoperative period. There were no adverse events noted in the perioperative period among both the groups. Maxillary block along with greater and lesser occipital nerve block is an effective alternative to scalp block for craniotomy and has longer duration of analgesia.

Traditional practices used by infertile women in Turkey.

PubMed

Ayaz, S; Efe, S Yaman

2010-09-01

Numerous traditional methods are used in the treatment of infertility around the world. To identify the traditional practices of infertile women using one clinic in Ankara, Turkey. The population comprised all women (5700) who attended one infertility outpatient clinic in 2007. The sample was calculated using sample calculation formula and 410 women were included in the study. The survey method was used for data collection. Of the responding women, 27.3% had tried a traditional practice, and 67.8% who tried traditional practices used an herbal mixture. The reason for the women's use of a traditional practice was 'hope' (66.9%), and 15.2% of them had experienced an adverse effect related with traditional practice. Maternal education level, perceived economic status, duration of marriage all significantly affected the use of traditional practices (P<0.05). The women who had received unsuccessful medical treatment for infertility and who had experienced side effects after medical treatment had a higher rate of use of traditional practice (P<0.05). Almost one in three of the women who responded to the questionnaire had tried traditional methods, and some experienced adverse effects related to the practice. For couples with infertility problems, educational programmes and consultation services should be organized with respect to their traditional culture. Women should be informed about the hazards of traditional practices and avoidance of harmful practices, and continuous emotional support must be provided for infertile couples. In the future, nursing staff should play a much larger role in these supportive services.

Ethanolic extracts of Alstonia Scholaris and Bacopa Monniera possess neuroleptic activity due to anti-dopaminergic effect

PubMed Central

Jash, Rajiv; Chowdary, K. Appana

2014-01-01

Background: An increased inclination has been observed for the use of herbal drugs in chronic and incurable diseases. Treatment of psychiatric diseases like schizophrenia is largely palliative and more importantly, a prominent adverse effect prevails with the majority of anti-psychotic drugs, which are the extrapyramidal motor disorders. Existing anti-psychotic drug therapy is not so promising, and their adverse effect is a matter of concern for continuing the therapy for long duration. Objective: This experimental study was done to evaluate the neuroleptic activity of the ethanolic extracts of two plants Alstonia Scholaris and Bacopa Monnieri with different anti-psychotic animal models with a view that these plant extracts shall have no or at least reduced adverse effect so that it can be used for long duration. Materials and Methods: Two doses of both the extracts (100 and 200 mg/kg) and also standard drug haloperidol (0.2 mg/kg) were administered to their respective groups once daily with 5 different animal models. After that, the concentration of the dopamine neurotransmitter was estimated in two different regions of the brain viz. frontal cortex and striatum. Results: The result of the study indicated a significant reduction of amphetamine-induced stereotype and conditioned avoidance response for both the extracts compared with the control group, but both did not have any significant effect in phencyclidine-induced locomotor activity and social interaction activity. However, both the extracts showed minor signs of catalepsy compared to the control group. The study also revealed that the neuroleptic effect was due to the reduction of the dopamine concentration in the frontal cortex region of the rat brain. The results largely pointed out the fact that both the extract may be having the property to alleviate the positive symptoms of schizophrenia by reducing the dopamine levels of dopaminergic neurons of the brain. Conclusion: The estimation of dopamine in the two major regions of brain indicated the alteration of dopamine levels was the reason for the anti-psychotic activity as demonstrated by the different animal models. PMID:24497742

Why Clinicians Don't Report Adverse Drug Events: Qualitative Study.

PubMed

Hohl, Corinne M; Small, Serena S; Peddie, David; Badke, Katherin; Bailey, Chantelle; Balka, Ellen

2018-02-27

Adverse drug events are unintended and harmful events related to medications. Adverse drug events are important for patient care, quality improvement, drug safety research, and postmarketing surveillance, but they are vastly underreported. Our objectives were to identify barriers to adverse drug event documentation and factors contributing to underreporting. This qualitative study was conducted in 1 ambulatory center, and the emergency departments and inpatient wards of 3 acute care hospitals in British Columbia between March 2014 and December 2016. We completed workplace observations and focus groups with general practitioners, hospitalists, emergency physicians, and hospital and community pharmacists. We analyzed field notes by coding and iteratively analyzing our data to identify emerging concepts, generate thematic and event summaries, and create workflow diagrams. Clinicians validated emerging concepts by applying them to cases from their clinical practice. We completed 238 hours of observations during which clinicians investigated 65 suspect adverse drug events. The observed events were often complex and diagnosed over time, requiring the input of multiple providers. Providers documented adverse drug events in charts to support continuity of care but never reported them to external agencies. Providers faced time constraints, and reporting would have required duplication of documentation. Existing reporting systems are not suited to capture the complex nature of adverse drug events or adapted to workflow and are simply not used by frontline clinicians. Systems that are integrated into electronic medical records, make use of existing data to avoid duplication of documentation, and generate alerts to improve safety may address the shortcomings of existing systems and generate robust adverse drug event data as a by-product of safer care. ©Corinne M Hohl, Serena S Small, David Peddie, Katherin Badke, Chantelle Bailey, Ellen Balka. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 27.02.2018.

Nanocarriers for optimizing the balance between interfollicular permeation and follicular uptake of topically applied clobetasol to minimize adverse effects.

PubMed

Mathes, C; Melero, A; Conrad, P; Vogt, T; Rigo, L; Selzer, D; Prado, W A; De Rossi, C; Garrigues, T M; Hansen, S; Guterres, S S; Pohlmann, A R; Beck, R C R; Lehr, C-M; Schaefer, U F

2016-02-10

The treatment of various hair disorders has become a central focus of good dermatologic patient care as it affects men and women all over the world. For many inflammatory-based scalp diseases, glucocorticoids are an essential part of treatment, even though they are known to cause systemic as well as local adverse effects when applied topically. Therefore, efficient targeting and avoidance of these side effects are of utmost importance. Optimizing the balance between drug release, interfollicular permeation, and follicular uptake may allow minimizing these adverse events and simultaneously improve drug delivery, given that one succeeds in targeting a sustained release formulation to the hair follicle. To test this hypothesis, three types of polymeric nanocarriers (nanospheres, nanocapsules, lipid-core nanocapsules) for the potent glucocorticoid clobetasol propionate (CP) were prepared. They all exhibited a sustained release of drug, as was desired. The particles were formulated as a dispersion and hydrogel and (partially) labeled with Rhodamin B for quantification purposes. Follicular uptake was investigated using the Differential Stripping method and was found highest for nanocapsules in dispersion after application of massage. Moreover, the active ingredient (CP) as well as the nanocarrier (Rhodamin B labeled polymer) recovered in the hair follicle were measured simultaneously, revealing an equivalent uptake of both. In contrast, only negligible amounts of CP could be detected in the hair follicle when applied as free drug in solution or hydrogel, regardless of any massage. Skin permeation experiments using heat-separated human epidermis mounted in Franz Diffusion cells revealed equivalent reduced transdermal permeability for all nanocarriers in comparison to application of the free drug. Combining these results, nanocapsules formulated as an aqueous dispersion and applied by massage appeare to be a good candidate to maximize follicular targeting and minimize drug penetration into the interfollicular epidermis. We conclude that such nanotechnology-based formulations provide a viable strategy for more efficient drug delivery to the hair follicle. Moreover, they present a way to minimize adverse effects of potent glucocorticoids by releasing the drug in a controlled manner and simultaneously decreasing interfollicular permeation, offering an advantage over conventional formulations for inflammatory-based skin/scalp diseases. Copyright © 2015 Elsevier B.V. All rights reserved.

Exposure to Secondhand Tobacco Smoke and Interventions Among Pregnant Women in China: A Systematic Review

PubMed Central

Hsia, Jason; Tu, Xiaoming; Xia, Yang; Zhang, Lihong; Bi, Zhenqiang; Liu, Hongyan; Li, Xiaoming; Stanton, Bonita

2015-01-01

Introduction Smoking prevalence is high among men in China. One result is that a large number of nonsmoking Chinese women may be exposed daily to secondhand smoke (SHS). Exposure is particularly problematic for pregnant women because of potential adverse reproductive effects. To determine the extent of this exposure and to summarize existing intervention studies designed to reduce SHS exposure in China, a systematic review of the literature published from 1995 through 2012 was conducted. Methods We searched the PubMed and Wanfang databases for studies published from 1995 through 2012 using various search terms including SHS, pregnant women, and China. Only articles on prevalence of SHS exposure and interventions to reduce exposure to SHS were selected. Results We identified 132 studies during the initial searches. Eight of 13 eligible studies reported the prevalence of SHS exposure among pregnant women; estimates ranged from 38.9% to 75.1%. Few SHS prevention interventions among pregnant women in China have been studied; we found only 5 such studies. The interventions primarily focused on changing husbands’ smoking behaviors; some interventions focused on women’s avoidance behaviors. Conclusion Prevalence of exposure to SHS among pregnant women is high in China. Information is limited on effective interventions to protect pregnant women from exposure. The results of this review can provide the basis for the design and evaluation of interventions to help pregnant women avoid SHS exposure. PMID:25789496

Avoiding Weight Gain in Cardiometabolic Disease: A Systematic Review

PubMed Central

Maruthur, Nisa M.; Fawole, Oluwakemi A.; Wilson, Renee F.; Lau, Brandyn D.; Anderson, Cheryl A. M.; Bleich, Sara N.; Segal, Jodi

2014-01-01

Patients with cardiometabolic disease are at higher risk for obesity-related adverse effects. Even without weight loss, weight maintenance may be beneficial. We performed a systematic review to identify the effect of nonweight loss-focused lifestyle interventions in adults with cardiometabolic disease. We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify comparative studies of lifestyle interventions (self-management, diet, exercise, or their combination) without a weight loss focus in adults with or at risk for diabetes and cardiovascular disease. Weight, BMI, and waist circumference at ≥12 months were the primary outcomes. Of 24,870 citations, we included 12 trials (self-management, n = 2; diet, n = 2; exercise, n = 2; combination, n = 6) studying 4,206 participants. Self-management plus physical activity ± diet versus minimal/no intervention avoided meaningful weight (−0.65 to −1.3 kg) and BMI (−0.4 to −0.7 kg/m2) increases. Self-management and/or physical activity prevented meaningful waist circumference increases versus control (−2 to −4 cm). In patients with cardiometabolic disease, self-management plus exercise may prevent weight and BMI increases and self-management and/or exercise may prevent waist circumference increases versus minimal/no intervention. Future studies should confirm these findings and evaluate additional risk factors and clinical outcomes. PMID:25610639

Open top culverts as an alternative drainage system to minimize ecological effects in earth roads.

NASA Astrophysics Data System (ADS)

García, Jose L.; Elorrieta, Jose; Robredo, Jose C.; García, Ricardo; García, Fernando; Gimenez, Martin C.

2013-04-01

During the last fifteen years a research team from School of Forestry at the Technical University of Madrid (Spain) has developed several competitive research projects regarding forest roads and open top culverts. A first approach was established with a prototype of 7 meters length in a hydraulic channel at the laboratory determining main parameters of different open top culverts in relation to different sizes of gravels and the self washing properties relationship with different slopes up to 8 %. The curves obtained may help to properly install these drainage systems avoiding maintenance costs. In addition more targeted pilot studies were developed in different forest earth roads in center and north Spain. The construction of the stations under study was financed by the U.P.M and the R&D National Plan. The main outcomes relates the low variation of humidity in a 20 m. wide range at both sides of the open top culverts and several considerations relating the angle of installation, the spacing of such drainage systems and the benefits against rilling along the roads. Also the erosion produced downhill was established and some construction methods to avoid adverse ecological effects. The diffusion of results includes congresses and a small booklet with a great acceptance in forestry services. Also a patent (ES 2 262 437) of an advanced model has been registered.

New developments and concepts related to biomarker application to vaccines

PubMed Central

Ahmed, S. Sohail; Black, Steve; Ulmer, Jeffrey

2012-01-01

Summary This minireview will provide a perspective on new developments and concepts related to biomarker applications for vaccines. In the context of preventive vaccines, biomarkers have the potential to predict adverse events in select subjects due to differences in genetic make‐up/underlying medical conditions or to predict effectiveness (good versus poor response). When expanding them to therapeutic vaccines, their utility in identification of patients most likely to respond favourably (or avoid potentially negative effects of treatment) becomes self‐explanatory. Despite the progress made so far on dissection of various pathways of biological significance in humans, there is still plenty to unravel about the mysteries related to the quantitative and qualitative aspects of the human host response. This review will provide a focused overview of new concepts and developments in the field of vaccine biomarkers including (i) vaccine‐dependent signatures predicting subject response and safety, (ii) predicting therapeutic vaccine efficacy in chronic diseases, (iii) exploring the genetic make‐up of the host that may modulate subject‐specific adverse events or affect the quality of immune responses, and (iv) the topic of volunteer stratification as a result of biomarker screening (e.g. for therapeutic vaccines but also potentially for preventive vaccines) or as a reflection of an effort to compare select groups (e.g. vaccinated subjects versus patients recovering from infection) to enable the discovery of clinically relevant biomarkers for preventive vaccines. PMID:21895991

GILBERT'S SYNDROME - A CONCEALED ADVERSITY FOR PHYSICIANS AND SURGEONS.

PubMed

Rasool, Ahsan; Sabir, Sabir; Ashlaq, Muhammad; Farooq, Umer; Khan, Muhammad Zatmar; Khan, Faisal Yousaf

2015-01-01

Gilbert's syndrome (often abbreviated as GS) is most common hereditary cause of mild unconjugated (indirect) hyperbilirubinemia. Various studies have been published depicting clinical and pharmacological effects of Gilbert's syndrome (GS). However GS as a sign of precaution for physician and surgeons has not been clearly established. A systematic study of the available literature was done. Key words of Gilbert's syndrome, hyperbilirubinemia and clinical and pharmacological aspects of GS were searched using PubMed as search engine. Considering the study done in last 40 years, 375 articles were obtained and their abstracts were studied. The criterion for selecting the articles for through study was based on their close relevance with the topic. Thus 40 articles and 2 case reports were thoroughly studied. It was concluded that Gilbert's syndrome has immense clinical importance because the mild hyperbilirubinemia can be mistaken for a sign of occult, chronic, or progressive liver disease. GS is associated with lack of detoxification of few drugs. It is related with spherocytosis, cholithiasis, haemolytic anaemia, intra-operative toxicity, irinotecan toxicity, schizophrenia and problems in morphine metabolism. It also has profound phenotypic effect as well. The bilirubin level of a GS individual can rise abnormally high in various conditions in a person having Gilbert's syndrome. This can mislead the physicians and surgeons towards false diagnosis. Therefore proper diagnosis of GS should be ascertained in order to avoid the concealed adversities of this syndrome.

Hydrocortisone in the management of acute hypoadrenocorticism in dogs: a retrospective series of 30 cases.

PubMed

Gunn, E; Shiel, R E; Mooney, C T

2016-05-01

The objectives of this study were to describe the efficacy, outcome and adverse effects of intravenous hydrocortisone and fluid therapy for the management of acute hypoadrenocorticism in dogs. A retrospective review of dogs with primary hypoadrenocorticism receiving intravenous hydrocortisone and fluid therapy was performed. Thirty newly-diagnosed dogs were included. There was an excellent clinical response, with all dogs surviving to discharge within a median of 2 days. In 23 cases with complete data, the mean rate of change of sodium over 24 hours was 0·48 (±0·28) mmol/L/hour, while the mean rate of change of potassium was -0·12 (±0·06) mmol/L/hour. Circulating potassium concentration normalised in 68·4% and 100% of cases of by 12 and 24 hours, respectively. Additional treatment for hyperkalaemia was not found necessary. Plasma sodium concentration increased by >12 mmol/L/24 hours on 7 of 23 (30·4%) occasions. One dog exhibited associated temporary neurological signs. Intravenous hydrocortisone infusion and fluid therapy for the management of acute hypoadrenocorticism is associated with a rapid resolution of hyperkalaemia and is well tolerated with few adverse effects. Regular electrolyte monitoring is required to ensure that rapid increases in sodium concentration are avoided. © 2016 British Small Animal Veterinary Association.

Using technology to prevent adverse drug events in the intensive care unit.

PubMed

Hassan, Erkan; Badawi, Omar; Weber, Robert J; Cohen, Henry

2010-06-01

Critically ill patients are particularly susceptible to adverse drug events (ADEs) due to their rapidly changing and unstable physiology, complex therapeutic regimens, and large percentage of medications administered intravenously. There are a wide variety of technologies that can help prevent the points of failure commonly associated with ADEs (i.e., the five "Rights": right patient; right drug; right route; right dose; right frequency). These technologies are often categorized by their degree of complexity to design and engineer and the type of error they are designed to prevent. Focusing solely on the software and hardware design of technology may over- or underestimate the degree of difficulty to avoid ADEs at the bedside. Alternatively, we propose categorizing technological solutions by identifying the factors essential for success. The two major critical success factors are: 1) the degree of clinical assessment required by the clinician to appropriately evaluate and disposition the issue identified by a technology; and 2) the complexity associated with effective implementation. This classification provides a way of determining how ADE-preventing technologies in the intensive care unit can be successfully integrated into clinical practice. Although there are limited data on the effectiveness of many technologies in reducing ADEs, we will review the technologies currently available in the intensive care unit environment. We will also discuss critical success factors for implementation, common errors made during implementation, and the potential errors using these systems.

Serious adverse events associated with yellow fever vaccine.

PubMed

de Menezes Martins, Reinaldo; Fernandes Leal, Maria da Luz; Homma, Akira

2015-01-01

Yellow fever vaccine was considered one of the safest vaccines, but in recent years it was found that it could rarely cause invasive and disseminated disease in some otherwise healthy individuals, with high lethality. After extensive studies, although some risk factors have been identified, the real cause of causes of this serious adverse event are largely unknown, but findings point to individual host factors. Meningoencephalitis, once considered to happen only in children less than 6 months of age, has also been identified in older children and adults, but with good prognosis. Efforts are being made to develop a safer yellow fever vaccine, and an inactivated vaccine or a vaccine prepared with the vaccine virus envelope produced in plants are being tested. Even with serious and rare adverse events, yellow fever vaccine is the best way to avoid yellow fever, a disease of high lethality and should be used routinely in endemic areas, and on people from non-endemic areas that could be exposed, according to a careful risk-benefit analysis.

Abacavir-induced fulminant hepatic failure in a HIV/HCV co-infected patient

PubMed Central

Haas, Christopher; Ziccardi, Mary Rodriguez; Borgman, Jody

2015-01-01

Abacavir hypersensitivity is a rare, yet significant adverse reaction that results in a spectrum of physical and laboratory abnormalities, and has been postulated to stem from a variety of aetiological factors. The major histocompatibility complex haplotype human leucocyte antigen (HLA)-B5701 is a significant risk factor in development of hypersensitivity reactions, yet only 55% of HLA-B5701+ individuals develop such reactions, suggesting a multifactorial aetiology. Nevertheless, prospective screening and avoidance of abacavir in these patients has limited adverse events. Within this spectrum of adverse events, abacavir-induced liver toxicity is exceedingly rare and reported events have ranged from mild elevations of aminotransferases to fulminant hepatic failure. We report the case of a 50-year-old Caucasian woman with a history significant for HIV, hepatitis C virus and a HLA-B5701+ status, transferred to our emergency department in a hypotensive state and found to have acute liver failure, acute renal failure and significant rhabdomyolysis following a change of highly active antiretroviral therapy regimen. PMID:26670894

Abacavir-induced fulminant hepatic failure in a HIV/HCV co-infected patient.

PubMed

Haas, Christopher; Ziccardi, Mary Rodriguez; Borgman, Jody

2015-12-15

Abacavir hypersensitivity is a rare, yet significant adverse reaction that results in a spectrum of physical and laboratory abnormalities, and has been postulated to stem from a variety of aetiological factors. The major histocompatibility complex haplotype human leucocyte antigen (HLA)-B5701 is a significant risk factor in development of hypersensitivity reactions, yet only 55% of HLA-B5701+ individuals develop such reactions, suggesting a multifactorial aetiology. Nevertheless, prospective screening and avoidance of abacavir in these patients has limited adverse events. Within this spectrum of adverse events, abacavir-induced liver toxicity is exceedingly rare and reported events have ranged from mild elevations of aminotransferases to fulminant hepatic failure. We report the case of a 50-year-old Caucasian woman with a history significant for HIV, hepatitis C virus and a HLA-B5701+ status, transferred to our emergency department in a hypotensive state and found to have acute liver failure, acute renal failure and significant rhabdomyolysis following a change of highly active antiretroviral therapy regimen. 2015 BMJ Publishing Group Ltd.

Effects of local nasal immunotherapy in allergic airway inflammation: Using urea denatured Dermatophagoides pteronyssinus

PubMed Central

Yu, Sheng-Jie; Liao, En-Chih; Tsai, Jaw-Ji

2015-01-01

Despite improvements in anti-allergy medication, the prevalence of allergic airway inflammation remains high, affecting up to 40% of the population worldwide. Allergen immunotherapy is effective for inducing tolerance but has the adverse effect of severe allergic reaction. This can be avoided by denaturing with urea. In this study, we demonstrated that the serum level of allergen-specific IgE in mice sensitized with native Dermatophagoides pteronyssinus (Der p) crude extract after receiving local nasal immunotherapy (LNIT) with urea-denatured Der p crude extract (DN-Dp) significantly decreased compared to that in the normal saline (NS) treatment group. Expressions of IL-4 were significantly reduced in lung tissues after treatment. Inflammation around the bronchial epithelium improved and airway hypersensitivity was down-regulated. LNIT with DN-Dp can down-regulate IL-1b, IL-6 and TNF-a expression and then decrease Der p-induced allergic airway inflammation. This therapeutic modality may be used as an alternative treatment for airway allergic diseases. PMID:25933184

[Individual versus collective protection: bioethical analysis of the national program of mass child vaccination].

PubMed

Lessa, Sérgio de Castro; Schramm, Fermin Roland

2015-01-01

Vaccination is considered one of the most efficient and cost-effective public health policies most used in the control and prevention of disease. However, it is also one of the most polemic and controversial biomedical techniques, making it difficult to avoid an ethical dilemma, especially when vaccination is compulsory for the entire population. Indeed, since vaccines are not totally effective and safe, there is an ethical conflict between the individual and the collective interest, because children effectively carry the burden of vaccination for the benefit of public health when they are affected with serious adverse reactions and do not benefit from the care that should be offered by the government. The objective of this article was to demonstrate that the tools of bioethics are relevant in this discussion to understand and analyze these dilemmas critically by providing convincing arguments to underpin the development of biopolitics that consider prevention not only rigorously, but also the joint responsibility of all as fundamental for individual and collective protection.

Use of Hematopoietic Growth Factor in the Management of Hematological Side Effects Associated to Antiviral Treatment for Hcv Hepatitis

PubMed Central

Mancino, Paola; Falasca, Katia; Ucciferri, Claudio; Pizzigallo, Eligio; Vecchiet, Jacopo

2010-01-01

Haematological abnormalities are common during combination antiviral therapy for chronic hepatitis C. Although dose reduction or discontinuation can easily treat these side effects, they can adversely affect the efficacy of combination antiviral therapy reducing the likelihood of a sustained viral response (SVR). To avoid potentially diminishing a patient’s chance of response, many physicians have begun using growth factors off-label to manage anaemia and neutropenia in hepatitis C. Haematopoietic growth factors are generally well tolerated and they may be useful for managing haematological side effects of anti-HCV therapy improving patients’ quality of life. To date, the role and benefit of these agents during anti-HCV therapy and their positive impact on SVR have not conclusively determined in the published studies. However, the possibility of a benefit to individual outpatients remains, and an individualized approach is recommended. This review explores the incidence, clinical significance, and management of anaemia, neutropenia and thrombocytopenia associated with combination therapy for HCV infection. PMID:21415945

Local anesthetic lidocaine delivery system: chitosan and hyaluronic acid-modified layer-by-layer lipid nanoparticles.

PubMed

Zhang, Laizhu; Wang, Jianguo; Chi, Huimin; Wang, Shilei

2016-11-01

Transdermal local anesthesia is one of the most applied strategies to avoid systemic adverse effects; there is an appealing need for a prolonged local anesthetic that would provide better bioavailability and longer pain relief with a single administration. Layer-by-layer (LBL) technique was used in this study to explore a nanosized drug delivery system for local anesthetic therapy. LBL-coated lidocaine-loaded nanostructured lipid nanoparticles (LBL-LA/NLCs) were prepared and characterized in terms of particle size (PS), zeta potential, drug encapsulation efficiency (EE), in vitro skin permeation and in vivo local anesthetic studies. Evaluation of the in vitro skin permeation and in vivo anesthesia effect illustrated that LBL-LA/NLCs can enhance and prolong the anesthetic effect of LA. LBL-LA/NLCs could function as a promising drug delivery strategy for overcoming the barrier function of the skin and could deliver anesthetic through the skin with sustained release behavior for local anesthetic therapy.

Vortical flow management for improved configuration aerodynamics: Recent experiences

NASA Technical Reports Server (NTRS)

Rao, D. M.

1983-01-01

Recent progress in vortex-control applications for alleviating the adverse consequences of three dimensional separation and vortical interactions on slender body/swept wing configurations is reported. Examples include helical separation trip to alleviate the side force due to forebody vortex asymmetry; hinged strakes to avoid vortex breakdown effects; compartmentation of swept leading edge separation to delay the pitch-up instability; under wing vortex trip and vortex trip and vortex flaps for drag reduction at high lift; and an apex-flap trimmer to fully utilize the lift capability of trailing-edge flaps for take off and landing of delta wings. Experimental results on generic wind-tunnel models are presented to illustrate the vortex-management concepts involved and to indicate their potential for enhancing the subsonic aerodynamics of supersonic-cruise type vehicles.

[Advance in studies on food allergy mechanism based on gut barrier].

PubMed

Wang, Juan-hong; Li, Huan-zhou; Li, Meng; Pan, Su-hua

2015-04-01

Food allergies, as a type of adverse immune-mediated reactions to ingested food proteins, have become a serious public health issue that harms children and adults health, with increasing incidence year by year. However, without effective therapy for food allergies, doctors-have mostly advised to avoid allergens and provided symptomatic treatment. According to the findings of many studies, allergic diseases are correlated with intestinal barrier function injury, as evidenced by the significant increase in the intestinal permeability among patients with food allergies. In this paper, recent studies on correlations between food allergies and intestinal barrier functions, intestinal barrier function injury mechanisms of allergic foods and food allergy intervention strategies based on intestinal barrier functions were summarized to provide reference for laboratory researches and clinical treatment of food allergic diseases.

Treatment of symptomatic coral reef aorta with an uncovered stent graft.

PubMed

Bosanquet, D C; Wood, A; Williams, I M

2015-10-01

Coral reef aorta is a rare condition characterised by extreme calcific growths affecting the juxta and suprarenal aorta. It can cause symptoms due to visceral ischaemia, lower limb hypoperfusion, and distal embolisation. We present a case of a 61-year-old man with unresponsive hypertension, who was found to have an occluded right renal artery, and an extensive coral reef aorta with a marked pressure gradient across the lesion. Renal hypoperfusion secondary to aortic coral reef aorta was thought to be the cause for his hypertension. Endovascular placement of a balloon expandable uncovered stent resolved his hypertension within one month, with no adverse effects noted at subsequent follow-up. Endovascular treatment of coral reef aorta is technically possible and avoids a major vascular procedure. © The Author(s) 2014.

Treatment of diabetes with encapsulated pig islets: an update on current developments*

PubMed Central

Zhu, Hai-tao; Lu, Lu; Liu, Xing-yu; Yu, Liang; Lyu, Yi; Wang, Bo

2015-01-01

The potential use of allogeneic islet transplantation in curing type 1 diabetes mellitus has been adequately demonstrated, but its large-scale application is limited by the short supply of donor islets and the need for sustained and heavy immunosuppressive therapy. Encapsulation of pig islets was therefore suggested with a view to providing a possible alternative source of islet grafts and avoiding chronic immunosuppression and associated adverse or toxic effects. Nevertheless, several vital elements should be taken into account before this therapy becomes a clinical reality, including cell sources, encapsulation approaches, and implantation sites. This paper provides a comprehensive review of xenotransplantation of encapsulated pig islets for the treatment of type 1 diabetes mellitus, including current research findings and suggestions for future studies. PMID:25990050

Endoscopic Options for Gastroesophageal Reflux: Where Are We Now and What Does the Future Hold?

PubMed

Triadafilopoulos, George

2016-09-01

Early in the twenty-first century, novel endoscopic techniques were introduced for the management of gastroesophageal reflux disease, providing minimally invasive ways to eliminate pharmacologic acid inhibition and avoid the need for anti-reflux surgery. These techniques do not significantly alter the anatomy of the gastroesophageal junction, minimizing short- and long-term adverse effects, such as dysphagia and bloating. After extensive clinical testing, many endoscopic therapies were abandoned due to either lack of durable efficacy or unfavorable safety profile. Today, only four such therapies remain clinically available, each with variable levels of clinical validation and market penetration. This review will provide an assessment of these endoscopic therapies, highlighting their respective strengths and weaknesses and their present and future applicability to patients with gastroesophageal reflux disease.

Update on Difficult Polypectomy Techniques.

PubMed

Ngamruengphong, Saowanee; Pohl, Heiko; Haito-Chavez, Yamile; Khashab, Mouen A

2016-01-01

Endoscopists often encounter colon polyps that are technically difficult to resect. These lesions traditionally were managed surgically, with significant potential morbidity and mortality. Recent advances in endoscopic techniques and instruments have allowed endoscopists to safely and effectively remove colorectal lesions with high technical and clinical success and potentially avoid invasive surgery. Endoscopic mucosal resection (EMR) has gained acceptance as the first-line therapy for large colorectal lesions. Endoscopic submucosal dissection (ESD) has been reported to be associated with higher rate of en bloc resection and less risk of short-time recurrence, but with an increased risk of adverse events. Therefore, the role of colorectal ESD should be restricted to lesions with high-risk morphologic features of submucosal invasion. In this article, we review the recent literature on the endoscopic management of difficult colorectal neoplasms.

[Reasonable and safe application of Shuxuetong injection and intravenous medication's combined application in acute cerebral infarction's therapy].

PubMed

Li, Ming-Quan; Xie, Yan-Ming; Zhao, Jian-Jun

2012-09-01

Shuxuetong injection is a kind of compound injection which is made from traditional Chinese medicine Hirudo and Pheretime, which has a clear anticoagulant, fibrinolytic promoting, blood rheology improving, blood lipids regulating and cell protecting effect, and the injection has been widely used in clinical. Especially, the injection has often been combined with other Chinese and modern medicine in the treatment of cerebral infarction disease. However, there are still many non-standard and irrational aspects in clinical practice so as to make a more reasonable and safer use of Shuxuetong injection. In order to avoid the occurrence of adverse reactions to provide a reference for regulating the use of the injection,the paper systematically expounds the Shuxuetong injection's main clinical problems and the reasonable combination.

Management of pemphigus vulgaris: challenges and solutions

PubMed Central

Gregoriou, Stamatis; Efthymiou, Ourania; Stefanaki, Christina; Rigopoulos, Dimitris

2015-01-01

The main objective in the treatment of pemphigus vulgaris is to control the disease, prevent relapses, and avoid adverse events associated with the prolonged use of steroids and immunosuppressive agents. Systemic corticosteroids remain the gold standard treatment for pemphigus vulgaris. Azathioprine and mycophenolate mofetil are the first line of steroid-sparing treatment. Rituximab is extremely effective in recalcitrant pemphigus, when other treatments fail to control the disease. The European Dermatology Forum recommends tapering prednisolone by 25% every 2 weeks after the consolidation phase, and a 5 mg reduction every 4 weeks when the dose is reduced to <20 mg. If the patient relapses, options include increasing steroids back to the previous dose, adding an immunosuppressant if using steroid monotherapy, or replacing a first-line immunosuppressant by another if already on combination therapy. PMID:26543381

Optimising mechanical properties of hot forged nickel superalloy 625 components

NASA Astrophysics Data System (ADS)

Singo, Nthambe; Coles, John; Rosochowska, Malgorzata; Lalvani, Himanshu; Hernandez, Jose; Ion, William

2018-05-01

Hot forging and subsequent heat treatment were resulting in substandard mechanical properties of nickel superalloy, Alloy 625, components. The low strength was found to be due to inadequate deformation during forging, excessive grain growth and precipitation of carbides during subsequent heat treatment. Experimentation in a drop forging company and heat treatment facility led to the establishment of optimal parameters to minimise grain size and mitigate the adverse effects of carbide precipitation, leading to successful fulfilment of mechanical property specifications. This was achieved by reducing the number of operations, maximising the extent of deformation by changing the slug dimensions and its orientation in the die, and minimising the time of exposure to elevated temperatures in both the forging and subsequent heat treatment processes to avoid grain growth.

Mechanistic Insights into Neurotoxicity Induced by Anesthetics in the Developing Brain

PubMed Central

Lei, Xi; Guo, Qihao; Zhang, Jun

2012-01-01

Compelling evidence has shown that exposure to anesthetics used in the clinic can cause neurodegeneration in the mammalian developing brain, but the basis of this is not clear. Neurotoxicity induced by exposure to anesthestics in early life involves neuroapoptosis and impairment of neurodevelopmental processes such as neurogenesis, synaptogenesis and immature glial development. These effects may subsequently contribute to behavior abnormalities in later life. In this paper, we reviewed the possible mechanisms of anesthetic-induced neurotoxicity based on new in vitro and in vivo findings. Also, we discussed ways to protect against anesthetic-induced neurotoxicity and their implications for exploring cellular and molecular mechanisms of neuroprotection. These findings help in improving our understanding of developmental neurotoxicology and in avoiding adverse neurological outcomes in anesthesia practice. PMID:22837663

Survival After Accidental Extrahepatic Distribution of Y90 Microspheres to the Mesentery During a Radioembolization Procedure

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

Sabet, Amir; Ahmadzadehfar, Hojjat; Schaefer, Nico

2012-08-15

We present the acute management and outcome of a patient after an accidental mesenteric distribution of Y90 microspheres during radioembolization (RE). This report describes and highlights: (1) the incidence of a significant reflux during a RE session while injecting into a replaced right hepatic artery from the superior mesenteric artery, (2) the appearance of diffuse mesenteric Y90 distribution in bremsstrahlung-imaging, (3) the management protocol with the radiation protection agent amifostine, (4) the development of typical adverse effects in the expected time window, and (5) survival of the patient without long-term sequelae. This report should sensitize physicians to this particular problemmore » and may help to avoid as well as manage similar radioembolization incidences.« less

Approach and Issues Relating to Shield Material Design to Protect Astronauts from Space Radiation

NASA Technical Reports Server (NTRS)

Wilson, J. W.; Cucinotta, F. A.; Miller, J.; Shinn, J. L.; Thibeault, S. A.; Singleterry, R. C.; Simonsen, L. C.; Kim, M. H.

2001-01-01

One major obstacle to human space exploration is the possible limitations imposed by the adverse effects of long-term exposure to the space environment. Even before human spaceflight began, the potentially brief exposure of astronauts to the very intense random solar energetic particle (SEP) events was of great concern. A new challenge appears in deep space exploration from exposure to the low-intensity heavy-ion flux of the galactic cosmic rays (GCR) since the missions are of long duration and the accumulated exposures can be high. Since aluminum (traditionally used in spacecraft to avoid potential radiation risks) leads to prohibitively expensive mission launch costs, alternative materials need to be explored. An overview of the materials related issues and their impact on human space exploration will be given.

Anti-HIV drugs nevirapine and efavirenz affect anxiety-related behavior and cognitive performance in mice.

PubMed

Romão, Pedro R T; Lemos, Joelson C; Moreira, Jeverson; de Chaves, Gisele; Moretti, Morgana; Castro, Adalberto A; Andrade, Vanessa M; Boeck, Carina R; Quevedo, João; Gavioli, Elaine C

2011-01-01

Nevirapine (NVP) and efavirenz (EFV) belong to the class of anti-HIV drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs), commonly used as part of highly active antiretroviral therapy (HAART). Although the HAART is able to bring down viral load to undetectable levels and restore immune function, their prolonged use causes several adverse effects. It has been demonstrated that both NVP and EFV are able to cross the blood-brain barrier, causing important central nervous system-related side effects. Thus, this study investigated the effects of chronic administration of EFV (10 mg/kg) and NVP (3.3 mg/kg) in mice submitted to two distinct series of experiments, which aimed to evaluate: (1) the emotional behavior (elevated plus-maze, forced swimming, and open-field test) and (2) the cognitive performance (object recognition and inhibitory avoidance test) of mice. Our results demonstrated that EFV, but not NVP, reduced the exploration to open arms in the elevated plus-maze test. Neither NVP nor EFV altered mouse behavior in the forced swimming and open-field tests. Both drugs reduced the recognition index in the object recognition test, but only EFV significantly impaired the aversive memory assessed in the inhibitory avoidance test 24 h after training. In conclusion, our findings point to a genuine anxiogenic-like effect to EFV, since it reduced exploration to open arms of elevated plus-maze test without affecting spontaneous locomotion. Additionally, both drugs impaired recognition memory, while only the treatment with EFV impaired significantly aversive memory.

Grapefruit and drug interactions.

PubMed

2012-12-01

Since the late 1980s, grapefruit juice has been known to affect the metabolism of certain drugs. Several serious adverse effects involving drug interactions with grapefruit juice have been published in detail. The components of grapefruit juice vary considerably depending on the variety, maturity and origin of the fruit, local climatic conditions, and the manufacturing process. No single component accounts for all observed interactions. Other grapefruit products are also occasionally implicated, including preserves, lyophylised grapefruit juice, powdered whole grapefruit, grapefruit seed extract, and zest. Clinical reports of drug interactions with grapefruit juice are supported by pharmacokinetic studies, each usually involving about 10 healthy volunteers, in which the probable clinical consequences were extrapolated from the observed plasma concentrations. Grapefruit juice inhibits CYP3A4, the cytochrome P450 isoenzyme most often involved in drug metabolism. This increases plasma concentrations of the drugs concerned, creating a risk of overdose and dose-dependent adverse effects. Grapefruit juice also inhibits several other cytochrome P450 isoenzymes, but they are less frequently implicated in interactions with clinical consequences. Drugs interacting with grapefruit and inducing serious clinical consequences (confirmed or very probable) include: immunosuppressants, some statins, benzodiazepines, most calcium channel blockers, indinavir and carbamazepine. There are large inter-individual differences in enzyme efficiency. Along with the variable composition of grapefruit juice, this makes it difficult to predict the magnitude and clinical consequences of drug interactions with grapefruit juice in a given patient. There is increasing evidence that transporter proteins such as organic anion transporters and P-glycoprotein are involved in interactions between drugs and grapefruit juice. In practice, numerous drugs interact with grapefruit juice. Although only a few reports involving severe clinical consequences have been published, they suggest that grapefruit juice should be avoided during drug therapy, especially when the drug has a narrow therapeutic margin or carries a risk of serious dose-dependent adverse effects. Patients should be informed of this risk whenever a drug is prescribed or dispensed.

Cost-Effectiveness Analysis of Isavuconazole vs. Voriconazole as First-Line Treatment for Invasive Aspergillosis.

PubMed

Harrington, Rachel; Lee, Edward; Yang, Hongbo; Wei, Jin; Messali, Andrew; Azie, Nkechi; Wu, Eric Q; Spalding, James

2017-01-01

Invasive aspergillosis (IA) is associated with a significant clinical and economic burden. The phase III SECURE trial demonstrated non-inferiority in clinical efficacy between isavuconazole and voriconazole. No studies have evaluated the cost-effectiveness of isavuconazole compared to voriconazole. The objective of this study was to evaluate the costs and cost-effectiveness of isavuconazole vs. voriconazole for the first-line treatment of IA from the US hospital perspective. An economic model was developed to assess the costs and cost-effectiveness of isavuconazole vs. voriconazole in hospitalized patients with IA. The time horizon was the duration of hospitalization. Length of stay for the initial admission, incidence of readmission, clinical response, overall survival rates, and experience of adverse events (AEs) came from the SECURE trial. Unit costs were from the literature. Total costs per patient were estimated, composed of drug costs, costs of AEs, and costs of hospitalizations. Incremental costs per death avoided and per additional clinical responders were reported. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted. Base case analysis showed that isavuconazole was associated with a $7418 lower total cost per patient than voriconazole. In both incremental costs per death avoided and incremental costs per additional clinical responder, isavuconazole dominated voriconazole. Results were robust in sensitivity analysis. Isavuconazole was cost saving and dominant vs. voriconazole in most DSA. In PSA, isavuconazole was cost saving in 80.2% of the simulations and cost-effective in 82.0% of the simulations at the $50,000 willingness to pay threshold per additional outcome. Isavuconazole is a cost-effective option for the treatment of IA among hospitalized patients. Astellas Pharma Global Development, Inc.

Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars.

PubMed

Venkat Narayanan, J; Gurram, Prashanthi; Krishnan, Radhika; Muthusubramanian, Veerabahu; Sadesh Kannan, V

2017-09-01

The aim of this study is to assess the efficacy of 4% articaine with 1:100,000 adrenaline given as buccal and lingual infiltration in adult patients undergoing erupted mandibular first and second molar teeth extraction versus inferior alveolar nerve block technique using 2% lignocaine with 1:80,000 adrenaline. A total of 100 patients undergoing extraction of mandibular posterior teeth were divided into two equally matched groups for the study, out of which 50 patients were given 4% articaine with 1:100,000 adrenaline as buccal and lingual infiltration and 50 patients were given 2% lignocaine with 1:80,000 adrenaline using classic direct inferior alveolar nerve block with lingual and buccal nerve block. Efficacy of anesthesia was determined using a numeric analog scale (NAS) ranging from 0 indicating no pain to 10 indicating the worst pain imaginable. The NAS was taken by a different operator to avoid bias. The pain scores in both groups were analyzed using the Mann-Whitney U test, and a p value of 0.338 was obtained which is not statistically significant. Hence, no significant difference in the pain score was established between both groups. The adverse effects of both the local anesthetics if any were noted. From this study, we concluded that the use of 4% articaine with 1:100,000 adrenaline is as effective as inferior alveolar nerve block with lignocaine but without the risk of attendant adverse effects of inferior alveolar nerve block technique.

A randomized double-blind crossover comparison of continuous and intermittent subcutaneous administration of opioid for cancer pain.

PubMed

Watanabe, Sharon; Pereira, Jose; Tarumi, Yoko; Hanson, John; Bruera, Eduardo

2008-05-01

ABSTRACT Although the preferred route of opioid administration is oral, patients with cancer often require an alternative route. Options include continuous subcutaneous infusion (CSCI) or regularly scheduled intermittent subcutaneous injections (ISCI). CSCI maintains steady drug levels, theoretically avoiding the "bolus effect" of nausea and sedation immediately post-dose, and breakthrough pain prior to the next dose. However, portable infusion pumps can be costly to use. The Edmonton Injector is an inexpensive portable device for ISCI. CSCI and ISCI have not been directly compared. The objective of this trial was to compare CSCI and ISCI of opioid for treatment of cancer pain. Patients were recruited from two tertiary palliative care units. Eligibility criteria included stable cancer pain requiring opioid therapy, need for parenteral route, and normal cognition. Patients were randomly assigned to receive opioid by CSCI by portable pump or ISCI by Edmonton Injector for 48 hours, followed by crossover to the alternative modality for 48 hours. During each phase, placebo was administered by the alternative modality. The study was closed after 12 patients were entered, due to slow accrual. Eleven patients completed the study. There were no differences between CSCI and ISCI in mean visual analogue score (VAS) for pain, nausea or drowsiness; categorical rating score of pain; number of breakthrough opioid doses per day; global rating of treatment effectiveness; or adverse effects. In all cases, patients and investigators expressed no preference for one modality over another. Further research is required to confirm that opioid administration by CSCI and ISCI provide similar analgesic and adverse effects.

Fatal hemoptysis in patients with advanced esophageal cancer treated with apatinib.

PubMed

Wang, Wei; Zhang, Lin; Xie, Yan; Zhen, Tianchang; Su, Gongzhang; Zang, Qi

2018-01-01

Targeted therapy is commonly used for treating advanced malignant tumors. Compared with cytotoxic drugs, targeted drugs have the characteristics of good curative results, less adverse effects, and convenient oral administration. Hence, they are especially suitable for patients with cancer who are not able to tolerate chemotherapy. Anti-angiogenic therapy can achieve the objective by inhibiting the formation of new blood vessels in tumors. Apatinib is a novel tyrosine kinase inhibitor targeting the intracellular domain of vascular endothelial growth factor receptor-2. It has been proven to be effective and safe in treating patients with gastric carcinoma and gastroesophageal junction carcinoma. So far, no reports are available on the treatment of esophageal cancer with apatinib. Two patients with advanced esophageal cancer were treated with oral apatinib because of their poor physical condition. After treatment, the dyspnea symptoms disappeared and quality of life significantly improved. Chest computed tomography showed massive necrosis of tumor tissues in each patient. The tumors significantly reduced and a cavity was formed locally in each patient. However, both patients died of massive hemoptysis, probably due to the rupture of the bronchial artery eroded by tumors. The results indicated that apatinib was effective in treating some patients with advanced esophageal cancer, and adverse effects were controllable. However, doctors should choose appropriate candidates according to apatinib's indications. In addition, the use of apatinib should be carefully controlled for patients with esophageal cancer, especially in those with large vessels and trachea or bronchus eroded by tumor, so as to avoid or reduce the occurrence of fatal hemorrhage.

Fatal hemoptysis in patients with advanced esophageal cancer treated with apatinib

PubMed Central

Wang, Wei; Zhang, Lin; Xie, Yan; Zhen, Tianchang; Su, Gongzhang; Zang, Qi

2018-01-01

Targeted therapy is commonly used for treating advanced malignant tumors. Compared with cytotoxic drugs, targeted drugs have the characteristics of good curative results, less adverse effects, and convenient oral administration. Hence, they are especially suitable for patients with cancer who are not able to tolerate chemotherapy. Anti-angiogenic therapy can achieve the objective by inhibiting the formation of new blood vessels in tumors. Apatinib is a novel tyrosine kinase inhibitor targeting the intracellular domain of vascular endothelial growth factor receptor-2. It has been proven to be effective and safe in treating patients with gastric carcinoma and gastroesophageal junction carcinoma. So far, no reports are available on the treatment of esophageal cancer with apatinib. Two patients with advanced esophageal cancer were treated with oral apatinib because of their poor physical condition. After treatment, the dyspnea symptoms disappeared and quality of life significantly improved. Chest computed tomography showed massive necrosis of tumor tissues in each patient. The tumors significantly reduced and a cavity was formed locally in each patient. However, both patients died of massive hemoptysis, probably due to the rupture of the bronchial artery eroded by tumors. The results indicated that apatinib was effective in treating some patients with advanced esophageal cancer, and adverse effects were controllable. However, doctors should choose appropriate candidates according to apatinib’s indications. In addition, the use of apatinib should be carefully controlled for patients with esophageal cancer, especially in those with large vessels and trachea or bronchus eroded by tumor, so as to avoid or reduce the occurrence of fatal hemorrhage. PMID:29765235

Complications of subthalamic nucleus stimulation in Parkinson's disease.

PubMed

Umemura, Atsushi; Oka, Yuichi; Yamamoto, Kenichi; Okita, Kenji; Matsukawa, Noriyuki; Yamada, Kazuo

2011-01-01

Subthalamic nucleus deep brain stimulation (STN-DBS) is effective for medically refractory Parkinson's disease. We retrospectively analyzed complications in 180 consecutive patients who underwent bilateral STN-DBS. Surgery-related complications were symptomatic intracerebral hemorrhage in 2, chronic subdural hematoma in 1, and transient deterioration of medication-induced psychosis in 2 patients. Device-related complications involved device infection in 5, skin erosion in 5, and implantable pulse generator malfunction in 2 patients. All of these patients required surgical repair. Surgery and device-related complications could be reduced with increased surgical experience and the introduction of new surgical equipment and technology. Treatment or stimulation-related complications were intractable dyskinesia/dystonia in 11, problematic dysarthria in 7, apraxia of eyelid opening (ALO) in 11, back pain in 10, and restless leg syndrome in 6 patients. Neuropsychiatric complications were transient mood changes in some, impulse control disorder in 2, severe depression related to excessive reduction of dopaminergic medications in 2, rapid progression of dementia in 1, and suicide attempts in 2 patients. Most complications were mild and transient. Dysarthria and ALO were the most frequent permanent sequelae after STN-DBS. Treatment-related adverse events may be caused not only by the effect of stimulation effect but also excessive reduction of dopaminergic medication, or progression of the disease. In conclusion, STN-DBS seems to be a relatively safe procedure. Although serious complications with permanent sequelae are rare, significant incidences of adverse effects occur. Physicians engaged in this treatment should have a comprehensive understanding of the probable complications and how to avoid them.

Failure or success of search strategies to identify adverse effects of medical devices: a feasibility study using a systematic review.

PubMed

Golder, Su; Wright, Kath; Rodgers, Mark

2014-10-13

Research has indicated that adverse effects terms are increasingly prevalent in the title, abstract or indexing terms of articles that contain adverse drug effects data in MEDLINE and Embase. However, it is unknown whether adverse effects terms are present in the database records of articles that contain adverse effects data of medical devices, and thus, to what extent the development of an adverse effects search filter for medical devices may be feasible. A case study systematic review of a medical device was selected. The included studies from a systematic review of the safety of recombinant human bone morphogenetic protein-2 (rhBMP-2) for spinal fusion were used in the analysis. For each included study, the corresponding database record on MEDLINE and Embase was assessed to measure the presence or absence of adverse effects terms in the title, abstract or indexing. The performance of each potential adverse effects search term was also measured and compared. There were 82 publications (49 studies) included in the systematic review with 51 of these indexed on MEDLINE and 55 on Embase. Ninety-four percent (48/51) of the records on MEDLINE and 95% (52/55) of the records on Embase contained at least one adverse effects related search term. The wide variety of adverse effects terms included in the title, abstract or indexing of bibliographic records, and the lack of any individual high-performing search terms suggests that a combination of terms in different fields is required to identify adverse effects of medical devices. In addition, the most successful search terms differed from the most successful terms for identifying adverse drug effects. The search filters currently available for adverse drug effects are not necessarily useful for searching adverse effects data of medical devices. The presence of adverse effects terms in the bibliographic records of articles on medical devices, however, indicates that combinations of adverse effects search terms may be useful in search strategies in MEDLINE and Embase. The results, therefore, suggest that not only a search filter for the adverse effects of medical devices is feasible, but also that it should be a research priority.

Is There a Critical Period for the Developmental Neurotoxicity of Low-Level Tobacco Smoke Exposure?

PubMed

Slotkin, Theodore A; Stadler, Ashley; Skavicus, Samantha; Card, Jennifer; Ruff, Jonathan; Levin, Edward D; Seidler, Frederic J

2017-01-01

Secondhand tobacco smoke exposure in pregnancy increases the risk of neurodevelopmental disorders. We evaluated in rats whether there is a critical period during which tobacco smoke extract (TSE) affects the development of acetylcholine and serotonin systems, prominent targets for adverse effects of nicotine and tobacco smoke. We simulated secondhand smoke exposure by administering TSE so as to produce nicotine concentrations one-tenth those in active smoking, with 3 distinct, 10-day windows: premating, early gestation or late gestation. We conducted longitudinal evaluations in multiple brain regions, starting in early adolescence (postnatal day 30) and continued to full adulthood (day 150). TSE exposure in any of the 3 windows impaired presynaptic cholinergic activity, exacerbated by a decrement in nicotinic cholinergic receptor concentrations. Although the adverse effects were seen for all 3 treatment windows, there was a distinct progression, with lowest sensitivity for premating exposure and higher sensitivity for gestational exposures. Serotonin receptors were also reduced by TSE exposure with the same profile: little effect with premating exposure, intermediate effect with early gestational exposure and large effect with late gestational exposure. As serotonergic circuits can offset the neurobehavioral impact of cholinergic deficits, these receptor changes were maladaptive. Thus, there is no single 'critical period' for effects of low-level tobacco smoke but there is differential sensitivity dependent upon the developmental stage at the time of exposure. Our findings reinforce the need to avoid secondhand smoke exposure not only during pregnancy, but also in the period prior to conception, or generally for women of childbearing age. © The Author 2016. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Nocebo phenomena in medicine: their relevance in everyday clinical practice.

PubMed

Häuser, Winfried; Hansen, Ernil; Enck, Paul

2012-06-01

Nocebo phenomena are common in clinical practice and have recently become a popular topic of research and discussion among basic scientists, clinicians, and ethicists. We selectively searched the PubMed database for articles published up to December 2011 that contained the key words "nocebo" or "nocebo effect." By definition, a nocebo effect is the induction of a symptom perceived as negative by sham treatment and/or by the suggestion of negative expectations. A nocebo response is a negative symptom induced by the patient's own negative expectations and/or by negative suggestions from clinical staff in the absence of any treatment. The underlying mechanisms include learning by Pavlovian conditioning and reaction to expectations induced by verbal information or suggestion. Nocebo responses may come about through unintentional negative suggestion on the part of physicians and nurses. Information about possible complications and negative expectations on the patient's part increases the likelihood of adverse effects. Adverse events under treatment with medications sometimes come about by a nocebo effect. Physicians face an ethical dilemma, as they are required not just to inform patients of the potential complications of treatment, but also to minimize the likelihood of these complications, i.e., to avoid inducing them through the potential nocebo effect of thorough patient information. Possible ways out of the dilemma include emphasizing the fact that the proposed treatment is usually well tolerated, or else getting the patient's permission to inform less than fully about its possible side effects. Communication training in medical school, residency training, and continuing medical education would be desirable so that physicians can better exploit the power of words to patients' benefit, rather than their detriment.

Are adverse effects incorporated in economic models? An initial review of current practice.

PubMed

Craig, D; McDaid, C; Fonseca, T; Stock, C; Duffy, S; Woolacott, N

2009-12-01

To identify methodological research on the incorporation of adverse effects in economic models and to review current practice. Major electronic databases (Cochrane Methodology Register, Health Economic Evaluations Database, NHS Economic Evaluation Database, EconLit, EMBASE, Health Management Information Consortium, IDEAS, MEDLINE and Science Citation Index) were searched from inception to September 2007. Health technology assessment (HTA) reports commissioned by the National Institute for Health Research (NIHR) HTA programme and published between 2004 and 2007 were also reviewed. The reviews of methodological research on the inclusion of adverse effects in decision models and of current practice were carried out according to standard methods. Data were summarised in a narrative synthesis. Of the 719 potentially relevant references in the methodological research review, five met the inclusion criteria; however, they contained little information of direct relevance to the incorporation of adverse effects in models. Of the 194 HTA monographs published from 2004 to 2007, 80 were reviewed, covering a range of research and therapeutic areas. In total, 85% of the reports included adverse effects in the clinical effectiveness review and 54% of the decision models included adverse effects in the model; 49% included adverse effects in the clinical review and model. The link between adverse effects in the clinical review and model was generally weak; only 3/80 (< 4%) used the results of a meta-analysis from the systematic review of clinical effectiveness and none used only data from the review without further manipulation. Of the models including adverse effects, 67% used a clinical adverse effects parameter, 79% used a cost of adverse effects parameter, 86% used one of these and 60% used both. Most models (83%) used utilities, but only two (2.5%) used solely utilities to incorporate adverse effects and were explicit that the utility captured relevant adverse effects; 53% of those models that included utilities derived them from patients on treatment and could therefore be interpreted as capturing adverse effects. In total, 30% of the models that included adverse effects used withdrawals related to drug toxicity and therefore might be interpreted as using withdrawals to capture adverse effects, but this was explicitly stated in only three reports. Of the 37 models that did not include adverse effects, 18 provided justification for this omission, most commonly lack of data; 19 appeared to make no explicit consideration of adverse effects in the model. There is an implicit assumption within modelling guidance that adverse effects are very important but there is a lack of clarity regarding how they should be dealt with and considered in modelling. In many cases a lack of clear reporting in the HTAs made it extremely difficult to ascertain what had actually been carried out in consideration of adverse effects. The main recommendation is for much clearer and explicit reporting of adverse effects, or their exclusion, in decision models and for explicit recognition in future guidelines that 'all relevant outcomes' should include some consideration of adverse events.

SEASAT economic assessment. Volume 8: Ocean fishing case study. [economic benefits of SEASAT satellites to ocean fishing industries in the United States and Canada

NASA Technical Reports Server (NTRS)

1975-01-01

The potential application of SEASAT data with regard to ocean fisheries is discussed. Tracking fish populations, indirect assistance in forecasting expected populations and assistance to fishing fleets in avoiding costs incurred due to adverse weather through improved ocean conditions forecasts were investigated. Case studies on fisheries in the United States and Canada are cited.

Environmental Assessment for A-29 Light Air Support (LAS) Training Beddown

DTIC Science & Technology

2014-08-21

Nation. Appendix A Updated to include responses/letters from federal and local agencies. Page 1 of 1 FINDING OF NO SIGNIFICANT IMPACT A-29...32 CFR §989, Environmental Impact Analysis Process, the U.S. Air Force (Air Force) assessed the potential environmental consequences associated with...protection measures to avoid or reduce adverse environmental impacts . The EA considers all potential impacts of basing this training unit at three

Strategies for blood conservation in pediatric cardiac surgery

PubMed Central

Singh, Sarvesh Pal

2016-01-01

Cardiac surgery accounts for the majority of blood transfusions in a hospital. Blood transfusion has been associated with complications and major adverse events after cardiac surgery. Compared to adults it is more difficult to avoid blood transfusion in children after cardiac surgery. This article takes into account the challenges and emphasizes on the various strategies that could be implemented, to conserve blood during pediatric cardiac surgery. PMID:27716703

Analysis of contributing factors associated to related patients safety incidents in Intensive Care Medicine.

PubMed

Martín Delgado, M C; Merino de Cos, P; Sirgo Rodríguez, G; Álvarez Rodríguez, J; Gutiérrez Cía, I; Obón Azuara, B; Alonso Ovies, Á

2015-01-01

To explore contributing factors (CF) associated to related critical patients safety incidents. SYREC study pos hoc analysis. A total of 79 Intensive Care Departments were involved. The study sample consisted of 1.017 patients; 591 were affected by one or more incidents. The CF were categorized according to a proposed model by the National Patient Safety Agency from United Kingdom that was modified. Type, class and severity of the incidents was analyzed. A total 2,965 CF were reported (1,729 were associated to near miss and 1,236 to adverse events). The CF group more frequently reported were related patients factors. Individual factors were reported more frequently in near miss and task related CF in adverse events. CF were reported in all classes of incidents. The majority of CF were reported in the incidents classified such as less serious, even thought CF patients factors were associated to serious incidents. Individual factors were considered like avoidable and patients factors as unavoidable. The CF group more frequently reported were patient factors and was associated to more severe and unavoidable incidents. By contrast, individual factors were associated to less severe and avoidable incidents. In general, CF most frequently reported were associated to near miss. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Adverse effects of aromatherapy: a systematic review of case reports and case series.

PubMed

Posadzki, Paul; Alotaibi, Amani; Ernst, Edzard

2012-01-01

This systematic review was aimed at critically evaluating the evidence regarding the adverse effects associated with aromatherapy. Five electronic databases were searched to identify all relevant case reports and case series. Forty two primary reports met our inclusion criteria. In total, 71 patients experienced adverse effects of aromatherapy. Adverse effects ranged from mild to severe and included one fatality. The most common adverse effect was dermatitis. Lavender, peppermint, tea tree oil and ylang-ylang were the most common essential oils responsible for adverse effects. Aromatherapy has the potential to cause adverse effects some of which are serious. Their frequency remains unknown. Lack of sufficiently convincing evidence regarding the effectiveness of aromatherapy combined with its potential to cause adverse effects questions the usefulness of this modality in any condition.

Glucocorticosteroid-free versus glucocorticosteroid-containing immunosuppression for liver transplanted patients.

PubMed

Fairfield, Cameron; Penninga, Luit; Powell, James; Harrison, Ewen M; Wigmore, Stephen J

2018-04-09

Liver transplantation is an established treatment option for end-stage liver failure. Now that newer, more potent immunosuppressants have been developed, glucocorticosteroids may no longer be needed and their removal may prevent adverse effects. To assess the benefits and harms of glucocorticosteroid avoidance (excluding intra-operative use or treatment of acute rejection) or withdrawal versus glucocorticosteroid-containing immunosuppression following liver transplantation. We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Science Citation Index Expanded and Conference Proceedings Citation Index - Science, Literatura Americano e do Caribe em Ciencias da Saude (LILACS), World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and The Transplant Library until May 2017. Randomised clinical trials assessing glucocorticosteroid avoidance or withdrawal versus glucocorticosteroid-containing immunosuppression for liver transplanted people. Our inclusion criteria stated that participants should have received the same co-interventions. We included trials that assessed complete glucocorticosteroid avoidance (excluding intra-operative use or treatment of acute rejection) versus short-term glucocorticosteroids, as well as trials that assessed short-term glucocorticosteroids versus long-term glucocorticosteroids. We used RevMan to conduct meta-analyses, calculating risk ratio (RR) for dichotomous variables and mean difference (MD) for continuous variables, both with 95% confidence intervals (CIs). We used a random-effects model and a fixed-effect model and reported both results where a discrepancy existed; otherwise we reported only the results from the fixed-effect model. We assessed the risk of systematic errors using 'Risk of bias' domains. We controlled for random errors by performing Trial Sequential Analysis. We presented our results in a 'Summary of findings' table. We included 17 completed randomised clinical trials, but only 16 studies with 1347 participants provided data for the meta-analyses. Ten of the 16 trials assessed complete postoperative glucocorticosteroid avoidance (excluding intra-operative use or treatment of acute rejection) versus short-term glucocorticosteroids (782 participants) and six trials assessed short-term glucocorticosteroids versus long-term glucocorticosteroids (565 participants). One additional study assessed complete post-operative glucocorticosteroid avoidance but could only be incorporated into qualitative analysis of the results due to limited data published in an abstract. All trials were at high risk of bias. Only eight trials reported on the type of donor used. Overall, we found no statistically significant difference for mortality (RR 1.15, 95% CI 0.93 to 1.44; low-quality evidence), graft loss including death (RR 1.15, 95% CI 0.90 to 1.46; low-quality evidence), or infection (RR 0.88, 95% CI 0.73 to 1.05; very low-quality evidence) when glucocorticosteroid avoidance or withdrawal was compared with glucocorticosteroid-containing immunosuppression. Acute rejection and glucocorticosteroid-resistant rejection were statistically significantly more frequent when glucocorticosteroid avoidance or withdrawal was compared with glucocorticosteroid-containing immunosuppression (RR 1.33, 95% CI 1.08 to 1.64; low-quality evidence; and RR 2.14, 95% CI 1.13 to 4.02; very low-quality evidence). Diabetes mellitus and hypertension were statistically significantly less frequent when glucocorticosteroid avoidance or withdrawal was compared with glucocorticosteroid-containing immunosuppression (RR 0.81, 95% CI 0.66 to 0.99; low-quality evidence; and RR 0.76, 95% CI 0.65 to 0.90; low-quality evidence). We performed Trial Sequential Analysis for all outcomes. None of the outcomes crossed the monitoring boundaries or reached the required information size. Hence, we cannot exclude random errors from the results of the conventional meta-analyses. Many of the benefits and harms of glucocorticosteroid avoidance or withdrawal remain uncertain because of the limited number of published randomised clinical trials, limited numbers of participants and outcomes, and high risk of bias in the trials. Glucocorticosteroid avoidance or withdrawal appears to reduce diabetes mellitus and hypertension whilst increasing acute rejection, glucocorticosteroid-resistant rejection, and renal impairment. We could identify no other benefits or harms of glucocorticosteroid avoidance or withdrawal. Glucocorticosteroid avoidance or withdrawal may be of benefit in selected patients, especially those at low risk of rejection and high risk of hypertension or diabetes mellitus. The optimal duration of glucocorticosteroid administration remains unclear. More randomised clinical trials assessing glucocorticosteroid avoidance or withdrawal are needed. These should be large, high-quality trials that minimise the risk of random and systematic error.

Pediatric Patients Discharged from the Emergency Department with Abnormal Vital Signs.

PubMed

Winter, Josephine; Waxman, Michael J; Waterman, George; Ata, Ashar; Frisch, Adam; Collins, Kevin P; King, Christopher

2017-08-01

Children often present to the emergency department (ED) with minor conditions such as fever and have persistently abnormal vital signs. We hypothesized that a significant portion of children discharged from the ED would have abnormal vital signs and that those discharged with abnormal vital signs would experience very few adverse events. We performed a retrospective chart review encompassing a 44-month period of all pediatric patients (aged two months to 17 years) who were discharged from the ED with an abnormal pulse rate, respiratory rate, temperature, or oxygen saturation. We used a local quality assurance database to identify pre-defined adverse events after discharge in this population. Our primary aim was to determine the proportion of children discharged with abnormal vital signs and the frequency and nature of adverse events. Additionally, we performed a sub-analysis comparing the rate of adverse events in children discharged with normal vs. abnormal vital signs, as well as a standardized review of the nature of each adverse event. Of 33,185 children discharged during the study period, 5,540 (17%) of these patients had at least one abnormal vital sign. There were 24/5,540 (0.43%) adverse events in the children with at least one abnormal vital sign vs. 47/27,645 (0.17%) adverse events in the children with normal vital signs [relative risk = 2.5 (95% confidence interval, 1.6 to 2.4)].However, upon review of each adverse event we found only one case that was related to the index visit, was potentially preventable by a 23-hour hospital observation, and caused permanent disability. In our study population, 17% of the children were discharged with at least one abnormal vital sign, and there were very few adverse (0.43%) events associated with this practice. Heart rate was the most common abnormal vital sign leading to an adverse event. Severe adverse events that were potentially related to the abnormal vital sign(s) were exceedingly rare. Additional research is needed in broader populations to better determine the rate of adverse events and possible methods of avoiding them.

Cost-effectiveness analysis of genotyping for HLA-B*5801 and an enhanced safety program in gout patients starting allopurinol in Singapore.

PubMed

Dong, Di; Tan-Koi, Wei-Chuen; Teng, Gim Gee; Finkelstein, Eric; Sung, Cynthia

2015-11-01

Allopurinol is an efficacious urate-lowering therapy (ULT), but is associated with rare serious adverse drug reactions of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with higher risk among HLA-B*5801 carriers. We assessed the cost-effectiveness of HLA-B*5801 testing, an enhanced safety program or strategies with both components. The analysis adopted a health systems perspective and considered Singaporean patients with chronic gout, over a lifetime horizon, using allopurinol or probenecid. The model incorporated SJS/TEN and gout treatment outcomes, allele frequencies, drug prices and other medical costs. Based on cost-effectiveness threshold of US$50,000 per quality-adjusted life year, HLA-B*5801-guided ULT selection or enhanced safety program was not cost effective. Avoidance of ULTs was the least preferred strategy as uncontrolled gout leads to lower quality-adjusted life years and higher costs. The analysis underscores the need for biomarkers with higher positive predictive value for SJS/TEN, less expensive genetic tests or safety programs, or more effective gout drugs. .

Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania

PubMed Central

Kidanto, Hussein L; Mogren, Ingrid; van Roosmalen, Jos; Thomas, Angela N; Massawe, Siriel N; Nystrom, Lennarth; Lindmark, Gunilla

2009-01-01

Background Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR). Methods From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133) with birth weight 1500 g or more at Muhimbili National Hospital (MNH). The audit was done by three obstetricians, two external and one internal auditors. Each auditor independently evaluated the cases narratives. Suboptimal factors were identified in the antepartum, intrapartum and early neonatal period and classified into three levels of delay (community, infrastructure and health care). The contribution of each suboptimal factor to adverse perinatal outcome was identified and the case graded according to possible avoidability. Degree of agreement between auditors was assessed by the kappa coefficient. Results The PMR was 92 per 1000 total births. Suboptimal factors were identified in 80% of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was indirectly associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors. Conclusion There are significant areas of care that need improvement. Poor monitoring during labour was a major cause of avoidable perinatal mortality. This type of audit was a good starting point for quality assurance at MNH. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the staff may be a useful strategy to reduce perinatal mortality. PMID:19765312