Everything you always wanted to hear about rate making but were afraid to ask

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

Cady, W.A.

1983-08-04

Rate making is a complicated and time-consuming procedure. That it could benefit from judiciously chosen reforms is beyond question. This article covers several major areas of contention within the regulatory arena, all of which have been the subject of considerable debate in recent years. In an effort to find a compromise position between extremes, the author makes three specific suggestions that, if adopted, could enable parties involved to devote their time and resources to more fundamental questions regarding the regulated utility industries. 3 references.

Treatment of psychological factors in a child with difficult asthma: a case report.

PubMed

Anbar, Ran D; Sachdeva, Shagun

2011-07-01

Difficult asthma is defined as the persistence of asthma symptoms, abnormal pulmonary function showing airway obstruction, and continued requirement for short-acting bronchodilator therapy, despite adequate treatment with inhaled corticosteroids. It calls for a thorough evaluation of the patient to look into alternate and complicating diagnoses. The authors report a case of a 9-year-old patient with difficult asthma who failed to respond to conventional therapy. Although it was recognized that he had a number of potential medical complicating factors including allergies, chronic sinusitis, and gastroesophageal reflux, a psychological intervention using hypnosis ultimately appeared to help alleviate his symptoms completely. Thus, psychological evaluation and intervention should be considered early in the course of management of a patient with difficult asthma, because it may help avoid time-consuming and expensive investigations of potential complicating factors, and it may yield rapid improvement in the patient's clinical condition.

[Demographics, clinical features, treatments, and outcomes of patients who were transferred to emergency facilities in Japan after consuming dangerous drugs].

PubMed

Kamijo, Yoshito

2015-09-01

We conducted a multicenter survey of patients who were transported to emergency facilities in Japan from January 2006 to December 2012 after consuming dangerous drugs. Participants were 518 patients. Harmful behavior was observed at the scene of poisoning for about 10% of patients, including violence to others, and traffic accidents. Some patients had physical complications such as rhabdomyolysis, renal dysfunction, and hepatic dysfunction. Of the 182 patients admitted to hospitals, 29 needed respirators and 21 were hospitalized for ≥ 7 days. Although most patients completely recovered, consuming dangerous drugs can result in physical complications including rhabdomyolysis, as well as physical or neuropsychiatric symptoms, which may require active interventions such as respirator use or prolonged hospitalization.

Hybrid and Disposable Facilities for Manufacturing of Biopharmaceuticals: Pros and Cons

NASA Astrophysics Data System (ADS)

Ravisé, Aline; Cameau, Emmanuelle; de Abreu, Georges; Pralong, Alain

Modern biotechnology has grown over the last 35 years to a maturing industry producing and delivering high-value biopharmaceuticals that yield important medical and economical benefits. The constantly increasing need for biopharmaceuticals and significant costs related to time-consuming R&D work makes this industry risky and highly competitive. This trend is confirmed by the important number of biopharmaceuticals that are actually under development at all stages by all major pharmaceutical industry companies. A consequence of this evolution is an increasing need for development and manufacturing capacity. The build up of traditional - stainless steel - technology is complicated, time consuming and very expensive. The decision for such a major investment needs to be taken early in the development cycle of a promising drug to cope with future demands for clinical trials and product launch. Possibilities for the reduction of R&D and manufacturing costs are therefore of significant interest in order to be competitive.

Dietary sodium intake in young Korean adults and its relationship with eating frequency and taste preference

PubMed Central

Shim, Eugene; Ryu, Ha-Jung; Hwang, Jinah; Kim, Soo Yeon

2013-01-01

Dietary sodium intake is considered one of the major causal factors for hypertension. Thus, to control the increase of blood pressure and reduce the risk of hypertension-related clinical complications, a reduction in sodium intake is recommended. The present study aimed at determining the association of dietary sodium intake with meal and snack frequency, snacking time, and taste preference in Korean young adults aged 20-26 years, using a 125-item dish-frequency questionnaire. The mean dietary sodium intakes of men and women were 270.6 mmol/day and 213.1 mmol/day, which were approximately 310% and 245% of the daily sodium intake goal for Korean men and women, respectively. Dietary sodium intake was positively correlated with systolic blood pressure in the total group, and BMI in the total and men-only groups. In the total and men-only groups, those who consumed meals more times per day consumed more dietary sodium, but the number of times they consumed snacks was negatively correlated with dietary sodium intake in the total, men-only, and women-only groups. In addition, those who consumed snacks in the evening consumed more sodium than those who did so in the morning in the men-only group. The sodium intake was also positively associated with preference for salty and sweet taste in the total and women-only groups. Such a high intake of sodium in these young subjects shows that a reduction in sodium intake is important for the prevention of hypertension and related diseases in the future. PMID:23766880

Biomechanical reposition techniques in anterior shoulder dislocation: a randomised multicentre clinical trial— the BRASD-trial protocol

PubMed Central

Roetman, Martijn H; Boeije, Tom; Roodheuvel, Floris; Mullaart-Jansen, Nieke; Peeters, Suzanne; Burg, Mike D

2017-01-01

Introduction Glenohumeral (shoulder) dislocations are the most common large joint dislocations seen in the emergency department (ED). They cause pain, often severe, and require timely interventions to minimise discomfort and tissue damage. Commonly used reposition or relocation techniques often involve traction and/or leverage. These techniques have high success rates but may be painful and time consuming. They may also cause complications. Recently, other techniques—the biomechanical reposition techniques (BRTs)—have become more popular since they may cause less pain, require less time and cause fewer complications. To our knowledge, no research exists comparing the various BRTs. Our objective is to establish which BRT or BRT combination is fastest, least painful and associated with the lowest complication rate for adult ED patients with anterior glenohumeral dislocations (AGDs). Methods and analysis Adults presenting to the participating EDs with isolated AGDs, as determined by radiographs, will be randomised to one of three BRTs: Cunningham, modified Milch or scapular manipulation. Main study parameters/endpoints are ED length of stay and patients’ self-report of pain. Secondary study parameters/endpoints are procedure times, need for analgesic and/or sedative medications, iatrogenic complications and rates of successful reduction. Ethics and dissemination Non-biomechanical AGD repositioning techniques based on traction and/or leverage are inherently painful and potentially harmful. We believe that the three BRTs used in this study are more physiological, more patient friendly, less likely to cause pain, more time efficient and less likely to produce complications. By comparing these three techniques, we hope to improve the care provided to adults with acute AGDs by reducing their ED length of stay and minimising pain and procedure-related complications. We also hope to define which of the three BRTs is quickest, most likely to be successful and least likely to require sedative or analgesic medications to achieve reduction. Trial registration number NTR5839. PMID:28729305

Association of Reference Payment for Colonoscopy With Consumer Choices, Insurer Spending, and Procedural Complications.

PubMed

Robinson, James C; Brown, Timothy T; Whaley, Christopher; Finlayson, Emily

2015-11-01

Regulatory limits on consumer cost sharing permit wide variation in the prices charged for screening and diagnostic tests such as colonoscopy. Employers are experimenting with reference payment initiatives that offer full insurance coverage at low-priced facilities but require substantial cost sharing if patients select high-priced alternatives. To ascertain the effect of reference payment on facility choice, insurer spending, consumer cost sharing, and procedural complications for colonoscopy. The California Public Employees' Retirement System (CalPERS) implemented reference payment in January 2012. We obtained data on 21 644 CalPERS enrollees who underwent colonoscopy in the 3 years prior to implementation and on 13 551 patients in the 2 years after implementation. Control group data were obtained on 258 616 Anthem Blue Cross enrollees who underwent colonoscopy and who were not subject to reference payment initiatives during this 5-year period. Consumer choice of facility, price paid per procedure, total insurer spending, consumer cost sharing, and procedural complications. Choices, prices, and complications were compared for CalPERS and Anthem patients before and after implementation of reference payments, using difference-in-difference multivariable regressions to adjust for patient demographic characteristics and comorbidities, procedure indications, and geographic location. Utilization of low-priced facilities for CalPERS members increased from 68.6% in 2009 to 90.5% in 2013. After adjusting for patient demographic characteristics, comorbidities, and other factors, the implementation of reference payment increased use of low-priced facilities by 17.6 percentage points (95% CI, 11.8 to 23.4; P < .001). The mean price paid for colonoscopy for the CalPERS population increased from $1587 (95% CI, $1555-$1618) in 2009 to $1716 (95% CI, $1678-$1753) in 2011 and then decreased to $1508 (95% CI, $1469-$1548) in 2013 for patients subject to reference payment. After adjustment for other relevant factors, reference payment was responsible for a 21.0% (95% CI, -26.0% to -15.6%, P < .001) reduction in the price. Reference payment was associated with a small but statistically insignificant decline in procedural complications, from 2.1% in 2009 to 2.0% in 2013 (P = .47). In the first 2 years after implementation, CalPERS saved $7.0 million (28%) on spending for the procedure. Implementation of reference payment for colonoscopy was associated with reduced spending and no change in complications.

The quality dilemma.

PubMed

Lucassen, Peter

2007-06-01

In the language and logic of the free market, providers of health care will have to demonstrate the quality of their work. However, in this setting quality is only interpreted in quantitative ways and consequently does not necessarily do justice to good physicians. Moreover, both outcome measures and process measures have serious drawbacks. An emphasis on outcome measures will disadvantage physicians working in deprived areas and doctors managing more complicated cases. Although process measures give the most direct information on the physician's performance, their evidence base is not always as straightforward as commonly supposed. Finally, measurement of quality indicators is complicated and time consuming. Physicians should be aware of the drawbacks of quality measurement and of the poor effects of quality improvement strategies on patient outcomes.

Alcohol: impact on sports performance and recovery in male athletes.

PubMed

Barnes, Matthew J

2014-07-01

Alcohol is the most commonly used recreational drug globally and its consumption, often in large volume, is deeply embedded in many aspects of Western society. Indeed, athletes are not exempt from the influence alcohol has on society; they often consume greater volumes of alcohol through bingeing behaviour compared with the general population, yet it is often expected and recommended that athletes abstain from alcohol to avoid the negative impact this drug may have on recovery and sporting performance. While this recommendation may seem sensible, the impact alcohol has on recovery and sports performance is complicated and depends on many factors, including the timing of alcohol consumption post-exercise, recovery time required before recommencing training/competition, injury status and dose of alcohol being consumed. In general, acute alcohol consumption, at the levels often consumed by athletes, may negatively alter normal immunoendocrine function, blood flow and protein synthesis so that recovery from skeletal muscle injury may be impaired. Other factors related to recovery, such as rehydration and glycogen resynthesis, may be affected to a lesser extent. Those responsible for the wellbeing of athletes, including the athlete themselves, should carefully monitor habitual alcohol consumption so that the generic negative health and social outcomes associated with heavy alcohol use are avoided. Additionally, if athletes are to consume alcohol after sport/exercise, a dose of approximately 0.5 g/kg body weight is unlikely to impact most aspects of recovery and may therefore be recommended if alcohol is to be consumed during this period.

A two steps solution approach to solving large nonlinear models: application to a problem of conjunctive use.

PubMed

Vieira, J; Cunha, M C

2011-01-01

This article describes a solution method of solving large nonlinear problems in two steps. The two steps solution approach takes advantage of handling smaller and simpler models and having better starting points to improve solution efficiency. The set of nonlinear constraints (named as complicating constraints) which makes the solution of the model rather complex and time consuming is eliminated from step one. The complicating constraints are added only in the second step so that a solution of the complete model is then found. The solution method is applied to a large-scale problem of conjunctive use of surface water and groundwater resources. The results obtained are compared with solutions determined with the direct solve of the complete model in one single step. In all examples the two steps solution approach allowed a significant reduction of the computation time. This potential gain of efficiency of the two steps solution approach can be extremely important for work in progress and it can be particularly useful for cases where the computation time would be a critical factor for having an optimized solution in due time.

Strategies to reduce sodium consumption: a food industry perspective.

PubMed

Dötsch, Mariska; Busch, Johanneke; Batenburg, Max; Liem, Gie; Tareilus, Erwin; Mueller, Rudi; Meijer, Gert

2009-11-01

The global high prevalence of hypertension and cardiovascular disease has raised concerns regarding the sodium content of the foods which we consume. Over 75% of sodium intake in industrialized diets is likely to come from processed and restaurant foods. Therefore international authorities, such as the World Health Organisation, are encouraging the food industry to reduce sodium levels in their products. Significant sodium reduction is not without complications as salt plays an important role in taste, and in some products is needed also for preservation and processing. The most promising sodium reduction strategy is to adapt the preference of consumers for saltiness by reducing sodium in products in small steps. However, this is a time-consuming approach that needs to be applied industry-wide in order to be effective. Therefore the food industry is also investigating solutions that will maintain the same perceived salt intensity at lower sodium levels. Each of these has specific advantages, disadvantages, and time lines for implementation. Currently applied approaches are resulting in sodium reduction between 20-30%. Further reduction will require new technologies. Research into the physiology of taste perception and salt receptors is an emerging area of science that is needed in order to achieve larger sodium reductions.

Community Health: FCS Extension Educators Deliver Diabetes Education in PA

ERIC Educational Resources Information Center

Cox, Jill N.; Corbin, Marilyn

2011-01-01

For decades, family and consumer sciences (FCS) Extension educators have provided health related education to consumers through Cooperative Extension programming at land grant universities. However, offering diabetes education can be extra challenging due to the complicated nature of the disease and the multi-faceted treatment required. Faced with…

Biomechanical reposition techniques in anterior shoulder dislocation: a randomised multicentre clinical trial- the BRASD-trial protocol.

PubMed

Baden, David N; Roetman, Martijn H; Boeije, Tom; Roodheuvel, Floris; Mullaart-Jansen, Nieke; Peeters, Suzanne; Burg, Mike D

2017-07-20

Glenohumeral (shoulder) dislocations are the most common large joint dislocations seen in the emergency department (ED). They cause pain, often severe, and require timely interventions to minimise discomfort and tissue damage. Commonly used reposition or relocation techniques often involve traction and/or leverage. These techniques have high success rates but may be painful and time consuming. They may also cause complications. Recently, other techniques-the biomechanical reposition techniques (BRTs)-have become more popular since they may cause less pain, require less time and cause fewer complications. To our knowledge, no research exists comparing the various BRTs. Our objective is to establish which BRT or BRT combination is fastest, least painful and associated with the lowest complication rate for adult ED patients with anterior glenohumeral dislocations (AGDs). Adults presenting to the participating EDs with isolated AGDs, as determined by radiographs, will be randomised to one of three BRTs: Cunningham, modified Milch or scapular manipulation. Main study parameters/endpoints are ED length of stay and patients' self-report of pain. Secondary study parameters/endpoints are procedure times, need for analgesic and/or sedative medications, iatrogenic complications and rates of successful reduction. Non-biomechanical AGD repositioning techniques based on traction and/or leverage are inherently painful and potentially harmful. We believe that the three BRTs used in this study are more physiological, more patient friendly, less likely to cause pain, more time efficient and less likely to produce complications. By comparing these three techniques, we hope to improve the care provided to adults with acute AGDs by reducing their ED length of stay and minimising pain and procedure-related complications. We also hope to define which of the three BRTs is quickest, most likely to be successful and least likely to require sedative or analgesic medications to achieve reduction. NTR5839. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Sharp Dissection versus Electrocautery for Radial Artery Harvesting

PubMed Central

Marzban, Mehrab; Arya, Reza; Mandegar, Mohammad Hossein; Karimi, Abbas Ali; Abbasi, Kiomars; Movahed, Namvar; Abbasi, Seyed Hesameddin

2006-01-01

Radial arteries have been increasingly used during the last decade as conduits for coronary artery revascularization. Although various harvesting techniques have been described, there has been little comparative study of arterial damage and patency. A radial artery graft was used in 44 consecutive patients, who were randomly divided into 2 groups. In the 1st group, the radial artery was harvested by sharp dissection and in the 2nd, by electrocautery. These groups were compared with regard to radial artery free flow, harvest time, number of clips used, complications, and endothelial damage. Radial artery free flow before and after intraluminal administration of papaverine was significantly greater in the electrocautery group (84.3 ± 50.7 mL/min and 109.7 ± 68.5 mL/min) than in the sharp-dissection group (52.9 ± 18.3 mL/min and 69.6 ± 28.2 mL/ min) (P =0.003). Harvesting time by electrocautery was significantly shorter (25.4 ± 4.3 min vs 34.4 ± 5.9 min) (P =0.0001). Electrocautery consumed an average of 9.76 clips, versus 22.45 clips consumed by sharp dissection. The 2 groups were not different regarding postoperative complications, except for 3 cases of temporary paresthesia of the thumb in the electrocautery group; histopathologic examination found no endothelial damage. We conclude that radial artery harvesting by electrocautery is faster and more economical than harvesting by sharp dissection and is associated with better intraoperative flow and good preservation of endothelial integrity. PMID:16572861

Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

PubMed

Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

2017-05-01

A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P < 0.001), compared with nonsarcopenic patients. The multivariate analysis demonstrated that sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P < 0.001) and the Charlson comorbidity index ≥2 (odds ratio: 3.357, 95% CI: 1.144-9.848, P = 0.027) were independent risk factors for postoperative complications. Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

Dynamic Learning in Virtual Spaces: Producers and Consumers of Meaning

ERIC Educational Resources Information Center

Abrams, Sandra Schamroth; Rowsell, Jennifer

2011-01-01

Twenty-first century education includes dynamic learning that is complicated by interactions in both fixed and protean virtual spaces, and it is important to consider the degree of power, agency, and awareness students have as producers and consumers of interactive technology. Outside of school, students engage in meaning making practices, and…

Epidemiological and sociodemographic factors associated with complicated alcohol withdrawal syndrome.

PubMed

Monte-Secades, R; Blanco-Soto, M; Díaz-Peromingo, J A; Sanvisens-Bergé, A; Martín-González, M C; Barbosa, A; Rosón-Hernández, B; Tejero-Delgado, M A; Puerta-Louro, R; Rabuñal-Rey, R

2017-10-01

To analyse the influence of epidemiological and sociodemographic factors in complicated alcohol withdrawal syndrome (AWS). A multicentre, observational prospective study was conducted on consecutively added patients with AWS hospitalised in internal medicine departments. We recorded sociodemographic, epidemiological, clinical and progression data. Complicated AWS was defined as that which progressed with seizures or delirium tremens. We studied 228 episodes of AWS in 219 patients. The mean age was 54.5 years (SD, 11.5), and 90.8% were men. AWS was the cause for hospitalisation in 39.9% of the patients. Some 27.1% of the cases presented seizures, and 32.4% presented delirium tremens. The daily quantity of alcohol ingested was 17.8 standard drink units (SD, 21.4), with 16.6 years of dependence (SD, 11.3). The pattern of alcohol abuse was regular in 82.8% of the patients. Some 38.4% of the patients were married or had a partner, and 45.6% had children. Some 72.7% of the patients were unemployed or retired. Some 68.5% had only completed primary studies. Some 4.8% consumed cannabis, 5.2% consumed cocaine and 3% consumed opioids. The independent variables related to complicated AWS were consumption of a drug other than alcohol (OR, 5.3; 95% CI 1.5-18.7), low education level (OR, 3.4; 95% CI 1.6-7.3) and hospitalisation for AWS (OR, 2.9; 95% CI 1.5-5.6). The model's receiver operating characteristic area was 0.718 (95% CI 0.643-0.793). Concomitant drug abuse and a low educational level could help identify patients at risk of complicated AWS. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Corneal approach 20 Guage vitrectomy system for the management of congenital cataract

PubMed Central

Memon, Mariya Nazish; Bukhari, Sadia; Bhutto, Israr Ahmed

2016-01-01

Objective: To evaluate the efficacy and complications of 20 gauge vitrectomy via corneal approach for the management of congenital cataract. Method: We performed anterior capsular vitreorhexis, lens matter aspiration (LMA), primary posterior vitrectorhexis and anterior vitrectomy via corneal approach using 20 gauge vitrectomy system in children younger than two years of age with congenital cataract between January 2014 to December 2014. The intra and postoperative complications were observed. Results: Twenty nine eyes of 21 children were included in this study. Congenital cataract surgery using 20 gauge vitrectomy system via corneal approach did not reveal any intra operative complication. Post operatively all children were able to freely open their operated eyes. Conjunctival congestion at the incision site in four eyes and mild anterior chamber reaction in 8 eyes were seen on 1st daywhich resolved at one week follow up. Other major post operative complications such as inflammatory membrane, irregular pupil, posterior/anterior syneache and opacification of visual axis were not seen during follow up period. Conclusion: The 20-gauge vitrectomy system via corneal approach is easy to perform, is less time consuming, safe and effective for the management of congenital cataract in younger children. PMID:27182257

Corneal approach 20 Guage vitrectomy system for the management of congenital cataract.

PubMed

Memon, Mariya Nazish; Bukhari, Sadia; Bhutto, Israr Ahmed

2016-01-01

To evaluate the efficacy and complications of 20 gauge vitrectomy via corneal approach for the management of congenital cataract. We performed anterior capsular vitreorhexis, lens matter aspiration (LMA), primary posterior vitrectorhexis and anterior vitrectomy via corneal approach using 20 gauge vitrectomy system in children younger than two years of age with congenital cataract between January 2014 to December 2014. The intra and postoperative complications were observed. Twenty nine eyes of 21 children were included in this study. Congenital cataract surgery using 20 gauge vitrectomy system via corneal approach did not reveal any intra operative complication. Post operatively all children were able to freely open their operated eyes. Conjunctival congestion at the incision site in four eyes and mild anterior chamber reaction in 8 eyes were seen on 1(st) daywhich resolved at one week follow up. Other major post operative complications such as inflammatory membrane, irregular pupil, posterior/anterior syneache and opacification of visual axis were not seen during follow up period. The 20-gauge vitrectomy system via corneal approach is easy to perform, is less time consuming, safe and effective for the management of congenital cataract in younger children.

Fibrin glue in ophthalmology

PubMed Central

Panda, Anita; Kumar, Sandeep; Kumar, Abhiyan; Bansal, Raseena; Bhartiya, Shibal

2009-01-01

Suturing is a time consuming task in ophthalmology and suture induced irritation and redness are frequent problems. Postoperative wound infection and corneal graft rejection are examples of possible suture related complications. To prevent these complications, ophthalmic surgeons are switching to sutureless surgery. A number of recent developments have established tissue adhesives like cyanoacrylate glue and fibrin glue as attractive alternatives to sutures. A possible and promising new application for tissue adhesives is to provide a platform for tissue engineering. Currently, tissue glue is being used for conjunctival closure following pterygium and strabismus surgery, forniceal reconstruction surgery, amniotic membrane transplantation, lamellar corneal grafting, closure of corneal perforations and descematoceles, management of conjunctival wound leaks after trabeculectomy, lid surgery, adnexal surgery and as a hemostat to minimise bleeding. The purpose of this review is to discuss the currently available information on fibrin glue. PMID:19700876

A High Altitude Infrared Radiance Model

DTIC Science & Technology

1977-11-30

retain the Tŗ/ 2 dependence. The chief complication with the functions for Voigt profiles is that for inter- mediate values of x the behavior is similar... behavior has been found by Malkmus (1967, 1968) for curves of growth for various random band models. A strict derivation of the asymptotic expansions...slightly faster than the 1974 mode. The most time consuming process is now the 65- 0 ൱ 0 u 41’ 0I 9-4- "V-4 4 J Řr- B06 co 4J . I0 Ch- 0 P-44

Comparison of rigid and flexible endoscopy for removing esophageal foreign bodies in an emergency.

PubMed

Tseng, Chia-Chen; Hsiao, Tzu-Yu; Hsu, Wei-Chung

2016-08-01

Despite the effectiveness of endoscopies in removing ingested foreign bodies (FBs) impacted in the esophagus, the merits and limitations of flexible endoscopy (FE) and rigid endoscopy (RE) remain unclear. Therefore, this study compares the advantages and disadvantages of both endoscopic procedures from a clinical perspective. A retrospective review was made of 273 patients suspected of esophageal FBs in emergency consultations of a tertiary medical referral center from March 2010 to March 2014. All patients received routine physical examinations, otolaryngological examinations, and X-rays of the neck and chest. The door-to-endoscopy time, procedure time, postendoscopic hospital stay, successful removal rates, and complications were analyzed as well. In this study, the most common esophageal FBs were fish and animal bones (76%) in adults and coins (74%) in children. The patients with existing esophageal FBs had significantly more frequent symptoms of dysphagia and signs of linear opacity as detected with lateral neck radiography than those without FB. Additionally, the door-to-endoscopy time, procedure time, and postendoscopic hospital stay was significantly shorter in FE patients than in RE patients. However, both RE and FE patients had high rates of successful FB removal (95%) and low complication rates (2%). Both FE and RE remove esophageal FBs successfully, as evidenced by their high success rates, low complication rates, and high detection rates. Although FE under local anesthesia is a less time-consuming procedure for adults, RE under general anesthesia may be preferable for children and can serve as an alternative to FE. Copyright © 2015. Published by Elsevier B.V.

Are there any advantages in using a distal aiming device for tibial nailing? Comparing the Centro Nailing System with the Unreamed Tibia Nail.

PubMed

Veen, Egbert J D; Ettema, Harmen B; Zuurmond, Rutger G; Mostert, Adriaan K

2011-10-01

The distal locking of an intramedullary tibial nail can be challenging and time consuming when performed freehand. This study was conducted to evaluate if a distal aiming device would reduce surgical time. A case-controlled study was performed between 2007 and 2009 with 30 patients receiving a reamed tibial nail (Centronail) with the use of a distal aiming device and 30 patients who were treated with an Unreamed Tibia Nail (UTN), with freehand distal locking, in the same period. The primary outcome in this study was operative time. Secondary outcomes were the need for fluoroscopy, time to consolidation and complications. Operation time was longer in the Centronail group compared with the UTN group (126 min vs. 96 min, p=0.000). Use of fluoroscopy for distal locking was needed in half of the cases (n=16) using a distal aiming device. No differences were found regarding time to consolidation, time to removal of the nail and complications. The use of an aiming device for distal locking of a tibia nail lengthens operation time rather than reducing it. Fluoroscopy was still needed in about half of the cases. No difference was seen in clinical outcomes. The use of a distal aiming device to lock a tibial nail appears to have no benefit. Copyright © 2011 Elsevier Ltd. All rights reserved.

Variation in the cost of care for primary total knee arthroplasties.

PubMed

Haas, Derek A; Kaplan, Robert S

2017-03-01

The study examined the cost variation across 29 high-volume US hospitals and their affiliated orthopaedic surgeons for delivering a primary total knee arthroplasty without major complicating conditions. The hospitals had similar patient demographics, and more than 80% of them had statistically-similar Medicare risk-adjusted readmission and complication rates. Hospital and physician personnel costs were calculated using time-driven activity-based costing. Consumable supply costs, such as the prosthetic implant, were calculated using purchase prices, and postacute care costs were measured using either internal costs or external claims as reported by each hospital. Despite having similar patient demographics and readmission and complication rates, the average cost of care for total knee arthroplasty across the hospitals varied by a factor of about 2 to 1. Even after adjusting for differences in internal labor cost rates, the hospital at the 90th percentile of cost spent about twice as much as the one at the 10th percentile of cost. The large variation in costs among sites suggests major and multiple opportunities to transfer knowledge about process and productivity improvements that lower costs while simultaneously maintaining or improving outcomes.

Paper-based tuberculosis diagnostic devices with colorimetric gold nanoparticles

NASA Astrophysics Data System (ADS)

Tsai, Tsung-Ting; Shen, Shu-Wei; Cheng, Chao-Min; Chen, Chien-Fu

2013-08-01

A colorimetric sensing strategy employing gold nanoparticles and a paper assay platform has been developed for tuberculosis diagnosis. Unmodified gold nanoparticles and single-stranded detection oligonucleotides are used to achieve rapid diagnosis without complicated and time-consuming thiolated or other surface-modified probe preparation processes. To eliminate the use of sophisticated equipment for data analysis, the color variance for multiple detection results was simultaneously collected and concentrated on cellulose paper with the data readout transmitted for cloud computing via a smartphone. The results show that the 2.6 nM tuberculosis mycobacterium target sequences extracted from patients can easily be detected, and the turnaround time after the human DNA is extracted from clinical samples was approximately 1 h.

Psychopharmacology Decision-Making Among Pregnant and Postpartum Women and Health Providers: Informing Compassionate and Collaborative Care Women's Health

PubMed Central

Price, Sarah Kye; Bentley, Kia J.

2013-01-01

Psychopharmaceutical use by pregnant and postpartum women is complicated by the complexity of prescribing as well as the sociocultural context in which medication-related decisions are made. This study sought to advance understanding of decision–making processes and communication experiences regarding use of psychopharmaceuticals during pregnancy by considering both provider and consumer perspectives. An electronic survey was conducted with health care providers (N = 88) and women consumers (N = 3) from July 2010 through October 2011 regarding the perceived costs and benefits of taking mental health medication during and around the time of pregnancy. Descriptive analysis compared and contrasted experiences between the two groups regarding consumer-provider communication, critical incidents and triggers in decision-making, and response to case scenarios crafted around hypothetical client experiences. Both similarities and differences were evident among health care provider and women consumer responses regarding costs, benefits, communication experiences, and case scenario responses. Both quantitative and qualitative survey results indicated the need for more accurate, unbiased, and complete information exchange around mental health and medication. Study results suggested the centrality of the client-provider milieu to guide decision-making and emphasized the expressed need within both groups to create a shared decision-making practice environment characterized by authenticity, non-judgmental decision-making, compassion, humaneness, and reciprocity. PMID:23517513

Psychopharmacology decision-making among pregnant and postpartum women and health providers: informing compassionate and collaborative care women's health.

PubMed

Price, Sarah Kye; Bentley, Kia J

2013-01-01

Psychopharmaceutical use by pregnant and postpartum women is complicated by the complexity of prescribing as well as the sociocultural context in which medication-related decisions are made. This study sought to advance understanding of decision-making processes and communication experiences regarding use of psychopharmaceuticals during pregnancy by considering both provider and consumer perspectives. An electronic survey was conducted with health care providers (N = 88) and women consumers (N = 83) from July 2010 through October 2011 regarding the perceived costs and benefits of taking mental health medication during and around the time of pregnancy. Descriptive analysis compared and contrasted experiences between the two groups regarding consumer-provider communication, critical incidents and triggers in decision-making, and response to case scenarios crafted around hypothetical client experiences. Both similarities and differences were evident among health care provider and women consumer responses regarding costs, benefits, communication experiences, and case scenario responses. Both quantitative and qualitative survey results indicated the need for more accurate, unbiased, and complete information exchange around mental health and medication. Study results suggested the centrality of the client-provider milieu to guide decision-making and emphasized the expressed need within both groups to create a shared decision-making practice environment characterized by authenticity, non-judgmental decision-making, compassion, humaneness, and reciprocity.

Reference Pricing Changes The 'Choice Architecture' Of Health Care For Consumers.

PubMed

Robinson, James C; Brown, Timothy T; Whaley, Christopher

2017-03-01

Reference pricing in health insurance creates incentives for patients to select for nonemergency services providers that charge relatively low prices and still offer high quality of care. It changes the "choice architecture" by offering standard coverage if the patient chooses cost-effective providers but requires considerable consumer cost sharing if more expensive alternatives are selected. The short-term impact of reference pricing has been to shift patient volumes from hospital-based to freestanding surgical, diagnostic, imaging, and laboratory facilities. This article summarizes reference pricing's impacts to date on patient choice, provider prices, surgical complications, and employer spending and estimates its potential impacts if expanded to more services and a broader population. Reference pricing induces consumers to select lower-price alternatives for all of the forms of care studied, leading to significant reductions in prices paid and spending incurred by insurers and employers. The impact on consumer cost sharing is mixed, with some studies finding higher copayments and some lower. We conclude with a discussion of the incentives created for providers to redesign their clinical processes and for efficient providers to expand into price-sensitive markets. Over time, reference pricing may increase pressures for price competition and lead to further cost-reducing innovations in health care products and processes. Project HOPE—The People-to-People Health Foundation, Inc.

Estimating the costs for the treatment of abortion complications in two public referral hospitals: a cross-sectional study in Ouagadougou, Burkina Faso.

PubMed

Ilboudo, Patrick G C; Greco, Giulia; Sundby, Johanne; Torsvik, Gaute

2016-10-07

Treatment costs of induced abortion complications can consume a substantial amount of hospital resources. This use of hospitals scarce resources to treat induced abortion complications may affect hospitals' capacities to deliver other health care services. In spite of the importance of studying the burden of the treatment of induced abortion complications, few studies have been conducted to document the costs of treating abortion complications in Burkina Faso. Our objective was to estimate the costs of six abortion complications including incomplete abortion, hemorrhage, shock, infection/sepsis, cervix or vagina laceration, and uterus perforation treated in two public referral hospital facilities in Ouagadougou and the cost saving of providing safe abortion care services. The distribution of abortion-related complications was assessed through a review of postabortion care-registers combined with interviews with key informants in maternity wards and in hospital facilities. Two structured questionnaires were used for data collection following the perspective of the hospital. The first questionnaire collected information on the units and the unit costs of drugs and medical supplies used in the treatment of each complication. The second questionnaire gathered information on salaries and overhead expenses. All data were entered in a spreadsheet designed for studying abortion, and analyses were performed on Excel 2007. Across six types of abortion complications, the mean cost per patient was USD45.86. The total cost to these two public referral hospital facilities for treating the complications of abortion was USD22,472.53 in 2010 equivalent to USD24,466.21 in 2015. Provision of safe abortion care services to women who suffered from complications of unsafe induced abortion and who received care in these public hospitals would only have cost USD2,694, giving potential savings of more than USD19,778.53 in that year. The treatment of the complications of abortion consumes a significant proportion (up to USD22,472.53) of the two public hospitals resources in Burkina Faso. Safe abortion care services may represent a cost beneficial alternative, as it may have saved USD19,778.53 in 2010.

Role of non-invasive ventilation in difficult-to-wean children with acute neuromuscular disease.

PubMed

Reddy, V G; Nair, M P; Bataclan, F

2004-05-01

Weaning from mechanical ventilation in children could be time-consuming and on many occasions, leads to reintubation with its associate complications. We report two children with acute neuromuscular disease, in whom bi-level positive airway pressure (BiPAP) as a mode of non-invasive ventilation was successfully used to wean the child from ventilators and prevented the need for tracheostomy. Despite the limited number of studies published in the literature suggesting BiPAP as a mode of weaning from mechanical ventilation, the technique when applied correctly seems to be safe and effective in weaning and avoiding tracheostomy.

Hydraulic Robotic Surgical Tool Changing Manipulator

PubMed Central

Pourghodrat, Abolfazl; Nelson, Carl A.; Oleynikov, Dmitry

2017-01-01

Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique to perform “scarless” abdominal operations. Robotic technology has been exploited to improve NOTES and circumvent its limitations. Lack of a multitasking platform is a major limitation. Manual tool exchange can be time consuming and may lead to complications such as bleeding. Previous multifunctional manipulator designs use electric motors. These designs are bulky, slow, and expensive. This paper presents design, prototyping, and testing of a hydraulic robotic tool changing manipulator. The manipulator is small, fast, low-cost, and capable of carrying four different types of laparoscopic instruments. PMID:28450979

Transmasseteric antero-parotid approach for open reduction and internal fixation of condylar fractures.

PubMed

Wilson, A W; Ethunandan, M; Brennan, P A

2005-02-01

The morbidity that results from surgical approaches to the condylar neck, and the time-consuming nature of the operation inhibits many surgeons from using open reduction and internal fixation for the treatment of condylar fractures. The many approaches that have been described stand testimony to the disadvantages of the individual techniques. The most common problems are limited access and injury to the facial nerve. We describe the transmasseteric antero-parotid (TMAP) technique, which offers swift access to the condylar neck while substantially reducing the risk to the facial nerve and eliminating the complications associated with transparotid approaches.

[Diagnostic criteria and risk assessment of complications after gastric cancer surgery in western countries].

PubMed

Wu, Zhouqiao; Wang, Qi; Shi, Jinyao; Cherry, Koh; Desiderio, Jacopo; Li, Ziyu; Ji, Jiafu

2017-02-25

Postoperative complications are important outcome measurements for surgical quality and safety control. However, the complication registration has always been problematic due to the lack of definition consensus and the other practical difficulties. This narrative review summarizes the data registry system for single institutional registry, national data registry, international multi-center trial registries in the western world, aiming to share the experience of complication classification and data registration. We interviewed Dr. Koh from Royal Prince Alfred Hospital in Australia for single institutional experience, Dr. van der Wielen and Dr. Desideriofor, from two international multi-center trial(STOMACH) and registry (IMIGASTRIC) respectively, and Prof. Dr. Wijnhoven from the Dutch Upper GI Audit(DUCA). The major questions include which complications are obligated to report in the respective registry, what are the definitions of those complications, who perform the registration, and how are the complications evaluated or classified. Four telephone conferences were initiated to discuss the above-mentioned topics. The DUCA and IMGASTRIC provided the definition of the major complications. The consent definition provided by DUCA was based on the LOW classification which came out after a four-year discussion and consensus meeting among international experts in the according field. However, none of the four registries asked for an obligatory standardization of the diagnostic criteria among the participating centers or surgeons. Instead, all the registries required a detailed recording of the diagnostic strategy and classification of the complications with the Clavien-Dindo scoring system. Most data were registered by surgeons or data managers during or immediately after the hospitalization. The investigators or an independent third party conducted the auditing of the data quality. Standardization of complication diagnosis among different centers is a difficult task, consuming much effort and time. On top of that, standardization of the complication registration is of critical and practical importance. We encourage all centers to register complications with the diagnostic criteria and following intervention. Based on this, the Clavien-Dindo classification can be properly justified, which has been widely accepted by most centers and should be routinely used as the standard evaluation system for postoperative complications in gastric tumor surgery.

Whittling Down the Wait Time: Exploring Models to Minimize the Delay from Initial Concern to Diagnosis and Treatment of Autism Spectrum Disorder.

PubMed

Gordon-Lipkin, Eliza; Foster, Jessica; Peacock, Georgina

2016-10-01

The process from initial concerns to diagnosis of autism spectrum disorder (ASD) can be a long and complicated process. The traditional model for evaluation and diagnosis of ASD often consists of long wait-lists and evaluations that result in a 2-year difference between the earliest signs of ASD and mean age of diagnosis. Multiple factors contribute to this diagnostic bottleneck, including time-consuming evaluations, cost of care, lack of providers, and lack of comfort of primary care providers to diagnose autism. This article explores innovative clinical models that have been implemented to address this as well as future directions and opportunities. Copyright © 2016 Elsevier Inc. All rights reserved.

Food Labeling and Consumer Associations with Health, Safety, and Environment.

PubMed

Sax, Joanna K; Doran, Neal

2016-12-01

The food supply is complicated and consumers are increasingly calling for labeling on food to be more informative. In particular, consumers are asking for the labeling of food derived from genetically modified organisms (GMO) based on health, safety, and environmental concerns. At issue is whether the labels that are sought would accurately provide the information desired. The present study examined consumer (n = 181) perceptions of health, safety and the environment for foods labeled organic, natural, fat free or low fat, GMO, or non-GMO. Findings indicated that respondents consistently believed that foods labeled GMO are less healthy, safe and environmentally-friendly compared to all other labels (ps < .05). These results suggest that labels mean something to consumers, but that a disconnect may exist between the meaning associated with the label and the scientific consensus for GMO food. These findings may provide insight for the development of labels that provide information that consumers seek.

Impact of water quality on chlorine demand of corroding copper.

PubMed

Lytle, Darren A; Liggett, Jennifer

2016-04-01

Copper is widely used in drinking water premise plumbing system materials. In buildings such as hospitals, large and complicated plumbing networks make it difficult to maintain good water quality. Sustaining safe disinfectant residuals throughout a building to protect against waterborne pathogens such as Legionella is particularly challenging since copper and other reactive distribution system materials can exert considerable demands. The objective of this work was to evaluate the impact of pH and orthophosphate on the consumption of free chlorine associated with corroding copper pipes over time. A copper test-loop pilot system was used to control test conditions and systematically meet the study objectives. Chlorine consumption trends attributed to abiotic reactions with copper over time were different for each pH condition tested, and the total amount of chlorine consumed over the test runs increased with increasing pH. Orthophosphate eliminated chlorine consumption trends with elapsed time (i.e., chlorine demand was consistent across entire test runs). Orthophosphate also greatly reduced the total amount of chlorine consumed over the test runs. Interestingly, the total amount of chlorine consumed and the consumption rate were not pH dependent when orthophosphate was present. The findings reflect the complex and competing reactions at the copper pipe wall including corrosion, oxidation of Cu(I) minerals and ions, and possible oxidation of Cu(II) minerals, and the change in chlorine species all as a function of pH. The work has practical applications for maintaining chlorine residuals in premise plumbing drinking water systems including large buildings such as hospitals. Published by Elsevier Ltd.

Evolution of the Interstellar Gas Fraction Over Cosmic Time

NASA Astrophysics Data System (ADS)

Wiklind, Tommy; CANDELS

2018-01-01

Galaxies evolve by transforming gas into stars. The gas is acquired through accretion and mergers and is a highly intricate process where feed-back processes play an important role. Directly measuring the gas content in distant galaxies is, however, both complicated and time consuming. A direct observations involves either observing neutral hydrogen using the 21cm line or observing the molecular gas component using tracer molecules such as CO. The former method is impeded by man-made radio interference, and the latter is time consuming even with sensitive instruments such s ALMA. An indirect method is to observe the Raleigh-Jeans part of the dust SED and from this infer the gas mass. Here we present the results from a project using ALMA to measure the RJ part of the dust SED in a carefully selected sample of 70 galaxies at redshifts z=2-5. The galaxies are selected solely based on their redshift and stellar mass and therefore represents an unbiased sample. The stellar masses are selected using the MEAM method and thus the sample corresponds to progenitors of a z=0 galaxy of a particular stellar mass. Preliminary results show that the average gas fraction increases with redshift over the range z=2-3 in accordance with theoretical models, but at z≥4 the observed gas fraction is lower.

Consumer Health: CAM Claims

MedlinePlus

... over-the-counter medications can interact with certain dietary supplements. For example, the herbal supplement ginkgo can interact with the blood-thinning medication warfarin (Coumadin) and increase the risk of serious bleeding complications. Before surgery, tell your ...

Open vs Laparoscopic Simple Prostatectomy: A Comparison of Initial Outcomes and Cost.

PubMed

Demir, Aslan; Günseren, Kadir Ömür; Kordan, Yakup; Yavaşçaoğlu, İsmet; Vuruşkan, Berna Aytaç; Vuruşkan, Hakan

2016-08-01

We compared the cost-effectiveness of laparoscopic simple prostatectomy (LSP) vs open prostatectomy (OP). A total of 73 men treated for benign prostatic hyperplasia were enrolled for OP and LSP in groups 1 and 2, respectively. The findings were recorded perioperative, including operation time (OT), blood lost, transfusion rate, conversion to the open surgery, and the complications according to the Clavien Classification. The postoperative findings, including catheterization and drainage time, the amount of analgesic used, hospitalization time, postoperative complications, international prostate symptom score (IPSS) and International Index of Erectile Function (IIEF) scores, the extracted prostate weight, the uroflowmeter, as well as postvoiding residual (PVR) and quality of life (QoL) score at the postoperative third month, were analyzed. The cost of both techniques was also compared statistically. No statistical differences were found in the preoperative parameters, including age, IPSS and QoL score, maximum flow rate (Qmax), PVR, IIEF score, and prostate volumes, as measured by transabdominal ultrasonography. No statistical differences were established in terms of the OT and the weight of the extracted prostate. No differences were established with regard to complications according to Clavien's classification in groups. However, the bleeding rate was significantly lower in group 2. The drainage, catheterization, and hospitalization times and the amount of analgesics were significantly lower in the second group. The postoperative third month findings were not different statistically. Only the Qmax values were significantly greater in group 2. While there was only a $52 difference between groups with regard to operation cost, this difference was significantly different. The use of LSP for the prostates over 80 g is more effective than the OP in terms of OT, bleeding amount, transfusion rates, catheterization time, drain removal time, hospitalization time, consumed analgesic amount, and Qmax values. On the other hand, the mean cost of the LSP is higher than OP. Better effectiveness comes with higher cost.

Trend of telomerase activity change during human iPSC self-renewal and differentiation revealed by a quartz crystal microbalance based assay

NASA Astrophysics Data System (ADS)

Zhou, Yitian; Zhou, Ping; Xin, Yinqiang; Wang, Jie; Zhu, Zhiqiang; Hu, Ji; Wei, Shicheng; Ma, Hongwei

2014-11-01

Telomerase plays an important role in governing the life span of cells for its capacity to extend telomeres. As high activity of telomerase has been found in stem cells and cancer cells specifically, various methods have been developed for the evaluation of telomerase activity. To overcome the time-consuming procedures and complicated manipulations of existing methods, we developed a novel method named Telomeric Repeat Elongation Assay based on Quartz crystal microbalance (TREAQ) to monitor telomerase activity during the self-renewal and differentiation of human induced pluripotent stem cells (hiPSCs). TREAQ results indicated hiPSCs possess invariable telomerase activity for 11 passages on Matrigel and a steady decline of telomerase activity when differentiated for different periods, which is confirmed with existing golden standard method. The pluripotency of hiPSCs during differentiation could be estimated through monitoring telomerase activity and compared with the expression levels of markers of pluripotency gene via quantitative real time PCR. Regular assessment for factors associated with pluripotency or stemness was expensive and requires excessive sample consuming, thus TREAQ could be a promising alternative technology for routine monitoring of telomerase activity and estimate the pluripotency of stem cells.

A method for automatic matching of multi-timepoint findings for enhanced clinical workflow

NASA Astrophysics Data System (ADS)

Raghupathi, Laks; Dinesh, MS; Devarakota, Pandu R.; Valadez, Gerardo Hermosillo; Wolf, Matthias

2013-03-01

Non-interventional diagnostics (CT or MR) enables early identification of diseases like cancer. Often, lesion growth assessment done during follow-up is used to distinguish between benign and malignant ones. Thus correspondences need to be found for lesions localized at each time point. Manually matching the radiological findings can be time consuming as well as tedious due to possible differences in orientation and position between scans. Also, the complicated nature of the disease makes the physicians to rely on multiple modalities (PETCT, PET-MR) where it is even more challenging. Here, we propose an automatic feature-based matching that is robust to change in organ volume, subpar or no registration that can be done with very less computations. Traditional matching methods rely mostly on accurate image registration and applying the resulting deformation map on the findings coordinates. This has disadvantages when accurate registration is time-consuming or may not be possible due to vast organ volume differences between scans. Our novel matching proposes supervised learning by taking advantage of the underlying CAD features that are already present and considering the matching as a classification problem. In addition, the matching can be done extremely fast and at reasonable accuracy even when the image registration fails for some reason. Experimental results∗ on real-world multi-time point thoracic CT data showed an accuracy of above 90% with negligible false positives on a variety of registration scenarios.

Is Satisfaction with the Acute-Care Experience Higher amongst Consumers Treated in the Private Sector? A Survey of Public and Private Sector Arthroplasty Recipients.

PubMed

Naylor, Justine M; Descallar, Joseph; Grootemaat, Mechteld; Badge, Helen; Harris, Ian A; Simpson, Grahame; Jenkin, Deanne

2016-01-01

Consumer satisfaction with the acute-care experience could reasonably be expected to be higher amongst those treated in the private sector compared to those treated in the public sector given the former relies on high-level satisfaction of its consumers and their subsequent recommendations to thrive. The primary aims of this study were to determine, in a knee or hip arthroplasty cohort, if surgery in the private sector predicts greater overall satisfaction with the acute-care experience and greater likelihood to recommend the same hospital. A secondary aim was to determine whether satisfaction across a range of service domains is also higher in the private sector. A telephone survey was conducted 35 days post-surgery. The hospital cohort comprised eight public and seven private high-volume arthroplasty providers. Consumers rated overall satisfaction with care out of 100 and likeliness to recommend their hospital on a 5-point Likert scale. Additional Likert-style questions were asked covering specific service domains. Generalized estimating equation models were used to analyse overall satisfaction (dichotomised as ≥ 90 or < 90) and future recommendations for care (dichotomised as 'definitely recommend' or 'other'), whilst controlling for covariates. The proportions of consumers in each sector reporting the best Likert response for each individual domain were compared using non-parametric tests. 457 survey respondents (n = 210 private) were included. Less patient-reported joint impairment pre-surgery [OR 1.03 (95% CI 1.01-1.05)] and absence of an acute complication (OR 2.13 95% CI 1.41-3.23) significantly predicted higher overall satisfaction. Hip arthroplasty [OR 1.84 (1.1-2.96)] and an absence of an acute complication [OR 2.31 (1.28-4.17] significantly predicted greater likelihood for recommending the hospital. The only care domains where the private out-performed the public sector were hospitality (46.7 vs 35.6%, p <0.01) and frequency of surgeon visitation (76.4 vs 65.8%, p = 0.03). Arthroplasty consumers treated in the private sector are not more satisfied with their acute-care experience nor are they more likely to recommend their hospital provider. Rather, avoidance of complications in either sector appears to result in improved satisfaction as well as a greater likelihood that patients would recommend their hospital provider.

Rapid performance modeling and parameter regression of geodynamic models

NASA Astrophysics Data System (ADS)

Brown, J.; Duplyakin, D.

2016-12-01

Geodynamic models run in a parallel environment have many parameters with complicated effects on performance and scientifically-relevant functionals. Manually choosing an efficient machine configuration and mapping out the parameter space requires a great deal of expert knowledge and time-consuming experiments. We propose an active learning technique based on Gaussion Process Regression to automatically select experiments to map out the performance landscape with respect to scientific and machine parameters. The resulting performance model is then used to select optimal experiments for improving the accuracy of a reduced order model per unit of computational cost. We present the framework and evaluate its quality and capability using popular lithospheric dynamics models.

Fixation methods for electron microscopy of human and other liver

PubMed Central

Wisse, Eddie; Braet, Filip; Duimel, Hans; Vreuls, Celien; Koek, Ger; Olde Damink, Steven WM; van den Broek, Maartje AJ; De Geest, Bart; Dejong, Cees HC; Tateno, Chise; Frederik, Peter

2010-01-01

For an electron microscopic study of the liver, expertise and complicated, time-consuming processing of hepatic tissues and cells is needed. The interpretation of electron microscopy (EM) images requires knowledge of the liver fine structure and experience with the numerous artifacts in fixation, embedding, sectioning, contrast staining and microscopic imaging. Hence, the aim of this paper is to present a detailed summary of different methods for the preparation of hepatic cells and tissue, for the purpose of preserving long-standing expertise and to encourage new investigators and clinicians to include EM studies of liver cells and tissue in their projects. PMID:20556830

Obsolescence of electronics at the VLT

NASA Astrophysics Data System (ADS)

Hüdepohl, Gerhard; Haddad, Juan-Pablo; Lucuix, Christian

2016-07-01

The ESO Very Large Telescope Observatory (VLT) at Cerro Paranal in Chile had its first light in 1998. Most of the telescopes' electronics components were chosen and designed in the mid 1990s and are now around 20 years old. As a consequence we are confronted with increasing failure rates due to aging and lack of spare parts, since many of the components are no longer available on the market. The lifetime of large telescopes is generally much beyond 25 years. Therefore the obsolescence of electronics components and modules becomes an issue sooner or later and forces the operations teams to upgrade the systems to new technology in order to avoid that the telescope becomes inoperable. Technology upgrade is a time and money consuming process, which in many cases is not straightforward and has various types of complications. This paper shows the strategy, analysis, approach, timeline, complications and progress in obsolescence driven electronics upgrades at the ESO Very Large Telescope (VLT) at the Paranal Observatory.

Intelligent transportation systems : incorporating the consumer

DOT National Transportation Integrated Search

1999-05-01

Intelligent Transportation Systems (ITS) techniques are improving mobility for travelers throughout the nation and world. To date, ITS has largely been the focus of professionals who are applying innovative methods to complicated traffic and travel i...

Health Insurance for "Humans": Information Frictions, Plan Choice, and Consumer Welfare.

PubMed

Handel, Benjamin R; Kolstad, Jonathan T

2015-08-01

Traditional models of insurance choice are predicated on fully informed and rational consumers protecting themselves from exposure to financial risk. In practice, choosing an insurance plan is a complicated decision often made without full information. In this paper we combine new administrative data on health plan choices and claims with unique survey data on consumer information to identify risk preferences, information frictions, and hassle costs. Our additional friction measures are important predictors of choices and meaningfully impact risk preference estimates. We study the implications of counterfactual insurance allocations to illustrate the importance of distinguishing between these micro-foundations for welfare analysis.

Beneficence vs. obligation: challenges of the Americans with Disabilities Act for consumer employment in mental health services.

PubMed

Francis, Linda E; Colson, Paul W; Mizzi, Pamela

2002-04-01

Involvement of mental health service consumers in the provision of mental health services is a growing model in community mental health. It is, however, a complicated issue, made ever more so by the passage of the Americans with Disabilities Act. In this ethnographic case study, we seek to explore the changes one social services agency has made to adjust to the requirements of the ADA and the impact of these changes on their consumer employees. Our results indicate potential for positive progress as a result of the ADA, but also unexpected pitfalls as organizational cultures change as well.

A novel technique using high energy synchronous double-wave laser in endoscopic submucosal dissection of patients with superficial esophageal neoplasm.

PubMed

Yao, Jun; Li, Jun; Wang, Peng; Liu, Feng; Li, Zhaoshen

2018-06-08

BACKGROUND : Endoscopic submucosal dissection (ESD) has been widely used to treat superficial esophageal neoplasms (SENs). Intraoperative bleeding is one of the main concerns that makes ESD in the esophagus more difficult and time consuming with higher complication rates. We introduced a novel laser endoknife system that enabled better intraoperative hemostasis, and preliminarily investigated its feasibility in ESD for patients with SENs.  17 consecutive patients with SENs were prospectively enrolled. The laser endoknife system was used in marking and submucosal dissection. Data on therapeutic outcomes were collected and analyzed.  The median diameter of the lesions was 2.5 cm and of the resected specimens was 3.0 cm. The median procedure time was 48 minutes. Histologic evaluation revealed 15 high grade intraepithelial neoplasias and two squamous cell carcinomas. No intraoperative bleeding occurred during laser cutting and no significant complications occurred postoperatively. Curative R0 resection was achieved in all patients.  Our new laser endoknife system was feasible in the submucosal dissection of SENs and showed great prospects for future application. © Georg Thieme Verlag KG Stuttgart · New York.

Semi-physical simulation test for micro CMOS star sensor

NASA Astrophysics Data System (ADS)

Yang, Jian; Zhang, Guang-jun; Jiang, Jie; Fan, Qiao-yun

2008-03-01

A designed star sensor must be extensively tested before launching. Testing star sensor requires complicated process with much time and resources input. Even observing sky on the ground is a challenging and time-consuming job, requiring complicated and expensive equipments, suitable time and location, and prone to be interfered by weather. And moreover, not all stars distributed on the sky can be observed by this testing method. Semi-physical simulation in laboratory reduces the testing cost and helps to debug, analyze and evaluate the star sensor system while developing the model. The test system is composed of optical platform, star field simulator, star field simulator computer, star sensor and the central data processing computer. The test system simulates the starlight with high accuracy and good parallelism, and creates static or dynamic image in FOV (Field of View). The conditions of the test are close to observing real sky. With this system, the test of a micro star tracker designed by Beijing University of Aeronautics and Astronautics has been performed successfully. Some indices including full-sky autonomous star identification time, attitude update frequency and attitude precision etc. meet design requirement of the star sensor. Error source of the testing system is also analyzed. It is concluded that the testing system is cost-saving, efficient, and contributes to optimizing the embed arithmetic, shortening the development cycle and improving engineering design processes.

High-Resolution Three-Dimensional Computed Tomography for Assessing Complications Related to Intrathecal Drug Delivery.

PubMed

Morgalla, Matthias; Fortunato, Marcos; Azam, Ala; Tatagiba, Marcos; Lepski, Guillherme

2016-07-01

The assessment of the functionality of intrathecal drug delivery (IDD) systems remains difficult and time-consuming. Catheter-related problems are still very common, and sometimes difficult to diagnose. The aim of the present study is to investigate the accuracy of high-resolution three-dimensional computed tomography (CT) in order to detect catheter-related pump dysfunction. An observational, retrospective investigation. Academic medical center in Germany. We used high-resolution three dimensional (3D) computed tomography with volume rendering technique (VRT) or fluoroscopy and conventional axial-CT to assess IDD-related complications in 51 patients from our institution who had IDD systems implanted for the treatment of chronic pain or spasticity. Twelve patients (23.5%) presented a total of 22 complications. The main type of complication in our series was catheter-related (50%), followed by pump failure, infection, and inappropriate refilling. Fluoroscopy and conventional CT were used in 12 cases. High-resolution 3D CT VRT scan was used in 35 instances with suspected yet unclear complications. Using 3D-CT (VRT) the sensitivity was 58.93% - 100% (CI 95%) and the specificity 87.54% - 100% (CI 95%).The positive predictive value was 58.93% - 100% (CI 95%) and the negative predictive value: 87.54% - 100% (CI 95%).Fluoroscopy and axial CT as a combined diagnostic tool had a sensitivity of 8.3% - 91.7% (CI 95%) and a specificity of 62.9% - 100% (CI 95%). The positive predictive value was 19.29% - 100% (CI 95%) and the negative predictive value: 44.43% - 96.89% (CI 95%). This study is limited by its observational design and the small number of cases. High-resolution 3D CT VRT is a non- invasive method that can identify IDD-related complications with more precision than axial CT and fluoroscopy.

Quantifying swallowing function for healthy adults in different age groups using acoustic analysis

NASA Astrophysics Data System (ADS)

Leung, Man-Yin

Dysphagia is a medical condition that can lead to devastating complications including weight loss, aspiration pneumonia, dehydration, and malnutrition; hence, timely identification is essential. Current dysphagia evaluation tools are either invasive, time consuming, or highly dependent on the experience of an individual clinician. The present study aims to develop a non-invasive, quantitative screening tool for dysphagia identification by capturing acoustic data from swallowing and mastication. The first part of this study explores the feasibility of using acoustic data to quantify swallowing and mastication. This study then further identifies mastication and swallowing trends in a neurotypical adult population. An acoustic capture protocol for dysphagia screening is proposed. Finally, the relationship among speaking, lingual and mastication rates are explored. Results and future directions are discussed.

Autocorrelated process control: Geometric Brownian Motion approach versus Box-Jenkins approach

NASA Astrophysics Data System (ADS)

Salleh, R. M.; Zawawi, N. I.; Gan, Z. F.; Nor, M. E.

2018-04-01

Existing of autocorrelation will bring a significant effect on the performance and accuracy of process control if the problem does not handle carefully. When dealing with autocorrelated process, Box-Jenkins method will be preferred because of the popularity. However, the computation of Box-Jenkins method is too complicated and challenging which cause of time-consuming. Therefore, an alternative method which known as Geometric Brownian Motion (GBM) is introduced to monitor the autocorrelated process. One real case of furnace temperature data is conducted to compare the performance of Box-Jenkins and GBM methods in monitoring autocorrelation process. Both methods give the same results in terms of model accuracy and monitoring process control. Yet, GBM is superior compared to Box-Jenkins method due to its simplicity and practically with shorter computational time.

Overcoming information asymmetry in consumer-directed health plans.

PubMed

Retchin, Sheldon M

2007-04-01

Consumer-centric healthcare has been extolled as the centerpiece of a new model for managing both quality and price. However, information asymmetry in consumer-directed health plans (CDHPs) is a challenge that must be addressed. For CDHPs to work as intended and to gain acceptance, consumers need information regarding the quality and price of healthcare purchases. The federal government, particularly the Agency for Healthcare Research and Quality, could function as an official resource for information on performance and comparisons among facilities and providers. Because of workforce constraints among primary care physicians, a new group of healthcare professionals called "medical decision advisors" could be trained. Academic health centers would have to play a critical role in devising an appropriate curriculum, as well as designing a certification and credentialing process. However, with appropriate curricula and training, medical decision advisors could furnish information for consumers and aid in the complicated decisions they will face under CDHPs.

Optimization of the Monte Carlo code for modeling of photon migration in tissue.

PubMed

Zołek, Norbert S; Liebert, Adam; Maniewski, Roman

2006-10-01

The Monte Carlo method is frequently used to simulate light transport in turbid media because of its simplicity and flexibility, allowing to analyze complicated geometrical structures. Monte Carlo simulations are, however, time consuming because of the necessity to track the paths of individual photons. The time consuming computation is mainly associated with the calculation of the logarithmic and trigonometric functions as well as the generation of pseudo-random numbers. In this paper, the Monte Carlo algorithm was developed and optimized, by approximation of the logarithmic and trigonometric functions. The approximations were based on polynomial and rational functions, and the errors of these approximations are less than 1% of the values of the original functions. The proposed algorithm was verified by simulations of the time-resolved reflectance at several source-detector separations. The results of the calculation using the approximated algorithm were compared with those of the Monte Carlo simulations obtained with an exact computation of the logarithm and trigonometric functions as well as with the solution of the diffusion equation. The errors of the moments of the simulated distributions of times of flight of photons (total number of photons, mean time of flight and variance) are less than 2% for a range of optical properties, typical of living tissues. The proposed approximated algorithm allows to speed up the Monte Carlo simulations by a factor of 4. The developed code can be used on parallel machines, allowing for further acceleration.

Towards an automated intelligence product generation capability

NASA Astrophysics Data System (ADS)

Smith, Alison M.; Hawes, Timothy W.; Nolan, James J.

2015-05-01

Creating intelligence information products is a time consuming and difficult process for analysts faced with identifying key pieces of information relevant to a complex set of information requirements. Complicating matters, these key pieces of information exist in multiple modalities scattered across data stores, buried in huge volumes of data. This results in the current predicament analysts find themselves; information retrieval and management consumes huge amounts of time that could be better spent performing analysis. The persistent growth in data accumulation rates will only increase the amount of time spent on these tasks without a significant advance in automated solutions for information product generation. We present a product generation tool, Automated PrOduct Generation and Enrichment (APOGEE), which aims to automate the information product creation process in order to shift the bulk of the analysts' effort from data discovery and management to analysis. APOGEE discovers relevant text, imagery, video, and audio for inclusion in information products using semantic and statistical models of unstructured content. APOGEEs mixed-initiative interface, supported by highly responsive backend mechanisms, allows analysts to dynamically control the product generation process ensuring a maximally relevant result. The combination of these capabilities results in significant reductions in the time it takes analysts to produce information products while helping to increase the overall coverage. Through evaluation with a domain expert, APOGEE has been shown the potential to cut down the time for product generation by 20x. The result is a flexible end-to-end system that can be rapidly deployed in new operational settings.

Reducing the Burden of Price.

ERIC Educational Resources Information Center

Hansen, Janet S.

1984-01-01

Setting prices for undergraduate education and assessing their effects on consumers and institutions is complicated by widespread price discounting. Student aid programs, credit, subsidized employment, and tax policy can reduce the actual costs paid by students and their families. (MSE)

J-tube technique for double-j stent insertion during laparoscopic upper urinary tract surgical procedures.

PubMed

Kim, Hyung Suk; Lee, Byung Ki; Jung, Jin-Woo; Lee, Jung Keun; Byun, Seok-Soo; Lee, Sang Eun; Jeong, Chang Wook

2014-11-01

Double-J stent insertion has been generally performed during laparoscopic upper urinary tract (UUT) surgical procedures to prevent transient urinary tract obstruction and postoperative flank pain from ureteral edema and blood clots. Several restrictive conditions that make this procedure difficult and time consuming, however, include the coiled distal ends of the flexible Double-J stent and the limited bending angle of the laparoscopic instruments. To overcome these limitations, we devised a Double-J stent insertion method using the new J-tube technique. Between July 2011 and May 2013, Double-J stents were inserted using the J-tube technique in 33 patients who underwent a laparoscopic UUT surgical procedure by a single surgeon. The mean stent placement time was 4.8±2.7 minutes, and there were no intraoperative complications. In conclusion, the J-tube technique is a safe and time-saving method for Double-J stent insertion during laparoscopic surgical procedures.

The Selection and Placement Method of Materialized Views on Big Data Platform of Equipment Condition Assessment

NASA Astrophysics Data System (ADS)

Ma, Yan; Yao, Jinxia; Gu, Chao; Chen, Yufeng; Yang, Yi; Zou, Lida

2017-05-01

With the formation of electric big data environment, more and more big data analyses emerge. In the complicated data analysis on equipment condition assessment, there exist many join operations, which are time-consuming. In order to save time, the approach of materialized view is usually used. It places part of common and critical join results on external storage and avoids the frequent join operation. In the paper we propose the methods of selecting and placing materialized views to reduce the query time of electric transmission and transformation equipment, and make the profits of service providers maximal. In selection method we design a computation way for the value of non-leaf node based on MVPP structure chart. In placement method we use relevance weights to place the selected materialized views, which help reduce the network transmission time. Our experiments show that the proposed selection and placement methods have a high throughput and good optimization ability of query time for electric transmission and transformation equipment.

[Endoscopic full-thickness resection].

PubMed

Meier, B; Schmidt, A; Caca, K

2016-08-01

Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) are powerful tools for the treatment of gastrointestinal (GI) neoplasms. However, those techniques are limited to the superficial layers of the GI wall (mucosa and submucosa). Lesions without lifting sign (usually arising from deeper layers) or lesions in difficult anatomic positions (appendix, diverticulum) are difficult - if not impossible - to resect using conventional techniques, due to the increased risk of complications. For larger lesions (>2 cm), ESD appears to be superior to the conventional techniques because of the en bloc resection, but the procedure is technically challenging, time consuming, and associated with complications even in experienced hands. Since the development of the over-the-scope clips (OTSC), complications like bleeding or perforation can be endoscopically better managed. In recent years, different endoscopic full-thickness resection techniques came to the focus of interventional endoscopy. Since September 2014, the full-thickness resection device (FTRD) has the CE marking in Europe for full-thickness resection in the lower GI tract. Technically the device is based on the OTSC system and combines OTSC application and snare polypectomy in one step. This study shows all full-thickness resection techniques currently available, but clearly focuses on the experience with the FTRD in the lower GI tract.

American alligator digestion rate of blue crabs and its implications for stomach contents analysis

USGS Publications Warehouse

Nifong, James C.; Rosenblatt, Adam E.; Johnson, Nathan A.; Barichivich, William; Silliman, Brian; Heithaus, Michael R.

2012-01-01

Stomach contents analysis (SCA) provides a snap-shot observation of a consumer's diet. Interpretation of SCA data can be complicated by many factors, including variation in gastric residence times and digestion rates among prey taxa. Although some SCA methods are reported to efficiently remove all stomach contents, the effectiveness of these techniques has rarely been tested for large irregular shaped prey with hard exoskeletons. We used a controlled feeding trial to estimate gastric residency time and decomposition rate of a large crustacean prey item, the Blue Crab (Callinectes sapidus), which is consumed by American Alligators (Alligator mississippiensis), an abundant apex predator in coastal habitats of the southeastern United States. The decomposition rate of C. sapidus in the stomachs of A. mississippiensis followed a predictable pattern, and some crab pieces remained in stomachs for at least 14 days. We also found that certain portions of C. sapidus were prone to becoming caught within the stomach or esophagus, meaning not all crab parts are consistently recovered using gastric lavage techniques. However, because the state of decomposition of crabs was predictable, it is possible to estimate time since consumption for crabs recovered from wild alligators. This information, coupled with a detailed understanding of crab distributions and alligator movement tactics could help elucidate patterns of cross-ecosystem foraging by the American Alligator in coastal habitats

Vaccum drainage system application in the management of operation-related non-regional epidural hematoma

PubMed Central

2013-01-01

Background Epidural intracranial hematoma is one of the most common complications of surgeries for intracranial tumors. The non-regional epidural hematoma is related to severe fluctuation of the intracranial pressure during the operation. The traditional management of hematoma evacuation through craniotomy is time-consuming and may aggravate intracranial pressure imbalance, which causes further complications. We designed a method using vaccum epidural drainage system, and tried to evaluate advantage and the disadvantage of this new technique. Methods Seven patients of intracranial tumors were selected. All of the patients received tumor resection and intra-operative non-regional epidural hematoma was confirmed through intra-operative ultrasound or CT scan. The vaccum drainage system was applied. Another ten patients who received craniotomy for intra-operative non-regional epidural hematoma evacuation were selected as comparison. Regular tests, like serial CT scan, were performed afterward to evaluate the effectiveness and to help deciding when to remove the drainage system. Results The vaccum drainage method was effective in epidual hemotoma clearance and prevented recurrent epidural hemorrhage. The drainage systems were removed within 4 days. All of the patients recovered well. No complications related to the drainage system were observed. Conclusions Compared to the traditional craniotomy, the new method of epidural hemoatoma management using vaccum epidural drainage system proved to be as effective in hematoma clearance, and was less-invasive and easier to perform, with less complication, shorter hospitalization, less economic burden, and better prognosis. PMID:23842198

Sternotomy or bilateral thoracoscopy: pain and postoperative complications after lung-volume reduction surgery

PubMed Central

Boley, Theresa M.; Reid, Adam J.; Manning, Blaine T.; Markwell, Stephen J.; Vassileva, Christina M.; Hazelrigg, Stephen R.

2012-01-01

OBJECTIVES Video-assisted thoracoscopic surgery (VATS) and median sternotomy (MS) are two approaches in lung-volume reduction surgery (LVRS). This study focused on the two surgical approaches with regard to postoperative pain. METHODS In this prospective, non-randomized study, pain was measured preoperatively and postoperatively using the visual analog scale (VAS) and the brief pain inventory (BPI). Incentive spirometry (IS) assessed restriction of the thoracic cage due to pain. Factors associated with treatment complications, medication usage, hospital stay, operating times, and chest-tube duration differences were examined between groups. RESULTS Of 85 patients undergoing LVRS, 23 patients underwent reduction via MS and 62 patients via bilateral VATS. VAS scores revealed no difference in postoperative pain except for VAS scores on days 6 (PM) and 7 (PM). BPI scores yielded higher scores in the VATS group on postoperative day (POD) 1 in the reactive dimension, but no other overall differences. MS patients receiving tramadol consumed a higher mean amount than VATS patients on POD 5 and POD 6. IS change from baseline to postoperative were similar between groups, and increased pain correlated with decreased IS scores on POD 1. Chest-tube duration, complications, and pain medication were similar between groups. CONCLUSIONS Bilateral VATS and MS offer similar outcomes with regard to postoperative pain and complications. These results suggest that the choice of LVRS operative approach should be dependent on disease presentation, surgeon expertise, and patient preference, not based upon differences in perceived postoperative pain between MS and bilateral VATS. PMID:21601469

Relationship of Caffeine with Adiponectin and Blood Sugar Levels in Subjects with and without Diabetes

PubMed Central

Bhaktha, Geetha; Mayya, Shreemathi; Shantaram, Manjula

2015-01-01

Introduction: Coffee though not usually thought of as healthy food but can be treated as one of the beneficial drink. Many researchers have found strong evidence that coffee reduces the risk of several serious ailments, including diabetes, heart disease, cirrhosis of the liver, etc. The long term beneficial effect of coffee on diabetes is now understood to be more influential and obliging. Materials and Methods: This study comprised 220 healthy subjects of which 143 consumed coffee and 77 did not. These were matched with 90 diabetic subjects. Among the 90 diabetics, 48 consumed coffee and 42 did not consume coffee. Results: The mean adiponectin value was significantly higher in coffee consumed normal and diabetic subjects than the subjects who did not consume coffee. The decrease in fasting blood sugar and HbA1c values were also observed in normal and diabetic subjects who consumed coffee than the other groups who did not consume coffee. Significant difference (p<0.05) in mean FBG, PPBS, HbA1c and adiponectin were observed between coffee consumed and no coffee consumed groups. Conclusion: The long term use of caffeine is more efficient on blood sugar and adiponectin levels, which needed in the prevention of complications in diabetic subjects. PMID:25737971

Possibility and Challenges of Conversion of Current Virus Species Names to Linnaean Binomials

PubMed Central

Postler, Thomas S.; Clawson, Anna N.; Amarasinghe, Gaya K.; Basler, Christopher F.; Bavari, Sbina; Benkő, Mária; Blasdell, Kim R.; Briese, Thomas; Buchmeier, Michael J.; Bukreyev, Alexander; Calisher, Charles H.; Chandran, Kartik; Charrel, Rémi; Clegg, Christopher S.; Collins, Peter L.; Juan Carlos, De La Torre; Derisi, Joseph L.; Dietzgen, Ralf G.; Dolnik, Olga; Dürrwald, Ralf; Dye, John M.; Easton, Andrew J.; Emonet, Sébastian; Formenty, Pierre; Fouchier, Ron A. M.; Ghedin, Elodie; Gonzalez, Jean-Paul; Harrach, Balázs; Hewson, Roger; Horie, Masayuki; Jiāng, Dàohóng; Kobinger, Gary; Kondo, Hideki; Kropinski, Andrew M.; Krupovic, Mart; Kurath, Gael; Lamb, Robert A.; Leroy, Eric M.; Lukashevich, Igor S.; Maisner, Andrea; Mushegian, Arcady R.; Netesov, Sergey V.; Nowotny, Norbert; Patterson, Jean L.; Payne, Susan L.; PaWeska, Janusz T.; Peters, Clarence J.; Radoshitzky, Sheli R.; Rima, Bertus K.; Romanowski, Victor; Rubbenstroth, Dennis; Sabanadzovic, Sead; Sanfaçon, Hélène; Salvato, Maria S.; Schwemmle, Martin; Smither, Sophie J.; Stenglein, Mark D.; Stone, David M.; Takada, Ayato; Tesh, Robert B.; Tomonaga, Keizo; Tordo, Noël; Towner, Jonathan S.; Vasilakis, Nikos; Volchkov, Viktor E.; Wahl-Jensen, Victoria; Walker, Peter J.; Wang, Lin-Fa; Varsani, Arvind; Whitfield, Anna E.; Zerbini, F. Murilo; Kuhn, Jens H.

2017-01-01

Abstract Botanical, mycological, zoological, and prokaryotic species names follow the Linnaean format, consisting of an italicized Latinized binomen with a capitalized genus name and a lower case species epithet (e.g., Homo sapiens). Virus species names, however, do not follow a uniform format, and, even when binomial, are not Linnaean in style. In this thought exercise, we attempted to convert all currently official names of species included in the virus family Arenaviridae and the virus order Mononegavirales to Linnaean binomials, and to identify and address associated challenges and concerns. Surprisingly, this endeavor was not as complicated or time-consuming as even the authors of this article expected when conceiving the experiment. PMID:27798405

Cosimulation of embedded system using RTOS software simulator

NASA Astrophysics Data System (ADS)

Wang, Shihao; Duan, Zhigang; Liu, Mingye

2003-09-01

Embedded system design often employs co-simulation to verify system's function; one efficient verification tool of software is Instruction Set Simulator (ISS). As a full functional model of target CPU, ISS interprets instruction of embedded software step by step, which usually is time-consuming since it simulates at low-level. Hence ISS often becomes the bottleneck of co-simulation in a complicated system. In this paper, a new software verification tools, the RTOS software simulator (RSS) was presented. The mechanism of its operation was described in a full details. In RSS method, RTOS API is extended and hardware simulator driver is adopted to deal with data-exchange and synchronism between the two simulators.

Virtual Screening of Receptor Sites for Molecularly Imprinted Polymers.

PubMed

Bates, Ferdia; Cela-Pérez, María Concepción; Karim, Kal; Piletsky, Sergey; López-Vilariño, José Manuel

2016-08-01

Molecularly Imprinted Polymers (MIPs) are highly advantageous in the field of analytical chemistry. However, interference from secondary molecules can also impede capture of a target by a MIP receptor. This greatly complicates the design process and often requires extensive laboratory screening which is time consuming, costly, and creates substantial waste products. Herein, is presented a new technique for screening of "virtually imprinted receptors" for rebinding of the molecular template as well as secondary structures, correlating the virtual predictions with experimentally acquired data in three case studies. This novel technique is particularly applicable to the evaluation and prediction of MIP receptor specificity and efficiency in complex aqueous systems. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Path generation algorithm for UML graphic modeling of aerospace test software

NASA Astrophysics Data System (ADS)

Qu, MingCheng; Wu, XiangHu; Tao, YongChao; Chen, Chao

2018-03-01

Aerospace traditional software testing engineers are based on their own work experience and communication with software development personnel to complete the description of the test software, manual writing test cases, time-consuming, inefficient, loopholes and more. Using the high reliability MBT tools developed by our company, the one-time modeling can automatically generate test case documents, which is efficient and accurate. UML model to describe the process accurately express the need to rely on the path is reached, the existing path generation algorithm are too simple, cannot be combined into a path and branch path with loop, or too cumbersome, too complicated arrangement generates a path is meaningless, for aerospace software testing is superfluous, I rely on our experience of ten load space, tailor developed a description of aerospace software UML graphics path generation algorithm.

Minimally invasive video-assisted thyroid surgery: how can we improve the learning curve?

PubMed

Castagnola, G; Giulii Cappone, M; Tierno, S M; Mezzetti, G; Centanini, F; Vetrone, I; Bellotti, C

2012-10-01

Minimally invasive video-assisted thyroidectomy (MIVAT) is a technically demanding procedure and requires a surgical team skilled in both endocrine and endoscopic surgery. A time consuming learning and training period is mandatory at the beginning of the experience. The aim of our report is to focus some aspects of the learning curve of the surgeon who practices video-assisted thyroid procedures for the first time, through the analysis of our preliminary series of 36 cases. From September 2004 to April 2005 we selected 36 patients for minimally invasive video-assisted surgery of the thyroid. The patients were considered eligible if they presented with a nodule not exceeding 35 mm in maximum diameter; total thyroid volume within normal range; absence of biochemical and echographic signs of thyroiditis. We analyzed surgical results, conversion rate, operating time, post-operative complications, hospital stay, cosmetic outcome of the series. We performed 36 total thyroidectomy. The procedure was successfully carried out in 33/36 cases. Post-operative complications included 3 transient recurrent nerve palsies and 2 transient hypocalcemias; no definitive hypoparathyroidism was registered. All patients were discharged 2 days after operation. The cosmetic result was considered excellent by most patients. Advances in skills and technology have enabled surgeons to reproduce most open surgical techniques with video-assistance or laparoscopically. Training is essential to acquire any new surgical technique and it should be organized in detail to exploit it completely.

Is Satisfaction with the Acute-Care Experience Higher amongst Consumers Treated in the Private Sector? A Survey of Public and Private Sector Arthroplasty Recipients

PubMed Central

Naylor, Justine M.; Descallar, Joseph; Grootemaat, Mechteld; Badge, Helen; Harris, Ian A.; Simpson, Grahame; Jenkin, Deanne

2016-01-01

Background Consumer satisfaction with the acute-care experience could reasonably be expected to be higher amongst those treated in the private sector compared to those treated in the public sector given the former relies on high-level satisfaction of its consumers and their subsequent recommendations to thrive. The primary aims of this study were to determine, in a knee or hip arthroplasty cohort, if surgery in the private sector predicts greater overall satisfaction with the acute-care experience and greater likelihood to recommend the same hospital. A secondary aim was to determine whether satisfaction across a range of service domains is also higher in the private sector. Methods A telephone survey was conducted 35 days post-surgery. The hospital cohort comprised eight public and seven private high-volume arthroplasty providers. Consumers rated overall satisfaction with care out of 100 and likeliness to recommend their hospital on a 5-point Likert scale. Additional Likert-style questions were asked covering specific service domains. Generalized estimating equation models were used to analyse overall satisfaction (dichotomised as ≥ 90 or < 90) and future recommendations for care (dichotomised as ‘definitely recommend’ or ‘other’), whilst controlling for covariates. The proportions of consumers in each sector reporting the best Likert response for each individual domain were compared using non-parametric tests. Results 457 survey respondents (n = 210 private) were included. Less patient-reported joint impairment pre-surgery [OR 1.03 (95% CI 1.01–1.05)] and absence of an acute complication (OR 2.13 95% CI 1.41–3.23) significantly predicted higher overall satisfaction. Hip arthroplasty [OR 1.84 (1.1–2.96)] and an absence of an acute complication [OR 2.31 (1.28–4.17] significantly predicted greater likelihood for recommending the hospital. The only care domains where the private out-performed the public sector were hospitality (46.7 vs 35.6%, p <0.01) and frequency of surgeon visitation (76.4 vs 65.8%, p = 0.03). Conclusions Arthroplasty consumers treated in the private sector are not more satisfied with their acute-care experience nor are they more likely to recommend their hospital provider. Rather, avoidance of complications in either sector appears to result in improved satisfaction as well as a greater likelihood that patients would recommend their hospital provider. PMID:27490358

Impact of water quality on chlorine demand of corroding copper

EPA Pesticide Factsheets

Copper is widely used in drinking water premise plumbing system materials. In buildings such ashospitals, large and complicated plumbing networks make it difficult to maintain good water quality.Sustaining safe disinfectant residuals throughout a building to protect against waterborne pathogenssuch as Legionella is particularly challenging since copper and other reactive distribution system materialscan exert considerable demands. The objective of this work was to evaluate the impact of pH andorthophosphate on the consumption of free chlorine associated with corroding copper pipes over time. Acopper test-loop pilot system was used to control test conditions and systematically meet the studyobjectives. Chlorine consumption trends attributed to abiotic reactions with copper over time weredifferent for each pH condition tested, and the total amount of chlorine consumed over the test runsincreased with increasing pH. Orthophosphate eliminated chlorine consumption trends with elapsedtime (i.e., chlorine demand was consistent across entire test runs). Orthophosphate also greatly reducedthe total amount of chlorine consumed over the test runs. Interestingly, the total amount of chlorineconsumed and the consumption rate were not pH dependent when orthophosphate was present. Thefindings reflect the complex and competing reactions at the copper pipe wall including corrosion,oxidation of Cu(I) minerals and ions, and possible oxidation of Cu(II) minerals, and the change in

Hybrid and disposable facilities for manufacturing of biopharmaceuticals: pros and cons.

PubMed

Ravisé, Aline; Cameau, Emmanuelle; De Abreu, Georges; Pralong, Alain

2009-01-01

Modern biotechnology has grown over the last 35 years to a maturing industry producing and delivering high-value biopharmaceuticals that yield important medical and economical benefits. The constantly increasing need for biopharmaceuticals and significant costs related to time-consuming R&D work makes this industry risky and highly competitive. This trend is confirmed by the important number of biopharmaceuticals that are actually under development at all stages by all major pharmaceutical industry companies. A consequence of this evolution is an increasing need for development and manufacturing capacity. The build up of traditional - stainless steel - technology is complicated, time consuming and very expensive. The decision for such a major investment needs to be taken early in the development cycle of a promising drug to cope with future demands for clinical trials and product launch. Possibilities for the reduction of R&D and manufacturing costs are therefore of significant interest in order to be competitive.In this chapter, four case studies are presented which outline ways to reduce significantly R&D and manufacturing costs by using disposable technology in the frame of a the transfer of an antibody manufacturing process, the preparation of media and buffers in commercial manufacturing and a direct comparison of a traditional and a fully disposable pilot plant.

Unpacking brown food-webs: Animal trophic identity reflects rampant microbivory

USDA-ARS?s Scientific Manuscript database

Detritivory is the dominant trophic paradigm in most terrestrial, aquatic, and marine ecosystems, yet accurate measurement of consumer trophic position within detrital (= ‘brown’) food-webs has remained impenetrable. Measurement of detritivore trophic position is complicated by the fact that detritu...

Bringing a probiotic-containing functional food to the market: microbiological, product, regulatory and labeling issues.

PubMed

Sanders, M E; Huis in't Veld, J

1999-01-01

Properly formulated probiotic-containing foods offer consumers a low risk, low cost dietary component that has the potential to promote health in a variety of ways. Several such products are available commercially, although markets in Japan and Europe are more developed than in the USA. Once healthful attributes of a probiotic product have been identified, there remain microbiological, product, regulatory and labeling issues to be addressed prior to marketing. Microbiological and product issues include safety, effective scale-up for manufacturing, definition of probiotic activity, probiotic stability in the product over the course of product manufacture, shelf-life and consumption, definition of effective dose and target population(s), and development of quality assurance approaches. Examples of probiotic-containing foods are given. Regulatory and labeling issues are complicated because they differ for each country, but are likewise critical because they provide the means for communication of the product benefits to the consumer. The regulatory climate worldwide appears to be one of caution about overstating the benefits of such products but at the same time not preventing corporate commitment to marketing.

Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial.

PubMed

Andersson, Bodil; Hallén, Magnus; Leveau, Per; Bergenfelz, Anders; Westerdahl, Johan

2003-05-01

This study was designed to compare an open tension-free technique (Lichtenstein repair) with a laparoscopic totally extraperitoneal hernia repair (TEP). One hundred sixty-eight men aged 30 to 65 years with primary or recurrent inguinal hernia were randomized to TEP or open mesh technique in the manner of Lichtenstein. Follow-up was after 1 and 6 weeks, and 1 year. Eighty-one patients were randomized to TEP, and 87 to open repair. For 1 patient in each group, the operation was converted to a different type of repair. No difference was seen in overall complications between the 2 groups. However, 1 patient in the TEP group underwent operation for small bowel obstruction after surgery. A higher frequency of postoperative hematomas was seen in the open group (P <.05). Patients in the TEP group consumed less analgesic after surgery (P <.001), returned to work earlier (P <.01), and had a shorter time to full recovery (P <.01). Two recurrences occurred in the TEP group 1 year after surgery. The TEP technique was associated with less postoperative pain, a shorter time to full recovery, and an earlier return to work compared with the open tension-free repair. No difference was seen in overall complications. However, 2 recurrences did occur after 1 year in the TEP group.

Rapid and highly sensitive detection of Enterovirus 71 by using nanogold-enhanced electrochemical impedance spectroscopy

NASA Astrophysics Data System (ADS)

Li, Hsing-Yuan; Tseng, Shing-Hua; Cheng, Tsai-Mu; Chu, Hsueh-Liang; Lu, Yu-Ning; Wang, Fang-Yu; Tsai, Li-Yun; Shieh, Juo-Yu; Yang, Jyh-Yuan; Juan, Chien-Chang; Tu, Lung-Chen; Chang, Chia-Ching

2013-07-01

Enterovirus 71 (EV71) infection is an emerging infectious disease causing neurological complications and/or death within two to three days after the development of fever and rash. A low viral titre in clinical specimens makes the detection of EV71 difficult. Conventional approaches for detecting EV71 are time consuming, poorly sensitive, or complicated, and cannot be used effectively for clinical diagnosis. Furthermore, EV71 and Coxsackie virus A16 (CA16) may cross react in conventional assays. Therefore, a rapid, highly sensitive, specific, and user-friendly test is needed. We developed an EV71-specific nanogold-modified working electrode for electrochemical impedance spectroscopy in the detection of EV71. Our results show that EV71 can be distinguished from CA16, Herpes simplex virus, and lysozyme, with the modified nanogold electrode being able to detect EV71 in concentrations as low as 1 copy number/50 μl reaction volume, and the duration between sample preparation and detection being 11 min. This detection platform may have the potential for use in point-of-care diagnostics.

Integrating microbes into food-chains: Insect trophic identity reflects rampant microbivory

USDA-ARS?s Scientific Manuscript database

Detritivory is the dominant trophic paradigm in most terrestrial, aquatic, and marine ecosystems, yet accurate measurement of consumer trophic position within detrital (= ‘brown’) food-webs has remained relatively impenetrable. Measurement of detritivore trophic position is complicated by the fact t...

A time-driven, activity-based costing methodology for determining the costs of red blood cell transfusion in patients with beta thalassaemia major.

PubMed

Burns, K E; Haysom, H E; Higgins, A M; Waters, N; Tahiri, R; Rushford, K; Dunstan, T; Saxby, K; Kaplan, Z; Chunilal, S; McQuilten, Z K; Wood, E M

2018-04-10

To describe the methodology to estimate the total cost of administration of a single unit of red blood cells (RBC) in adults with beta thalassaemia major in an Australian specialist haemoglobinopathy centre. Beta thalassaemia major is a genetic disorder of haemoglobin associated with multiple end-organ complications and typically requiring lifelong RBC transfusion therapy. New therapeutic agents are becoming available based on advances in understanding of the disorder and its consequences. Assessment of the true total cost of transfusion, incorporating both product and activity costs, is required in order to evaluate the benefits and costs of these new therapies. We describe the bottom-up, time-driven, activity-based costing methodology used to develop process maps to provide a step-by-step outline of the entire transfusion pathway. Detailed flowcharts for each process are described. Direct observations and timing of the process maps document all activities, resources, staff, equipment and consumables in detail. The analysis will include costs associated with performing these processes, including resources and consumables. Sensitivity analyses will be performed to determine the impact of different staffing levels, timings and probabilities associated with performing different tasks. Thirty-one process maps have been developed, with over 600 individual activities requiring multiple timings. These will be used for future detailed cost analyses. Detailed process maps using bottom-up, time-driven, activity-based costing for determining the cost of RBC transfusion in thalassaemia major have been developed. These could be adapted for wider use to understand and compare the costs and complexities of transfusion in other settings. © 2018 British Blood Transfusion Society.

Consumer Choice Between Hospital-Based and Freestanding Facilities for Arthroscopy: Impact on Prices, Spending, and Surgical Complications.

PubMed

Robinson, James C; Brown, Timothy T; Whaley, Christopher; Bozic, Kevin J

2015-09-16

Hospital-based outpatient departments traditionally charge higher prices for ambulatory procedures, compared with freestanding surgery centers. Under emerging reference-based benefit designs, insurers establish a contribution limit that they will pay, requiring the patient to pay the difference between that contribution limit and the actual price charged by the facility. The purpose of this study was to evaluate the impact of reference-based benefits on consumer choices, facility prices, employer spending, and surgical outcomes for orthopaedic procedures performed at ambulatory surgery centers. We obtained data on 3962 patients covered by the California Public Employees' Retirement System (CalPERS) who underwent arthroscopy of the knee or shoulder in the three years prior to the implementation of reference-based benefits in January 2012 and on 2505 patients covered by CalPERS who underwent arthroscopy in the two years after implementation. Control group data were obtained on 57,791 patients who underwent arthroscopy and were not subject to reference-based benefits. The impact of reference-based benefits on consumer choices between hospital-based and freestanding facilities, facility prices, employer spending, and surgical complications was assessed with use of difference-in-differences multivariable regressions to adjust for patient demographic characteristics, comorbidities, and geographic location. By the second year of the program, the shift to reference-based benefits was associated with an increase in the utilization of freestanding ambulatory surgery centers by 14.3 percentage points (95% confidence interval, 8.1 to 20.5 percentage points) for knee arthroscopy and by 9.9 percentage points (95% confidence interval, 3.2 to 16.7 percentage points) for shoulder arthroscopy and a corresponding decrease in the use of hospital-based facilities. The mean price paid by CalPERS fell by 17.6% (95% confidence interval, -24.9% to -9.6%) for knee procedures and by 17.0% (95% confidence interval, -29.3% to -2.5%) for shoulder procedures. The shift to reference-based benefits was not associated with a change in the rate of surgical complications. In the first two years after the implementation of reference-based benefits, CalPERS saved $2.3 million (13%) on these two orthopaedic procedures. Reference-based benefits increase consumer sensitivity to price differences between freestanding and hospital-based surgical facilities. This study shows that the implementation of reference-based benefits does not result in a significant increase in measured complication rates for those subject to reference-based benefits. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Laparoscopic treatment of colovesical fistulas due to complicated colonic diverticular disease: a systematic review.

PubMed

Cirocchi, R; Cochetti, G; Randolph, J; Listorti, C; Castellani, E; Renzi, C; Mearini, E; Fingerhut, A

2014-10-01

Colovesical fistulas originating from complicated sigmoid diverticular disease are rare. The primary aim of this review was to evaluate the role of laparoscopic surgery in the treatment of this complication. The secondary aim was to determine the best surgical treatment for this disease. A systematic search was conducted for studies published between 1992 and 2012 in PubMed, the Cochrane Register of Controlled Clinical Trials, Scopus, and Publish or Perish. Studies enrolling adults undergoing fully laparoscopic, laparoscopic-assisted, or hand-assisted laparoscopic surgery for colovesical fistula secondary to complicated sigmoid diverticular disease were considered. Data extracted concerned the surgical technique, intraoperative outcomes, and postoperative outcomes based on the Cochrane Consumers and Communication Review Group's template. Descriptive statistics were reported according to the PRISMA statement. In all, 202 patients from 25 studies were included in this review. The standard treatment was laparoscopic colonic resection and primary anastomosis or temporary colostomy with or without resection of the bladder wall. Operative time ranged from 150 to 321 min. It was not possible to evaluate the conversion rate to open surgery because colovesical fistulas were not distinguished from other types of enteric fistulas in most of the studies. One anastomotic leak after bowel anastomosis was reported. There was zero mortality. Few studies conducted follow-up longer than 12 months. One patient required two reoperations. Laparoscopic treatment of colovesical fistulas secondary to sigmoid diverticular disease appears to be a feasible and safe approach. However, further studies are needed to establish whether laparoscopy is preferable to other surgical approaches.

Optimized stereo matching in binocular three-dimensional measurement system using structured light.

PubMed

Liu, Kun; Zhou, Changhe; Wei, Shengbin; Wang, Shaoqing; Fan, Xin; Ma, Jianyong

2014-09-10

In this paper, we develop an optimized stereo-matching method used in an active binocular three-dimensional measurement system. A traditional dense stereo-matching algorithm is time consuming due to a long search range and the high complexity of a similarity evaluation. We project a binary fringe pattern in combination with a series of N binary band limited patterns. In order to prune the search range, we execute an initial matching before exhaustive matching and evaluate a similarity measure using logical comparison instead of a complicated floating-point operation. Finally, an accurate point cloud can be obtained by triangulation methods and subpixel interpolation. The experiment results verify the computational efficiency and matching accuracy of the method.

Possibility and challenges of conversion of current virus species names to Linnaean binomials

USGS Publications Warehouse

Thomas, Postler; Clawson, Anna N.; Amarasinghe, Gaya K.; Basler, Christopher F.; Bavari, Sina; Benko, Maria; Blasdell, Kim R.; Briese, Thomas; Buchmeier, Michael J.; Bukreyev, Alexander; Calisher, Charles H.; Chandran, Kartik; Charrel, Remi; Clegg, Christopher S.; Collins, Peter L.; De la Torre, Juan Carlos; DeRisi, Joseph L.; Dietzgen, Ralf G.; Dolnik, Olga; Durrwald, Ralf; Dye, John M.; Easton, Andrew J.; Emonet, Sebastian; Formenty, Pierre; Fouchier, Ron A. M.; Ghedin, Elodie; Gonzalez, Jean-Paul; Harrach, Balazs; Hewson, Roger; Horie, Masayuki; Jiang, Daohong; Kobinger, Gary P.; Kondo, Hideki; Kropinski, Andrew; Krupovic, Mart; Kurath, Gael; Lamb, Robert A.; Leroy, Eric M.; Lukashevich, Igor S.; Maisner, Andrea; Mushegian, Arcady; Netesov, Sergey V.; Nowotny, Norbert; Patterson, Jean L.; Payne, Susan L.; Paweska, Janusz T.; Peters, C.J.; Radoshitzky, Sheli; Rima, Bertus K.; Romanowski, Victor; Rubbenstroth, Dennis; Sabanadzovic, Sead; Sanfacon, Helene; Salvato , Maria; Schwemmle, Martin; Smither, Sophie J.; Stenglein, Mark; Stone, D.M.; Takada , Ayato; Tesh, Robert B.; Tomonaga, Keizo; Tordo, N.; Towner, Jonathan S.; Vasilakis, Nikos; Volchkov, Victor E.; Jensen, Victoria; Walker, Peter J.; Wang, Lin-Fa; Varsani, Arvind; Whitfield , Anna E.; Zerbini, Francisco Murilo; Kuhn, Jens H.

2017-01-01

Botanical, mycological, zoological, and prokaryotic species names follow the Linnaean format, consisting of an italicized Latinized binomen with a capitalized genus name and a lower case species epithet (e.g., Homo sapiens). Virus species names, however, do not follow a uniform format, and, even when binomial, are not Linnaean in style. In this thought exercise, we attempted to convert all currently official names of species included in the virus family Arenaviridae and the virus order Mononegavirales to Linnaean binomials, and to identify and address associated challenges and concerns. Surprisingly, this endeavor was not as complicated or time-consuming as even the authors of this article expected when conceiving the experiment.

Investigation of Reperfusion Injury and Ischemic Preconditioning in Microsurgry

PubMed Central

Wang, Wei Zhong

2008-01-01

Ischemia/reperfusion (I/R) is inevitable in many vascular and musculoskeletal traumas, diseases, free tissue transfers, and during time-consuming reconstructive surgeries in the extremities. Salvage of a prolonged ischemic extremity or flap still remains a challenge for the microvascular surgeon. One of the common complications after microsurgery is I/R-induced tissue death or I/R injury. Twenty years after the discovery, ischemic preconditioning (IPC) has emerged as a powerful method for attenuating I/R injury in a variety of organs or tissues. However, its therapeutic expectations still need to be fulfilled. In this article, the author reviews some important experimental evidences of I/R injury as well as preconditioning-induced protection in the fields relevant to microsurgery. PMID:18946882

Temporary endoscopic metallic stent for idiopathic esophageal achalasia.

PubMed

Coppola, Franco; Gaia, Silvia; Rolle, Emanuela; Recchia, Serafino

2014-02-01

Idiopathic achalasia is a motor disorder of the esophagus of unknown etiology caused by loss of motor neurons determining an altered motility. It may determine severe symptoms such as progressive dysphagia, regurgitations, and pulmonary aspirations. Many therapeutic options may be offered to patients with achalasia, from surgery to endoscopic treatments such as pneumatic dilation, botulinum injection, peroral endoscopic myotomy, or endoscopic stenting. Recently, temporary placement of a stent was proposed by Cheng as therapy for achalasia disorders, whereas no Western authors have dealt with it up to date. The present study reports our preliminary experience in 7 patients with achalasia treated with a temporary stent. Partially covered self-expanding metallic stents (Micro-Tech, Nanjin, China) 80 mm long and 30 mm wide were placed under fluoroscopic control and removed after 6 days. Clinical follow-up was scheduled to check endoscopic success, symptoms release, and complications. The placement and the removal of the stents were obtained in all patients without complications. Mean clinical follow-up was 19 months. Five out of 7 patients referred total symptoms release and 2 experienced significant improvement of dysphagia. The procedure was not time consuming and was safe; no mild or severe complications were registered. In conclusion, our results may suggest a possible safe and effective endoscopic alternative treatment in patients with achalasia; however, further larger studies are necessary to confirm these promising, but very preliminary, data.

A Multilateral Negotiation Model for Cloud Service Market

NASA Astrophysics Data System (ADS)

Yoo, Dongjin; Sim, Kwang Mong

Trading cloud services between consumers and providers is a complicated issue of cloud computing. Since a consumer can negotiate with multiple providers to acquire the same service and each provider can receive many requests from multiple consumers, to facilitate the trading of cloud services among multiple consumers and providers, a multilateral negotiation model for cloud market is necessary. The contribution of this work is the proposal of a business model supporting a multilateral price negotiation for trading cloud services. The design of proposed systems for cloud service market includes considering a many-to-many negotiation protocol, and price determining factor from service level feature. Two negotiation strategies are implemented: 1) MDA (Market Driven Agent); and 2) adaptive concession making responding to changes of bargaining position are proposed for cloud service market. Empirical results shows that MDA achieved better performance in some cases that the adaptive concession making strategy, it is noted that unlike the MDA, the adaptive concession making strategy does not assume that an agent has information of the number of competitors (e.g., a consumer agent adopting the adaptive concession making strategy need not know the number of consumer agents competing for the same service).

Constructing, Consuming, and Complicating the Human-Nature Binary: Communication Practices in Forest Environmental Education

ERIC Educational Resources Information Center

Dickinson, Elizabeth A.

2010-01-01

This project combines interdisciplinary conversations within the field of communication to examine environmental meaning systems and communication practices in the context of forest environmental education. Due to concerns over children's environmental alienation, there has been a continued push toward place-based environmental education. One such…

Willingness To Pay for Information: An Analyst's Guide.

ERIC Educational Resources Information Center

Lee, Kyung Hee; Hatcher, Charles B.

2001-01-01

Compares methods for estimating consumer willingness to pay for information: contingent valuation, experimental auction, conjoint analysis, and hedonic price equations. Shows how, in the case of food dating, measurement of willingness is complicated by the question of whether the information adds to the product's value. (Contains 31 references.)…

Minimally invasive video-assisted thyroidectomy: Ascending the learning curve

PubMed Central

Capponi, Michela Giulii; Bellotti, Carlo; Lotti, Marco; Ansaloni, Luca

2015-01-01

BACKGROUND: Minimally invasive video-assisted thyroidectomy (MIVAT) is a technically demanding procedure and requires a surgical team skilled in both endocrine and endoscopic surgery. The aim of this report is to point out some aspects of the learning curve of the video-assisted thyroid surgery, through the analysis of our preliminary series of procedures. PATIENTS AND METHODS: Over a period of 8 months, we selected 36 patients for minimally invasive video-assisted surgery of the thyroid. The patients were considered eligible if they presented with a nodule not exceeding 35 mm and total thyroid volume <20 ml; presence of biochemical and ultrasound signs of thyroiditis and pre-operative diagnosis of cancer were exclusion criteria. We analysed surgical results, conversion rate, operating time, post-operative complications, hospital stay and cosmetic outcomes of the series. RESULTS: We performed 36 total thyroidectomy and in one case we performed a consensual parathyroidectomy. The procedure was successfully carried out in 33 out of 36 cases (conversion rate 8.3%). The mean operating time was 109 min (range: 80-241 min) and reached a plateau after 29 MIVAT. Post-operative complications included three transient recurrent nerve palsies and two transient hypocalcemias; no definitive hypoparathyroidism was registered. The cosmetic result was considered excellent by most patients. CONCLUSIONS: Advances in skills and technology allow surgeons to easily reproduce the standard open total thyroidectomy with video-assistance. Although the learning curve represents a time-consuming step, training remains a crucial point in gaining a reasonable confidence with video-assisted surgical technique. PMID:25883451

Nutrition targeting by food timing: time-related dietary approaches to combat obesity and metabolic syndrome.

PubMed

Sofer, Sigal; Stark, Aliza H; Madar, Zecharia

2015-03-01

Effective nutritional guidelines for reducing abdominal obesity and metabolic syndrome are urgently needed. Over the years, many different dietary regimens have been studied as possible treatment alternatives. The efficacy of low-calorie diets, diets with different proportions of fat, protein, and carbohydrates, traditional healthy eating patterns, and evidence-based dietary approaches were evaluated. Reviewing literature published in the last 5 y reveals that these diets may improve risk factors associated with obesity and metabolic syndrome. However, each diet has limitations ranging from high dropout rates to maintenance difficulties. In addition, most of these dietary regimens have the ability to attenuate some, but not all, of the components involved in this complicated multifactorial condition. Recently, interest has arisen in the time of day foods are consumed (food timing). Studies have examined the implications of eating at the right or wrong time, restricting eating hours, time allocation for meals, and timing of macronutrient consumption during the day. In this paper we review new insights into well-known dietary therapies as well as innovative time-associated dietary approaches for treating obesity and metabolic syndrome. We discuss results from systematic meta-analyses, clinical interventions, and animal models. © 2015 American Society for Nutrition.

Nutrition Targeting by Food Timing: Time-Related Dietary Approaches to Combat Obesity and Metabolic Syndrome1234

PubMed Central

Sofer, Sigal; Stark, Aliza H; Madar, Zecharia

2015-01-01

Effective nutritional guidelines for reducing abdominal obesity and metabolic syndrome are urgently needed. Over the years, many different dietary regimens have been studied as possible treatment alternatives. The efficacy of low-calorie diets, diets with different proportions of fat, protein, and carbohydrates, traditional healthy eating patterns, and evidence-based dietary approaches were evaluated. Reviewing literature published in the last 5 y reveals that these diets may improve risk factors associated with obesity and metabolic syndrome. However, each diet has limitations ranging from high dropout rates to maintenance difficulties. In addition, most of these dietary regimens have the ability to attenuate some, but not all, of the components involved in this complicated multifactorial condition. Recently, interest has arisen in the time of day foods are consumed (food timing). Studies have examined the implications of eating at the right or wrong time, restricting eating hours, time allocation for meals, and timing of macronutrient consumption during the day. In this paper we review new insights into well-known dietary therapies as well as innovative time-associated dietary approaches for treating obesity and metabolic syndrome. We discuss results from systematic meta-analyses, clinical interventions, and animal models. PMID:25770260

State of the art in benefit-risk analysis: consumer perception.

PubMed

Ueland, Ø; Gunnlaugsdottir, H; Holm, F; Kalogeras, N; Leino, O; Luteijn, J M; Magnússon, S H; Odekerken, G; Pohjola, M V; Tijhuis, M J; Tuomisto, J T; White, B C; Verhagen, H

2012-01-01

Benefit and risk perception with respect to food consumption, have been a part of human daily life from beginning of time. In today's society the food chain is long with many different types of actors and low degree of transparency. Making informed food choices where knowledge of benefits and risks is part of the decision making process are therefore complicated for consumers. Thus, to understand how consumers perceive benefits and risks of foods, their importance in relation to quality evaluations are aspects that need to be addressed. The objective of this paper is to discuss state of the art in understanding consumer perceptions of benefits and risks of foods in order to improve understanding of consumer behaviour in the food domain. Risks may be associated with both acute and long term consequences, some of which may have serious effects. Perceived risks are connected to morbidity and mortality along two dimensions relating to unknown risk, and to which extent the risk is dreaded by the consumer. Unfamiliar, uncertain, unknown, uncontrollable, and severe consequences are some factors associated with risk perception. Novel food processing techniques, for instance, score high on several of these parameters and are consequently regarded with suspicion and perceived as risky by consumers. On a daily basis, benefits of foods and food consumption are more important in most consumers' minds than risks. Benefits are often associated with food's ability to assuage hunger, and to provide pleasure through eating and socialising. In addition, two main categories of benefits that are important for acceptance of product innovations are health and environmental benefits. Benefit and risk perception of foods seem to be inversely correlated, so when something is perceived as being highly beneficial, it is correspondingly perceived as having low risk. However, slightly different paths are used in the formation of these perceptions; benefit perception is based on heuristics and experience, while risk perception is to a larger extent the result of cognitive information processing. Consumers are particularly conservative when it comes to perception and acceptance of foods compared to other products. Benefit-risk evaluations tend to be skewed towards acceptance of all that is traditional and well-known (benefits), and rejection or suspicion towards anything that is novel or highly processed (risks) regardless of actual risk. Knowledge of how consumers perceive benefits and risks of foods, may contribute to understanding benefit-risk perception in other areas related to personal, societal or environmental perspectives. Copyright © 2011 Elsevier Ltd. All rights reserved.

Practitioner Perceptions of Patients Wearing Decorative Contact Lenses Purchased Through Unauthorized Sellers.

PubMed

Gaiser, Hilary; Ho, Connie; Janier, Nicole; Wee, Amy; Johnson, Catherine; Watanabe, Ronald

2017-03-01

To describe practitioner experiences regarding ocular complications in patients wearing decorative contact lenses, and to investigate the compliance of unauthorized distributors of decorative contact lenses to current Food and Drug Administration (FDA) and Federal Trade Commission (FTC) regulations. Also, to provide data to support a more targeted public health approach to reducing the incidence of illegal contact lens sales and associated ocular complications. An institutional review board-approved online survey was distributed through mass email to a list of 98 optometrists in the Boston, MA area. Concurrently, an empirical evaluation of independent, online decorative contact lens sellers who were not associated with FDA-approved contact lens manufacturers was performed to determine their adherence to FDA and FTC guidelines. The first 18 noncoincidental websites that resulted from a Google search for "costume contact lens sellers" and "cosmetic contact lens sellers" were examined as to the brands and parameters of lenses being sold, whether or not a valid prescription was required or verified, and if consumer education was provided. Twenty-two optometrists completed the online survey. Seventy-seven percent of respondents reported having patients with complications from decorative contact lenses that were purchased both legally and illegally. The most common age group for complications was 18 to 25 years (61%). One third of complications were seen in first-time lens wearers, half of whom never received proper care instructions or were unaware that care instructions existed. One quarter of the lenses were purchased illegally with unlicensed stores being the most common place of purchase. Of the 18 online sites examined, 72% of sellers failed to adhere to FTC and FDA regulations. A significant number of individuals who obtain contact lenses illegally from unauthorized sources are young adults. Most unauthorized sellers reviewed did not adhere to the proper protocol for selling contact lenses or instruct their customers on proper lens wear and care. A significant percentage of optometrists responding to the survey reported complications associated with contact lenses purchased through unauthorized sources, suggesting that the risk of contact lens-related complications increases when the lenses are purchased from one of these sources.

Quantitative determination of wool in textile by near-infrared spectroscopy and multivariate models.

PubMed

Chen, Hui; Tan, Chao; Lin, Zan

2018-08-05

The wool content in textiles is a key quality index and the corresponding quantitative analysis takes an important position due to common adulterations in both raw and finished textiles. Conventional methods are maybe complicated, destructive, time-consuming, environment-unfriendly. Developing a quick, easy-to-use and green alternative method is interesting. The work focuses on exploring the feasibility of combining near-infrared (NIR) spectroscopy and several partial least squares (PLS)-based algorithms and elastic component regression (ECR) algorithms for measuring wool content in textile. A total of 108 cloth samples with wool content ranging from 0% to 100% (w/w) were collected and all the compositions are really existent in the market. The dataset was divided equally into the training and test sets for developing and validating calibration models. When using local PLS, the original spectrum axis was split into 20 sub-intervals. No obvious difference of performance can be seen for the local PLS models. The ECR model is comparable or superior to the other models due its flexibility, i.e., being transition state from PCR to PLS. It seems that ECR combined with NIR technique may be a potential method for determining wool content in textile products. In addition, it might have regulatory advantages to avoid time-consuming and environmental-unfriendly chemical analysis. Copyright © 2018 Elsevier B.V. All rights reserved.

Towards Implementation of a Generalized Architecture for High-Level Quantum Programming Language

NASA Astrophysics Data System (ADS)

Ameen, El-Mahdy M.; Ali, Hesham A.; Salem, Mofreh M.; Badawy, Mahmoud

2017-08-01

This paper investigates a novel architecture to the problem of quantum computer programming. A generalized architecture for a high-level quantum programming language has been proposed. Therefore, the programming evolution from the complicated quantum-based programming to the high-level quantum independent programming will be achieved. The proposed architecture receives the high-level source code and, automatically transforms it into the equivalent quantum representation. This architecture involves two layers which are the programmer layer and the compilation layer. These layers have been implemented in the state of the art of three main stages; pre-classification, classification, and post-classification stages respectively. The basic building block of each stage has been divided into subsequent phases. Each phase has been implemented to perform the required transformations from one representation to another. A verification process was exposed using a case study to investigate the ability of the compiler to perform all transformation processes. Experimental results showed that the efficacy of the proposed compiler achieves a correspondence correlation coefficient about R ≈ 1 between outputs and the targets. Also, an obvious achievement has been utilized with respect to the consumed time in the optimization process compared to other techniques. In the online optimization process, the consumed time has increased exponentially against the amount of accuracy needed. However, in the proposed offline optimization process has increased gradually.

Comparing the Effectiveness of Patient Control Analgesia Pump and Bolus Morphine in Controlling Pain After Cardiopulmonary Bypass Graft Surgery.

PubMed

Imantalab, Vali; Mirmansouri, Ali; Mohammadzadeh Jouryabi, Ali; Naderi Nabi, Bahram; Kanani, Gholamreza; Nassiri Sheikhani, Nassir; Atrkarroushan, Zahra; Ghazanfar Tehran, Samaneh; Samadpour, Nastaran

2017-10-01

Postoperative pain is a complex process commonly caused by surgical trauma. It is one of the major concerns of patients undergoing heart surgery. Despite new techniques and modern analgesic treatments, postoperative pain is still one of the most important controversial issues. 68 patients scheduled for elective CABG with CPB were included in a prospective, double-blind clinical trial. They were randomly divided into two groups. One group received PCA pump including morphine (group P) with underlying infusion of 0.02 mg/kg/Qh, bolus dose of 1 mg, lockout time of 15 minutes, and a maximum of 4 bolus of 0.02 mg/kg for one hour and the other group received morphine bolus (group B). Three patients were excluded from the study, and 33 and 32 patients participated in the groups P and B, respectively. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (nausea and vomiting, GI Bleeding, and hypoxia), level of pain based on VAS, opioid consumption, hemodynamic, and sedation status were measured in both groups. There was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complication, sedation score, and hemodynamic status in most of the assessment periods. By assessing the pain severity in the groups at different periods, results showed a significant difference between the groups except at enrollment, and a lower severity of pain was noted in the group P compared to the group B. The consumed opioid was significantly higher in the group P than in the group B. However, higher doses of diclofenac and paracetamol were administered in the group B compared to the group P. Results showed that higher morphine would be used in patients with PCA pump after extubation following heart surgery, and this increased dose of opioid was associated with better pain control and lack of complication. Therefore, PCA pump with underlying infusion could be effectively used in patients undergoing CABG that are directly assessed in intensive care unite.

Comparing the Effectiveness of Patient Control Analgesia Pump and Bolus Morphine in Controlling Pain After Cardiopulmonary Bypass Graft Surgery

PubMed Central

Imantalab, Vali; Mirmansouri, Ali; Mohammadzadeh Jouryabi, Ali; Naderi Nabi, Bahram; Kanani, Gholamreza; Nassiri Sheikhani, Nassir; Atrkarroushan, Zahra; Ghazanfar Tehran, Samaneh; Samadpour, Nastaran

2017-01-01

Background Postoperative pain is a complex process commonly caused by surgical trauma. It is one of the major concerns of patients undergoing heart surgery. Despite new techniques and modern analgesic treatments, postoperative pain is still one of the most important controversial issues. Methods 68 patients scheduled for elective CABG with CPB were included in a prospective, double-blind clinical trial. They were randomly divided into two groups. One group received PCA pump including morphine (group P) with underlying infusion of 0.02 mg/kg/Qh, bolus dose of 1 mg, lockout time of 15 minutes, and a maximum of 4 bolus of 0.02 mg/kg for one hour and the other group received morphine bolus (group B). Three patients were excluded from the study, and 33 and 32 patients participated in the groups P and B, respectively. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (nausea and vomiting, GI Bleeding, and hypoxia), level of pain based on VAS, opioid consumption, hemodynamic, and sedation status were measured in both groups. Results There was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complication, sedation score, and hemodynamic status in most of the assessment periods. By assessing the pain severity in the groups at different periods, results showed a significant difference between the groups except at enrollment, and a lower severity of pain was noted in the group P compared to the group B. The consumed opioid was significantly higher in the group P than in the group B. However, higher doses of diclofenac and paracetamol were administered in the group B compared to the group P. Conclusions Results showed that higher morphine would be used in patients with PCA pump after extubation following heart surgery, and this increased dose of opioid was associated with better pain control and lack of complication. Therefore, PCA pump with underlying infusion could be effectively used in patients undergoing CABG that are directly assessed in intensive care unite. PMID:29696108

Mundane science use in a practice theoretical perspective: Different understandings of the relations between citizen-consumers and public communication initiatives build on scientific claims.

PubMed

Halkier, Bente

2015-08-13

Public communication initiatives play a part in placing complicated scientific claims in citizen-consumers' everyday contexts. Lay reactions to scientific claims framed in public communication, and attempts to engage citizens, have been important subjects of discussion in the literatures of public understanding and public engagement with science. Many of the public communication initiatives, however, address lay people as consumers rather than citizens. This creates specific challenges for understanding public engagement with science and scientific citizenship. The article compares five different understandings of the relations between citizen-consumers and public issue communication involving science, where the first four types are widely represented in the Public Understanding of Science discussions. The fifth understanding is a practice theoretical perspective. The article suggests how the public understanding of and engagement in science literature can benefit from including a practice theoretical approach to research about mundane science use and public engagement. © The Author(s) 2015.

A Comparison of Two Fat Grafting Methods on Operating Room Efficiency and Costs.

PubMed

Gabriel, Allen; Maxwell, G Patrick; Griffin, Leah; Champaneria, Manish C; Parekh, Mousam; Macarios, David

2017-02-01

Centrifugation (Cf) is a common method of fat processing but may be time consuming, especially when processing large volumes. To determine the effects on fat grafting time, volume efficiency, reoperations, and complication rates of Cf vs an autologous fat processing system (Rv) that incorporates fat harvesting and processing in a single unit. We performed a retrospective cohort study of consecutive patients who underwent autologous fat grafting during reconstructive breast surgery with Rv or Cf. Endpoints measured were volume of fat harvested (lipoaspirate) and volume injected after processing, time to complete processing, reoperations, and complications. A budget impact model was used to estimate cost of Rv vs Cf. Ninety-eight patients underwent fat grafting with Rv, and 96 patients received Cf. Mean volumes of lipoaspirate (506.0 vs 126.1 mL) and fat injected (177.3 vs 79.2 mL) were significantly higher (P < .0001) in the Rv vs Cf group, respectively. Mean time to complete fat grafting was significantly shorter in the Rv vs Cf group (34.6 vs 90.1 minutes, respectively; P < .0001). Proportions of patients with nodule and cyst formation and/or who received reoperations were significantly less in the Rv vs Cf group. Based on these outcomes and an assumed per minute operating room cost, an average per patient cost savings of $2,870.08 was estimated with Rv vs Cf. Compared to Cf, the Rv fat processing system allowed for a larger volume of fat to be processed for injection and decreased operative time in these patients, potentially translating to cost savings. LEVEL OF EVIDENCE 3. © 2016 The American Society for Aesthetic Plastic Surgery, Inc.

Laparoscopic bilateral transperitoneal adrenalectomy for Cushing syndrome: surgical challenges and lessons learnt.

PubMed

Aggarwal, Sandeep; Yadav, Kunal; Sharma, Aditya P; Sethi, Vrishketan

2013-06-01

Laparoscopic adrenalectomy is well established for treatment of adrenal lesions. However, bilateral adrenalectomy for Cushing syndrome is a challenging and time-consuming operation. We report our experience of laparoscopic bilateral adrenalectomy for this disease in 19 patients. From September 2009 to August 2012, we have operated 19 patients with Cushing syndrome and performed bilateral laparoscopic adrenalectomy using the transperitoneal approach; synchronous in 15 patients and staged in 4 patients. In 15 patients, the surgery was carried out sequentially on both the sides in lateral position with intraoperative change in position. Complete adrenalectomy including periadrenal fat was carried out on both the sides. Nineteen patients were referred from Department of Endocrinology for bilateral adrenalectomy for adrenocorticotropin hormone (ACTH)-dependent and ACTH-independent Cushing syndrome. The indications for surgery were Cushing disease in 15 patients, occult/ectopic source of ACTH in 2 patients, and primary adrenal hyperplasia in 2 patients. Fifteen patients underwent bilateral adrenalectomy during the same operation. Four patients underwent staged procedures. All procedures were completed laparoscopically with no conversions. The mean operating time for simultaneous bilateral adrenalectomy was 210 minutes (range, 150 to 240 min). This included the repositioning and reprepping time. There were no major intraoperative complications. The average blood loss was 100 mL (range, 50 to 200 mL). None of the patients required blood transfusions in the postoperative period. The postoperative complications included minor port-site infection in 2 patients. One severely debilitated patient died on the 14th postoperative day because of hospital-acquired pneumonia. The remaining 18 patients have done well in terms of impact on the disease. Laparoscopic bilateral adrenalectomy for Cushing syndrome is feasible and safe. It confers all the advantages of minimally invasive approach such as less postoperative pain, shorter hospitalization, lesser wound complications, and faster recovery. The advantages of the laparoscopic approach have led to an earlier referral for bilateral adrenalectomy by endocrinologist in patients with failed pituitary surgery.

[Comparison of Two Symptom-Triggered Treatments for Alcohol Withdrawal: HAES vs. SAB-P].

PubMed

Holzbach, R; Ihlow, C; Takla, T; Kemper, U; Naber, D

2016-02-01

For alcohol withdrawal during hospitalization, often a medication as means for withdrawal needs to be chosen. Modern, score-controlled processes that can be used by the nursing staff after instruction by physicians are frequently not used and even unknown in hospitals. One reason for this is that some of the scores require checking several criteria and are therefore more time-consuming and complicated than use of a fixed-dosage strategy. The SAB-P and HAES are short with only 6 items that can be checked by the nursing staff. Safety of the Hamburg Alcohol Withdrawal Scale (Hamburger Alkoholentzugs-Skala (HAES)) was analyzed retrospectively and prospectively with regard to score-controlled alcohol-withdrawal treatment after rating by the nurse staff (Scoregesteuerte Alkoholentzugsbehandlung nach Rating durch das Pflegepersonal (SAB-P)). Incidence of complications in patients treated with SAB-P and HAES was nearly similar with 1% start of delirium and 3% seizures (SAB-P) and 0.5 to 1.5% start of delirium and 0 to 0.5% seizures in the HAES group. With both scales it was possible to start medical treatment while still under falling alcohol levels (0.93 and 0.91%, respectively). Medication dosage was initially higher using the HAES, so that the time needed to monitor withdrawal symptoms could be reduced (3.8 vs. 3.1 days). Using a score-controlled strategy for alcohol withdrawal leads to a lower complication rate than found in literature. The structured procedure was helpful for the nursing staff as well as for the physicians. SAB-P as well as HAES made withdrawal for the patients more comfortable and led to fewer complaints. Because of rapid reaction and faster symptom reduction of HAES, there was less time necessary for monitoring. Simple handling, clomethiazol, oxazepam or diazepam as applicable medication and clear documentation are the advantages of HAES. © Georg Thieme Verlag KG Stuttgart · New York.

Estimating Forest Recreation Demand Using Count Data Models

Treesearch

Jeffrey E. Englin; Thomas P. Holmes; Erin O. Sills

2003-01-01

Forests, along with related natural areas such as mountains, lakes, and rivers, provide opportunities for a wide variety of recreational activities. Although the recreational services supplied by forested areas produce value for the consumers of those services, the measurement of recreational value is complicated by the fact that access to most natural areas is non-...

Choosing Selves: The Salience of Parental Identity in the School Choice Process

ERIC Educational Resources Information Center

Cucchiara, Maia Bloomfield; Horvat, Erin McNamara

2014-01-01

With the proliferation of choice policies in education, parents are increasingly positioned as "consumers" tasked with choosing the "best" school for their children. Yet a large body of research has shown that the process of selecting a school is far more complicated than policy-makers and researchers often predict. This…

The unwary purchaser: consumer psychology and the regulation of commerce in America.

PubMed

Pettit, Michael J

2007-01-01

Starting in the 1870s, American jurists deciding cases of trademark infringement began advancing arguments that the ordinary purchaser was an unwary one, easily deceived by imitations. Embedded within their legal decisions was a vision of the typical consumers' habitual behavior and cognitive ability. In response to legal critics who argued that the presumed psychology of the consumer was unevenly deployed, applied psychologists developed laboratory-based experiments and scales for determining the likelihood that the "average" purchaser would be confused. Although these psychologists failed in their goal of securing regular legal patronage, this commercial context and the resulting experiments were constitutive of the delineation of "recognition" as a distinct mental process. Furthermore, this case study complicates the scholarly consensus about the role of standardization and personal responsibility in the liberal administration of mass society.

A Review of Commercial and Medical-Grade Physiological Monitoring Devices for Biofeedback-Assisted Quality of Life Improvement Studies.

PubMed

Nogueira, Pedro; Urbano, Joana; Reis, Luís Paulo; Cardoso, Henrique Lopes; Silva, Daniel Castro; Rocha, Ana Paula; Gonçalves, Joaquim; Faria, Brígida Mónica

2018-04-17

With the rise in wearable technology and "health culture", we are seeing an increasing interest and affordances in studying how to not only prolong life expectancy but also in how to improve individuals' quality of life. On the one hand, this attempts to give meaning to the increasing life expectancy, as living above a certain threshold of pain and lack of autonomy or mobility is both degrading and unfair. On the other hand, it lowers the cost of continuous care, as individuals with high quality of life indexes tend to have lower hospital readmissions or secondary complications, not to mention higher physical and mental health. In this paper, we evaluate the current state of the art in physiological therapy (biofeedback) along with the existing medical grade and consumer grade hardware for physiological research. We provide a quick primer on the most commonly monitored physiologic metrics, as well as a brief discussion on the current state of the art in biofeedback-assisted medical applications. We then go on to present a comparative analysis between medical and consumer grade biofeedback devices and discuss the hardware specifications and potential practical applications of each consumer grade device in terms of functionality and adaptability for controlled (laboratory) and uncontrolled (field) studies. We end this article with some empirical observations based on our study so that readers might use take them into consideration when arranging a laboratory or real-world experience, thus avoiding costly time delays and material expenditures.

Possibility and Challenges of Conversion of Current Virus Species Names to Linnaean Binomials

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

Postler, Thomas S.; Clawson, Anna N.; Amarasinghe, Gaya K.

Botanical, mycological, zoological, and prokaryotic species names follow the Linnaean format, consisting of an italicized Latinized binomen with a capitalized genus name and a lower case species epithet (e.g., Homo sapiens). Virus species names, however, do not follow a uniform format, and, even when binomial, are not Linnaean in style. In this thought exercise, we attempted to convert all currently official names of species included in the virus family Arenaviridae and the virus order Mononegavirales to Linnaean binomials, and to identify and address associated challenges and concerns. Surprisingly, this endeavor was not as complicated or time-consuming as even the authorsmore » of this article expected when conceiving the experiment. [Arenaviridae; binomials; ICTV; International Committee on Taxonomy of Viruses; Mononegavirales; virus nomenclature; virus taxonomy.]« less

Current status of endoluminal grafting for exclusion of abdominal aortic aneurysms. The beauty and the beast.

PubMed Central

Diethrich, E B

1998-01-01

The exclusion of abdominal aortic aneurysms with endoluminal grafts has generated a great deal of interest since the early 1990s, and many centers are currently evaluating the procedure and comparing it to classic surgical exclusion. Although endoluminal grafting procedures show promise, development and clinical testing of devices is a time-consuming process that is influenced greatly by the regulatory climate in the country where the clinical trials take place. Nevertheless, a number of devices are currently under study, and the advantages of 2nd- and 3rd-generation technology are reflected in reduced rates of complications such as endoleaks and thrombosis. Further study will be required to perfect these devices and observe their long-term success in the exclusion of abdominal aortic aneurysms. Images PMID:9566057

Current status of endoluminal grafting for exclusion of abdominal aortic aneurysms. The beauty and the beast.

PubMed

Diethrich, E B

1998-01-01

The exclusion of abdominal aortic aneurysms with endoluminal grafts has generated a great deal of interest since the early 1990s, and many centers are currently evaluating the procedure and comparing it to classic surgical exclusion. Although endoluminal grafting procedures show promise, development and clinical testing of devices is a time-consuming process that is influenced greatly by the regulatory climate in the country where the clinical trials take place. Nevertheless, a number of devices are currently under study, and the advantages of 2nd- and 3rd-generation technology are reflected in reduced rates of complications such as endoleaks and thrombosis. Further study will be required to perfect these devices and observe their long-term success in the exclusion of abdominal aortic aneurysms.

Gadolinium-doped hollow CeO2-ZrO2 nanoplatform as multifunctional MRI/CT dual-modal imaging agent and drug delivery vehicle.

PubMed

Wei, Zuwu; Wu, Ming; Li, Zuanfang; Lin, Zhan; Zeng, Jinhua; Sun, Haiyan; Liu, Xiaolong; Liu, Jingfeng; Li, Buhong; Zeng, Yongyi

2018-11-01

Developing multifunctional nanoparticle-based theranostic platform for cancer diagnosis and treatment is highly desirable, however, most of the present theranostic platforms are fabricated via complicated structure/composition design and time-consuming synthesis procedures. Herein, the multifunctional Gd/CeO 2 -ZrO 2 /DOX-PEG nanoplatform with single nano-structure was fabricated through a facile route, which possessed MR/CT dual-model imaging and chemotherapy ability. The nanoplatform not only exhibited well-defined shapes, tunable compositions and narrow size distributions, but also presented a well anti-cancer effect and MR/CT imaging ability. Therefore, the Gd/CeO 2 -ZrO 2 /DOX-PEG nanoplatform could be applied for chemotherapy as well as dual-model MR/CT imaging.

Expedite random structure searching using objects from Wyckoff positions

NASA Astrophysics Data System (ADS)

Wang, Shu-Wei; Hsing, Cheng-Rong; Wei, Ching-Ming

2018-02-01

Random structure searching has been proved to be a powerful approach to search and find the global minimum and the metastable structures. A true random sampling is in principle needed yet it would be highly time-consuming and/or practically impossible to find the global minimum for the complicated systems in their high-dimensional configuration space. Thus the implementations of reasonable constraints, such as adopting system symmetries to reduce the independent dimension in structural space and/or imposing chemical information to reach and relax into low-energy regions, are the most essential issues in the approach. In this paper, we propose the concept of "object" which is either an atom or composed of a set of atoms (such as molecules or carbonates) carrying a symmetry defined by one of the Wyckoff positions of space group and through this process it allows the searching of global minimum for a complicated system to be confined in a greatly reduced structural space and becomes accessible in practice. We examined several representative materials, including Cd3As2 crystal, solid methanol, high-pressure carbonates (FeCO3), and Si(111)-7 × 7 reconstructed surface, to demonstrate the power and the advantages of using "object" concept in random structure searching.

Development of aptamers against unpurified proteins.

PubMed

Goto, Shinichi; Tsukakoshi, Kaori; Ikebukuro, Kazunori

2017-12-01

SELEX (Systematic Evolution of Ligands by EXponential enrichment) has been widely used for the generation of aptamers against target proteins. However, its requirement for pure target proteins remains a major problem in aptamer selection, as procedures for protein purification from crude bio-samples are not only complicated but also time and labor consuming. This is because native proteins can be found in a large number of diverse forms because of posttranslational modifications and their complicated molecular conformations. Moreover, several proteins are difficult to purify owing to their chemical fragility and/or rarity in native samples. An alternative route is the use of recombinant proteins for aptamer selection, because they are homogenous and easily purified. However, aptamers generated against recombinant proteins produced in prokaryotic cells may not interact with the same proteins expressed in eukaryotic cells because of posttranslational modifications. Moreover, to date recombinant proteins have been constructed for only a fraction of proteins expressed in the human body. Therefore, the demand for advanced SELEX methods not relying on complicated purification processes from native samples or recombinant proteins is growing. This review article describes several such techniques that allow researchers to directly develop an aptamer from various unpurified samples, such as whole cells, tissues, serum, and cell lysates. The key advantages of advanced SELEX are that it does not require a purification process from a crude bio-sample, maintains the functional states of target proteins, and facilitates the development of aptamers against unidentified and uncharacterized proteins in unpurified biological samples. © 2017 Wiley Periodicals, Inc.

Celebrating the Family: Ethnicity, Consumer Culture, and Family Rituals.

ERIC Educational Resources Information Center

Pleck, Elizabeth H.

This book examines family traditions of over two centuries in the United States and finds a complicated process of change in the way Americans have celebrated holidays such as Christmas, Easter, Thanksgiving, Passover, and Chinese New Year as well as the life cycle rituals of birth, birthdays, coming of age, marriage, and death. The book notes…

Comparison of Stereotactic and Ultrasound-guided Biopsy of Solid Supratentorial Tumor: A Preliminary Report

PubMed Central

Satyarthee, Guru Dutta; Chandra, P. Sarat; Sharma, Bhawani S.; Mehta, V. S.

2017-01-01

Introduction: The computed tomography (CT) guided stereotactic biopsy (STB) is considered as method of choice for biopsy of intracranial mass lesions. However, it's disadvantages are frame fixation, time requirement for transportation between CT scan suit to the operation theater with added much higher equipment cost in the relatively resource scarred developing country. Ultrasound-guided biopsy (USGB) is relatively simpler, economical, less time consuming, and real-time procedure. Clinical Materials and Methods: Thirty-seven consecutively admitted patients with supratentorial brain tumors, who underwent biopsy of the lesion using CT compatible stereotactic and ultrasound-guided (USGB) procedure formed cohort of the study. Based on location and size of the lesions, the cases were divided into two groups, superficial and deep. Twenty-two patients underwent ultrasound-guided biopsy and 15 with STB. Results: The diagnostic yield of STB was 93% and 91% for ultrasound-guided biopsy. The mean operation time of STB group was 149.00 min and 94 min for USGB, which was statistically significant. Two cases in each group developed hematoma; however, one case in USGB group needed surgical evacuation. The real-time monitoring detected two hematoma intraoperatively, which were further also confirmed on postoperative CT scan head. Conclusions: The ultrasound-guided biopsy procedure (USGB) was simple, relatively shorter time-consuming procedure and equally efficacious and utilizing economical equipment and can act as a safer alternative to CT STB process for biopsy of the intracranial mass lesion. Furthermore, USGB also provided intra-operative real-time monitoring, which provided clue for close monitoring in the postoperative period after completion of biopsy to look for development of fresh hematoma development not only at the biopsy site but also along the biopsy track and adjoining area. Perhaps, a longer period of ultrasonic monitoring following the procedure would be of greater help to detect hematoma formation, which is one of the most common complications of the biopsy procedure. PMID:29114280

Development of a QFD-based expert system for CNC turning centre selection

NASA Astrophysics Data System (ADS)

Prasad, Kanika; Chakraborty, Shankar

2015-12-01

Computer numerical control (CNC) machine tools are automated devices capable of generating complicated and intricate product shapes in shorter time. Selection of the best CNC machine tool is a critical, complex and time-consuming task due to availability of a wide range of alternatives and conflicting nature of several evaluation criteria. Although, the past researchers had attempted to select the appropriate machining centres using different knowledge-based systems, mathematical models and multi-criteria decision-making methods, none of those approaches has given due importance to the voice of customers. The aforesaid limitation can be overcome using quality function deployment (QFD) technique, which is a systematic approach for integrating customers' needs and designing the product to meet those needs first time and every time. In this paper, the adopted QFD-based methodology helps in selecting CNC turning centres for a manufacturing organization, providing due importance to the voice of customers to meet their requirements. An expert system based on QFD technique is developed in Visual BASIC 6.0 to automate the CNC turning centre selection procedure for different production plans. Three illustrative examples are demonstrated to explain the real-time applicability of the developed expert system.

Doppler-guided hemorrhoidal artery ligation does not offer any advantage over suture ligation of grade 3 symptomatic hemorrhoids.

PubMed

Gupta, P J; Kalaskar, S; Taori, S; Heda, P S

2011-12-01

Doppler-guided ligation of hemorrhoidal vessels is being proposed as a treatment of grade 2 and 3 hemorrhoids. Many researchers are coupling this procedure with mucopexy or lifting of hemorrhoids to control the prolapse more effectively. The present study was conducted in patients with 3rd-degree hemorrhoids to determine the usefulness of Doppler-guided hemorrhoidal artery ligation compared to mucopexy of prolapsing hemorrhoids and to compare it with mere mucopexy of the hemorrhoids. A double-blind, randomized controlled study was conducted on 48 consecutive patients with grade III hemorrhoids requiring surgery. The patients were randomized into two groups. Half of them were treated with ligation and mucopexy [SL], while the remaining patients underwent a Doppler-guided hemorrhoidal artery ligation followed by ligation and mucopexy [DSL]. The patients were examined by a blinded independent observer at 2, 4, and 6 weeks and at the end of 1 year after the operation to evaluate postoperative pain scores, amount of analgesics consumed, and complications encountered. The observer also assessed recurrence of hemorrhoids after 1 year. Operative time was significantly longer in the DSL group (31 min vs. 9 min P < 0.003). The postoperative pain score was significantly higher in the Doppler group [4.4 vs. 2.2, P < 0.002 (visual analogue scale)]. The mean total analgesic dose and duration of pain control using analgesics were greater and longer for the Doppler group than for the SL group (17 vs. 11 tablets, and 13 days vs. 9 days, respectively; P < 0. 01). Complications were similar in both the groups. At 1-year follow-up, the recurrence of hemorrhoids was not statistically significant in either group (4 patients in SL group and 3 patients in DSL group; P < 0.93). Suture ligation of hemorrhoids is a simple, cost-effective, and convenient modality for treating grade 3 hemorrhoids. Doppler assistance in ligating the hemorrhoidal vessels prior to hemorrhoidal mucopexy offers no advantage and is a time-consuming procedure.

Multikanban model for disassembly line with demand fluctuation

NASA Astrophysics Data System (ADS)

Udomsawat, Gun; Gupta, Surendra M.; Al-Turki, Yousef A. Y.

2004-02-01

In recent years, the continuous growth in consumer waste and dwindling natural resources has seriously threatened the environment. Realizing this, several countries have passed regulations that force manufacturers not only to manufacture environmentally conscious products, but also to take back their used products from consumers so that the components and materials recovered from the products may be reused and/or recycled. Disassembly plays an important role in product recovery. A disassembly line is perhaps the most suitable setting for disassembly of products in large quantities. Because a disassembly line has a tendency to generate excessive inventory, employing a kanban system can reduce the inventory level and let the system run more efficiently. A disassembly line is quite different from an assembly line. For example, not only can the demand arrive at the last station, it can also arrive at any of the other stations in the system. The demand for a component on the disassembly line could fluctuate widely. In fact, there are many other complicating matters that need to be considered to implement the concept of kanbans in such an environment. In this paper, we discuss the complications that are unique to a disassembly line. We discuss the complications in utilizing the conventional production control mechanisms in a disassembly line setting. We then show how to overcome them by implementing kanbans in a disassembly line setting with demand fluctuation and introduce the concept of multi-kanban mechanism. We demonstrate its effectiveness using a simulation model. An example is presented to illustrate the concept.

Emerging Trends On Drug Delivery Strategy of Momordica charantia against Diabetes and its Complications.

PubMed

Thent, Zar Chi; Das, Srijit; Zaidun, Nurul Hannim

2018-01-01

The incidence of diabetes mellitus has increased drastically over the past few decades. This oxidant-antioxidant imbalance resulting in complication of diabetes mellitus includes macro- and microvascular complications. Resistance to conventional treatment and patient compliance has paved the way to the usage of effective natural products and supplements. Momordica charantia (bitter gourd) is widely consumed in many parts of Malaysia as a vegetable. Momordica charantia (MC) is mainly used in the management of diabetes mellitus. The present review discusses the literature concerning the antidiabetic and antioxidant properties of MC focusing on the complication of diabetes mellitus along with its mode of delivery. We found that among the whole part of MC, its fruit extract has been widely studied, therapeutically. The evidence based analysis of the beneficiary effects of MC on the different organs involved in diabetes complication is also highlighted. This review elucidated an essential understanding of MC based drug delivery system in both clinical and experimental studies and appraised the great potential of the protein based MC extract against diabetes mellitus. The review paper is believed to assist the researchers and medical personnel in treating diabetic associated complications. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Plexiform neurofibroma tissue classification

NASA Astrophysics Data System (ADS)

Weizman, L.; Hoch, L.; Ben Sira, L.; Joskowicz, L.; Pratt, L.; Constantini, S.; Ben Bashat, D.

2011-03-01

Plexiform Neurofibroma (PN) is a major complication of NeuroFibromatosis-1 (NF1), a common genetic disease that involving the nervous system. PNs are peripheral nerve sheath tumors extending along the length of the nerve in various parts of the body. Treatment decision is based on tumor volume assessment using MRI, which is currently time consuming and error prone, with limited semi-automatic segmentation support. We present in this paper a new method for the segmentation and tumor mass quantification of PN from STIR MRI scans. The method starts with a user-based delineation of the tumor area in a single slice and automatically detects the PN lesions in the entire image based on the tumor connectivity. Experimental results on seven datasets yield a mean volume overlap difference of 25% as compared to manual segmentation by expert radiologist with a mean computation and interaction time of 12 minutes vs. over an hour for manual annotation. Since the user interaction in the segmentation process is minimal, our method has the potential to successfully become part of the clinical workflow.

Hypophosphataemia: an easy strategy for diagnosis and treatment in HIV patients.

PubMed

Bagnis, Corinne Isnard; Karie, Svetlana; Deray, Gilbert; Essig, Marie

2009-01-01

Because HIV infection has become a chronic disease, it is crucial that metabolic complications secondary to HIV infection or prolonged therapy be diagnosed and managed appropriately over time. Therefore the optimal follow-up becomes complex and time consuming. Our review aimed to provide physicians in charge of HIV-infected patients with key data helping them to diagnose and understand hypophosphataemia in HIV patients. Hypophosphataemia is frequent and sometimes secondary to renal phosphate wasting. It is very rarely a component of a complex proximal tubular disorder, such as Fanconi syndrome. When isolated, hypophosphataemia is easy to rule out and treat. In rare cases, prolonged hypophosphataemia, when related to renal phosphate wasting and tubular dysfunction, might have potential consequences on bone outcome, however, more studies are needed. HIV infection by itself might be a risk factor for bone metabolism abnormalities; antiretroviral drugs might also be involved. Therefore, it seems valuable for patients that the minimal screening should be performed routinely, in order to prevent long-term disabilities.

Using NU-KNIT® for hemostasis around recurrent laryngeal nerve during transthoracic esophagectomy with lymphadenectomy for esophageal cancer.

PubMed

Rino, Yasushi; Yukawa, Norio; Sato, Tsutomu; Yamamoto, Naoto; Tamagawa, Hiroshi; Hasegawa, Shinichi; Oshima, Takashi; Yoshikawa, Takaki; Masuda, Munetaka; Imada, Toshio

2014-03-06

We thought that using electrocautery for hemostasis caused recurrent laryngeal nerve palsy. We reflected the prolonged use of electrocautery and employed NU-KNIT® to achieve hemostasis nearby the recurrent laryngeal nerve. We assessed that using NU-KNIT® hemostasis prevented or not postoperative recurrent laryngeal nerve palsy, retrospectively. The present study was evaluated to compare using electrocautery hemostasis with using NU-KNIT® hemostasis during lymphadenectomy along recurrent laryngeal nerve. The variables compared were morbidity rate of recurrent laryngeal nerve palsy, operation time, and blood loss. We use NU-KNIT® to achieve hemostasis without strong compression. This group is named group N. On the other hand, we use electrocautery to achieve hemostasis. This group is named group E. Complication rate of recurrent laryngeal nerve palsy was higher in group E (55.6%) than group N (5.3%) (p = 0.007). Even hemostasis using NU-KNIT® was slightly more time-consuming than using electrocautery, we concluded that it would be useful to prevent recurrent laryngeal nerve palsy.

Test systems of the STS-XYTER2 ASIC: from wafer-level to in-system verification

NASA Astrophysics Data System (ADS)

Kasinski, Krzysztof; Zubrzycka, Weronika

2016-09-01

The STS/MUCH-XYTER2 ASIC is a full-size prototype chip for the Silicon Tracking System (STS) and Muon Chamber (MUCH) detectors in the new fixed-target experiment Compressed Baryonic Matter (CBM) at FAIR-center, Darmstadt, Germany. The STS assembly includes more than 14000 ASICs. The complicated, time-consuming, multi-step assembly process of the detector building blocks and tight quality assurance requirements impose several intermediate testing to be performed for verifying crucial assembly steps (e.g. custom microcable tab-bonding before wire-bonding to the PCB) and - if necessary - identifying channels or modules for rework. The chip supports the multi-level testing with different probing / contact methods (wafer probe-card, pogo-probes, in-system tests). A huge number of ASICs to be tested restricts the number and kind of tests possible to be performed within a reasonable time. The proposed architectures of test stand equipment and a brief summary of methodologies are presented in this paper.

Report of the Workshop on Extreme Ground Motions at Yucca Mountain, August 23-25, 2004

USGS Publications Warehouse

Hanks, T.C.; Abrahamson, N.A.; Board, M.; Boore, D.M.; Brune, J.N.; Cornell, C.A.

2006-01-01

This Workshop has its origins in the probabilistic seismic hazard analysis (PSHA) for Yucca Mountain, the designated site of the underground repository for the nation's high-level radioactive waste. In 1998 the Nuclear Regulatory Commission's Senior Seismic Hazard Analysis Committee (SSHAC) developed guidelines for PSHA which were published as NUREG/CR-6372, 'Recommendations for probabilistic seismic hazard analysis: guidance on uncertainty and the use of experts,' (SSHAC, 1997). This Level-4 study was the most complicated and complex PSHA ever undertaken at the time. The procedures, methods, and results of this PSHA are described in Stepp et al. (2001), mostly in the context of a probability of exceedance (hazard) of 10-4/yr for ground motion at Site A, a hypothetical, reference rock outcrop site at the elevation of the proposed emplacement drifts within the mountain. Analysis and inclusion of both aleatory and epistemic uncertainty were significant and time-consuming aspects of the study, which took place over three years and involved several dozen scientists, engineers, and analysts.

A new model of skeletal muscle atrophy induced by immobilization using a hook-and-loop fastener in mice

PubMed Central

Aihara, Masahiro; Hirose, Noboru; Katsuta, Wakana; Saito, Fumiaki; Maruyama, Hitoshi; Hagiwara, Hiroki

2017-01-01

[Purpose] To study muscle atrophy, the muscle atrophy model mice have been used frequently. In particular, cast immobilization is the most common method to induce muscle atrophy. However, it is time consuming and often causes adverse events including skin injury, edema, and necrosis. The present study, we developed a hook-and-loop fastener (Velcro) immobilization method as a new, simple, and less invasive approach to induce muscle atrophy. [Subjects and Methods] Mice were bandaged in the knee joint extension and ankle plantar extension position. Muscle atrophy was induced by either winding a cast or Velcro around the limb. [Results] According to weight and fiber size, Velcro immobilization induced equivalent muscle atrophy to cast immobilization. Velcro immobilization reduced significantly the time for the procedure and the frequency of adverse events. [Conclusion] Velcro immobilization can induce muscle atrophy comparable to cast immobilization, but in a shorter time and with less complications. Velcro immobilization may contribute to the study of disuse muscle atrophy in clinical practice of physical therapy using a mouse model. PMID:29184288

The Gellyfish: An In-Situ Equilibrium-Based Sampler for Determining Multiple Free Metal Ion Concentrations in Marine Ecosystems

PubMed Central

Dong, Zhao; Lewis, Christopher G.; Burgess, Robert M.; Shine, James P.

2016-01-01

Free metal ions are usually the most bioavailable and toxic metal species to aquatic organisms, but they are difficult to measure due to their extremely low concentrations in the marine environment. Many of the current methods for determining free metal ions are complicated, time-consuming, and can only measure one metal at a time. We developed a new version of the ‘Gellyfish’, an in-situ equilibrium-based sampler, with significantly reduced equilibration time and the capability of measuring multiple free metal ions simultaneously. By calibrating the Gellyfish to account for its uptake of cationic metal complexes and validating them in multi-metal competition experiments, we were able to determine free metal ion concentrations previously collected over ten months at five locations in Boston Harbor for Cu, Zn, Pb, Ni, and Cd. This work generated one of the largest free metal ion datasets and demonstrated the applicability of the Gellyfish as an easy-to-use and inexpensive tool for monitoring free ion concentrations of metal mixtures in marine ecosystems. PMID:25598362

Attitudes and beliefs regarding direct-to-consumer advertising of pharmaceutical drugs: an exploratory comparison of physicians and pharmaceutical sales representatives.

PubMed

Schulz, Steven A; Broekemier, Gregory M; Burkink, Tim J

2014-01-01

Even with many changes in regulation in recent years, direct-to-consumer advertising (DTCA) of pharmaceutical drugs remains a complicated and contentious issue. Many in our society argue for increased legislation of DTCA while others believe that DTCA serves a useful purpose and should not be overregulated. This study was designed to compare attitudes and beliefs regarding DTCA held by two key stakeholder groups, physicians and pharmaceutical sales representatives. A questionnaire was created, pretested, and administered to 30 physicians and 30 pharmaceutical sales representatives to investigate these issues. Significant differences between these two groups were found and implications for DTCA are discussed.

Comparison of estimation methods for creating small area rates of acute myocardial infarction among Medicare beneficiaries in California.

PubMed

Yasaitis, Laura C; Arcaya, Mariana C; Subramanian, S V

2015-09-01

Creating local population health measures from administrative data would be useful for health policy and public health monitoring purposes. While a wide range of options--from simple spatial smoothers to model-based methods--for estimating such rates exists, there are relatively few side-by-side comparisons, especially not with real-world data. In this paper, we compare methods for creating local estimates of acute myocardial infarction rates from Medicare claims data. A Bayesian Monte Carlo Markov Chain estimator that incorporated spatial and local random effects performed best, followed by a method-of-moments spatial Empirical Bayes estimator. As the former is more complicated and time-consuming, spatial linear Empirical Bayes methods may represent a good alternative for non-specialist investigators. Copyright © 2015 Elsevier Ltd. All rights reserved.

Sandia and the Waste Isolation Pilot Plant, 1974--1999

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

MORA,CARL J.

2000-04-11

Engineers have learned to design and build big projects, which certainly describes the WIPP project, but also includes defense projects, highway networks, space exploration, the Internet, etc., through what has been called a messily complex embracing of contradictions. When something massive and complicated has to be built these days, it leads to a protracted political process in which every special interest makes a stand, lobbyists exert what influence they can, lawmakers bicker, contractors change things, Congress struggles with costs, environmentalists hold things up--and this is good. It may seem amazing that anything gets done, but when it does, everyone hasmore » had their say. It's an intensely democratic, even if expensive and time-consuming, process. The corporate historian of Sandia National Laboratories presents a unique background of the WIPP project and Sandia's part in it.« less

Enteroscopy in the diagnosis and management of celiac disease.

PubMed

Rondonotti, Emanuele; Villa, Federica; Saladino, Valeria; de Franchis, Roberto

2009-07-01

Esophagogastroduodenoscopy (EGD) with 3 to 6 biopsies in the descending duodenum is the gold standard for the diagnosis of celiac disease. At the time of the first diagnosis of celiac disease, an extensive evaluation of the small bowel is not recommended. However, video capsule endoscopy, because of its good sensitivity and specificity in recognizing the Endoscopic features of celiac disease, can be considered a valid alternative to EGD in patients unable or unwilling to undergo EGD with biopsies. Capsule endoscopy is also a possible option in selected cases with strong suspicion of celiac disease but negative first-line tests. In evaluating patients with refractory or complicated celiac disease, in whom a complete evaluation of the small bowel is mandatory (at least in refractory celiac disease type II patients) because of the possible presence of complications beyond the reach of conventional endoscopes, both capsule endoscopy and balloon-assisted enteroscopy have been found to be helpful. In these patients, capsule endoscopy offers several advantages: it is well tolerated, it allows inspection of the entire small bowel, and it is able to recognize subtle mucosal changes. However, in this setting, capsule endoscopy should ideally be coupled with imaging techniques that provide important information about the thickness of the wall of the intestine and about extraluminal abnormalities. Although deep enteroscopy (such as balloon enteroscopy) is expensive, time-consuming, and potentially risky in these frail patients, they may have a key role, because they make it possible to take tissue samples from deep in the small intestine.

The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician's point of view.

PubMed

Kovshoff, Hanna; Williams, Sarah; Vrijens, May; Danckaerts, Marina; Thompson, Margaret; Yardley, Lucy; Hodgkins, Paul; Sonuga-Barke, Edmund J S

2012-02-01

Clinical decision making is influenced by a range of factors and constitutes an inherently complex task. Here we present results from the decisions regarding ADHD management (DRAMa) study in which we undertook a thematic analysis of clinicians' experiences and attitudes to assessment, diagnosis and treatment of ADHD. Fifty prescribing child psychiatrists and paediatricians from Belgium and the UK took part in semi-structured interviews about their decisions regarding the assessment, diagnosis and treatment of ADHD. Interviews were transcribed and processed using thematic analysis and the principles of grounded theory. Clinicians described the assessment and diagnostic process as inherently complicated and requiring time and experience to piece together the accounts of children made by multiple sources and through the use of varying information gathering techniques. Treatment decisions were viewed as a shared process between families, children, and the clinician. Published guidelines were viewed as vague, and few clinicians spoke about the use of symptom thresholds or specific impairment criteria. Furthermore, systematic or operationalised criteria to assess treatment outcomes were rarely used. Decision making in ADHD is regarded as a complicated, time consuming process which requires extensive use of clinical impression, and involves a partnership with parents. Clinicians want to separate biological from environmental causal factors to understand the level of impairment and the subsequent need for a diagnosis of ADHD. Clinical guidelines would benefit from revisions to take into account the real-world complexities of clinical decision making for ADHD.

10 CFR Appendix Y to Subpart B of... - Uniform Test Method for Measuring the Energy Consumption of Battery Chargers

Code of Federal Regulations, 2011 CFR

2011-01-01

... power (i.e., watts) consumed as the time series integral of the power consumed over a 1-hour test period...) consumed as the time series integral of the power consumed over a 1-hour test period, divided by the period...-maintenance mode and standby mode over time periods defined in the test procedure. b. Active mode is the...

10 CFR Appendix Y to Subpart B of... - Uniform Test Method for Measuring the Energy Consumption of Battery Chargers

Code of Federal Regulations, 2010 CFR

2010-01-01

... power (i.e., watts) consumed as the time series integral of the power consumed over a 1-hour test period...) consumed as the time series integral of the power consumed over a 1-hour test period, divided by the period...-maintenance mode and standby mode over time periods defined in the test procedure. b. Active mode is the...

Engineered nanomaterials in food: implications for food safety and consumer health.

PubMed

Martirosyan, Alina; Schneider, Yves-Jacques

2014-05-28

From the current state-of-the-art, it is clear that nanotechnology applications are expected to bring a range of benefits to the food sector aiming at providing better quality and conservation. In the meantime, a growing number of studies indicate that the exposure to certain engineered nanomaterials (ENMs) has a potential to lead to health complications and that there is a need for further investigations in order to unravel the biological outcomes of nanofood consumption. In the current review, we summarize the existing data on the (potential) use of ENMs in the food industry, information on the toxicity profiles of the commonly applied ENMs, such as metal (oxide) nanoparticles (NPs), address the potential food safety implications and health hazards connected with the consumption of nanofood. A number of health complications connected with the human exposure to ENMs are discussed, demonstrating that there is a real basis for the arisen concern not only connected with the gut health, but also with the potency to lead to systemic toxicity. The toxicological nature of hazard, exposure levels and risk to consumers from nanotechnology-derived food are on the earliest stage of investigation and this review also highlights the major gaps that need further research and regulation.

Development of a Time-Intensity Evaluation System for Consumers: Measuring Bitterness and Retronasal Aroma of Coffee Beverages in 106 Untrained Panelists.

PubMed

Gotow, Naomi; Moritani, Ami; Hayakawa, Yoshinobu; Akutagawa, Akihito; Hashimoto, Hiroshi; Kobayakawa, Tatsu

2015-06-01

In order to develop products that are acceptable to consumers, it is necessary to incorporate consumers' intentions into products' characteristics. Therefore, investigation of consumers' perceptions of the taste or smell of common beverages provides information that should be useful in predicting market responses. In this study, we sought to develop a time-intensity evaluation system for consumer panels. Using our system, we performed time-intensity evaluation of flavor attributes (bitterness and retronasal aroma) that consumers perceived after swallowing a coffee beverage. Additionally, we developed quantitative evaluation methods for determining whether consumer panelists can properly perform time-intensity evaluation. In every trial, we fitted an exponential function to measured intensity data for bitterness and retronasal aroma. The correlation coefficients between measured time-intensity data and the fitted exponential curves were greater than 0.8 in about 90% of trials, indicating that we had successfully developed a time-intensity system for use with consumer panelists, even after just a single training trial using a nontrained consumer. We classified participants into two groups based on their consumption of canned coffee beverages. Significant difference was observed in only AUC of sensory modality (bitterness compared with retronasal aroma) among conventional TI parameters using two-way ANOVA. However, three-way ANOVA including a time course revealed significant difference between bitterness and retronasal aroma in the high-consumption group. Moreover, the high-consumption group more easily discriminated between bitterness and retronasal aroma than the low-consumption group. This finding implied that manufacturers should select consumer panelists who are suitable for their concepts of new products. © 2015 Institute of Food Technologists®

RTL validation methodology on high complexity wireless microcontroller using OVM technique for fast time to market

NASA Astrophysics Data System (ADS)

Zhafirah Muhammad, Nurul; Harun, A.; Hambali, N. A. M. A.; Murad, S. A. Z.; Mohyar, S. N.; Isa, M. N.; Jambek, AB

2017-11-01

Increased demand in internet of thing (IOT) application based has inadvertently forced the move towards higher complexity of integrated circuit supporting SoC. Such spontaneous increased in complexity poses unequivocal complicated validation strategies. Hence, the complexity allows researchers to come out with various exceptional methodologies in order to overcome this problem. This in essence brings about the discovery of dynamic verification, formal verification and hybrid techniques. In reserve, it is very important to discover bugs at infancy of verification process in (SoC) in order to reduce time consuming and fast time to market for the system. Ergo, in this paper we are focusing on the methodology of verification that can be done at Register Transfer Level of SoC based on the AMBA bus design. On top of that, the discovery of others verification method called Open Verification Methodology (OVM) brings out an easier way in RTL validation methodology neither as the replacement for the traditional method yet as an effort for fast time to market for the system. Thus, the method called OVM is proposed in this paper as the verification method for larger design to avert the disclosure of the bottleneck in validation platform.

12 CFR Supplement I to Part 213 - Official Staff Commentary to Regulation M

Code of Federal Regulations, 2013 CFR

2013-01-01

... primary use. 2. Period of time. To be a consumer lease, the initial term of the lease must be more than... lease (unless terminable without penalty at any time by the consumer) under which the consumer: i... time of consummation. The threshold amount in effect during a particular time period is the amount...

12 CFR Supplement I to Part 213 - Official Staff Commentary to Regulation M

Code of Federal Regulations, 2014 CFR

2014-01-01

... primary use. 2. Period of time. To be a consumer lease, the initial term of the lease must be more than... lease (unless terminable without penalty at any time by the consumer) under which the consumer: i... time of consummation. The threshold amount in effect during a particular time period is the amount...

12 CFR Supplement I to Part 213 - Official Staff Commentary to Regulation M

Code of Federal Regulations, 2012 CFR

2012-01-01

... primary use. 2. Period of time. To be a consumer lease, the initial term of the lease must be more than... lease (unless terminable without penalty at any time by the consumer) under which the consumer: i... time of consummation. The threshold amount in effect during a particular time period is the amount...

How Growing Complexity of Consumer Choices and Drivers of Consumption Behaviour Affect Demand for Animal Source Foods.

PubMed

Perry, B D; Grace, D C

2015-12-01

Many societies are spoiled for choice when they purchase meat and other livestock products, and around the globe food choice has grown dramatically in the last two decades. What is more, besides the cost and obvious health concerns influencing commodity section, an increasing proportion of choices is made to contribute to the achievement of certain ideals, such as natural resource management, climate change mitigation, animal welfare concerns and personal lifestyle. At the same time, human health considerations are becoming more important for consumption choices as richer societies, and increasingly the urban poor in low- and middle-income countries, face an unprecedented epidemic of over-consumption and associated diet-related non-communicable diseases. Animal source foods are considered significant contributors to this trend. This paper reviews this complicated arena, and explores the range of considerations that influence consumers' preferences for meat and other animal source foods. This paper also argues that deeper drivers of consumption behaviour of many foods may act in opposition to the articulated preferences for choices around animal source food consumption. We review how the returns to different causes are being valued, how emerging metrics are helping to manage and influence consumption behaviours, and draw conclusions regarding options which influence food choice.

12 CFR Supplement I to Part 1005 - Official Interpretations

Code of Federal Regulations, 2013 CFR

2013-01-01

... used to capture the Magnetic Ink Character Recognition (MICR) encoding to initiate a one-time automated clearinghouse (ACH) debit. For example, if a consumer authorizes a one-time ACH debit from the consumer's... involved at the time of the transaction, if the consumer's asset account is subsequently debited for the...

12 CFR Supplement I to Part 1005 - Official Interpretations

Code of Federal Regulations, 2012 CFR

2012-01-01

... used to capture the Magnetic Ink Character Recognition (MICR) encoding to initiate a one-time automated clearinghouse (ACH) debit. For example, if a consumer authorizes a one-time ACH debit from the consumer's... involved at the time of the transaction, if the consumer's asset account is subsequently debited for the...

12 CFR 205.3 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... to initiate a one-time electronic fund transfer from a consumer's account. The consumer must...-time electronic fund transfer (in providing a check to a merchant or other payee for the MICR encoding... information for the transfer shall also provide a notice to the consumer at the same time it provides the...

12 CFR 1005.3 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

...-time electronic fund transfer from a consumer's account. The consumer must authorize the transfer. (ii... one-time electronic fund transfer (in providing a check to a merchant or other payee for the MICR... transfer. A consumer authorizes a one-time electronic fund transfer from his or her account to pay the fee...

12 CFR 205.3 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... to initiate a one-time electronic fund transfer from a consumer's account. The consumer must...-time electronic fund transfer (in providing a check to a merchant or other payee for the MICR encoding... information for the transfer shall also provide a notice to the consumer at the same time it provides the...

12 CFR 205.3 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... to initiate a one-time electronic fund transfer from a consumer's account. The consumer must...-time electronic fund transfer (in providing a check to a merchant or other payee for the MICR encoding... information for the transfer shall also provide a notice to the consumer at the same time it provides the...

The Effects of Drinking Coffee While Recovering from Colon and Rectal Resection Surgery

PubMed Central

Piric, Mirela; Pasic, Fuad; Rifatbegovic, Zijah; Konjic, Ferid

2015-01-01

Aim: Resection surgery on the colon and rectum are changing both anatomical and physiological relations within the abdominal cavity. Delayed functions of the gastrointestinal tract, flatulence, failure of peristalsis, prolonged spasms and pain, limited postoperative recovery of these patients increase the overall cost of treatment. Early consumption of coffee instead of tea should lead to faster restoration of normal function of the colon without unwanted negative repercussions. Method: This study is designed as a prospective-retrospective clinical study and was carried out at the Surgery Center Tuzla, during the year 2013/ 2014. Sixty patients were randomized in relation to the type of resection surgery, etiology of disease-malignant benign, and in relation to whether they were coffee users or not. Patients were divided into two groups. The first group of thirty patients was given 100 ml of instant coffee divided into three portions right after removing the nasogastric tube, first postoperative day, while the second group of thirty patients got 100 ml of tea. Monitored parameter was: time of first stool and the second group of monitored parameters was: whether there was returning of nasogastric tube or not, increased use of laxatives, whether there was anastomotic leak, radiologic and clinical dehiscence, audit procedures, or lethal outcomes in the treatment of patients. Results: A total of 61 patients were randomized into two groups of 30 int he group of tea and coffee 29 in the group, two patients were excluded from the study because they did not consume coffee before surgery. Time of getting stool in the postoperative period after elective resection surgery on the colon and rectum is significantly shorter after drinking coffee for about 15h (p <0.01). Also, the length of hospital stay was significantly shorter after drinking coffee (p <0.01). Time of hospitalization in subjects/respondents coffee consumers on average lasted 8.6 days with consumers of tea for 16 days. The incidence of postoperative complications was significantly lower after consumption of coffee (p <0.05). Conclusion: Postoperative consumption of coffee is a safe and effective way to accelerate the establishment of the bowel function after colorectal resection surgery. PMID:26843724

The Effects of Drinking Coffee While Recovering from Colon and Rectal Resection Surgery.

PubMed

Piric, Mirela; Pasic, Fuad; Rifatbegovic, Zijah; Konjic, Ferid

2015-12-01

Resection surgery on the colon and rectum are changing both anatomical and physiological relations within the abdominal cavity. Delayed functions of the gastrointestinal tract, flatulence, failure of peristalsis, prolonged spasms and pain, limited postoperative recovery of these patients increase the overall cost of treatment. Early consumption of coffee instead of tea should lead to faster restoration of normal function of the colon without unwanted negative repercussions. This study is designed as a prospective-retrospective clinical study and was carried out at the Surgery Center Tuzla, during the year 2013/ 2014. Sixty patients were randomized in relation to the type of resection surgery, etiology of disease-malignant benign, and in relation to whether they were coffee users or not. Patients were divided into two groups. The first group of thirty patients was given 100 ml of instant coffee divided into three portions right after removing the nasogastric tube, first postoperative day, while the second group of thirty patients got 100 ml of tea. Monitored parameter was: time of first stool and the second group of monitored parameters was: whether there was returning of nasogastric tube or not, increased use of laxatives, whether there was anastomotic leak, radiologic and clinical dehiscence, audit procedures, or lethal outcomes in the treatment of patients. A total of 61 patients were randomized into two groups of 30 int he group of tea and coffee 29 in the group, two patients were excluded from the study because they did not consume coffee before surgery. Time of getting stool in the postoperative period after elective resection surgery on the colon and rectum is significantly shorter after drinking coffee for about 15h (p <0.01). Also, the length of hospital stay was significantly shorter after drinking coffee (p <0.01). Time of hospitalization in subjects/respondents coffee consumers on average lasted 8.6 days with consumers of tea for 16 days. The incidence of postoperative complications was significantly lower after consumption of coffee (p <0.05). Postoperative consumption of coffee is a safe and effective way to accelerate the establishment of the bowel function after colorectal resection surgery.

Enteral nutrition tube placement assisted by ultrasonography in patients with severe acute pancreatitis

PubMed Central

Li, Gang; Pan, Yiyuan; Zhou, Jing; Tong, Zhihui; Ke, Lu; Li, Weiqin

2017-01-01

Abstract To evaluate the effect of a novel procedure using real-time ultrasonography to assist nasojejunal tube placement at bedside in patients with severe acute pancreatitis (SAP). Single center, prospective descriptive study in a 15-bed surgery intensive care unit of a university hospital. Thirty SAP patients were enrolled. The whole procedure of placing nasojejunal tube was performed by a single physician, who places nasojejunal tube at the bedside and performs ultrasonography to guide the tube positioning. The final nasojejunal tube position was confirmed by abdominal radiograph. The successful rate of the procedure as well as the time it took, the time from the decision of enteral feeding to commencement of feeding, and complications were recorded. Thirty-six intubations were performed in 30 patients by using ultrasonography-assisted method at bedside. Nasojejunal tubes were successful placed in 28 of 30 patients (93.3%). The average time of successful placement was 22.07 ± 5.78 minutes. The median time between physician's decision for tube placement and feeding initiation was 5.5 (2, 24) hours. No adverse events occurred in all of patients. This novel method of nasojejunal tube placement under ultrasound guidance is practical, less time consuming and reliable. PMID:29137035

Assessment of maternal smoking status during pregnancy and the associations with neonatal outcomes.

PubMed

Bakker, Rachel; Kruithof, Claudia; Steegers, Eric A P; Tiemeier, Henning; Mackenbach, Johan P; Hofman, Albert; Jaddoe, Vincent W V

2011-12-01

Single assessment of smoking during pregnancy may lead to misclassification due to underreporting or failure of smoking cessation. We examined the percentage of mothers who were misclassified in smoking status based on single assessment, as compared with repeated assessment, and whether this misclassification leads to altered effect estimates for the associations between maternal smoking and neonatal complications. This study was performed in 5,389 mothers participating in a prospective population-based cohort study in the Netherlands. Smoking status was assessed 3 times during pregnancy using questionnaires. Information on birth weight and neonatal complications was obtained from hospital records. For categorizing mothers per smoking status, Cohen's Kappa coefficient was .86 (p < .001) between single and repeated assessments. Of all mothers who reported nonsmoking or first trimester-only smoking in early pregnancy, 1.7% (70 of 4,141) and 33.7% (217 of 643), respectively, were reclassified to continued smoking based on repeated assessment. Younger, shorter lower educated mothers who had non-European ethnicity experienced more stress, consumed more alcohol, and did not use folic acid supplements had higher risk of underreporting their smoking status or failure of smoking cessation. Marginal differences were found on the associations of maternal smoking with neonatal complications between single or repeated assessment. Our results suggest that single assessment of smoking during pregnancy leads to underestimation of the continued smoking prevalence, especially among mothers who reported quitting smoking in first trimester. However, this underestimation does not materially change the effect estimates for the associations between maternal smoking and neonatal outcomes.

Cost of the treatment of complications of unsafe abortion in public hospitals.

PubMed

Naghma-e-Rehan

2011-02-01

To study the cost of induced abortions (unsafe abortion) and treatment of the complications of such abortions. Descriptive study was conducted between July, 2008 and December, 2008 in four tertiary care hospitals of Lahore: Sir Ganga Ram Hospital, Lady Wellingdon Hospital, General Hospital and Family Health Hospital of Family Planning Association of Pakistan. One hundred women admitted with complications of induced abortion were interviewed by lady doctors, who were trained to conduct the interviews. The data was collected through a structured pre-designed and pre-tested questionnaire approved by International Planned Parenthood Federation. Based on the information provided by the woman and/or her husband and hospital sources, the average cost of abortion was Rs.1686/-. The cost varied from Rs. 500/- to 7,000/-depending on the city, type of provider and facilities available at the clinic. The average cost of treating the complications was Rs. 4,197/- ranging from Rs. 1600/- to Rs 45,000/-. At the present exchange rate (September, 2009), the cost will be US$ 20/- to 560/-. Wide variation between two extremes was due to the type and extent of complications. Treatment for abortion-related complications consumes a large portion of hospital budgets for obstetrics and gynaecology and results in considerable mortality and morbidity. Due to restrictive laws and high cost of safe abortions, most women faced with an unwanted pregnancy resort to unsafe abortions.

An alternative treatment modality in closing bladder exstrophy: use of rectus abdominus muscle flap--preliminary results in a rat model.

PubMed

Büyükünal, S N; Kaner, G; Celayir, S

1989-06-01

The aim of this study was to find a new alternate method for bladder exstrophies with small capacity and inelasticity, and to resolve complications of other bladder augmentation techniques. In 50 Wistar albino rats, a large bladder defect was created excising at least one half of their original bladder, keeping the peritrigonal zone intact. In each rat, a 2.5 x 1-cm inferiorly based rectus abdominus muscle flap was prepared from the lower abdominal quadrant. This flap was then rotated to cover the bladder defect. The inner layer formed by the peritoneum was sutured to the edges of the bladder defect by 6-0 separate sutures. The post-operative radiologic and scintigraphic examination of the urinary system done at different intervals showed no difference from that of normal rats. The only observed disadvantage of this technique was the formation of calculi in the bladder in 8/50 rats in the late post-operative period. Post-mortem histopathologic investigations performed at different intervals showed the inner layer of the flap to be completely covered by the transitional urinary epithelium of the bladder. We think this technique is easy to perform, non-time-consuming, and has a low complication rate. It may be useful in infants with small, noncompliant, inelastic bladder exstrophies.

Induced pluripotent stem cell-based therapy for age-related macular degeneration.

PubMed

Bracha, Peter; Moore, Nicholas A; Ciulla, Thomas A

2017-09-01

In age-related macular degeneration (AMD), stem cells could possibly replace or regenerate disrupted pathologic retinal pigment epithelium (RPE), and produce supportive growth factors and cytokines such as brain-derived neurotrophic factor.  Induced pluripotent stem cells (iPSCs)-derived RPE was first subretinally transplanted in a neovascular AMD patient in 2014. Areas covered: Induced PSCs are derived from the introduction of transcription factors to adult cells under specific cell culture conditions, followed by differentiation into RPE cells. Induced PSC-derived RPE cells exhibit ion transport, membrane potential, polarized VEGF secretion and gene expression that is similar to native RPE. Despite having similar in vitro function, morphology, immunostaining and microscopic analysis, it remains to be seen if iPSC-derived RPE can replicate the myriad of in vivo functions, including immunomodulatory effects, of native RPE cells.  Historically, adjuvant RPE transplantation during CNV resections were technically difficult and complicated by immune rejection. Autologous iPSCs are hypothesized to reduce the risk of immune rejection, but their production is time-consuming and expensive.  Alternatively, allogenic transplantation using human leukocyte antigen (HLA)-matched iPSCs, similar to HLA-matched organ transplantation, is currently being investigated. Expert opinion: Challenges to successful transplantation with iPSCs include surgical technique, a pathologic subretinal microenvironment, possible immune rejection, and complications of immunosuppression.

Inhibition of α-glucosidase, α-amylase, and aldose reductase by potato polyphenolic compounds

PubMed Central

Kalita, Diganta; Holm, David G.; LaBarbera, Daniel V.; Petrash, J. Mark

2018-01-01

Diabetes mellitus is a chronic disease that is becoming a serious global health problem. Diabetes has been considered to be one of the major risks of cataract and retinopathy. Synthetic and natural product inhibitors of carbohydrate degrading enzymes are able to reduce type 2 diabetes and its complications. For a long time, potatoes have been portrayed as unhealthy for diabetic patients by some nutritionist due to their high starch content. However, purple and red potato cultivars have received considerable attention from consumers because they have high levels of polyphenolic compounds that have potent antioxidant activities. In this study, we screened the total phenolics (TP) and total anthocyanins (TA) and analyzed the phenolic and anthocyanin compounds in selected potato cultivars and advanced selections with distinct flesh colors (purple, red, yellow and white). Purple and red potato cultivars had higher levels of TP and TA than tubers with other flesh colors. Chlorogenic acid is the predominant phenolic acid, and major anthocyanin is composed of the derivatives of petunidin, peonidin, malvidin and pelargonidin. We tested the potential inhibitory effect of potato extracts on the activities of α-amylase and α-glucosidase, which were targeted to develop antidiabetic therapeutic agents. We also measured inhibitory effect of potato extracts on aldose reductase (AR) which is a key enzyme that has been a major drug target for the development of therapies to treat diabetic complications. Purple flesh tubers extract showed the most effective inhibition of α-amylase, α-glucosidase, and aldose reductase with IC50 values 25, 42, and 32 μg/ml, respectively. Kinetic studies showed that anthocyanins are noncompetitive inhibitors of these enzymes, whereas phenolic acids behaved as mixed inhibitors for α-amylase and α-glucosidase and noncompetitive inhibitors for AR. This study supports the development of a positive and healthful image of potatoes, which is an important issue for consumers. PMID:29370193

Inhibition of α-glucosidase, α-amylase, and aldose reductase by potato polyphenolic compounds.

PubMed

Kalita, Diganta; Holm, David G; LaBarbera, Daniel V; Petrash, J Mark; Jayanty, Sastry S

2018-01-01

Diabetes mellitus is a chronic disease that is becoming a serious global health problem. Diabetes has been considered to be one of the major risks of cataract and retinopathy. Synthetic and natural product inhibitors of carbohydrate degrading enzymes are able to reduce type 2 diabetes and its complications. For a long time, potatoes have been portrayed as unhealthy for diabetic patients by some nutritionist due to their high starch content. However, purple and red potato cultivars have received considerable attention from consumers because they have high levels of polyphenolic compounds that have potent antioxidant activities. In this study, we screened the total phenolics (TP) and total anthocyanins (TA) and analyzed the phenolic and anthocyanin compounds in selected potato cultivars and advanced selections with distinct flesh colors (purple, red, yellow and white). Purple and red potato cultivars had higher levels of TP and TA than tubers with other flesh colors. Chlorogenic acid is the predominant phenolic acid, and major anthocyanin is composed of the derivatives of petunidin, peonidin, malvidin and pelargonidin. We tested the potential inhibitory effect of potato extracts on the activities of α-amylase and α-glucosidase, which were targeted to develop antidiabetic therapeutic agents. We also measured inhibitory effect of potato extracts on aldose reductase (AR) which is a key enzyme that has been a major drug target for the development of therapies to treat diabetic complications. Purple flesh tubers extract showed the most effective inhibition of α-amylase, α-glucosidase, and aldose reductase with IC50 values 25, 42, and 32 μg/ml, respectively. Kinetic studies showed that anthocyanins are noncompetitive inhibitors of these enzymes, whereas phenolic acids behaved as mixed inhibitors for α-amylase and α-glucosidase and noncompetitive inhibitors for AR. This study supports the development of a positive and healthful image of potatoes, which is an important issue for consumers.

The unexpected truth about dates and hypoglycemia.

PubMed

Yasawy, Mohammed I

2016-01-01

Dates are a concentrated source of essential nutrients, vitamins, minerals, and carbohydrates (CHOs), which are necessary for the maintenance of optimum health. Most of the CHOs in dates come from sugars including glucose and fructose. Dates are commonly consumed in Saudi Arabia, particularly at the time of breaking the fast to provide instant energy and maintain blood sugar level. However, dates may cause hypoglycemia in a rare condition named as heredity fructose intolerance (HFI), and a few families have been to see us with a history of that nature. This is to report the preliminary results of an on-going study of a group of patients who get symptoms of hypoglycemia following the ingestion of dates and have suffered for years without an accurate diagnosis. This report is based on three patients, from the same family, living in a date growing region of the Kingdom of Saudi Arabia (KSA). The patients had been to several medical centers without getting any definite answers or diagnosis until they were referred to the Gastroenterology Clinic of King Fahd Hospital of the University, Al-Khobar, KSA. The data were obtained by careful history and laboratory investigations, and a final diagnosis of HFI made on fructose intolerance test (FIT). The patients reported that they had avoided eating dates because of various symptoms, such as bloating, nausea, and even hypoglycemia when larger amounts were consumed. Their other symptoms included sleepiness, sweating, and shivering. After full examinations and necessary laboratory tests based on the above symptoms, FIT was performed and the patients were diagnosed with HFI. They were referred to a dietitian who advised a fructose-free diet. They felt well and were free of symptoms. HFI may remain undiagnosed until adulthood and may lead to disastrous complications and even death. The diagnosis can only be suspected after a careful dietary history is taken supported by FIT. This can prevent serious complications. Restricting dietary fructose may give relief from symptoms in a high proportion of patients with this disorder.

Postreinforcement Pause in Grocery Shopping: Comparing Interpurchase Times across Products and Consumers

ERIC Educational Resources Information Center

Oliveira-Castro, Jorge M.; James, Victoria K.; Foxall, Gordon R.

2007-01-01

Purchase probability as a function of interpurchase time was examined through comparison of findings from laboratory experiments on reinforcement schedules and from marketing investigations of consumers' interpurchase time. Panel data, based on a sample of 80 consumers who purchased nine supermarket food products during 16 weeks, were used. For…

First clinical use of the EchoTrack guidance approach for radiofrequency ablation of thyroid gland nodules.

PubMed

Franz, Alfred Michael; Seitel, Alexander; Bopp, Nasrin; Erbelding, Christian; Cheray, Dominique; Delorme, Stefan; Grünwald, Frank; Korkusuz, Hüdayi; Maier-Hein, Lena

2017-06-01

Percutaneous radiofrequency ablation (RFA) of thyroid nodules is an alternative to surgical resection that offers the benefits of minimal scars for the patient, lower complication rates, and shorter treatment times. Ultrasound (US) is the preferred modality for guiding these procedures. The needle is usually kept within the US scanning plane to ensure needle visibility. However, this restricts flexibility in both transducer and needle movement and renders the procedure difficult, especially for inexperienced users. Existing navigation solutions often involve electromagnetic (EM) tracking, which requires placement of an external field generator (FG) in close proximity of the intervention site in order to avoid distortion of the EM field. This complicates the clinical workflow as placing the FG while ensuring that it neither restricts the physician's workspace nor affects tracking accuracy is awkward and time-consuming. The EchoTrack concept overcomes these issues by combining the US probe and the EM FG in one modality, simultaneously providing both real-time US and tracking data without requiring the placement of an external FG for tracking. We propose a system and workflow to use EchoTrack for RFA of thyroid nodules. According to our results, the overall error of the EchoTrack system resulting from errors related to tracking and calibration is below 2 mm. Navigated thyroid RFA with the proposed concept is clinically feasible. Motion of internal critical structures relative to external markers can be up to several millimeters in extreme cases. The EchoTrack concept with its simple setup, flexibility, improved needle visualization, and additional guidance information has high potential to be clinically used for thyroid RFA.

A Hidden Cause of Rising Tuition: Tuition Discounting in Public Colleges and Universities. The Progress of Education Reform. Volume 15, Number 4

ERIC Educational Resources Information Center

Gianneschi, Matt; Pingel, Sarah

2014-01-01

Why does tuition increase faster than inflation? And why does tuition continue to increase even when states increase their investments in public colleges and universities? These questions have perplexed policymakers and higher education consumers alike. Though tuition setting can be very complicated, one of the drivers for rising costs is price…

Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations

PubMed Central

Ketelaar, Nicole ABM; Faber, Marjan J; Flottorp, Signe; Rygh, Liv Helen; Deane, Katherine HO; Eccles, Martin P

2014-01-01

Background It is becoming increasingly common to release information about the performance of hospitals, health professionals or providers, and healthcare organisations into the public domain. However, we do not know how this information is used and to what extent such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers and purchasers, or to what extent the performance of professionals and providers can be affected. Objectives To determine the effectiveness of the public release of performance data in changing the behaviour of healthcare consumers, professionals and organisations. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE Ovid (from 1966), EMBASE Ovid (from 1979), CINAHL, PsycINFO Ovid (from 1806) and DARE up to 2011. Selection criteria We searched for randomised or quasi-randomised trials, interrupted time series and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or individuals. The papers had to report at least one main outcome related to selecting or changing care. Other outcome measures were awareness, attitude, views and knowledge of performance data and costs. Data collection and analysis Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers and healthcare purchasers), performance data, main outcomes (choice of healthcare provider and improvement by means of changes in care) and other outcomes (awareness, attitude, views, knowledge of performance data and costs). Main results We included four studies containing more than 35,000 consumers, and 1560 hospitals. Three studies were conducted in the USA and examined consumer behaviour after the public release of performance data. Two studies found no effect of Consumer Assessment of Healthcare Providers and Systems information on health plan choice in a Medicaid population. One interrupted time series study found a small positive effect of the publishing of data on patient volumes for coronary bypass surgery and low-complication outliers for lumbar discectomy, but these effects did not persist longer than two months after each public release. No effects on patient volumes for acute myocardial infarction were found. One cluster-randomised controlled trial, conducted in Canada, studied improvement changes in care after the public release of performance data for patients with acute myocardial infarction and congestive heart failure. No effects for the composite process-of-care indicators for either condition were found, but there were some improvements in the individual process-of-care indicators. There was an effect on the mortality rates for acute myocardial infarction. More quality improvement activities were initiated in response to the publicly-released report cards. No secondary outcomes were reported. Authors’ conclusions The small body of evidence available provides no consistent evidence that the public release of performance data changes consumer behaviour or improves care. Evidence that the public release of performance data may have an impact on the behaviour of healthcare professionals or organisations is lacking. PMID:22071813

Consumer Choice Between Hospital-Based and Freestanding Facilities for Arthroscopy

PubMed Central

Robinson, James C.; Brown, Timothy T.; Whaley, Christopher; Bozic, Kevin J.

2015-01-01

Background: Hospital-based outpatient departments traditionally charge higher prices for ambulatory procedures, compared with freestanding surgery centers. Under emerging reference-based benefit designs, insurers establish a contribution limit that they will pay, requiring the patient to pay the difference between that contribution limit and the actual price charged by the facility. The purpose of this study was to evaluate the impact of reference-based benefits on consumer choices, facility prices, employer spending, and surgical outcomes for orthopaedic procedures performed at ambulatory surgery centers. Methods: We obtained data on 3962 patients covered by the California Public Employees’ Retirement System (CalPERS) who underwent arthroscopy of the knee or shoulder in the three years prior to the implementation of reference-based benefits in January 2012 and on 2505 patients covered by CalPERS who underwent arthroscopy in the two years after implementation. Control group data were obtained on 57,791 patients who underwent arthroscopy and were not subject to reference-based benefits. The impact of reference-based benefits on consumer choices between hospital-based and freestanding facilities, facility prices, employer spending, and surgical complications was assessed with use of difference-in-differences multivariable regressions to adjust for patient demographic characteristics, comorbidities, and geographic location. Results: By the second year of the program, the shift to reference-based benefits was associated with an increase in the utilization of freestanding ambulatory surgery centers by 14.3 percentage points (95% confidence interval, 8.1 to 20.5 percentage points) for knee arthroscopy and by 9.9 percentage points (95% confidence interval, 3.2 to 16.7 percentage points) for shoulder arthroscopy and a corresponding decrease in the use of hospital-based facilities. The mean price paid by CalPERS fell by 17.6% (95% confidence interval, −24.9% to −9.6%) for knee procedures and by 17.0% (95% confidence interval, −29.3% to −2.5%) for shoulder procedures. The shift to reference-based benefits was not associated with a change in the rate of surgical complications. In the first two years after the implementation of reference-based benefits, CalPERS saved $2.3 million (13%) on these two orthopaedic procedures. Conclusions: Reference-based benefits increase consumer sensitivity to price differences between freestanding and hospital-based surgical facilities. Clinical Relevance: This study shows that the implementation of reference-based benefits does not result in a significant increase in measured complication rates for those subject to reference-based benefits. PMID:26378263

Comparison of closed and open methods of pneumoperitonium in laparoscopic cholecystectomy.

PubMed

Akbar, Mohammad; Khan, Ishtiaq Ali; Naveed, Danish; Khattak, Irfanuddin; Zafar, Arshad; Wazir, Muhammad Salim; Khan, Asif Nawaz; Zia-ur-Rehman

2008-01-01

Pneumoperitonium is the first step in laparoscopic surgery including cholecystectomy. Two commonly used methods to create pneumoperitonium are closed and open technique. Both have advantages and disadvantages. The current study was designed to compare these two techniques in terms of safety and time required to complete the procedure. This was a randomized controlled prospective study conducted at Department of Surgery, Ayub Hospital Complex Abbottabad, from 1st June 2007 to 31st May 2008. Randomization was done into two groups randomly using sealed envelopes containing the questionnaire. Seventy envelopes were kept in the cupboard, containing 35 proformas for group A and 35 for group B. An envelope was randomly fetched and opened upon selection of the patient after taking the informed consent. Pneumoperitonium was created by closed technique in group A, and by open technique in group B. Time required for successful pneumoperitonium was calculated in each group. Failure to induce pneumoperitonium was determined for each technique. Time required to close the wounds at completion, total operating time and injuries sustained during induction of pneumoperitonium were compared in both techniques. Out of the total 70 patients included in study, 35 were in group A and 35 in group B. Mean time required for successful pneumoperitonium was 9.17 minutes in group A and 8.11 minutes in group B. Total operating time ranged from 55 minutes to 130 minutes in group A and from 45 minutes to 110 minutes in group B. Mean of total operating time was 78.34 and 67 minutes in group A and B respectively. Mean time needed to close the wound was 9.88 minutes in group A and 4.97 minutes in group B. Failure of technique was noted in three patients in group A while no failure was experienced in group B. In two cases in group A minor complications during creation of pneumoperitonium were observed while in group B no complication occurred. No patient died in the study. We concluded from this study that open technique of pneumoperitonium was, less time consuming and safer than the closed technique.

Social marketing: two views, two opportunities.

PubMed

Saunders, S; Smith, W A

1984-01-01

Social marketing can refer to the promotion of either a product or an idea. The 1st approach includes the sale of a socially beneficial product such as condoms or oral rehydration salts. Although the product is generally subsidized to keep costs within the reach of consumers, the actual sale is considered critical because of its role in ensuring consumer motivation, increasing internal efficiency, and facilitating longterm self-sufficiency of the program. The 2nd approach stresses the promotion of socially beneficial ideas and practices rather than products, e.g. breastfeeding. Social products differ from commercial products in several important ways: they are more complex, often more controversial, less immediately satisfying to the consumer, require more spectacular results, and are aimed at an audience with fewer resources than most consumers of commercial products. In addition, there are many factors that make social marketing more difficult difficult than marketing in the commercial sector. Social programs have less control over the delivery system and consumer research is more complicated. Despite these differences, both social and commerical marketing are organized aroung the same 4 qualities: product, price, place, and promotion. The product must be configured to maximized consumer acceptance and use. Hidden costs must be considered. There must be an adequate distribution and supply system to ensure easy availability of the product. Finally, the product must be promoted through different communication channels by a wide array of techniques. Attention to these 4 factors can significantly enhance social service delivery of both products and ideas.

12 CFR Supplement I to Part 213 - Official Staff Commentary to Regulation M

Code of Federal Regulations, 2010 CFR

2010-01-01

... primary use. 2. Period of time. To be a consumer lease, the initial term of the lease must be more than... lease (unless terminable without penalty at any time by the consumer) under which the consumer: i... the lease contract, so long as all disclosures are given at the same time. Alternatively, all...

12 CFR Supplement I to Part 213 - Official Staff Commentary to Regulation M

Code of Federal Regulations, 2011 CFR

2011-01-01

... primary use. 2. Period of time. To be a consumer lease, the initial term of the lease must be more than... lease (unless terminable without penalty at any time by the consumer) under which the consumer: i... the lease contract, so long as all disclosures are given at the same time. Alternatively, all...

Time trends and patterns of reported egg consumption in the U.S. by sociodemographic characteristics

USDA-ARS?s Scientific Manuscript database

Objectives: To 1) describe time trends of the percentage of individuals in the U.S that consume eggs, 2) describe time trends of the daily amount of eggs consumed per day, and 3) examine differences in the amount of eggs consumed per day; overall and by gender, age, income, education, race-ethnicit...

A longitudinal model of the dynamics between HMOs' consumer-friendliness and preventive health care utilization.

PubMed

Xiao, Qian; Savage, Grant T; Zhuang, Weiling

2014-01-01

This study aims at replicating and extending Xiao and Savage's (2008) research to understand the multidimensional aspect of HMOs distinguished by HMOs' consumer-friendliness, and their relationship to consumers' preventive care utilization. This study develops a dynamic model to consider both concurrent and time lagging effects of HMOs' consumer-friendliness. Our data analysis discloses similar relationship patterns as revealed by Xiao and Savage. Additionally, our findings reveal the time-series changes of the influence of HMOs' consumer-friendliness that either the effects of early experienced HMOs' consumer-friendliness wear out totally or HMOs' consumer-friendly characteristics on the concurrent term contain most of the explanatory power.

Identification and visualisation of possible ancient ocean shoreline on Mars using submeter-resolution Digital Terrain Models

NASA Astrophysics Data System (ADS)

Świąder, Andrzej

2014-12-01

Digital Terrain Models (DTMs) produced from stereoscopic, submeter-resolution High Resolution Imaging Science Experiment (HiRISE) imagery provide a solid basis for all morphometric analyses of the surface of Mars. In view of the fact that a more effective use of DTMs is hindered by complicated and time-consuming manual handling, the automated process provided by specialists of the Ames Intelligent Robotics Group (NASA), Ames Stereo Pipeline, constitutes a good alternative. Four DTMs, covering the global dichotomy boundary between the southern highlands and northern lowlands along the line of the presumable Arabia shoreline, were produced and analysed. One of them included forms that are likely to be indicative of an oceanic basin that extended across the lowland northern hemisphere of Mars in the geological past. The high resolution DTMs obtained were used in the process of landscape visualisation.

A Strategy for Autogeneration of Space Shuttle Ground Processing Simulation Models for Project Makespan Estimations

NASA Technical Reports Server (NTRS)

Madden, Michael G.; Wyrick, Roberta; O'Neill, Dale E.

2005-01-01

Space Shuttle Processing is a complicated and highly variable project. The planning and scheduling problem, categorized as a Resource Constrained - Stochastic Project Scheduling Problem (RC-SPSP), has a great deal of variability in the Orbiter Processing Facility (OPF) process flow from one flight to the next. Simulation Modeling is a useful tool in estimation of the makespan of the overall process. However, simulation requires a model to be developed, which itself is a labor and time consuming effort. With such a dynamic process, often the model would potentially be out of synchronization with the actual process, limiting the applicability of the simulation answers in solving the actual estimation problem. Integration of TEAMS model enabling software with our existing schedule program software is the basis of our solution. This paper explains the approach used to develop an auto-generated simulation model from planning and schedule efforts and available data.

Development of a novel hexa-plex PCR method for identification and serotyping of Salmonella species.

PubMed

Li, Ruichao; Wang, Yang; Shen, Jianzhong; Wu, Congming

2014-01-01

Salmonella is one of the most important foodborne pathogens, which causes a huge economic burden worldwide. To detect Salmonella rapidly is very meaningful in preventing salmonellosis and decreasing economic losses. Currently, isolation of Salmonella is confirmed by biochemical and serobased serotyping methods, which are time consuming, labor intensive, and complicated. To solve this problem, a hexa-plex polymerase chain reaction (PCR) method was developed using comparative genomics analysis and multiplex PCR technology to detect Salmonella and Salmonella Typhimurium, Salmonella Enteritidis, Salmonella Agona, Salmonella Choleraesuis, and Salmonella Pullorum simultaneously. The accuracy of this method was tested by a collection of 142 Salmonella. Furthermore, the strategy described in this article to mine serovar-specific fragments for Salmonella could be used to find specific fragments for other Salmonella serotypes and bacteria. The combination of this strategy and multiplex PCR is promising in the rapid identification of foodborne pathogens.

Chemometric analysis of attenuated total reflectance infrared spectra of Proteus mirabilis strains with defined structures of LPS.

PubMed

Zarnowiec, Paulina; Mizera, Andrzej; Chrapek, Magdalena; Urbaniak, Mariusz; Kaca, Wieslaw

2016-07-01

Proteus spp. strains are some of the most important pathogens associated with complicated urinary tract infections and bacteremia affecting patients with immunodeficiency and long-term urinary catheterization. For epidemiological purposes, various molecular typing methods have been developed for this pathogen. However, these methods are labor intensive and time consuming. We evaluated a new method of differentiation between strains. A collection of Proteus spp. strains was analyzed by attenuated total reflectance Fourier transform infrared (ATR FT-IR) spectroscopy in the mid-infrared region. ATR FT-IR spectroscopy used in conjunction with a diamond ATR accessory directly produced the biochemical profile of the surface chemistry of bacteria. We conclude that a combination of ATR FT-IR spectroscopy and mathematical modeling provides a fast and reliable alternative for discrimination between Proteus isolates, contributing to epidemiological research. © The Author(s) 2016.

Sugar-free medicines are counterproductive.

PubMed

Sundar, S

2012-09-01

Sugar in food and drinks is responsible for the poor dental health of many children and adults. On the other hand, there is no evidence that the small amount of sugar in medicines has been responsible for any dental problems. A recent British Heart Foundation survey found that nearly one in three UK children are eating sweets, chocolate and crisps three or more times a day. Hence it is futile administering sugar-free medicine to a child consuming lot of sweets. Moreover, sugar in medicines makes them palatable and bitter medicines inevitably affect compliance with the prescribed treatment. Poor compliance leads to inadequate treatment of illness and consequently increases the risk of complications from illness. Hence sugar-free medicines promoted as a public health policy could have actually caused more harm than any meaningful net benefit. There is an urgent need for a healthy debate and a fresh look at the policy of promoting sugar-free medicines.

Computer-aided implant design for the restoration of cranial defects.

PubMed

Chen, Xiaojun; Xu, Lu; Li, Xing; Egger, Jan

2017-06-23

Patient-specific cranial implants are important and necessary in the surgery of cranial defect restoration. However, traditional methods of manual design of cranial implants are complicated and time-consuming. Our purpose is to develop a novel software named EasyCrania to design the cranial implants conveniently and efficiently. The process can be divided into five steps, which are mirroring model, clipping surface, surface fitting, the generation of the initial implant and the generation of the final implant. The main concept of our method is to use the geometry information of the mirrored model as the base to generate the final implant. The comparative studies demonstrated that the EasyCrania can improve the efficiency of cranial implant design significantly. And, the intra- and inter-rater reliability of the software were stable, which were 87.07 ± 1.6% and 87.73 ± 1.4% respectively.

Paper-based ion concentration polarization device for selective preconcentration of muc1 and lamp-2 genes

NASA Astrophysics Data System (ADS)

Son, Seok Young; Lee, Hyomin; Kim, Sung Jae

2017-12-01

Recently, novel biomolecules separation and detection methods based on ion concentration polarization (ICP) phenomena have been extensively researched due to its high amplification ratio and high-speed accumulation. Despite of these bright advances, the fabrication of conventional ICP devices still have complicated and times-consuming tasks. As an alternative platform, a paper have been recently used for the identical ICP operations. In this work, we demonstrated the selective preconcentration of a muc1 gene fragment as human breast cancer marker and a lamp-2 gene fragment as the cause of Danon disease in paper-based ICP devices. As a result, these two DNA fragments were successfully concentrated up to 60 fold at different location in a single paper-channel. The device would be a promising platform for point-of-care device due to an economic fabrication, the easy extraction of concentrated sample and an easy disposability.

16 CFR 433.3 - Exemption of sellers taking or receiving open end consumer credit contracts before November 1...

Code of Federal Regulations, 2010 CFR

2010-01-01

... make loans, from time to time, directly from the creditor or indirectly by use of a credit card, check... open end consumer credit contracts before November 1, 1977 from requirements of § 433.2(a). 433.3... CONSUMERS' CLAIMS AND DEFENSES § 433.3 Exemption of sellers taking or receiving open end consumer credit...

77 FR 38305 - Agency Information Collection Activities; Announcement of Office of Management and Budget...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-27

...; ``Real Time'' Surveys of Consumers' Knowledge, Perceptions and Reported Behavior Concerning Foodborne...' Surveys of Consumers' Knowledge, Perceptions and Reported Behavior Concerning Foodborne Illness Outbreaks... ```Real Time' Surveys of Consumers' Knowledge, Perceptions and Reported Behavior Concerning Foodborne...

A modified intraoral and extraoral approach osteotomy for the prominent mandibular angle.

PubMed

Lei, Rui; Wang, Yang; Xu, Shengquan; Hong, Fuliang; Xu, Mingyuan; Wei, Liyuan; Xu, Jinghong

2017-08-01

A prominent mandibular angle (PMA) is a relatively common condition in Asians, and surgeons typically use the intraoral approach to treat it. However, the approach can have many drawbacks due to the limited operative field and view. The procedures of osteotomy are not easily manipulated, and an exact resection is difficult. In addition, some major complications can easily occur. This article presents a modified osteotomy method for the PMA that avoids these disadvantages and makes the procedure easier to execute. Four modifications of the procedures have been made: 1. The addition of a small extraoral incision in the auriculocephalic sulcus behind the earlobe; 2. A modest reduction in both the intraoral incision length and excessive mouth traction; 3. The use of a reciprocating saw through the extraoral incision tunnel to simplify the operative procedure; and 4. Extraction of sustained-suction drains from the extraoral incision. Postoperatively, all patients were followed up and administered the validated satisfaction questionnaire and the Patient Scar Assessment Questionnaire. From June 2010 to June 2015, 46 patients with a PMA underwent surgery using this method. All patients were satisfied with the esthetic results. The majority of patients could not feel an objectionable jaw line or bony step (86.9%), visible deformity (97.8%) or bony regrowth (95.6%). All patients noted a positive psychosocial influence. All patients perceived the overall appearance of their extraoral scar to be "good" or "excellent." Forty-five (97.8%) were "not at all" self-conscious of their scar. The overall complication rate was 6.5%, and no major complication was seen. The described method for the surgical treatment of PMA is a simple and safe procedure with fewer complications. The procedure is easy to perform, consumes less time, and can help resect the PMA accurately and easily. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Application of information theory methods to food web reconstruction

USGS Publications Warehouse

Moniz, L.J.; Cooch, E.G.; Ellner, S.P.; Nichols, J.D.; Nichols, J.M.

2007-01-01

In this paper we use information theory techniques on time series of abundances to determine the topology of a food web. At the outset, the food web participants (two consumers, two resources) are known; in addition we know that each consumer prefers one of the resources over the other. However, we do not know which consumer prefers which resource, and if this preference is absolute (i.e., whether or not the consumer will consume the non-preferred resource). Although the consumers and resources are identified at the beginning of the experiment, we also provide evidence that the consumers are not resources for each other, and the resources do not consume each other. We do show that there is significant mutual information between resources; the model is seasonally forced and some shared information between resources is expected. Similarly, because the model is seasonally forced, we expect shared information between consumers as they respond to the forcing of the resources. The model that we consider does include noise, and in an effort to demonstrate that these methods may be of some use in other than model data, we show the efficacy of our methods with decreasing time series size; in this particular case we obtain reasonably clear results with a time series length of 400 points. This approaches ecological time series lengths from real systems.

The United States and AfricaLooking Toward the Next Decade: Symposium Report

DTIC Science & Technology

2016-07-01

improve urban infrastructures and to tackle the unemployment issue. One factor complicating efforts to deal with the challenges of urbanization is...resources. They are producing many underqualified graduates. As a result, unemployment , and thereby frustration, among recent secondary school and...outside investment in Africa’s resource sectors , there has been a surge in both direct and portfolio investment in the consumer and services sectors of

Clinical Inertia and Outpatient Medical Errors

DTIC Science & Technology

2005-01-01

epidemiological studies and randomized clinical trials. Recent metanalyses suggest that for approximately every 20 adults with type 2 diabetes with an A1c...microvascular complication over 5 years.6, 8, 12, 16–19 More than 12 million adults are under treatment for type 2 diabetes in the United States, and at...marketing approaches is illustrated by successful direct-to-consumer pharmaceutical advertisements that encourage treatment of conditions such as erectile

Staffing for Cyberspace Operations: Summary of Analysis

DTIC Science & Technology

2016-08-01

Planning & Requirements, Office of the Assistant Secretary of Defense for Manpower & Reserve Affairs, Office of the Under Secretary of Defense for...planning effort. Total force mix has long been an important area in defense manpower management, given that the wrong total force mix can put the...mission at risk or result in inefficiencies that consume scarce defense resources. In the cyber arena, the problem is complicated by a lack of legal

School Meal Programs: Changes to Federal Agencies' Procedures Could Reduce Risk of School Children Consuming Recalled Food. Report to Congressional Requesters. GAO-09-649

ERIC Educational Resources Information Center

US Government Accountability Office, 2009

2009-01-01

Over the past few years, several food recalls, such as for beef and peanut products, have affected schools. It is especially important that recalls affecting schools be carried out efficiently and effectively because young children have a higher risk of complications from food-borne illnesses. GAO was asked to determine how federal agencies (1)…

Usefulness of Deep Hypothermic Circulatory Arrest and Regional Cerebral Perfusion in Children

PubMed Central

Guo, Zheng; Hu, Ren-Jie; Zhu, De-Ming; Zhu, Zhong-Qun; Zhang, Hai-Bo

2013-01-01

To compare the safety and usefulness of deep hypothermic circulatory arrest (DHCA) and regional cerebral perfusion (RCP) during pediatric open heart surgery. Between January 1, 2004 and September 30, 2012, 1250 children with congenital cardiac defect underwent corrective operation with the DHCA or RCP technique in the Shanghai Children's Medical Center. Of them, 947 cases underwent the operation with the aid of DHCA (DHCA group), and 303 cases with RCP (RCP group). The mean DHCA time was 30.64±15.81 (7–63) minutes and mean RCP time was 36.18±12.86 (10–82) minutes. The mortality rate was 7.18% (68/947) and 6.60% (20/30) in two groups, respectively. The postoperative incidences of temporary and permanent neurological dysfunction were 6.23% (59/947) in the DHCA group and 2.64% (8/303) in the RCP group (p<0.01). The incidence of other complications such as low cardiac output, renal dysfunction, and lung issues are similar in both groups. RCP is a reliable technique for cerebral protection and it facilitates time-consuming corrected procedures for complex congenital cardiac defect repair procedures. PMID:24066266

Engineered Nanomaterials in Food: Implications for Food Safety and Consumer Health

PubMed Central

Martirosyan, Alina; Schneider, Yves-Jacques

2014-01-01

From the current state-of-the-art, it is clear that nanotechnology applications are expected to bring a range of benefits to the food sector aiming at providing better quality and conservation. In the meantime, a growing number of studies indicate that the exposure to certain engineered nanomaterials (ENMs) has a potential to lead to health complications and that there is a need for further investigations in order to unravel the biological outcomes of nanofood consumption. In the current review, we summarize the existing data on the (potential) use of ENMs in the food industry, information on the toxicity profiles of the commonly applied ENMs, such as metal (oxide) nanoparticles (NPs), address the potential food safety implications and health hazards connected with the consumption of nanofood. A number of health complications connected with the human exposure to ENMs are discussed, demonstrating that there is a real basis for the arisen concern not only connected with the gut health, but also with the potency to lead to systemic toxicity. The toxicological nature of hazard, exposure levels and risk to consumers from nanotechnology-derived food are on the earliest stage of investigation and this review also highlights the major gaps that need further research and regulation. PMID:24879486

Consumer confidence in the safety of food and newspaper coverage of food safety issues: a longitudinal perspective.

PubMed

de Jonge, Janneke; Van Trijp, Hans; Renes, Reint Jan; Frewer, Lynn J

2010-01-01

This study develops a longitudinal perspective on consumer confidence in the safety of food to explore if, how, and why consumer confidence changes over time. In the first study, a theory-based monitoring instrument for consumer confidence in the safety of food was developed and validated. The monitoring instrument assesses consumer confidence together with its determinants. Model and measurement invariance were validated rigorously before developments in consumer confidence in the safety of food and its determinants were investigated over time. The results from the longitudinal analysis show that across four waves of annual data collection (2003-2006), the framework was stable and that the relative importance of the determinants of confidence was, generally, constant over time. Some changes were observed regarding the mean ratings on the latent constructs. The second study explored how newspaper coverage of food safety related issues affects consumer confidence in the safety of food through subjective consumer recall of food safety incidents. The results show that the newspaper coverage on food safety issues is positively associated with consumer recall of food safety incidents, both in terms of intensity and recency of media coverage.

[Abuse of energy drinks: does it pose a risk?].

PubMed

Petit, Aymeric; Karila, Laurent; Lejoyeux, Michel

2015-03-01

Energy drinks designate "any product in the form of a drink or concentrated liquid containing a mixture of ingredients having the property to raise the level of energy and liveliness". Their introduction has raised many reluctance and reserves after numerous cardiovascular and neurological injuries among regular consumers. This article attempts to synthesize the existing literature on energy drinks. The review focuses to show that excessive energy drinks consumption cause many complications. The literature review was conducted from 2001 to 2014, using PubMed, Google Scholar, EMBASE, and PsycInfo, using the following keywords alone or combined: energy drinks, caffeine, taurine, toxicity, dependence, complications. Occasional or moderate consumption of these cans seem to present little risk to healthy adults. However, their repeated consumption in proportions that far exceed the recommendations for recommended use by the manufacturers, combined with the use of alcohol or illicit drugs consumption increases the risk of occurrence of somatic and psychiatric complications, especially among underage, and subjects with cardiovascular and neurological history. Repeated consumption of energy drinks increases the risk of somatic and psychiatric complications. Further studies must be controlled to improve our understanding of other possible negative consequences on health. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Forecasting of indirect consumables for a Job Shop

NASA Astrophysics Data System (ADS)

Shakeel, M.; Khan, S.; Khan, W. A.

2016-08-01

A job shop has an arrangement where similar machines (Direct consumables) are grouped together and use indirect consumables to produce a product. The indirect consumables include hack saw blades, emery paper, painting brush etc. The job shop is serving various orders at a particular time for the optimal operation of job shop. Forecasting is required to predict the demand of direct and indirect consumables in a job shop. Forecasting is also needed to manage lead time, optimize inventory cost and stock outs. The objective of this research is to obtain the forecast for indirect consumables. The paper shows how job shop can manage their indirect consumables more accurately by establishing a new technique of forecasting. This results in profitable use of job shop by multiple users.

Contemporary cosmetic surgery: the potential risks and relevance for practice.

PubMed

Gilmartin, Jo

2011-07-01

To examine and critique the risks of cosmetic surgery and consider implications for practice. Cosmetic surgery is a growing industry with a significant global phenomenon. Feminists have been critical of aesthetic surgery practice, offering a range of representations in regard to 'identity', 'normality', 'cultural and social pressures', 'agency' and 'self-enhancement'. Discourses around minimising risk information acknowledge deficits in not supplying patients with full risk information. The results are usually devastating and lead to serious health complications that incisively diminish well-being for patients and increase health costs. Critical review. This paper represents a critical review of risks associated with cosmetic surgery. A Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System online (Medline) and British Nursing Index (BNI) search with relevant key words were undertaken and selected exemplary articles and research describing and/or evaluating cosmetic surgery risk. Only papers in the English language from 1982-2009 were reviewed. The papers examined were mainly empirical studies; some opinion papers, policy documents, textbooks and websites were examined too. The literature revealed that several factors influence consumer risks including regulation vagaries, medicalisation processes, fear of ageing discrimination, wanting to avoid ethnic prejudice and media pressure. Government strategies in the United Kingdom (UK) have attempted to improve clinical standards; however, little attempt has been made globally to raise institutional and professional awareness of the huge impact of cultural and social pressures on consumers. Avoiding shattering complications by improving the provision of risk information for patients is a worthwhile goal. Therefore, health professionals need to consider consumer rights and autonomy more carefully, facilitate rigorous screening and develop knowledge in regard to relational autonomy and alternative interventions. © 2010 Blackwell Publishing Ltd.

A Quick Assessment of Visuospatial Abilities in Adolescents Using the Design Organization Test (DOT).

PubMed

Burggraaf, Rudolf; Frens, Maarten A; Hooge, Ignace T C; van der Geest, Jos N

2016-01-01

Tests measuring visuospatial abilities have shown that these abilities increase during adolescence. Unfortunately, the Block Design test and other such tests are complicated and time-consuming to administer, making them unsuitable for use with large groups of restless adolescents. The results of the Design Organization Test (DOT), a quick pen-and-paper test, have been shown to correlate with those of the Block Design test. A group of 198 healthy adolescents (110 male and 88 female) aged 12 to 19 years old participated in this study. A slightly modified version of the DOT has been used in which we shortened the administration time to avoid a ceiling effect in the score. Scores show a linear increase with age (on average 2.0 points per year, r = .61) independent of sex. Scores did not differ between individual setting and group setting. Thus, the DOT is a simple and effective way to assess visuospatial ability in large groups, such as in schools, and it can be easily administered year after year to follow the development of students.

Process Improvement for Interinstitutional Research Contracting

PubMed Central

Logan, Jennifer; Bjorklund, Todd; Whitfield, Jesse; Reed, Peggy; Lesher, Laurie; Sikalis, Amy; Brown, Brent; Drollinger, Sandy; Larrabee, Kristine; Thompson, Kristie; Clark, Erin; Workman, Michael; Boi, Luca

2015-01-01

Abstract Introduction Sponsored research increasingly requires multiinstitutional collaboration. However, research contracting procedures have become more complicated and time consuming. The perinatal research units of two colocated healthcare systems sought to improve their research contracting processes. Methods The Lean Process, a management practice that iteratively involves team members in root cause analyses and process improvement, was applied to the research contracting process, initially using Process Mapping and then developing Problem Solving Reports. Results Root cause analyses revealed that the longest delays were the individual contract legal negotiations. In addition, the “business entity” was the research support personnel of both healthcare systems whose “customers” were investigators attempting to conduct interinstitutional research. Development of mutually acceptable research contract templates and language, chain of custody templates, and process development and refinement formats decreased the Notice of Grant Award to Purchase Order time from a mean of 103.5 days in the year prior to Lean Process implementation to 45.8 days in the year after implementation (p = 0.004). Conclusions The Lean Process can be applied to interinstitutional research contracting with significant improvement in contract implementation. PMID:26083433

Automatic cerebrospinal fluid segmentation in non-contrast CT images using a 3D convolutional network

NASA Astrophysics Data System (ADS)

Patel, Ajay; van de Leemput, Sil C.; Prokop, Mathias; van Ginneken, Bram; Manniesing, Rashindra

2017-03-01

Segmentation of anatomical structures is fundamental in the development of computer aided diagnosis systems for cerebral pathologies. Manual annotations are laborious, time consuming and subject to human error and observer variability. Accurate quantification of cerebrospinal fluid (CSF) can be employed as a morphometric measure for diagnosis and patient outcome prediction. However, segmenting CSF in non-contrast CT images is complicated by low soft tissue contrast and image noise. In this paper we propose a state-of-the-art method using a multi-scale three-dimensional (3D) fully convolutional neural network (CNN) to automatically segment all CSF within the cranial cavity. The method is trained on a small dataset comprised of four manually annotated cerebral CT images. Quantitative evaluation of a separate test dataset of four images shows a mean Dice similarity coefficient of 0.87 +/- 0.01 and mean absolute volume difference of 4.77 +/- 2.70 %. The average prediction time was 68 seconds. Our method allows for fast and fully automated 3D segmentation of cerebral CSF in non-contrast CT, and shows promising results despite a limited amount of training data.

Improved Virtual Planning for Bimaxillary Orthognathic Surgery.

PubMed

Hatamleh, Muhanad; Turner, Catherine; Bhamrah, Gurprit; Mack, Gavin; Osher, Jonas

2016-09-01

Conventional model surgery planning for bimaxillary orthognathic surgery can be laborious, time-consuming and may contain potential errors; hence three-dimensional (3D) virtual orthognathic planning has been proven to be an efficient, reliable, and cost-effective alternative. In this report, the 3D planning is described for a patient presenting with a Class III incisor relationship on a Skeletal III base with pan facial asymmetry complicated by reverse overjet and anterior open bite. A combined scan data of direct cone beam computer tomography and indirect dental scan were used in the planning. Additionally, a new method of establishing optimum intercuspation by scanning dental casts in final occlusion and positioning it to the composite-scans model was shown. Furthermore, conventional model surgery planning was carried out following in-house protocol. Intermediate and final intermaxillary splints were produced following the conventional method and 3D printing. Three-dimensional planning showed great accuracy and treatment outcome and reduced laboratory time in comparison with the conventional method. Establishing the final dental occlusion on casts and integrating it in final 3D planning enabled us to achieve the best possible intercuspation.

Process Improvement for Interinstitutional Research Contracting.

PubMed

Varner, Michael; Logan, Jennifer; Bjorklund, Todd; Whitfield, Jesse; Reed, Peggy; Lesher, Laurie; Sikalis, Amy; Brown, Brent; Drollinger, Sandy; Larrabee, Kristine; Thompson, Kristie; Clark, Erin; Workman, Michael; Boi, Luca

2015-08-01

Sponsored research increasingly requires multiinstitutional collaboration. However, research contracting procedures have become more complicated and time consuming. The perinatal research units of two colocated healthcare systems sought to improve their research contracting processes. The Lean Process, a management practice that iteratively involves team members in root cause analyses and process improvement, was applied to the research contracting process, initially using Process Mapping and then developing Problem Solving Reports. Root cause analyses revealed that the longest delays were the individual contract legal negotiations. In addition, the "business entity" was the research support personnel of both healthcare systems whose "customers" were investigators attempting to conduct interinstitutional research. Development of mutually acceptable research contract templates and language, chain of custody templates, and process development and refinement formats decreased the Notice of Grant Award to Purchase Order time from a mean of 103.5 days in the year prior to Lean Process implementation to 45.8 days in the year after implementation (p = 0.004). The Lean Process can be applied to interinstitutional research contracting with significant improvement in contract implementation. © 2015 Wiley Periodicals, Inc.

Health Care Utilization and Cost Burden of Herpes Zoster in a Community Population

PubMed Central

Yawn, Barbara P.; Itzler, Robbin F.; Wollan, Peter C.; Pellissier, James M.; Sy, Lina S.; Saddier, Patricia

2009-01-01

OBJECTIVE: To conduct a population-based study to assess health care utilization (HCU) and costs associated with herpes zoster (HZ) and its complications, including postherpetic neuralgia (PHN) and nonpain complications, in adults aged 22 years and older. PATIENTS AND METHODS: Medical record data on HCU were abstracted for all confirmed new cases of HZ from January 1, 1996, through December 31, 2001, among residents of Olmsted County, Minnesota. Herpes zoster-related costs were estimated by applying the Medicare Payment Fee Schedule to health care encounters and mean wholesale prices to medications. All costs were adjusted to 2006 US dollars using the medical care component of the Consumer Price Index. RESULTS: The HCU and cost of the 1669 incident HZ cases varied, depending on the complications involved. From 3 weeks before to 1 year after initial diagnosis, there were a mean of 1.8 outpatient visits and 3.1 prescribed medications at a cost of $720 for cases without PHN or nonpain complications compared with 7.5 outpatient visits and 14.7 prescribed medications at a cost of $3998 when complications, PHN, or nonpain complications were present. CONCLUSION: The annual medical care cost of treating incident HZ cases in the United States, extrapolated from the results of this study in Olmsted County, is estimated at $1.1 billion. Most of the costs are for the care of immunocompetent adults with HZ, especially among those 50 years and older. PMID:19720776

What Is Direct-to-Consumer Genetic Testing?

MedlinePlus

... consumer genetic testing? What is direct-to-consumer genetic testing? Most of the time, genetic testing is ... testing. For more information about direct-to-consumer genetic testing: Centers for Disease Control and Prevention (CDC) ...

Utility of a perioperative nutritional intervention on postoperative outcomes in high-risk head & neck cancer patients.

PubMed

Rowan, Nicholas R; Johnson, Jonas T; Fratangelo, Christina E; Smith, Brenda K; Kemerer, Patricia A; Ferris, Robert L

2016-03-01

Investigate both the utility and feasibility of perioperative nutritional supplementation with an arginine-enriched immunonutrition formula to high-risk head and neck cancer surgical patients and examine its effects on acute post-operative clinical outcomes. This prospective, non-randomized, interventional cohort study compared high-risk head and neck cancer surgical patients who consumed a pre- and post-operative arginine-based nutritional supplement to those that did not. Outcome measures included post-operative complications, length of hospitalization, readmission rates and measurement of nutritional biomarkers. 195 high-risk head and neck cancer surgical patients were enrolled. 59% of the patients used the nutritional supplement, 41% did not. Of the 80 patients who did not receive the immunonutrition formula, 38 (47.5%) experienced post-operative complications of all types as compared to 29 of the 115 (25.2%) patients who did consume the product (p=0.0021). Pharyngeal leaks or fistulas were the most common post-operative complications in both groups and more common in patients who did not receive supplementation (p=0.007). Length of stay was on average 2.8 days longer in patients who did not have enhanced nutrition (p=0.02), while readmission rates between the two groups were similar (p=0.91). Measurements of nutritional biomarkers were not reported secondary to low collection rates. Enhanced perioperative nutrition may result in significant reductions of post-operative fistula formations and decreased length of stay in a high-risk head and neck cancer population, even in the setting of poor compliance. The potential quality improvement in both patient care and healthcare cost is both real and significant. Copyright © 2016 Elsevier Ltd. All rights reserved.

[An analysis of the diabetic population in a Spanish rural are: morbidity profile, use of resources, complications and metabolic control].

PubMed

Inoriza, José M; Pérez, Marc; Cols, Montse; Sánchez, Inma; Carreras, Marc; Coderch, Jordi

2013-11-01

To describe the characteristics of a diabetic population, morbidity profile, resource consumption, complications and degree of metabolic control. Cross-sectional study during 2010. Four Health Areas (91.301 people) where the integrated management organization Serveis de Salut integrated Baix Empordà completely provide healthcare assistance. 4.985 diabetic individuals, identified through clinical codes using the ICD-9-MC classification and the 3M? Clinical Risk Groups software. Morbidity profile, related complications and degree of metabolic control were obtained for the target diabetic population. We analyzed the consumption of healthcare resources, pharmaceutical and blood glucose reagent strips. All measurements obtained at individual level. 99.3% of the diabetic population were attended at least once at a primary care center (14.9% of visits). 39.5% of primary care visits and less than 10% of the other scanned resources were related to the management of diabetes. The pharmaceutical expenditure was 25.4% of the population consumption (average cost ?1.014,57). 36.5% of diabetics consumed reagents strips (average cost ?120,65). The more frequent CRG are 5424-Diabetes (27%); 6144-Diabetes and Hypertension (25,5%) and 6143-Diabetes and Other Moderate Chronic Disease (17,2%). The degree of disease control is better in patients not consumers of antidiabetic drugs or treated with oral antidiabetic agents not secretagogues. Comorbidity is decisive in the consumption of resources. Just a few part of this consumption is specifically related to the management of diabetes. Results obtained provide a whole population approach to the main existing studies in our national and regional context. Copyright © 2012 Elsevier España, S.L. All rights reserved.

A multicenter retrospective survey of poisoning after consumption of products containing synthetic chemicals in Japan.

PubMed

Kamijo, Yoshito; Takai, Michiko; Fujita, Yuji; Hirose, Yasuo; Iwasaki, Yasumasa; Ishihara, Satoshi; Yokoyama, Takashi; Yagi, Keiichi; Sakamoto, Tetsuya

2014-01-01

We conducted a multicenter retrospective survey of patients poisoned by synthetic chemicals (SCs) in Japan. Letters were sent to 467 emergency facilities requesting participation in the study, and questionnaires were mailed to facilities that agreed to participate. Patients The study participants were patients who were transported to emergency facilities between January 2006 and December 2012 after consuming SC-containing products. We surveyed 518 patients from 60 (12.8%) facilities. Most patients were male (82.0%), in their 20s or 30s (80.5%), and had inhaled SCs (87.5%) contained in herbal products (86.0%). Harmful behavior was observed at the scene of poisoning for 56 patients (10.8%), including violence to others or things in 32, traffic accidents in seven, and self-injury or suicide attempts in four. Other than physical and neuropsychiatric symptoms, some patients also had physical complications, such as rhabdomyolysis (10.0%). Of the 182 patients (35.1%) admitted to hospitals, including 29 (5.6%) who needed respirators, all of the 21 (4.1%) hospitalized for at least seven days were male, and 20 had physical complications (rhabdomyolysis, 12; liver dysfunction, 5; renal dysfunction, 11; and physical injuries, 3). Most patients (95.6%) completely recovered, although 10 (1.9%) were transferred to a psychiatric department or hospital, and three (0.6%) were handed over to the police due to combative or violent behavior. SCs such as synthetic cannabinoids, synthetic cathinones, or methoxetamine were detected in 20 product samples. Consuming products containing SCs can result in physical complications, including rhabdomyolysis, injuries, and physical or neuropsychiatric symptoms, which may require active interventions, such as respirator use or prolonged hospitalization.

Does a time constraint modify results from rating-based conjoint analysis? Case study with orange/pomegranate juice bottles.

PubMed

Reis, Felipe; Machín, Leandro; Rosenthal, Amauri; Deliza, Rosires; Ares, Gastón

2016-12-01

People do not usually process all the available information on packages for making their food choices and rely on heuristics for making their decisions, particularly when having limited time. However, in most consumer studies encourage participants to invest a lot of time for making their choices. Therefore, imposing a time-constraint in consumer studies may increase their ecological validity. In this context, the aim of the present work was to evaluate the influence of a time-constraint on consumer evaluation of pomegranate/orange juice bottles using rating-based conjoint task. A consumer study with 100 participants was carried out, in which they had to evaluate 16 pomegranate/orange fruit juice bottles, differing in bottle design, front-of-pack nutritional information, nutrition claim and processing claim, and to rate their intention to purchase. Half of the participants evaluated the bottle images without time constraint and the other half had a time-constraint of 3s for evaluating each image. Eye-movements were recorded during the evaluation. Results showed that time-constraint when evaluating intention to purchase did not largely modify the way in which consumers visually processed bottle images. Regardless of the experimental condition (with or without time constraint), they tended to evaluate the same product characteristics and to give them the same relative importance. However, a trend towards a more superficial evaluation of the bottles that skipped complex information was observed. Regarding the influence of product characteristics on consumer intention to purchase, bottle design was the variable with the largest relative importance in both conditions, overriding the influence of nutritional or processing characteristics, which stresses the importance of graphic design in shaping consumer perception. Copyright © 2016 Elsevier Ltd. All rights reserved.

Residential Customer Enrollment in Time-based Rate and Enabling Technology Programs: Smart Grid Investment Grant Consumer Behavior Study Analysis

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

Todd, Annika; Cappers, Peter; Goldman, Charles

2013-05-01

The U.S. Department of Energy’s (DOE’s) Smart Grid Investment Grant (SGIG) program is working with a subset of the 99 SGIG projects undertaking Consumer Behavior Studies (CBS), which examine the response of mass market consumers (i.e., residential and small commercial customers) to time-varying electricity prices (referred to herein as time-based rate programs) in conjunction with the deployment of advanced metering infrastructure (AMI) and associated technologies. The effort presents an opportunity to advance the electric industry’s understanding of consumer behavior.

Does anyone understand HMO advertising?

PubMed

Bisinger, J M

1986-12-01

Much HMO advertising is executed with technical proficiency, but a high level of technical skill cannot compensate for poor objectives, an inadequate analysis of the business situation, or a lack of advertising effectiveness. Industrial marketing techniques often involve person-to-person selling via a sales staff, sales reps, on-site technical assistance and informational meetings, team selling, etc. Some HMOs also employ these techniques. In general, the promotional focus in these situations is not on mass media; communication tends to be in support of personal sales activities. These personal techniques are used because of the difficulty of selling complicated products or services. Is an HMO a simple product/service? If it is not, consumer promotional tactics will probably be ineffective. If used, these promotional tactics probably will be unintelligible because "consumers" do not select HMOs; their employers do.

Argan oil prevents prothrombotic complications by lowering lipid levels and platelet aggregation, enhancing oxidative status in dyslipidemic patients from the area of Rabat (Morocco).

PubMed

Haimeur, Adil; Messaouri, Hafida; Ulmann, Lionel; Mimouni, Virginie; Masrar, Azelarab; Chraibi, Abdelmjid; Tremblin, Gérard; Meskini, Nadia

2013-07-20

It is now established that patients with hyperlipidemia have a high risk of atherosclerosis and thrombotic complications, which are two important events responsible for the onset and progression of cardiovascular disease. In the context of managing dyslipidemia by means of dietary advice based on the consumption of argan oil, we wanted to investigate the effect of virgin argan oil on plasma lipids, and for the first time, on the platelet hyperactivation and oxidative status associated with dyslipidemia. This study concerns patients recruited in the area of Rabat in Morocco. 39 dyslipidemic (79% women) patients were recruited for our study in the area of Rabat in Morocco. They were randomly assigned to the two following groups: the argan group, in which the subjects consumed 25 mL/day of argan oil at breakfast for 3 weeks, and the control group in which argan oil was replaced by butter. After a 3-week consumption period, blood total cholesterol was significantly lower in the argan oil group, as was LDL cholesterol (23.8% and 25.6% lower, respectively). However, the HDL cholesterol level had increased by 26% at the end of the intervention period compared to baseline. Interestingly, in the argan oil group thrombin-induced platelet aggregation was lower, and oxidative status was enhanced as a result of lower platelet MDA and higher GPx activity, respectively. In conclusion, our results, even if it is not representative of the Moroccan population, show that argan oil can prevent the prothrombotic complications associated with dyslipidemia, which are a major risk factor for cardiovascular disease.

Argan oil prevents prothrombotic complications by lowering lipid levels and platelet aggregation, enhancing oxidative status in dyslipidemic patients from the area of Rabat (Morocco)

PubMed Central

2013-01-01

Background It is now established that patients with hyperlipidemia have a high risk of atherosclerosis and thrombotic complications, which are two important events responsible for the onset and progression of cardiovascular disease. In the context of managing dyslipidemia by means of dietary advice based on the consumption of argan oil, we wanted to investigate the effect of virgin argan oil on plasma lipids, and for the first time, on the platelet hyperactivation and oxidative status associated with dyslipidemia. This study concerns patients recruited in the area of Rabat in Morocco. Methods 39 dyslipidemic (79% women) patients were recruited for our study in the area of Rabat in Morocco. They were randomly assigned to the two following groups: the argan group, in which the subjects consumed 25 mL/day of argan oil at breakfast for 3 weeks, and the control group in which argan oil was replaced by butter. Results After a 3-week consumption period, blood total cholesterol was significantly lower in the argan oil group, as was LDL cholesterol (23.8% and 25.6% lower, respectively). However, the HDL cholesterol level had increased by 26% at the end of the intervention period compared to baseline. Interestingly, in the argan oil group thrombin-induced platelet aggregation was lower, and oxidative status was enhanced as a result of lower platelet MDA and higher GPx activity, respectively. Conclusions In conclusion, our results, even if it is not representative of the Moroccan population, show that argan oil can prevent the prothrombotic complications associated with dyslipidemia, which are a major risk factor for cardiovascular disease. PMID:23870174

Combination of magnetic dispersive micro solid-phase extraction and supramolecular solvent-based microextraction followed by high-performance liquid chromatography for determination of trace amounts of cholesterol-lowering drugs in complicated matrices.

PubMed

Arghavani-Beydokhti, Somayeh; Rajabi, Maryam; Asghari, Alireza

2017-07-01

A novel, efficient, rapid, simple, sensitive, selective, and environmentally friendly method termed magnetic dispersive micro solid-phase extraction combined with supramolecular solvent-based microextraction (Mdμ-SPE-SSME) followed by high-performance liquid chromatography (HPLC) with UV detection is introduced for the simultaneous microextraction of cholesterol-lowering drugs in complicated matrices. In the first microextraction procedure, using layered double hydroxide (LDH)-coated Fe 3 O 4 magnetic nanoparticles, an efficient sample cleanup is simply and rapidly provided without the need for time-consuming centrifugation and elution steps. In the first step, desorption of the target analytes is easily performed through dissolution of the LDH-coated magnetic nanoparticles containing the target analytes in an acidic solution. In the next step, an emulsification microextraction method based on a supramolecular solvent is used for excellent preconcentration, ultimately resulting in an appropriate determination of the target analytes in real samples. Under the optimal experimental conditions, the Mdμ-SPE-SSME-HPLC-UV detection procedure provides good linearity in the ranges of 1.0-1500 ng mL -1 , 1.5-2000 ng mL -1 , and 2.0-2000 ng mL -1 with coefficients of determination of 0.995 or less, low limits of detection (0.3, 0.5, and 0.5 ng mL -1 ), and good extraction repeatabilities (relative standard deviations below 7.8%, n = 5) in deionized water for rosuvastatin, atorvastatin, and gemfibrozil, respectively. Finally, the proposed method is successfully applied for the determination of the target analytes in complicated matrices. Graphical Abstract Mdμ-SPE-SSME procedure.

Surgical patient selection and counseling.

PubMed

Ziegelmann, Matt; Köhler, Tobias S; Bailey, George C; Miest, Tanner; Alom, Manaf; Trost, Landon

2017-08-01

The objectives of patient selection and counseling are ultimately to enhance successful outcomes. However, the definition for success is often narrowly defined in published literature (ability to complete surgery, complications, satisfaction) and fails to account for patient desires and expectations, temporal changes, natural history of underlying diseases, or independent validation. Factors associated with satisfaction and dissatisfaction are often surgery-specific, although correlation with pre-operative expectations, revisions, and complications are common with most procedures. The process of appropriate patient selection is determined by the integration of patient and surgeon factors, including psychological capacity to handle unsatisfactory results, baseline expectations, complexity of case, and surgeon volume and experience. Using this model, a high-risk scenario includes one in which a low-volume surgeon performs a complex case in a patient with limited psychological capacity and high expectations. In contrast, a high-volume surgeon performing a routine case in a male with low expectations and abundant psychiatric reserve is more likely to achieve a successful outcome. To further help identify patients who are at high risk for dissatisfaction, a previously published mnemonic is recommended: CURSED Patient (compulsive/obsessive, unrealistic, revision, surgeon shopping, entitled, denial, and psychiatric). Appropriate patient counseling includes setting appropriate expectations, reviewing the potential and anticipated risks of surgery, post-operative instruction to limit complications, and long-term follow-up. As thorough counseling is often a time-consuming endeavor, busy practices may elect to utilize various resources including educational materials, advanced practice providers, or group visits, among others. The consequences for poor patient selection and counseling may range from poor surgical outcomes and patient dissatisfaction to lawsuits, loss of credibility, or even significant patient or personal harm.

Surgical patient selection and counseling

PubMed Central

Ziegelmann, Matt; Köhler, Tobias S.; Bailey, George C.; Miest, Tanner; Alom, Manaf

2017-01-01

The objectives of patient selection and counseling are ultimately to enhance successful outcomes. However, the definition for success is often narrowly defined in published literature (ability to complete surgery, complications, satisfaction) and fails to account for patient desires and expectations, temporal changes, natural history of underlying diseases, or independent validation. Factors associated with satisfaction and dissatisfaction are often surgery-specific, although correlation with pre-operative expectations, revisions, and complications are common with most procedures. The process of appropriate patient selection is determined by the integration of patient and surgeon factors, including psychological capacity to handle unsatisfactory results, baseline expectations, complexity of case, and surgeon volume and experience. Using this model, a high-risk scenario includes one in which a low-volume surgeon performs a complex case in a patient with limited psychological capacity and high expectations. In contrast, a high-volume surgeon performing a routine case in a male with low expectations and abundant psychiatric reserve is more likely to achieve a successful outcome. To further help identify patients who are at high risk for dissatisfaction, a previously published mnemonic is recommended: CURSED Patient (compulsive/obsessive, unrealistic, revision, surgeon shopping, entitled, denial, and psychiatric). Appropriate patient counseling includes setting appropriate expectations, reviewing the potential and anticipated risks of surgery, post-operative instruction to limit complications, and long-term follow-up. As thorough counseling is often a time-consuming endeavor, busy practices may elect to utilize various resources including educational materials, advanced practice providers, or group visits, among others. The consequences for poor patient selection and counseling may range from poor surgical outcomes and patient dissatisfaction to lawsuits, loss of credibility, or even significant patient or personal harm. PMID:28904893

Implementation and Analysis of a Lean Six Sigma Program in Microsurgery to Improve Operative Throughput in Perforator Flap Breast Reconstruction.

PubMed

Hultman, Charles Scott; Kim, Sendia; Lee, Clara N; Wu, Cindy; Dodge, Becky; Hultman, Chloe Elizabeth; Roach, S Tanner; Halvorson, Eric G

2016-06-01

Perforator flaps have become a preferred method of breast reconstruction but can consume considerable resources. We examined the impact of a Six Sigma program on microsurgical breast reconstruction at an academic medical center. Using methods developed by Motorola and General Electric, we applied critical pathway planning, workflow analysis, lean manufacturing, continuous quality improvement, and defect reduction to microsurgical breast reconstruction. Primary goals were to decrease preoperative-to-cut time and total operative time, through reduced variability and improved efficiency. Secondary goals were to reduce length of stay, complications, and reoperation. The project was divided into 3 phases: (1) Pre-Six Sigma (24 months), (2) Six Sigma (10 months), (3) and Post-Six Sigma (24 months). These periods (baseline, intervention, control) were compared by Student t test and χ analysis. Over a 5-year period, 112 patients underwent 168 perforator flaps for breast reconstructions, by experienced microsurgeons. Total operative time decreased from 714 to 607 minutes (P < 0.01), across the study period, with the greatest drop occurring in unilateral cases, from 672 to 498 minutes (P < 0.01). Length of stay decreased from 6.3 to 5.2 days (P = 0.01). Overall complication rates (35.9% vs 30%, not significant) and take-back rates (20.5% vs 23.9%, not significant) remained similar over the 5-year period. Physician revenue/minute increased from US $6.28 to US $7.59, whereas hospital revenue/minute increased from US $21.84 to US $25.11. A Six Sigma program in microsurgical breast reconstruction was associated with better operational and financial outcomes. These incremental gains were maintained over the course of the study, suggesting that these benefits were due, in part, to process improvements. However, continued reductions in total operative time and length of stay, well after the intervention period, support the possibility that "learning curve" phenomenon may have contributed to the improvement in these outcomes.

Short term outcomes of GreenLight vapor incision technique (VIT) of the prostate: comparison of outcomes to standard GreenLight 120W HPS vaporization in prostate volumes greater than 80 cc.

PubMed

Ben-Zvi, Tal; Hueber, Pierre-Alain; Abdollah, Firas; Liberman, Daniel; Bhojani, Naeem; Gautam, Gagan; Zorn, Kevin C

2013-02-01

To evaluate a hybrid technique involving GreenLight 120W HPS vapor incision tissue removal in prostate glands > 80 cc. Vapor incision technique (VIT) was performed in 25 consecutive men with a prostate > 80 cc by a single surgeon from May 2010 until September 2010. VIT involved adenoma incisions at 5 and 7-o'clock positions followed by 3, 9 and 12 o'clock down to the surgical capsule. Side-fire vaporization along the capsule excised transurethral resection of the prostate (TURP) like tissue strips for later retrieval. Functional evaluations were performed at 1 and 3 months. Outcomes and complications were compared retrospectively to baseline and a size matched- cohort of 25 men who previously underwent standard vaporization-only photoselective vaporization prostatectomy (PVP). The VIT and control subgroups were comparable. Mean laser time, operative time and energy usage were reduced in the VIT group compared to controls (35 min versus 48 min; 63 min versus 80 min; and 227 k versus 325 kJ respectively; all p < 0.05). At 3 months the VIT subgroup demonstrated improved Qmax and post void residual (PVR) (197% versus 173%, 88% versus 72%; all p < 0.05) compared to control. VIT showed a 68% reduction in mean preoperative PSA at 3 months compared to 50% for the control group (p<0.01). Hospital stay, catheterization time and complication rates were comparable. Our data demonstrates that VIT provides superior short term outcomes to standard HPS-PVP in men with prostate volumes > 80 cc. VIT appears to be more time-efficient, consumes less energy and obtains tissue for pathological evaluation. Further follow up is required to assess the durability of GreenLight HPS-VIT to PVP vaporization-only for large prostate glands.

Exposure of man to mercury: a review. II. Contamination of food and analytical methods

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

Hugunin, A.G.; Bradley, R.L. Jr.

Man is exposed to mercury through every facet of his life, however, for the average citizen the most probable source of toxic levels of mercury would be his food supply. Although most foods contain less than 0.02 ppm mercury, considerable variation occurs depending on the type of food, production techniques, and location. Mercury is concentrated at higher trophic levels of food chains, particularily in aquatic food chains in which concentration factor of hundreds and thousands have been observed. The concentration of mercury in some large fish has been found to exceed the 0.5 ppm tolerance limit of the FDA andmore » the 1.0 ppm limit of the Swedish government. Fifty-seven grams of fish containing 0.5 ppm mercury in the methyl form could be consumed daily without exceeding the joint FAO/WHO recommended weekly tolerable intake of 0.2 mg. In the US, Sweden, and Japan the per capita daily fish consumptions are 18, 56, and 88 g, respectively. Determination of mercury concentrations generally involves colorimetric, atomic absorption or emission spectrometry, neutron activation, or gas chromatography techniques. The sample preparations are often time consuming, subject to numerous sources of error, and complicated by the low concentrations of mercury. Differentiation of mercury compounds usually necessitates selective extraction followed by gas chromatographic analysis. 256 references, 5 tables.« less

Anticipatory Consumer Socialization.

ERIC Educational Resources Information Center

Moore, Roy L.; Moschis, George P.

Anticipatory consumer socialization is the learning of consumer roles and perceptions, which will be assumed at a later time, such as those that children acquire before they become adult consumers. A survey of 784 adolescents was conducted in a southern state to examine the anticipatory consumer socialization effects of such factors as the mass…

An investigation of used electronics return flows: a data-driven approach to capture and predict consumers storage and utilization behavior.

PubMed

Sabbaghi, Mostafa; Esmaeilian, Behzad; Raihanian Mashhadi, Ardeshir; Behdad, Sara; Cade, Willie

2015-02-01

Consumers often have a tendency to store their used, old or un-functional electronics for a period of time before they discard them and return them back to the waste stream. This behavior increases the obsolescence rate of used still-functional products leading to lower profitability that could be resulted out of End-of-Use (EOU) treatments such as reuse, upgrade, and refurbishment. These types of behaviors are influenced by several product and consumer-related factors such as consumers' traits and lifestyles, technology evolution, product design features, product market value, and pro-environmental stimuli. Better understanding of different groups of consumers, their utilization and storage behavior and the connection of these behaviors with product design features helps Original Equipment Manufacturers (OEMs) and recycling and recovery industry to better overcome the challenges resulting from the undesirable storage of used products. This paper aims at providing insightful statistical analysis of Electronic Waste (e-waste) dynamic nature by studying the effects of design characteristics, brand and consumer type on the electronics usage time and end of use time-in-storage. A database consisting of 10,063 Hard Disk Drives (HDD) of used personal computers returned back to a remanufacturing facility located in Chicago, IL, USA during 2011-2013 has been selected as the base for this study. The results show that commercial consumers have stored computers more than household consumers regardless of brand and capacity factors. Moreover, a heterogeneous storage behavior is observed for different brands of HDDs regardless of capacity and consumer type factors. Finally, the storage behavior trends are projected for short-time forecasting and the storage times are precisely predicted by applying machine learning methods. Copyright © 2014 Elsevier Ltd. All rights reserved.

Identifying and integrating consumer perspectives in clinical practice guidelines on autosomal-dominant polycystic kidney disease.

PubMed

Tong, Allison; Tunnicliffe, David J; Lopez-Vargas, Pamela; Mallett, Andrew; Patel, Chirag; Savige, Judy; Campbell, Katrina; Patel, Manish; Tchan, Michel C; Alexander, Stephen I; Lee, Vincent; Craig, Jonathan C; Fassett, Robert; Rangan, Gopala K

2016-02-01

This study aimed to identify consumer perspectives on topics and outcomes to integrate in the Kidney Health Australia Caring for Australasians with Renal Impairment (KHA-CARI) clinical practice guidelines on autosomal-dominant polycystic kidney disease (ADPKD). A workshop involving three concurrent focus groups with 18 consumers (patients with ADPKD (n = 15), caregivers (n = 3)) was convened. Guideline topics, interventions and outcomes were identified, and integrated into guideline development. Thematic analysis was used to analyse the reasons for their choices. Twenty-two priority topics were identified, with most focussed on non-pharmacological management (diet, fluid intake, physical activity, complementary medicine), pain management and psychosocial care (mental health, counselling, cognitive and behavioural training, education, support groups). They also identified 26 outcomes including quality of life (QoL), progression of kidney disease, kidney function, cyst growth and nephrotoxity. Almost all topics and outcomes suggested were identified by health professionals with the exception of five topics/outcomes. Six themes reflected reasons for their choices: clarifying ambiguities, resolving debilitating pain, concern for family, preparedness for the future, taking control and significance of impact. Although there was considerable concordance between the priority topics and outcomes of health professionals and consumers for guidelines of ADPKD, there was also important discordance with consumers focused on fewer issues, but particularly on lifestyle, psychosocial support, pain, and QoL and renal outcomes. Active consumer engagement in guidelines development can help to ensure the inclusion of patient-centred recommendations, which may lead to better management of disease progression, symptoms, complications, and psychosocial impact. © 2015 Asian Pacific Society of Nephrology.

Traditional and online consumers in China: a preliminary study of their personality traits and decision-making styles.

PubMed

Zhu, Junpeng; Xu, You; Huang, Jingyi; Yeow, Changdar; Wang, Wei

2012-12-01

Population of online consumers increases rapidly, but the decision-making styles of online consumers and psychiatric denominators such as the personality correlates remain unclear. In 196 traditional, and 196 age-, education- and gender-matched online consumers, we have tested the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ) and the Consumer Style Inventory (CSI). After exploratory and confirmatory factor analyses, we have defined a five-factor model CSI with 24 items. Online consumers scored lower on ZKPQ Neuroticism-Anxiety and higher on Aggression-Hostility than traditional ones did, and scored higher on CSI Novelty-fashion consciousness and Brand consciousness, and lower on Time consciousness than the traditional consumers did. ZKPQ Neuroticism-Anxiety was positively correlated with CSI Confused by overchoice in both groups, Sociability was positively correlated with Novelty-fashion consciousness and negatively with Time consciousness in traditional group, and Impulsive Sensation Seeking was positively correlated with Novelty-fashion consciousness and Time consciousness in online group. Our study suggests that, regarding the decision-making styles, online consumers display curiosity that lacks security and need other ways to improve their social lives. It also calls further designs to address the contributions of other psychiatric features to the particular decision-making styles in online consumers.

Severe bradycardia and prolonged hypotension in ciguatera.

PubMed

Chan, Thomas Yan Keung

2013-06-01

Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed.

Peritoneal metastases of colorectal origin - cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). The financial aspect.

PubMed

Jastrzębski, Tomasz; Bębenek, Marek

2017-12-30

The incidence of peritoneal carcinomatosis of colorectal cancer amounts to 5%-15% for synchronous metastases and as much as 40% in cases of local recurrence. Best results are obtained for cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment offers much better outcomes, leading to 5-year survival rates of as much as 30%-50%. The procedures require significant experience in abdominal surgery, are time-consuming (mean duration of the procedure ranging from 6 to 8 hours) and are burdened by complications that are due not only to the procedure itself but also to the intraperitoneal administration of the cytostatic drug at elevated temperature (41.5 °C). After the procedure, patients are required to be admitted to intensive care units due to potential complications associated with the extent and duration of the procedure as well as chemotherapy administered in hyperthermia. Postoperative management of these patients requires appropriate experience of the entire medical and nursing team. Cytoreductive surgeries combined with HIPEC as highly specialized medical procedures should be assessed for their potential long-term benefits and their costs should be appropriately calculated with consideration to realistic reimbursement rates. Realistic valuation and reimbursement covering the overall average cost of the procedure is recommended by the National Consultant in Surgical Oncology as well as the ESMO consensus guidelines.

The impact of services that offer individualised funds, shared management, person-centred relationships, and self-direction on the lived experiences of consumers with mental illness.

PubMed

Peterson, Sunila; Buchanan, Angus; Falkmer, Torbjorn

2014-01-01

Mental health service providers across Australia, including Western Australia (WA), have begun to offer individualised funds, shared management, person-centred and self-directed (SPS) services. No research exists on the impact of SPS services on the lived experiences of these particular consumers. This study explored the impact of a SPS service offered for the first time in WA to consumers with mental illness. Data on sixteen consumers' lived experiences were analysed using an abbreviated grounded theory approach. These data had been developed by the consumers, Guides (staff) and an independent evaluator, and most of it had been collected in the past prior to the commencement of the study. Three over-arching categories, and related subcategories, emerged indicating that 1) access to individualised funds enabled practical and psychological benefits to consumers; 2) consistent contact in shared management and person-centred relationships enhanced the provision of timely and meaningful staff support to consumers; and 3) high quality shared management and person-centred relationships with staff and the opportunity to self-direct enabled consumers' change and growth. SPS services enhanced consumers' lived experiences and enabled staff to provide and consumers to experience timely access to recovery resources, consistent contact, responsive and high quality support, and self-direction of services. In this, consumers changed, grew and achieved desired recovery experiences. The overall impact of the SPS service seemed to be founded on the goodness of fit between person characteristics of staff and consumers, which enabled rich support that provided for corrective emotional experiences. This enabled consumers to build meaningful and hopeful lives where they started to live with, and beyond, their mental illness.

Factors affecting dry-cured ham consumer acceptability.

PubMed

Morales, R; Guerrero, L; Aguiar, A P S; Guàrdia, M D; Gou, P

2013-11-01

The objectives of the present study were (1) to compare the relative importance of price, processing time, texture and intramuscular fat in purchase intention of dry-cured ham through conjoint analysis, (2) to evaluate the effect of dry-cured ham appearance on consumer expectations, and (3) to describe the consumer sensory preferences of dry-cured ham using external preference mapping. Texture and processing time influenced the consumer preferences in conjoint analysis. Red colour intensity, colour uniformity, external fat and white film presence/absence influenced consumer expectations. The consumer disliked hams with bitter and metallic flavour and with excessive saltiness and piquantness. Differences between expected and experienced acceptability were found, which indicates that the visual preference of consumers does not allow them to select a dry-cured ham that satisfies their sensory preferences of flavour and texture. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Effects of Consumer Education on Consumer Search.

ERIC Educational Resources Information Center

Fast, Janet; And Others

1989-01-01

A study investigated the relationship between selected consumer and marketplace characteristics and consumers' prepurchase allocation of search time among information sources (product test reports; dealer sales representatives; advertisements; family and friends). The household production model proved useful; written educational materials appeared…

Influence of early neurological complications on clinical outcome following lung transplant.

PubMed

Gamez, Josep; Salvado, Maria; Martinez-de La Ossa, Alejandro; Deu, Maria; Romero, Laura; Roman, Antonio; Sacanell, Judith; Laborda, Cesar; Rochera, Isabel; Nadal, Miriam; Carmona, Francesc; Santamarina, Estevo; Raguer, Nuria; Canela, Merce; Solé, Joan

2017-01-01

Neurological complications after lung transplantation are common. The full spectrum of neurological complications and their impact on clinical outcomes has not been extensively studied. We investigated the neurological incidence of complications, categorized according to whether they affected the central, peripheral or autonomic nervous systems, in a series of 109 patients undergoing lung transplantation at our center between January 1 2013 and December 31 2014. Fifty-one patients (46.8%) presented at least one neurological complication. Critical illness polyneuropathy-myopathy (31 cases) and phrenic nerve injury (26 cases) were the two most prevalent complications. These two neuromuscular complications lengthened hospital stays by a median period of 35.5 and 32.5 days respectively. However, neurological complications did not affect patients' survival. The real incidence of neurological complications among lung transplant recipients is probably underestimated. They usually appear in the first two months after surgery. Despite not affecting mortality, they do affect the mean length of hospital stay, and especially the time spent in the Intensive Care Unit. We found no risk factor for neurological complications except for long operating times, ischemic time and need for transfusion. It is necessary to develop programs for the prevention and early recognition of these complications, and the prevention of their precipitant and risk factors.

Influence of early neurological complications on clinical outcome following lung transplant

PubMed Central

Salvado, Maria; Martinez-de La Ossa, Alejandro; Deu, Maria; Romero, Laura; Roman, Antonio; Sacanell, Judith; Laborda, Cesar; Rochera, Isabel; Nadal, Miriam; Carmona, Francesc; Santamarina, Estevo; Raguer, Nuria; Canela, Merce; Solé, Joan

2017-01-01

Background Neurological complications after lung transplantation are common. The full spectrum of neurological complications and their impact on clinical outcomes has not been extensively studied. Methods We investigated the neurological incidence of complications, categorized according to whether they affected the central, peripheral or autonomic nervous systems, in a series of 109 patients undergoing lung transplantation at our center between January 1 2013 and December 31 2014. Results Fifty-one patients (46.8%) presented at least one neurological complication. Critical illness polyneuropathy-myopathy (31 cases) and phrenic nerve injury (26 cases) were the two most prevalent complications. These two neuromuscular complications lengthened hospital stays by a median period of 35.5 and 32.5 days respectively. However, neurological complications did not affect patients’ survival. Conclusions The real incidence of neurological complications among lung transplant recipients is probably underestimated. They usually appear in the first two months after surgery. Despite not affecting mortality, they do affect the mean length of hospital stay, and especially the time spent in the Intensive Care Unit. We found no risk factor for neurological complications except for long operating times, ischemic time and need for transfusion. It is necessary to develop programs for the prevention and early recognition of these complications, and the prevention of their precipitant and risk factors. PMID:28301586

Exploring the complexity of inquiry learning in an open-ended problem space

NASA Astrophysics Data System (ADS)

Clarke, Jody

Data-gathering and problem identification are key components of scientific inquiry. However, few researchers have studied how students learn these skills because historically this required a time-consuming, complicated method of capturing the details of learners' data-gathering processes. Nor are classroom settings authentic contexts in which students could exhibit problem identification skills parallel to those involved in deconstructing complex real world situations. In this study of middle school students, because of my access to an innovative technology, I simulated a disease outbreak in a virtual community as a complicated, authentic problem. As students worked through the curriculum in the virtual world, their time-stamped actions were stored by the computer in event-logs. Using these records, I tracked in detail how the student scientists made sense of the complexity they faced and how they identified and investigated the problem using science-inquiry skills. To describe the degree to which students' data collection narrowed and focused on a specific disease over time, I developed a rubric and automated the coding of records in the event-logs. I measured the ongoing development of the students' "systematicity" in investigating the disease outbreak. I demonstrated that coding event-logs is an effective yet non-intrusive way of collecting and parsing detailed information about students' behaviors in real time in an authentic setting. My principal research question was "Do students who are more thoughtful about their inquiry prior to entry into the curriculum demonstrate increased systematicity in their inquiry behavior during the experience, by narrowing the focus of their data-gathering more rapidly than students who enter with lower levels of thoughtfulness about inquiry?" My sample consisted of 403 middle-school students from public schools in the US who volunteered to participate in the River City Project in spring 2008. Contrary to my hypothesis, I found that prior thoughtfulness of inquiry was not a predictor of the subsequent development of systematicity. However, all students did indeed become more systematic in their scientific behavior over time. On average, boys were generally more systematic than girls, but the rates at which systematicity increased with time was identical across the genders.

Socio-economic differences in takeaway food consumption among adults.

PubMed

Miura, Kyoko; Giskes, Katrina; Turrell, Gavin

2012-02-01

To examine socio-economic differences in the frequency and types of takeaway foods consumed. A cross-sectional postal survey. Participants were asked about their usual consumption of overall takeaway food (<4 times/month or ≥4 times/month) and of twenty-two specific takeaway food items (<1 time/month or ≥1 time/month); these latter foods were grouped into 'healthy' and 'less healthy' choices. Socio-economic position was measured on the basis of educational level and equivalised household income, and differences in takeaway food consumption were assessed by calculating prevalence ratios using log binomial regression. Adults aged 25-64 years from Brisbane, Australia, were randomly selected from the electoral roll (n 903; 63·7 % response rate). Compared with their more educated counterparts, the least educated were more regular consumers of overall takeaway food and fruit or vegetable juice and less regular consumers of sushi. For the 'less healthy' items, the least educated more regularly consumed potato chips, savoury pies, fried chicken and non-diet soft drinks; however, the least educated were less likely to consume curry. Household income was not associated with overall takeaway consumption. The lowest-income group was a more regular consumer of fruit or vegetable juice compared with the highest-income group. Among the 'less healthy' items, the lowest-income group was a more regular consumer of fried fish, ice cream and milk shakes, whereas curry was consumed less regularly. The frequency and types of takeaway foods consumed by socio-economically disadvantaged groups may contribute to inequalities in overweight or obesity and to chronic disease.

12 CFR 227.22 - Unfair acts or practices regarding time to make payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... THE FEDERAL RESERVE SYSTEM UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Consumer Credit Card.... Except as provided in paragraph (c) of this section, a bank must not treat a payment on a consumer credit card account as late for any purpose unless the consumer has been provided a reasonable amount of time...

75 FR 36639 - Change in Times for Meeting of Chronic Hazard Advisory Panel on Phthalates and Phthalate...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-28

... children's toys and child care articles, pursuant to section 108 of the Consumer Product Safety Improvement..., pursuant to section 108 of the Consumer Product Safety Improvement Act of 2008 (CPSIA) (Pub. L. 110-314... CONSUMER PRODUCT SAFETY COMMISSION Change in Times for Meeting of Chronic Hazard Advisory Panel on...

A comparison of septal stapler to suture closure in septoplasty: a prospective, randomized trial evaluating the effect on operative time.

PubMed

Sowerby, Leigh J; Wright, Erin D

2013-11-01

Septoplasty requires coaptation of the mucosal flaps at the conclusion of the procedure; classically this is done with nasal packing. Quilting sutures provide a welcome alternative to packing, but can be time-consuming to place. A septal stapler has recently been developed that provides a rapid alternative to quilting sutures but the timesaving has not been quantified. This study was a prospective, randomized trial comparing a septal stapler to quilting suture for coaptation of mucosal flaps in septoplasty. After meeting inclusion criteria, patients underwent septoplasty and inferior turbinoplasty. The total operative time, surgical segment times, including time for closure was recorded. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores were recorded. A sample size of 16 was determined to detect a difference of 5 minutes in closure time. A total of 16 patients were enrolled in the study. The mean time for closure with septal stapler was 35 ± 22 seconds vs 7 minutes ± 1 minute 10 seconds for suture closure (p < 0.0001). The mean total operative time using the septal stapler was 28 minutes ± 6 minutes whereas 43 minutes ± 13 minutes was required for suture (p = 0.014). No difference in postoperative complications or mucosal healing was seen; preoperative and postoperative improvement in NOSE scores was comparable. Coaptation of the mucosal flaps in septoplasty with a septal stapler affords a timesaving in the operating room with no difference in operative outcome. © 2013 ARS-AAOA, LLC.

Is It Safe to Provide Abortion Pills over the Counter? A Study on Outcome Following Self-Medication with Abortion Pills.

PubMed

Nivedita, K; Shanthini, Fatima

2015-01-01

Medical abortion is a safe method of termination of pregnancy when performed as per guidelines with a success rate of 92-97 %. But self-administration of abortion pills is rampant throughout the country due to over the counter availability of these drugs and complications are not uncommon due to this practice. The society perceives unsupervised medical abortion as a very safe method of termination and women use this as a method of spacing. The aim of this study was to study the implications of self-administration of abortion pills by pregnant women. Retrospective observational study done in Sri Manakula Vinayagar Medical College & Hospital between the period of July 2013 to June2014. Case sheets were analysed to obtain data regarding self-administration of abortion pills and complications secondary to its administration. The following data were collected. Age, marital status, parity, duration of pregnancy as perceived by the women, confirmation of pregnancy, duration between pill intake and visit to hospital, whether any intervention done elsewhere, any known medical or surgical complications, Hb level on admission, whether patient was in shock, USG findings, evidence of sepsis, blood transfusion, treatment given and duration of hospital stay. Descriptive analysis of the collected data was done. Among the 128 cases of abortion in the study period, 40 (31.25%) patients had self-administered abortion pills. Among these 40 patients 27.5% had consumed abortion pills after the approved time period of 63 days of which 17.5% had consumed pills after 12 weeks of gestation. The most common presentation was excessive bleeding (77.5%) Severe anaemia was found in 12.5% of the patients and 5% of patients presented with shock. The outcome was as follows : 62.5% of the patients were found to have incomplete abortion, 22.5% had failed abortion and 7.5% of patients had incomplete abortion with sepsis. Surgical evacuation was performed in 67.5% of the patients whereas 12.5% of the patients required surgical evacuation with blood transfusion. Medical methods were used in 15% of the patients whereas 2.5% required transfusion along with medical methods. Unsupervised medical abortion can lead to increased maternal morbidity and mortality. To curtail this harmful practice, strict legislations are required to monitor and also to restrict the sales of abortion pills over the counter and access to abortion pills for the public should be only through centers approved for MTP. Large scale prospective studies are required to assess the actual magnitude of this problem.

An investigation of used electronics return flows: A data-driven approach to capture and predict consumers storage and utilization behavior

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

Sabbaghi, Mostafa, E-mail: mostafas@buffalo.edu; Esmaeilian, Behzad, E-mail: b.esmaeilian@neu.edu; Raihanian Mashhadi, Ardeshir, E-mail: ardeshir@buffalo.edu

Highlights: • We analyzed a data set of HDDs returned back to an e-waste collection site. • We studied factors that affect the storage behavior. • Consumer type, brand and size are among factors which affect the storage behavior. • Commercial consumers have stored computers more than household consumers. • Machine learning models were used to predict the storage behavior. - Abstract: Consumers often have a tendency to store their used, old or un-functional electronics for a period of time before they discard them and return them back to the waste stream. This behavior increases the obsolescence rate of usedmore » still-functional products leading to lower profitability that could be resulted out of End-of-Use (EOU) treatments such as reuse, upgrade, and refurbishment. These types of behaviors are influenced by several product and consumer-related factors such as consumers’ traits and lifestyles, technology evolution, product design features, product market value, and pro-environmental stimuli. Better understanding of different groups of consumers, their utilization and storage behavior and the connection of these behaviors with product design features helps Original Equipment Manufacturers (OEMs) and recycling and recovery industry to better overcome the challenges resulting from the undesirable storage of used products. This paper aims at providing insightful statistical analysis of Electronic Waste (e-waste) dynamic nature by studying the effects of design characteristics, brand and consumer type on the electronics usage time and end of use time-in-storage. A database consisting of 10,063 Hard Disk Drives (HDD) of used personal computers returned back to a remanufacturing facility located in Chicago, IL, USA during 2011–2013 has been selected as the base for this study. The results show that commercial consumers have stored computers more than household consumers regardless of brand and capacity factors. Moreover, a heterogeneous storage behavior is observed for different brands of HDDs regardless of capacity and consumer type factors. Finally, the storage behavior trends are projected for short-time forecasting and the storage times are precisely predicted by applying machine learning methods.« less

The Field Artillery Battalion on the Nuclear Battlefield

DTIC Science & Technology

1975-06-06

flexibility of radio communications. The drawback to tactical wire communications is that the estao- lishment and maintenance of the system is time consuming ...Adjusted fires are a much simpler, though time consum - ing mission. Whatever the inaccuracies in target location, 16 . ■■■ ■’■"’ rgfimtm...SCP). The current practice of a separate SCP for the 8", SP battalion is both time consuming and illogical. Service support The application of the

What can happen after lung transplantation and the importance of the time since transplantation: radiological review of post-transplantation complications.

PubMed

Daimiel Naranjo, I; Alonso Charterina, S

2016-01-01

Lung transplantation is the best treatment option in the final stages of diseases such as cystic fibrosis, pulmonary hypertension, chronic obstructive pulmonary disease, or idiopathic pulmonary fibrosis. Better surgical techniques and advances in immunosuppressor treatments have increased survival in lung transplant recipients, making longer follow-up necessary because complications can occur at any time after transplantation. For practical purposes, complications can be classified as early (those that normally occur within two months after transplantation), late (those that normally occur more than two months after transplantation), or time-independent (those that can occur at any time after transplantation). Many complications have nonspecific clinical and radiological manifestations, so the time factor is key to narrow the differential diagnosis. Imaging can guide interventional procedures and can detect complications early. This article aims to describe and illustrate the complications that can occur after lung transplantation from the clinical and radiological viewpoints so that they can be detected as early as possible. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Rapidly differentiating grape seeds from different sources based on characteristic fingerprints using direct analysis in real time coupled with time-of-flight mass spectrometry combined with chemometrics.

PubMed

Song, Yuqiao; Liao, Jie; Dong, Junxing; Chen, Li

2015-09-01

The seeds of grapevine (Vitis vinifera) are a byproduct of wine production. To examine the potential value of grape seeds, grape seeds from seven sources were subjected to fingerprinting using direct analysis in real time coupled with time-of-flight mass spectrometry combined with chemometrics. Firstly, we listed all reported components (56 components) from grape seeds and calculated the precise m/z values of the deprotonated ions [M-H](-) . Secondly, the experimental conditions were systematically optimized based on the peak areas of total ion chromatograms of the samples. Thirdly, the seven grape seed samples were examined using the optimized method. Information about 20 grape seed components was utilized to represent characteristic fingerprints. Finally, hierarchical clustering analysis and principal component analysis were performed to analyze the data. Grape seeds from seven different sources were classified into two clusters; hierarchical clustering analysis and principal component analysis yielded similar results. The results of this study lay the foundation for appropriate utilization and exploitation of grape seed samples. Due to the absence of complicated sample preparation methods and chromatographic separation, the method developed in this study represents one of the simplest and least time-consuming methods for grape seed fingerprinting. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

DNA barcoding unveils skate (Chondrichthyes: Rajidae) species diversity in ‘ray’ products sold across Ireland and the UK

PubMed Central

Egan, Aaron; Fox, Jennifer; Greenfield, Adam; Mariani, Stefano

2013-01-01

Skates are widely consumed across the globe, but many large species are subject to considerable concern regarding their conservation and management. Within Europe such issues have recently driven policy changes so that, for the first time, reports of skate landings now have to be made under species-specific names. Total allowable catches have also been established for many groups, which have been set to zero for a number of the most vulnerable species (e.g., Dipturus batis, Raja undulata and Rostoraja alba). Whilst accurate species identification has become an important issue for landings, the sale of skates is still usually made under a blanket term of “skate” or “ray”. The matter of identifying species of skate is further complicated by their morphologically conservative nature and the fact that they are commercially valued for their wings. Thus, before sale their bodies are usually discarded (i.e., “winged”) and often skinned, making morphological identification impossible. For the first time, DNA barcoding (of the mitochondrial COI gene) was applied to samples of skate wings from retail outlets across the British Isles, providing insight into which species are sold for consumption. A total of 98 wing samples were analysed, revealing that six species were sold; blonde ray (Raja brachyura), spotted ray (Raja montagui), thornback ray (Raja clavata), cuckoo ray (Leucoraja naevus) small-eyed ray (Raja microocellata) and shagreen ray (Leucoraja fullonica). Statistical testing demonstrated that there were significant differences in the species sold in the distinct retail groups which suggests complex drivers behind the patterns of sale in skates. The results also indicate that endangered species are not commonly being passed on to consumers. In addition, the practice of selling skate wings under ambiguous labels is highlighted as it makes it extremely difficult for consumers to exercise a right to avoid species of conservation concern. Interestingly, a single retailer chain labelled their wings as originating from three smaller-growing species (generally to be considered of lower conservation concern); of the six samples analysed from this company a third were mislabelled and originated from the thornback ray (a larger species that is currently undergoing population declines). PMID:24024082

DNA barcoding unveils skate (Chondrichthyes: Rajidae) species diversity in 'ray' products sold across Ireland and the UK.

PubMed

Griffiths, Andrew Mark; Miller, Dana D; Egan, Aaron; Fox, Jennifer; Greenfield, Adam; Mariani, Stefano

2013-01-01

Skates are widely consumed across the globe, but many large species are subject to considerable concern regarding their conservation and management. Within Europe such issues have recently driven policy changes so that, for the first time, reports of skate landings now have to be made under species-specific names. Total allowable catches have also been established for many groups, which have been set to zero for a number of the most vulnerable species (e.g., Dipturus batis, Raja undulata and Rostoraja alba). Whilst accurate species identification has become an important issue for landings, the sale of skates is still usually made under a blanket term of "skate" or "ray". The matter of identifying species of skate is further complicated by their morphologically conservative nature and the fact that they are commercially valued for their wings. Thus, before sale their bodies are usually discarded (i.e., "winged") and often skinned, making morphological identification impossible. For the first time, DNA barcoding (of the mitochondrial COI gene) was applied to samples of skate wings from retail outlets across the British Isles, providing insight into which species are sold for consumption. A total of 98 wing samples were analysed, revealing that six species were sold; blonde ray (Raja brachyura), spotted ray (Raja montagui), thornback ray (Raja clavata), cuckoo ray (Leucoraja naevus) small-eyed ray (Raja microocellata) and shagreen ray (Leucoraja fullonica). Statistical testing demonstrated that there were significant differences in the species sold in the distinct retail groups which suggests complex drivers behind the patterns of sale in skates. The results also indicate that endangered species are not commonly being passed on to consumers. In addition, the practice of selling skate wings under ambiguous labels is highlighted as it makes it extremely difficult for consumers to exercise a right to avoid species of conservation concern. Interestingly, a single retailer chain labelled their wings as originating from three smaller-growing species (generally to be considered of lower conservation concern); of the six samples analysed from this company a third were mislabelled and originated from the thornback ray (a larger species that is currently undergoing population declines).

Evaluating the value of a web-based natural medicine clinical decision tool at an academic medical center

PubMed Central

2011-01-01

Background Consumer use of herbal and natural products (H/NP) is increasing, yet physicians are often unprepared to provide guidance due to lack of educational training. This knowledge deficit may place consumers at risk of clinical complications. We wished to evaluate the impact that a natural medicine clinical decision tool has on faculty attitudes, practice experiences, and needs with respect to H/NP. Methods All physicians and clinical staff (nurse practitioners, physicians assistants) (n = 532) in departments of Pediatrics, Family and Community Medicine, and Internal Medicine at our medical center were invited to complete 2 electronic surveys. The first survey was completed immediately before access to a H/NP clinical-decision tool was obtained; the second survey was completed the following year. Results Responses were obtained from 89 of 532 practitioners (16.7%) on the first survey and 87 of 535 (16.3%) clinicians on the second survey. Attitudes towards H/NP varied with gender, age, time in practice, and training. At baseline, before having an evidence-based resource available, nearly half the respondents indicated that they rarely or never ask about H/NP when taking a patient medication history. The majority of these respondents (81%) indicated that they would like to learn more about H/NP, but 72% admitted difficulty finding evidence-based information. After implementing the H/NP tool, 63% of database-user respondents indicated that they now ask patients about H/NP when taking a drug history. Compared to results from the baseline survey, respondents who used the database indicated that the tool significantly increased their ability to find reliable H/NP information (P < 0.0001), boosted their knowledge of H/NP (p < 0.0001), and increased their confidence in providing accurate H/NP answers to patients and colleagues (P < 0.0001). Conclusions Our results demonstrate healthcare provider knowledge and confidence with H/NP can be improved without costly and time-consuming formal H/NP curricula. Yet, it will be challenging to make providers aware of such resources. PMID:22011398

Model-based setup assistant for progressive tools

NASA Astrophysics Data System (ADS)

Springer, Robert; Gräler, Manuel; Homberg, Werner; Henke, Christian; Trächtler, Ansgar

2018-05-01

In the field of production systems, globalization and technological progress lead to increasing requirements regarding part quality, delivery time and costs. Hence, today's production is challenged much more than a few years ago: it has to be very flexible and produce economically small batch sizes to satisfy consumer's demands and avoid unnecessary stock. Furthermore, a trend towards increasing functional integration continues to lead to an ongoing miniaturization of sheet metal components. In the industry of electric connectivity for example, the miniaturized connectors are manufactured by progressive tools, which are usually used for very large batches. These tools are installed in mechanical presses and then set up by a technician, who has to manually adjust a wide range of punch-bending operations. Disturbances like material thickness, temperatures, lubrication or tool wear complicate the setup procedure. In prospect of the increasing demand of production flexibility, this time-consuming process has to be handled more and more often. In this paper, a new approach for a model-based setup assistant is proposed as a solution, which is exemplarily applied in combination with a progressive tool. First, progressive tools, more specifically, their setup process is described and based on that, the challenges are pointed out. As a result, a systematic process to set up the machines is introduced. Following, the process is investigated with an FE-Analysis regarding the effects of the disturbances. In the next step, design of experiments is used to systematically develop a regression model of the system's behaviour. This model is integrated within an optimization in order to calculate optimal machine parameters and the following necessary adjustment of the progressive tool due to the disturbances. Finally, the assistant is tested in a production environment and the results are discussed.

Beyond Yellow Curry: Assessing Commercial Curcumin Absorption Technologies.

PubMed

Douglass, Brad J; Clouatre, Dallas L

2015-01-01

Few natural products have demonstrated the range of protective and therapeutic promise as have turmeric and its principal bioactive components: curcumin, demethoxycurcumin, and bisdemethoxycurcumin. Success in translating this potential into tangible benefits has been limited by inherently poor intestinal absorption, rapid metabolism, and limited systemic bioavailability. Seeking to overcome these limitations, food ingredient formulators have begun to employ a variety of approaches to enhance absorption and bioactivity. Many of these strategies improve upon the age-old practice of consuming turmeric in fat-based sauces, such as in a fat-rich yellow curry. However, there exists uncertainty as to how the various commercially available offerings compare to each other in terms of either uptake or efficacy, and this uncertainty leaves physicians and nutritionists with a dearth of data for making recommendations to interested patients and consumers. Further complicating the issue are recent data suggesting that formulation strategies may not equally enhance the absorption of individual curcuminoids, a significant issue in that these curcuminoids exhibit somewhat different physiologic properties. This review introduces needed order to the curcumin marketplace by examining bioavailability studies on a number of commercial curcumin ingredients and evaluating them on a level playing field. The comparative analysis includes standard pharmacokinetic parameters and a new metric, relative mass efficiency (E). Relative mass efficiency allows for the comparison of different formulations even in cases in which the weight percentage of curcuminoids is vastly different. A hydrophilic carrier dispersed curcuminoid formula exhibits 45.9 times the bioavailability of the standard purified 95 percent curcuminoid preparation and, based on relative mass efficiency, 1.5 times the bioavailability of the next best commercial ingredient, a cyclodextrin complex. Delivery strategies can significantly improve the bioavailability of curcuminoids. Total formula mass is important for making practical formulation decisions about dosing, cost and space.

[Cost comparison of open and robot-assisted partial nephrectomy in treatment of renal tumor].

PubMed

Abd El Fattah, V; Chevrot, A; Meusy, A; Mercier, G; Wagner, L; Soustelle, L; Boukaram, M; Thuret, R; Costa, P; Droupy, S

2016-04-01

Robot-assisted partial nephrectomy rapidly took on among urologists, even though studies showing its superiority over other techniques are still scarce and its costs hard to evaluate, especially in the French medical system. To evaluate the cost overrun of robot-assisted partial nephrectomy compared to that of open partial nephrectomy. From January 2010 to December 2013, 77 patients underwent a partial nephrectomy, 46 of which by robot-assisted laparoscopy and the remaining 31 by lombotomy. The two groups were similar in composition. Economic data regarding the staff, the consumables and the premises involved have been analyzed. Costs are significantly higher in the NPR group (9253.21 euros vs. 7448.42 euros) due to higher consumable expenses as well as the costs pertaining to the amortization and maintenance of the robot. Yet, that difference tends to diminish as the duration of the experiment increases. No significant difference was found in warm ischemia times, operation duration and renal function a month after the operation. On the other hand, patients from the NPR group spent a significantly smaller amount of time in recovery room (159 minutes vs. 205 minutes, P=0.004), presented fewer complications and were discharged faster (6.1 days vs. 8.1 days, P=0.04). To be profitable for the hospital in the French GHS system, robot-assisted partial nephrectomy must take place in a complex where at least 300 robot-assisted interventions are performed annually, in the framework of a hospitalization lasting four days or less, the use of a single needle holder and no systematic use of a haemostatic agent. 4. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

National Economic Policies: The Impact on Consumer Welfare. Proceedings of the American Council on Consumer Interests Annual Conference (29th, Kansas City, Missouri, March 16-19, 1983).

ERIC Educational Resources Information Center

Goebel, Karen P., Ed.

These proceedings contain the texts of the papers presented at a conference on consumer interests. Addressed in the first series of concurrent sessions are the following topics: consumers' new economic positions, consumers' choices with respect to price and quality trade-offs, time value in consumption decisions, and consumer information issues.…

Longer Operative Time During Benign Laparoscopic and Robotic Hysterectomy Is Associated With Increased 30-Day Perioperative Complications.

PubMed

Catanzarite, Tatiana; Saha, Sujata; Pilecki, Matthew A; Kim, John Y S; Milad, Magdy P

2015-01-01

The relationship between operative time and perioperative morbidity has not been fully characterized in gynecology. We aimed to determine the impact of operative time on 30-day perioperative complications after laparoscopic and robotic hysterectomy. Patients undergoing laparoscopic and robotic hysterectomy for benign disease from 2006 to 2011 within the National Surgical Quality Improvement Program (NSQIP) database were identified by Current Procedural Terminology code. Operative times were stratified into 60-minute intervals and complication rates analyzed. Primary outcomes included 30-day overall, medical, and surgical complications. Bivariate analyses using χ(2), Fisher's exact, and one-way analysis of variance tests were performed to compare clinical and procedural characteristics associated with longer operative time and complications. Multivariable logistic regression analyses were then performed to determine the independent association between operative time and perioperative complications. Canadian Task Force classification II-2 (Evidence obtained from well-designed cohort or case-control studies preferably from more than 1 center or research group). American College of Surgeons NSQIP. Patients who underwent laparoscopic or robotic hysterectomy for benign disease from 2006 to 2011 at any institution participating in NSQIP. None, retrospective database study. Of the 7630 laparoscopic and robotic hysterectomies identified, 399 patients (5.2%) experienced complications, most commonly urinary tract infection (UTI; 2.1%), superficial surgical site infection (1.0%), and blood transfusion (1.0%). Return to the operating room was required in 97 patients (1.3%), and there were 4 deaths, for a mortality rate of .05%. Complications increased steadily with longer operative time. Operative time ≥ 240 minutes was associated with increased overall complications (13.8% vs 4.6%, p < .001), surgical complications (5.4% vs 1.5%, p < .001), medical complications (10.4% vs 3.2%, p < .001), return to the operating room (2.7% vs 1.2%, p = .002), deep venous thrombosis (.5% vs .06%, p = .011), pulmonary embolism (.7% vs .1%, p = .012), and blood transfusion (3.4% vs .8%, p < .001). These associations remained statistically significant after multivariable regression analysis. Based on continuous regression modeling, each additional hour of operative time would be expected to increase odds of overall complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.28-1.54; p < .001), medical complications (OR, 1.42; 95% CI, 1.28-1.57; p < .001), surgical complications (OR, 1.32; 95% CI, 1.17-1.49; p < .001), venous thromboembolism (OR, 1.47; 95% CI, 1.12-1.92; p = .005), UTI (OR, 1.20; 95% CI, 1.05-1.36; p = .006), blood transfusion (OR, 1.42; 95% CI, 1.18-1.71; p < .001), and return to the operating room (OR, 1.25; 95% CI, 1.08-1.45; p = .003). We demonstrated a direct, independent association between operative time and 30-day complications after laparoscopic and robotic hysterectomy. Future research should aim to further delineate risk factors for prolonged operative time and morbidity in laparoscopic hysterectomy to allow surgeons to maximize preoperative planning and optimize patient selection for minimally invasive hysterectomy. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Regulatory environment and claims - limits and opportunities.

PubMed

Martin, Ambroise

2010-01-01

During the past decade, the use of claims became more and more important in many countries in relation to the increased awareness of consumer about the link between foods and health, offering to industry a valuable opportunity to differentiate and valorize their products and to promote innovation. However, more and more stringent regulations are developed, all based on the general principles adopted by the Codex Alimentarius Commission. In addition to the different regulatory processes and administrative requirements according to the country, the high level (and cost) of scientific substantiation of claims, the constraints introduced by nutrient profiles and the poor knowledge of the impact on consumer depending on the cultural contexts may limit these opportunities or, at least complicate their use. All these issues are briefly analyzed, highlighting some striking convergences and differences between countries. Copyright © 2010 S. Karger AG, Basel.

Bridging the knowledge-action gap in diabetes: information technologies, physician incentives and consumer incentives converge.

PubMed

Nobel, Jeremy

2006-03-01

The gap between current medical knowledge and its application in chronic disease management is especially apparent in diabetes care. Although research over the last decade has shown that adherence to standards of care can prevent or delay the onset of devastating diabetic complications, little more than one-third of patients achieve adequate glycaemic control. Obstacles to better care include 'system' factors such as inadequate record-keeping and reimbursement policies that reimburse amply for illness but poorly for diabetes education and interventions via telephone and computer. Disparities in healthcare compound the difficulty among vulnerable populations in urban and rural areas. Emerging healthcare delivery systems that encourage payers, providers and consumers to improve diabetes care with the use of information technology and financial incentives are described in different health management settings.

Citizen journalism in a time of crisis: lessons from a large-scale California wildfire

Treesearch

S. Gillette; J. Taylor; D.J. Chavez; R. Hodgson; J. Downing

2007-01-01

The accessibility of news production tools through consumer communication technology has made it possible for media consumers to become media producers. The evolution of media consumer to media producer has important implications for the shape of public discourse during a time of crisis. Citizen journalists cover crisis events using camera cell phones and digital...

Consumer involvement in the health technology assessment program.

PubMed

Royle, Jane; Oliver, Sandy

2004-01-01

This study aims to describe a cycle of development leading to sustainable methods for involving consumers in the management of a program commissioning health technology assessment. Staff time was dedicated to developing procedures for recruiting and briefing consumers to participate in prioritizing, commissioning, and reporting research. Resources and support were developed in light of early feedback from consumers and those working with them. These were piloted and amended before being used routinely. Over 4 years, procedures and resources have been developed to support six consumers attending seven to eight prioritization meetings a year; thirty to forty-five consumers each year commenting on research need for particular topics; thirty consumers a year commenting on research proposals, and twenty a year commenting on research reports. The procedures include clear job descriptions, induction and development days, clear briefing materials, payment for substantial tasks, and regularly seeking feedback to improve procedures. Explicit, inclusive, and reproducible methods for supporting consumer involvement that satisfy National Health Service policy recommendations for involving consumers in research require dedicated staff time to support a cycle of organizational development.

Predictors of Complications in Patients Receiving Head and Neck Free Flap Reconstructive Procedures.

PubMed

Eskander, Antoine; Kang, Stephen; Tweel, Ben; Sitapara, Jigar; Old, Matthew; Ozer, Enver; Agrawal, Amit; Carrau, Ricardo; Rocco, James W; Teknos, Theodoros N

2018-05-01

Objective To (1) determine the overall complication rate, wound healing, and wound infection complications and (2) identify preoperative, intraoperative, and postoperative predictors of these complications. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (2006-2012) were assessed. Multivariable logistic regression assessed the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results Of the 515 patients identified, 54% had a complication predicted by longer operating room (OR) time, higher comorbidity index, and oral cavity and pharyngeal tumor sites. Predictors of wound-healing complications (15%) were longer OR time, volume of crystalloid given intraoperatively, and oral cavity and pharyngeal tumor sites. Predictors of wound infection (12%) were younger age, diabetes mellitus, and malnutrition. Conclusions Wound healing and infectious complications account for most complications in patients with head and neck cancer undergoing free flap reconstruction. Clean contaminated wounds are a significant predictor of wound complications. Advanced OR time, advanced age, and comorbidity status, including diabetes mellitus and malnutrition, are other important predictors. Crystalloid administration is also an important predictor of wound-healing complications, and this warrants further study.

16 CFR 1115.14 - Time computations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS SUBSTANTIAL... spend a reasonable time for investigation and evaluation. (See § 1115.14(d).) (d) Time for investigation and evaluation. A subject firm may conduct a reasonably expeditious investigation in order to evaluate...

Analysis of complications of cervix carcinoma treated by radiotherapy using the Franco-Italian glossary.

PubMed

Sinistrero, G; Sismondi, P; Rumore, A; Zola, P

1993-03-01

We analysed the complications of 215 patients with uterine cervix cancer, treated by radiotherapy (RT) alone. It was done according to the rules of the Franco-Italian glossary, presented at the 7th ESTRO meeting, held in The Hague on September 1988. They were ranked by organ sites and by degrees of gravity. The analysis was done on the total number of complications and they were scored at the highest reached grade of gravity. Seventy one complications were found in 55 patients; they were studied by patient, degree of severity, time of onset, organ system and grade, time of onset and grade, time of onset and organ sites, stage and RT doses and brachytherapy volumes. The importance of the study of complications is stressed, particularly when treatment combines external RT and brachytherapy; some guidelines are given to avoid severe complications.

Making Space for Consuming Practices

ERIC Educational Resources Information Center

Rooney, Donna; Manidis, Marie; Scheeres, Hermine

2016-01-01

This empirically driven paper is about workplace learning with specific focus on the "work" of "consuming practices." By "consuming" we refer to the eating, and the drinking, and (at times) to the smoking that workers, in most organisations, do on a daily basis. Indeed, it is the quotidian nature of consuming, coupled…

Protective role of sulphoraphane against vascular complications in diabetes.

PubMed

Yamagishi, Sho-Ichi; Matsui, Takanori

2016-10-01

Context Diabetes is a global health challenge. Although large prospective clinical trials have shown that intensive control of blood glucose or blood pressure reduces the risk for development and progression of vascular complications in diabetes, a substantial number of diabetic patients still experience renal failure and cardiovascular events, which could account for disabilities and high mortality rate in these subjects. Objective Sulphoraphane is a naturally occurring isothiocyanate found in widely consumed cruciferous vegetables, such as broccoli, cabbage and Brussels sprouts, and an inducer of phase II antioxidant and detoxification enzymes with anticancer properties. We reviewed here the protective role of sulphoraphane against diabetic vascular complications. Methods In this review, literature searches were undertaken in Medline and in CrossRef. Non-English language articles were excluded. Keywords [sulphoraphane and (diabetes, diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, diabetic complications, vascular, cardiomyocytes, heart or glycation)] have been used to select the articles. Results There is accumulating evidence that sulphoraphane exerts beneficial effects on vascular damage in both cell culture and diabetic animal models via antioxidative properties. Furthermore, we have recently found that sulphoraphane inhibits in vitro formation of advanced glycation end products (AGEs), suppresses the AGE-induced inflammatory reactions in rat aorta by reducing receptor for AGEs (RAGE) expression and decreases serum levels of AGEs in humans. Conclusion These findings suggest that blockade of oxidative stress and/or the AGE-RAGE axis by sulphoraphane may be a novel therapeutic strategy for preventing vascular complications in diabetes.

Strategies to Increase Behavior-Specific Teacher Praise in an Inclusive Environment

ERIC Educational Resources Information Center

Musti-Rao, Shobana; Haydon, Todd

2011-01-01

Managing students' disruptive behavior in the classroom can be a time-consuming task and greatly reduces the amount of time teachers spend on instruction. Although there are several research-validated classroom management strategies, teachers are more likely to adopt strategies that are less time-consuming than strategies that take more time or…

Low Magnitude, High Frequency Signals Could Reduce Bone Loss During Spaceflight

NASA Astrophysics Data System (ADS)

Hawkey, A.

The removal of gravitational loading results in a loss of homeostasis of the skeleton. This leads to significant losses of bone mass during long-duration missions in space. Conventional exercise countermeasures, such as running and resistance training, have only limited effectiveness in reducing the rate at which bone is demineralised in microgravity. Bone loss, therefore, remains a major concern and if not annulled could be so severe as to jeopardise an extended human presence in space. In addition, current exercise regimes occupy valuable crew time, and astronauts often find the equipment cumbersome and uncomfortable to use. Recent studies suggest that exposing the body to short periods (<20mins) of low magnitude (<1g), high frequency (15-35Hz) signals (vibration) everyday could reduce, even prevent, bone loss during conditions such as osteoporo- sis on earth. The new vibration therapy treatment could also have several advantages over existing exercise countermeasures used in spaceflight due to it being very simple to operate, relatively inexpensive, and requiring only short periods of time `training', unlike the complicated, expensive and time-consuming devices currently used. This review highlights the detrimen- tal effects that microgravity has on the strength and integrity of bone, how current countermeasures are ineffective at stemming this level of deterioration, and how new vibration techniques could significantly reduce space-induced bone loss.

Self-assembly of red-blood-cell-like (NH4)[Fe2(OH)(PO4)2]·2H2O architectures from 2D nanoplates by sonochemical method.

PubMed

Wu, Kaipeng; Liu, Diwei; Tang, Yun

2018-01-01

Red-blood-cell-like (RBC-like) (NH 4 )[Fe 2 (OH)(PO 4 ) 2 ]·2H 2 O architectures assembled from 2D nanoplates are successfully synthesized via a facile sonochemical method. XRD measurement indicates that the as-prepared sample is well crystallized with a monoclinic structure. The morphology of the sample is characterized by SEM analysis, which shows that the (NH 4 )[Fe 2 (OH)(PO 4 ) 2 ]·2H 2 O particles exhibit a unique biconcave red blood cell morphology with an average diameter of 4um and thickness of 1.5um. The detailed time-dependent experiments are conducted to investigate the morphological evolution process. It reveals that the ultrasonic time is crucial to the morphology of the products, and the RBC-like (NH 4 )[Fe 2 (OH)(PO 4 ) 2 ]·2H 2 O proceeds in steps of crystallization, formation of thin plates, and the subsequent self-assembly. Compared to the available methods that are typically time-consuming and complicated, this smart sonochemical strategy proposed herein is efficient and simple. Moreover, these obtained special RBC-like architectures will be more fascinating for application in many areas. Copyright © 2017 Elsevier B.V. All rights reserved.

Informed baseline subtraction of proteomic mass spectrometry data aided by a novel sliding window algorithm.

PubMed

Stanford, Tyman E; Bagley, Christopher J; Solomon, Patty J

2016-01-01

Proteomic matrix-assisted laser desorption/ionisation (MALDI) linear time-of-flight (TOF) mass spectrometry (MS) may be used to produce protein profiles from biological samples with the aim of discovering biomarkers for disease. However, the raw protein profiles suffer from several sources of bias or systematic variation which need to be removed via pre-processing before meaningful downstream analysis of the data can be undertaken. Baseline subtraction, an early pre-processing step that removes the non-peptide signal from the spectra, is complicated by the following: (i) each spectrum has, on average, wider peaks for peptides with higher mass-to-charge ratios ( m / z ), and (ii) the time-consuming and error-prone trial-and-error process for optimising the baseline subtraction input arguments. With reference to the aforementioned complications, we present an automated pipeline that includes (i) a novel 'continuous' line segment algorithm that efficiently operates over data with a transformed m / z -axis to remove the relationship between peptide mass and peak width, and (ii) an input-free algorithm to estimate peak widths on the transformed m / z scale. The automated baseline subtraction method was deployed on six publicly available proteomic MS datasets using six different m/z-axis transformations. Optimality of the automated baseline subtraction pipeline was assessed quantitatively using the mean absolute scaled error (MASE) when compared to a gold-standard baseline subtracted signal. Several of the transformations investigated were able to reduce, if not entirely remove, the peak width and peak location relationship resulting in near-optimal baseline subtraction using the automated pipeline. The proposed novel 'continuous' line segment algorithm is shown to far outperform naive sliding window algorithms with regard to the computational time required. The improvement in computational time was at least four-fold on real MALDI TOF-MS data and at least an order of magnitude on many simulated datasets. The advantages of the proposed pipeline include informed and data specific input arguments for baseline subtraction methods, the avoidance of time-intensive and subjective piecewise baseline subtraction, and the ability to automate baseline subtraction completely. Moreover, individual steps can be adopted as stand-alone routines.

A qualitative evaluation of New Zealand consumers perceptions of general practice nurses

PubMed Central

2013-01-01

Background An important consideration in health service delivery is ensuring that services meet consumer needs and that consumers are satisfied with service delivery. Patient satisfaction can impact on compliance with suggested treatments and therefore impact on health outcomes. Comparatively few studies have explored consumer satisfaction with nurses in general practice. Methods A sub-group of 18 consumers from a larger quantitative evaluation of consumer satisfaction with New Zealand general practice nurses participated in semi-structured telephone interviews. Interview data was analysed using thematic analysis. Results Four major themes emerged from the data. These themes highlighted that, despite confusion experienced by some consumers regarding the practice nurse role, consumers were happy with the level of care provided by them. Consumers felt valued by Practice Nurses and considered them competent and highly knowledgeable. Findings also convey that consumers appreciate the accessibility and financial benefits of utilising the services of practice nurses. Conclusions Consumers are highly satisfied with practice nurse service delivery and value their relationships with these health professionals. Consumers revealed that greater clarity around the practice nurse role and their scope of practice may enhance their utilisation. Spreading the message of practice nurses being the right person to deliver care, within their scope of practice, at the right time may have the potential to provide more timely care within the primary care setting. PMID:23433311

Consumption patterns of sweet drinks in a population of Australian children and adolescents (2003-2008).

PubMed

Jensen, Britt W; Nichols, Melanie; Allender, Steven; de Silva-Sanigorski, Andrea; Millar, Lynne; Kremer, Peter; Lacy, Kathleen; Swinburn, Boyd

2012-09-12

Intake of sweet drinks has previously been associated with the development of overweight and obesity among children and adolescents. The present study aimed to assess the consumption pattern of sweet drinks in a population of children and adolescents in Victoria, Australia. Data on 1,604 children and adolescents (4-18 years) from the comparison groups of two quasi-experimental intervention studies from Victoria, Australia were analysed. Sweet drink consumption (soft drink and fruit juice/cordial) was assessed as one day's intake and typical intake over the last week or month at two time points between 2003 and 2008 (mean time between measurement: 2.2 years). Assessed using dietary recalls, more than 70% of the children and adolescents consumed sweet drinks, with no difference between age groups (p = 0.28). The median intake among consumers was 500 ml and almost a third consumed more than 750 ml per day. More children and adolescents consumed fruit juice/cordial (69%) than soft drink (33%) (p < 0.0001) and in larger volumes (median intake fruit juice/cordial: 500 ml and soft drink: 375 ml). Secular changes in sweet drink consumption were observed with a lower proportion of children and adolescents consuming sweet drinks at time 2 compared to time 1 (significant for age group 8 to <10 years, p = 0.001). The proportion of Australian children and adolescents from the state of Victoria consuming sweet drinks has been stable or decreasing, although a high proportion of this sample consumed sweet drinks, especially fruit juice/cordial at both time points.

Noncontact discrimination of animal and human blood with vacuum blood vessel and factors affect the discrimination

NASA Astrophysics Data System (ADS)

Zhang, Linna; Zhang, Shengzhao; Sun, Meixiu; Li, Hongxiao; Li, Yingxin; Fu, Zhigang; Guan, Yang; Li, Gang; Lin, Ling

2017-03-01

Discrimination of human and nonhuman blood is crucial for import-export ports and inspection and quarantine departments. Current methods are usually destructive, complicated and time-consuming. We had previously demonstrated that visible diffuse reflectance spectroscopy combining PLS-DA method can successfully realize human blood discrimination. In that research, the spectra were measured with the fiber probe under the surface of blood samples. However, open sampling may pollute the blood samples. Virulence factors in blood samples can also endanger inspectors. In this paper, we explored the classification effect with the blood samples measured in the original containers-vacuum blood vessel. Furthermore, we studied the impact of different conditions of blood samples, such as coagulation and hemolysis, on the prediction ability of the discrimination model. The calibration model built with blood samples in different conditions displayed a satisfactory prediction result. This research demonstrated that visible and near-infrared diffuse reflectance spectroscopy method was potential for noncontact discrimination of human blood.

One-step electrochemical deposition of Schiff base cobalt complex as effective water oxidation catalyst

NASA Astrophysics Data System (ADS)

Huang, Binbin; Wang, Yan; Zhan, Shuzhong; Ye, Jianshan

2017-02-01

Schiff base metal complexes have been applied in many fields, especially, a potential homogeneous catalyst for water splitting. However, the high overpotential, time consumed synthesis process and complicated working condition largely limit their application. In the present work, a one-step approach to fabricate Schiff base cobalt complex modified electrode is developed. Microrod clusters (MRC) and rough spherical particles (RSP) can be obtained on the ITO electrode through different electrochemical deposition condition. Both of the MRC and RSP present favorable activity for oxygen evolution reaction (OER) compared to the commercial Co3O4, taking an overpotential of 650 mV and 450 mV to drive appreciable catalytic current respectively. The highly active and stable RSP shows a Tafel plot of 84 mV dec-1 and negligible decrease of the current density for 12 h bulk electrolysis. The synthesis strategy of effective and stable catalyst in this work provide a simple method to fabricate heterogeneous OER catalyst with Schiff base metal complex.

Triple-helix molecular switch-based aptasensors and DNA sensors.

PubMed

Bagheri, Elnaz; Abnous, Khalil; Alibolandi, Mona; Ramezani, Mohammad; Taghdisi, Seyed Mohammad

2018-07-15

Utilization of traditional analytical techniques is limited because they are generally time-consuming and require high consumption of reagents, complicated sample preparation and expensive equipment. Therefore, it is of great interest to achieve sensitive, rapid and simple detection methods. It is believed that nucleic acids assays, especially aptamers, are very important in modern life sciences for target detection and biological analysis. Aptamers and DNA-based sensors have been widely used for the design of various sensors owing to their unique features. In recent years, triple-helix molecular switch (THMS)-based aptasensors and DNA sensors have been broadly utilized for the detection and analysis of different targets. The THMS relies on the formation of DNA triplex via Watson-Crick and Hoogsteen base pairings under optimal conditions. This review focuses on recent progresses in the development and applications of electrochemical, colorimetric, fluorescence and SERS aptasensors and DNA sensors, which are based on THMS. Also, the advantages and drawbacks of these methods are discussed. Copyright © 2018 Elsevier B.V. All rights reserved.

The effect of visualizing the flow of multimedia content among and inside devices.

PubMed

Lee, Dong-Seok

2009-05-01

This study introduces a user interface, referred to as the flow interface, which provides a graphical representation of the movement of content among and inside audio/video devices. The proposed interface provides a different frame of reference with content-oriented visualization of the generation, manipulation, storage, and display of content as well as input and output. The flow interface was applied to a VCR/DVD recorder combo, one of the most complicated consumer products. A between-group experiment was performed to determine whether the flow interface helps users to perform various tasks and to examine the learning effect of the flow interface, particularly in regard to hooking up and recording tasks. The results showed that participants with access to the flow interface performed better in terms of success rate and elapsed time. In addition, the participants indicated that they could easily understand the flow interface. The potential of the flow interface for application to other audio video devices, and design issues requiring further consideration, are discussed.

A force-based, parallel assay for the quantification of protein-DNA interactions.

PubMed

Limmer, Katja; Pippig, Diana A; Aschenbrenner, Daniela; Gaub, Hermann E

2014-01-01

Analysis of transcription factor binding to DNA sequences is of utmost importance to understand the intricate regulatory mechanisms that underlie gene expression. Several techniques exist that quantify DNA-protein affinity, but they are either very time-consuming or suffer from possible misinterpretation due to complicated algorithms or approximations like many high-throughput techniques. We present a more direct method to quantify DNA-protein interaction in a force-based assay. In contrast to single-molecule force spectroscopy, our technique, the Molecular Force Assay (MFA), parallelizes force measurements so that it can test one or multiple proteins against several DNA sequences in a single experiment. The interaction strength is quantified by comparison to the well-defined rupture stability of different DNA duplexes. As a proof-of-principle, we measured the interaction of the zinc finger construct Zif268/NRE against six different DNA constructs. We could show the specificity of our approach and quantify the strength of the protein-DNA interaction.

A novel fast and flexible technique of radical kinetic behaviour investigation based on pallet for plasma evaluation structure and numerical analysis

NASA Astrophysics Data System (ADS)

Malinowski, Arkadiusz; Takeuchi, Takuya; Chen, Shang; Suzuki, Toshiya; Ishikawa, Kenji; Sekine, Makoto; Hori, Masaru; Lukasiak, Lidia; Jakubowski, Andrzej

2013-07-01

This paper describes a new, fast, and case-independent technique for sticking coefficient (SC) estimation based on pallet for plasma evaluation (PAPE) structure and numerical analysis. Our approach does not require complicated structure, apparatus, or time-consuming measurements but offers high reliability of data and high flexibility. Thermal analysis is also possible. This technique has been successfully applied to estimation of very low value of SC of hydrogen radicals on chemically amplified ArF 193 nm photoresist (the main goal of this study). Upper bound of our technique has been determined by investigation of SC of fluorine radical on polysilicon (in elevated temperature). Sources of estimation error and ways of its reduction have been also discussed. Results of this study give an insight into the process kinetics, and not only they are helpful in better process understanding but additionally they may serve as parameters in a phenomenological model development for predictive modelling of etching for ultimate CMOS topography simulation.

Highly-efficient liposome-mediated transformation system for the basidiomycetous fungus Flammulina velutipes.

PubMed

Shi, Liang; Chen, Dongdong; Xu, Chao; Ren, Ang; Yu, Hanshou; Zhao, Mingwen

2017-07-11

Flammulina velutipes is a well-known edible mushroom cultivated all over the world. However, because of the low transformation frequency, the expensive instruments required, and the complicated, time-consuming procedures necessary, there is insufficient genetic research on F. velutipes. In this study, we report a liposome-mediated transformation (LMT) system for the genetic transformation of F. velutipes. Using the LMT system, we obtained 82 ± 4 stable F. velutipes transformants per 10 5 protoplasts, which is a clear increase in transformation frequency compared to the other methods used. We were able to detect the expression of an EGFP reporter gene in the F. velutipes transformants using fluorescence imaging assays. Furthermore, we used this method to transfer the laccase gene into F. velutipes and found that the transcriptional level and enzymatic activity increased in these transformants. Mitotic stability analysis showed that all of the selected transformants remained mitotically stable, even after five successive rounds of sub-culturing. These results demonstrate a new transgenic approach that will facilitate F. velutipes research.

[Rapid bioluminescent antibiotic susceptibility assay].

PubMed

Frundzhian, V G; Ugarova, N N; Blatun, L A; Terekhova, R P; Rusanova, E V

2009-01-01

Rapid testing of pathogen susceptibility to antibiotics is of great practical value for rational chemotherapy of pyoinflammatory deseases and postoperative complications of microbial etiology. The standard microbiological methods, i.e., the disk diffusion method and the method of serial dilutions are labour- and time-consuming (not less than 18-36 hours). The method of the authors is based on measuring bioluminescence resulting from interaction of adenosine-5'-triphosphate (ATP) and ATP reagent, a standard reaction mixture of firefly luciferase (an enzyme) and luciferin. The bioluminescence intensity is proportional to the ATP concentration in the reaction mixture and the ATP concentration is proportional to the number of the pathogen viable cells in the sample. The bioluminescence intensity value in the pathogen suspension aliquots with and without (control) the antibiotic were compared after the incubation for 5 hours and the coefficient of the microbial cell growth inhibition was calculated. Satisfactory correlation (R2 > 88%) of the results of the bioluminescent assay and the assay with the disk diffusion method and the method of serial dilutions was observed.

Design of a novel noninvasive spectrometer for pesticide residues monitor

NASA Astrophysics Data System (ADS)

Ren, Zhong; Liu, Guodong; Huang, Zhen

2014-11-01

Although the gas or liquid chromatography had been widely used into pesticide residues monitoring, some drawbacks such as time-consuming, complicated operation and especially the destructivity for samples were existed. To overcome the limits of destructive detection methods, the noninvasive detection method based on spectroscopy was used to detect the pesticide residues in this paper. To overcome low resolution and light-efficiency due to the drawbacks of the classical plane and holography concave gratings, a novel noninvasive spectrometer for pesticide residues monitor (PRM) based on volume holography transmission (VHT) grating was designed. Meanwhile, a custom-built splitting light system for PRM based on the VHT grating was developed. In addition, the linear charge coupled device (CCD) with combined data acquisition (DAQ) card and the virtual-PRM based on LabVIEW were respectively used as the spectral acquisition hardware and software-platform. Experimental results showed that the spectral resolution of this spectrometer reached 2nm, and the VHT grating's diffraction efficiency was gotten via the simulation experiment.

Possibility and Challenges of Conversion of Current Virus Species Names to Linnaean Binomials.

PubMed

Postler, Thomas S; Clawson, Anna N; Amarasinghe, Gaya K; Basler, Christopher F; Bavari, Sbina; Benko, Mária; Blasdell, Kim R; Briese, Thomas; Buchmeier, Michael J; Bukreyev, Alexander; Calisher, Charles H; Chandran, Kartik; Charrel, Rémi; Clegg, Christopher S; Collins, Peter L; Juan Carlos, De La Torre; Derisi, Joseph L; Dietzgen, Ralf G; Dolnik, Olga; Dürrwald, Ralf; Dye, John M; Easton, Andrew J; Emonet, Sébastian; Formenty, Pierre; Fouchier, Ron A M; Ghedin, Elodie; Gonzalez, Jean-Paul; Harrach, Balázs; Hewson, Roger; Horie, Masayuki; Jiang, Dàohóng; Kobinger, Gary; Kondo, Hideki; Kropinski, Andrew M; Krupovic, Mart; Kurath, Gael; Lamb, Robert A; Leroy, Eric M; Lukashevich, Igor S; Maisner, Andrea; Mushegian, Arcady R; Netesov, Sergey V; Nowotny, Norbert; Patterson, Jean L; Payne, Susan L; PaWeska, Janusz T; Peters, Clarence J; Radoshitzky, Sheli R; Rima, Bertus K; Romanowski, Victor; Rubbenstroth, Dennis; Sabanadzovic, Sead; Sanfaçon, Hélène; Salvato, Maria S; Schwemmle, Martin; Smither, Sophie J; Stenglein, Mark D; Stone, David M; Takada, Ayato; Tesh, Robert B; Tomonaga, Keizo; Tordo, Noël; Towner, Jonathan S; Vasilakis, Nikos; Volchkov, Viktor E; Wahl-Jensen, Victoria; Walker, Peter J; Wang, Lin-Fa; Varsani, Arvind; Whitfield, Anna E; Zerbini, F Murilo; Kuhn, Jens H

2017-05-01

Botanical, mycological, zoological, and prokaryotic species names follow the Linnaean format, consisting of an italicized Latinized binomen with a capitalized genus name and a lower case species epithet (e.g., Homo sapiens). Virus species names, however, do not follow a uniform format, and, even when binomial, are not Linnaean in style. In this thought exercise, we attempted to convert all currently official names of species included in the virus family Arenaviridae and the virus order Mononegavirales to Linnaean binomials, and to identify and address associated challenges and concerns. Surprisingly, this endeavor was not as complicated or time-consuming as even the authors of this article expected when conceiving the experiment. [Arenaviridae; binomials; ICTV; International Committee on Taxonomy of Viruses; Mononegavirales; virus nomenclature; virus taxonomy.]. Published by Oxford University Press on behalf of Society of Systematic Biologists 2016. This work is written by a US Government employee and is in the public domain in the US.

Electrochemiluminescence-PCR detection of genetically modified organisms

NASA Astrophysics Data System (ADS)

Liu, Jinfeng; Xing, Da; Shen, Xingyan; Zhu, Debin

2005-01-01

The detection methods for genetically modified (GM) components in foods have been developed recently. But many of them are complicated and time-consuming; some of them need to use the carcinogenic substance, and can"t avoid false-positive results. In this study, an electrochemiluminescence polymerase chain reaction (ECL-PCR) method for detection GM tobaccos is proposed. The Cauliflower mosaic virus 35S (CaMV35S) promoter was amplified by PCR, Then hybridized with a Ru(bpy)32+ (TBR)-labeled and a biotinylated probe. The hybridization products were captured onto streptavidin-coated paramagnetic beads, and detected by measuring the electrochemiluminescence (ECL) signal of the TBR label. Whether the tobaccos contain GM components was discriminated by detecting the ECL signal of CaMV35S promoter. The experiment results show that the detection limit for CaMV35S promoter is 100 fmol, and the GM components can be clearly identified in GM tobaccos. The ECL-PCR method provide a new means in GMOs detection due to its safety, simplicity and high efficiency.

Review of Batteryless Wireless Sensors Using Additively Manufactured Microwave Resonators.

PubMed

Memon, Muhammad Usman; Lim, Sungjoon

2017-09-09

The significant improvements observed in the field of bulk-production of printed microchip technologies in the past decade have allowed the fabrication of microchip printing on numerous materials including organic and flexible substrates. Printed sensors and electronics are of significant interest owing to the fast and low-cost fabrication techniques used in their fabrication. The increasing amount of research and deployment of specially printed electronic sensors in a number of applications demonstrates the immense attention paid by researchers to this topic in the pursuit of achieving wider-scale electronics on different dielectric materials. Although there are many traditional methods for fabricating radio frequency (RF) components, they are time-consuming, expensive, complicated, and require more power for operation than additive fabrication methods. This paper serves as a summary/review of improvements made to the additive printing technologies. The article focuses on three recently developed printing methods for the fabrication of wireless sensors operating at microwave frequencies. The fabrication methods discussed include inkjet printing, three-dimensional (3D) printing, and screen printing.

Review of Batteryless Wireless Sensors Using Additively Manufactured Microwave Resonators

PubMed Central

2017-01-01

The significant improvements observed in the field of bulk-production of printed microchip technologies in the past decade have allowed the fabrication of microchip printing on numerous materials including organic and flexible substrates. Printed sensors and electronics are of significant interest owing to the fast and low-cost fabrication techniques used in their fabrication. The increasing amount of research and deployment of specially printed electronic sensors in a number of applications demonstrates the immense attention paid by researchers to this topic in the pursuit of achieving wider-scale electronics on different dielectric materials. Although there are many traditional methods for fabricating radio frequency (RF) components, they are time-consuming, expensive, complicated, and require more power for operation than additive fabrication methods. This paper serves as a summary/review of improvements made to the additive printing technologies. The article focuses on three recently developed printing methods for the fabrication of wireless sensors operating at microwave frequencies. The fabrication methods discussed include inkjet printing, three-dimensional (3D) printing, and screen printing. PMID:28891947

The influence of timing, radiation and reconstruction on complications and speech outcomes with tracheoesophageal puncture

PubMed Central

Gitomer, Sarah A.; Hutcheson, Kate A.; Christianson, Brandon L.; Samuelson, Madeleine B.; Barringer, Denise A.; Roberts, Dianna B.; Hessel, Amy C.; Weber, Randal S.; Lewin, Jan S.; Zafereo, Mark E.

2016-01-01

Background We evaluated impact of radiation, reconstruction and timing of tracheoesophageal puncture (TEP) on complications and speech outcomes. Methods Retrospective review identified 145 TEP patients between 2003–2007. Results Ninety-nine patients (68%) had primary and 46 (32%) secondary TEP, with complications occurring in 65% and 61% respectively (p=0.96). Twenty-nine patients (20%) had major complications (18 primary; 11 secondary, p=0.42). Ninety-four patients (65%) had pre-TEP radiation, 39 (27%) post-TEP radiation, and 12 (8%) no radiation. With patients grouped by TEP timing and radiation history, there was no difference in complications, fluency, or TEP use. With mean 4.7-year follow up, 82% primary and 85% secondary used TEP for primary communication (p=0.66). Free-flap patients used TEP more commonly for primary communication after secondary versus primary TEP (90% v 50%, p=0.02). Conclusions Primary and secondary tracheoesophageal speakers experience similar high rates of complications. Extent of pharyngeal reconstruction, rather than radiation, may be more important in selection of TEP timing. PMID:27394060

New fixation method for maxillary distraction osteogenesis using locking attachments.

PubMed

Suzuki, Eduardo Yugo; Buranastidporn, Boonsiva; Ishii, Masatoshi

2006-10-01

The external traction hooks of the intraoral splint used in the rigid external distraction (RED) system for maxillary distraction osteogenesis interfere with the surgical procedures. The purpose of this study is to introduce an innovative splint fixation method for maxillary distraction osteogenesis with Locking Attachments and evaluate their advantages, such as reduction of operating time compared with the traditional intraoral splint method. Retrospective comparison of operative times of maxillary Le Fort I osteotomy procedures was carried out with the traditional protocol using the intraoral splint cemented to the maxillary dentition (n = 14), and a removable intraoral splint that is inserted postsurgically (n = 14). Operative procedure times were compared and analyzed statistically using the data extracted from the surgical records. There were no complications inserting the removable splint postsurgically, including pain, discomfort, or time-consuming procedure. Stable and secure splint fixation was obtained before the distraction procedure and the desired treatment goals were obtained in all patients. The total operative procedure times were significantly reduced in the Locking Attachments group by 24% to 41% (approximately 65 minutes) compared with earlier operations involving the conventional splints (P < .05). Maxillary distraction osteogenesis with the Locking Attachments is a highly effective fixation approach to manage severe hypoplastic maxilla, eliminating lip constraints resulting from scarring and allowing for easier, more deliberate and careful dissection. The use of the Locking Attachments is reliable in craniofacial surgery and has proved to be advantageous in the reduction of the operating time and surgical risks.

Risk of complications in coeliac patients depends on age at diagnosis and type of clinical presentation.

PubMed

Biagi, Federico; Schiepatti, Annalisa; Maiorano, Gregorio; Fraternale, Giacomo; Agazzi, Simona; Zingone, Fabiana; Ciacci, Carolina; Volta, Umberto; Caio, Giacomo; Tortora, Raffaella; Klersy, Catherine; Corazza, Gino R

2018-06-01

Coeliac disease is characterised by an increased mortality mostly due to its complications. To study the risk of developing complications according to clinical presentation and age at diagnosis, a combined retrospective-prospective longitudinal study was performed in three Italian centres. Incidence of complications and mortality rates were calculated using type and age at diagnosis of coeliac disease, sex, and centre of diagnosis as predictors. Patients referred after being found to suffer from coeliac disease elsewhere were excluded. Between 01/1999 and 06/2015, 2225 adult coeliac patients were directly diagnosed in our centres. 17 of them developed a complication and 29 died. In patients older than 60 years at diagnosis of coeliac disease, the risk of complication is 18 times higher than in patients diagnosed at 18-40 years and 9 times higher than in patients diagnosed at 40-60 years. Classical presentation increases the risk of complications by 7 times compared to non-classical presentation; in asymptomatic patients the risk of complication is virtually absent. The risk of developing complications in coeliac patients is linked to age at diagnosis of coeliac disease and type of clinical presentation. Follow-up methods of coeliac patients should be tailored according to these parameters. Copyright © 2017. Published by Elsevier Ltd.

The impact of obesity on 30-day complications in pediatric surgery.

PubMed

Train, A T; Cairo, S B; Meyers, H A; Harmon, C M; Rothstein, D H

2017-11-01

To examine the effects of obesity on specialty-specific surgical outcomes in children. Retrospective cohort study using the National Surgical Quality Improvement Program, Pediatric, 2012-2014. Patients included those aged 2-17 years who underwent a surgical procedure in one of six specialties. Obesity was the primary patient variable of interest. Outcomes of interest were postoperative complications and operative times. Odds ratios for development of postoperative complications were calculated using stepwise multivariate regression analysis. Obesity was associated with a significantly greater risk of wound complications (OR 1.24, 95% CI 1.13-1.36), but decreased risk of non-wound complications (OR 0.68, 95% CI 0.63-0.73) and morbidity (OR 0.79, 95% CI 0.75-0.84). Obesity was not a significant factor in predicting postoperative complications in patients undergoing otolaryngology or plastic surgery procedures. Anesthesia times and operative times were significantly longer for obese patients undergoing most types of pediatric surgical procedures. Obesity confers an increased risk of wound complications in some pediatric surgical specialties and is associated with overall decreased non-wound complications and morbidity. These findings suggest that the relationship between obesity and postoperative complications is complex and may be more dependent on underlying procedure- or specialty-related factors than previously suspected.

[Anesthesia and bodybuilding].

PubMed

Hokema, Frank; Pietsch, Uta-Carolin; Führer, Dagmar; Kaisers, Udo

2008-05-01

A strong tendency toward body enhancement and body forming in western industrial societies makes it more likely for each anesthesiologist to get involved in the care of bodybuilders. These patients quite frequently consume androgenic anabolic steroids, human growth hormone and other drugs or substances which are believed to accelerate muscle gain. Cardiovascular, hepatic, psychiatric, hormonal and infectious side effects or complications are common and rarely monitored by health care professionals. The anesthesia risk is not exactly known but seems to be determined mainly by cardiovascular events like myocardial ischemia and dysrhythmias.

Pediatric Enteric Feeding Techniques: Insertion, Maintenance, and Management of Problems

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

Nijs, Els L. F., E-mail: nijs@email.chop.ed; Cahill, Anne Marie, E-mail: cahill@email.chop.ed

Enteral feeding is considered a widespread, well-accepted means of delivering nutrition to adults and children who are unable to consume food by mouth or who need support in maintaining adequate nutrition for a variety of reasons, including acute and chronic disease states. Delivery of enteral feeding to nutritionally deprived patients may be achieved by several means. In this article, the indications and insertion of enteral access in children will be reviewed. In addition, common complications and management of problems will be discussed.

Explaining Counterfeit Alcohol Purchases in Russia.

PubMed

Kotelnikova, Zoya

2017-04-01

Alcohol is a common target of counterfeiting in Russia. Counterfeit alcohol is defined here as the manufacture, distribution, unauthorized placement (forgery) of protected commodity trademarks, and infringement of the exclusive rights of the registered trademark holders of alcoholic beverages. It is often argued that the expansion of the counterfeit product market is due to the steady demand of economically disadvantaged people for low-priced goods. The situation becomes more complicated once deceptive and nondeceptive forms of counterfeiting are taken into account. This study aimed to identify markers of risky behavior associated with the purchase of counterfeit alcohol in Russia. The analysis relied on consumer self-reports of alcohol use and purchase collected nationwide by the Russia Longitudinal Monitoring Survey (RLMS-HSE) in 2012 to 2014. I used a generalized linear mixed-model logistic regression to identify predictors of risky behavior by consumers who purchased counterfeit alcohol, either knowingly or unknowingly, during the 30 days preceding the survey. Purchases of counterfeit alcohol declined slightly from 2012 to 2014, mainly due to a decrease in consumers mistakenly purchasing counterfeit products. Predictors of counterfeit alcohol purchases differed between consumers who knowingly and unknowingly purchased counterfeit products. Nondeceptive purchase of counterfeit alcohol was related primarily to an indifference to alcohol brands. Consumers with social networks that include drinkers of nonbeverage alcohol and producers of homemade alcohol were highly likely to consume counterfeit alcohol deliberately. Problem drinking was significantly associated with a higher risk of both deceptive and nondeceptive purchases of counterfeit alcohol. Poverty largely contributed to nondeceptive counterfeiting. The literature has overestimated the impact of low prices on counterfeit alcohol consumption. Problem drinking and membership in social networks of consumers of surrogate alcohol (i.e., nonbeverage) are more influential in explaining why people purchase counterfeit alcohol. Further research on these 2 factors is needed to more fully understand the purchase and consumption of counterfeit alcoholic beverages. Copyright © 2017 by the Research Society on Alcoholism.

Psychosocial and legal aspects of oncological treatment in patients with cognitive impairment.

PubMed

Kuśnierkiewicz, Maria; Kędziora, Justyna; Jaroszyk-Pawlukiewicz, Joanna; Nowak-Jaroszyk, Monika

2014-05-01

With society getting older and affected by many diseases, more and more people suffer from severe cognitive disorders. As practice shows, the legal situations of such people is often problematic. This is due to a number of factors, such as short time since the deterioration of patient's condition, initial symptoms ignored, social prejudice towards the idea of incapacitation or taking decisions for a patient, complicated procedures and, sometimes, insufficient knowledge of legal regulations. Cognitive disorders also occur in patients treated for cancer. To be effective, oncological treatment needs to be started as early as possible. This, however, does not meet the criteria of sudden threat to life. The present article relates to both the psychosocial and legal aspects of care of people suffering from intense disorders of memory, attention, problem solving, executive functions, and other. Surely, physicians know how to handle patients with the above dysfunctions. However, legal procedures aimed to protect patients' rights are often unclear and time consuming. In practice, this often amounts to a dilemma whether to treat or follow the applicable law. Certainly, solutions in this regard should be clearer and better adapted to the needs arising from specific treatment needs of particular groups of patients.

Charcoal versus LPG grilling: A carbon-footprint comparison

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

Johnson, Eric, E-mail: ejohnson@ecosite.co.u

2009-11-15

Undoubtedly, grilling is popular. Britons fire up their barbeques some 60 million times a year, consuming many thousands of tonnes of fuel. In milder climates consumption is even higher, and in the developing world, charcoal continues to be an essential cooking fuel. So it is worth comparing the carbon footprints of the two major grill types, charcoal and LPG, and that was the purpose of the study this paper documents. Charcoal and LPG grill systems were defined, and their carbon footprints were calculated for a base case and for some plausible variations to that base case. In the base case,more » the charcoal grilling footprint of 998 kg CO{sub 2}e is almost three times as large as that for LPG grilling, 349 kg CO{sub 2}e. The relationship is robust under all plausible sensitivities. The overwhelming factors are that as a fuel, LPG is dramatically more efficient than charcoal in its production and considerably more efficient in cooking. Secondary factors are: use of firelighters, which LPG does not need; LPG's use of a heavier, more complicated grill; and LPG's use of cylinders that charcoal does not need.« less

Paper-based microreactor array for rapid screening of cell signaling cascades.

PubMed

Huang, Chia-Hao; Lei, Kin Fong; Tsang, Ngan-Ming

2016-08-07

Investigation of cell signaling pathways is important for the study of pathogenesis of cancer. However, the related operations used in these studies are time consuming and labor intensive. Thus, the development of effective therapeutic strategies may be hampered. In this work, gel-free cell culture and subsequent immunoassay has been successfully integrated and conducted in a paper-based microreactor array. Study of the activation level of different kinases of cells stimulated by different conditions, i.e., IL-6 stimulation, starvation, and hypoxia, was demonstrated. Moreover, rapid screening of cell signaling cascades after the stimulations of HGF, doxorubicin, and UVB irradiation was respectively conducted to simultaneously screen 40 kinases and transcription factors. Activation of multi-signaling pathways could be identified and the correlation between signaling pathways was discussed to provide further information to investigate the entire signaling network. The present technique integrates most of the tedious operations using a single paper substrate, reduces sample and reagent consumption, and shortens the time required by the entire process. Therefore, it provides a first-tier rapid screening tool for the study of complicated signaling cascades. It is expected that the technique can be developed for routine protocol in conventional biological research laboratories.

Modeling activity recognition of multi resident using label combination of multi label classification in smart home

NASA Astrophysics Data System (ADS)

Mohamed, Raihani; Perumal, Thinagaran; Sulaiman, Md Nasir; Mustapha, Norwati; Zainudin, M. N. Shah

2017-10-01

Pertaining to the human centric concern and non-obtrusive way, the ambient sensor type technology has been selected, accepted and embedded in the environment in resilient style. Human activities, everyday are gradually becoming complex and thus complicate the inferences of activities when it involving the multi resident in the same smart environment. Current works solutions focus on separate model between the resident, activities and interactions. Some study use data association and extra auxiliary of graphical nodes to model human tracking information in an environment and some produce separate framework to incorporate the auxiliary for interaction feature model. Thus, recognizing the activities and which resident perform the activity at the same time in the smart home are vital for the smart home development and future applications. This paper will cater the above issue by considering the simplification and efficient method using the multi label classification framework. This effort eliminates time consuming and simplifies a lot of pre-processing tasks comparing with previous approach. Applications to the multi resident multi label learning in smart home problems shows the LC (Label Combination) using Decision Tree (DT) as base classifier can tackle the above problems.

Parameter Estimation of a Spiking Silicon Neuron

PubMed Central

Russell, Alexander; Mazurek, Kevin; Mihalaş, Stefan; Niebur, Ernst; Etienne-Cummings, Ralph

2012-01-01

Spiking neuron models are used in a multitude of tasks ranging from understanding neural behavior at its most basic level to neuroprosthetics. Parameter estimation of a single neuron model, such that the model’s output matches that of a biological neuron is an extremely important task. Hand tuning of parameters to obtain such behaviors is a difficult and time consuming process. This is further complicated when the neuron is instantiated in silicon (an attractive medium in which to implement these models) as fabrication imperfections make the task of parameter configuration more complex. In this paper we show two methods to automate the configuration of a silicon (hardware) neuron’s parameters. First, we show how a Maximum Likelihood method can be applied to a leaky integrate and fire silicon neuron with spike induced currents to fit the neuron’s output to desired spike times. We then show how a distance based method which approximates the negative log likelihood of the lognormal distribution can also be used to tune the neuron’s parameters. We conclude that the distance based method is better suited for parameter configuration of silicon neurons due to its superior optimization speed. PMID:23852978

76 FR 27665 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Consumer...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-12

... INFORMATION: The Consumer Price Index (CPI) is a measure of the average change over time in the prices paid by... for OMB Review; Comment Request; Consumer Price Index Commodities and Services Survey ACTION: Notice...) sponsored information collection request (ICR) titled, ``Consumer Price Index Commodities and Services...

77 FR 55833 - Announcement of Public Meeting on the Consumer Confidence Report (CCR) Rule Retrospective Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-11

... on the Consumer Confidence Report (CCR) Rule Retrospective Review and Request for Public Comment on... potential approaches for providing Consumer Confidence Reports (CCR) via electronic delivery. EPA plans to... meeting to give EPA time to process your request. Background Consumer Confidence Reports are a key part of...

12 CFR Supplement I to Part 205 - Official Staff Interpretations

Code of Federal Regulations, 2013 CFR

2013-01-01

...) encoding to initiate a one-time ACH debit. For example, if a consumer authorizes a one-time ACH debit from... electronic terminal is involved at the time of the transaction, if the consumer's asset account is... receive a notice that the transaction will be processed as an EFT for each transaction at POS or each time...

12 CFR Supplement I to Part 205 - Official Staff Interpretations

Code of Federal Regulations, 2014 CFR

2014-01-01

...) encoding to initiate a one-time ACH debit. For example, if a consumer authorizes a one-time ACH debit from... electronic terminal is involved at the time of the transaction, if the consumer's asset account is... receive a notice that the transaction will be processed as an EFT for each transaction at POS or each time...

Effectiveness of Postoperative Wound Drains in One- and Two-Level Cervical Spine Fusions

PubMed Central

Poorman, Caroline E.; Bianco, Kristina M.; Boniello, Anthony; Yang, Sun; Gerling, Michael C.

2014-01-01

Background Cervical drains have historically been used to avoid postoperative wound and respiratory complications such as excessive edema, hematoma, infection, re-intubation, delayed extubation, or respiratory distress. Recently, some surgeons have ceased using drains because they may prolong hospital stay, operative time, or patient discomfort. The objective of this retrospective case-control series is to investigate the effectiveness of postoperative drains following one- and two-level cervical fusions. Methods A chart review was conducted at a single institution from 2010-2013. Outcome measures included operative time, hospital stay, estimated blood loss and incidence of wound complications (infection, hematoma, edema, and complications with wound healing or evacuation), respiratory complications (delayed extubation, re-intubation, and respiratory treatment), and overall complications (wound complications, respiratory complications, dysphagia, and other complications). Statistical analyses including independent samples t-test, chi-square, analysis of covariance, and linear regression were used to compare patients who received a postoperative drain to those who did not. Results The study population included 39 patients who received a postoperative drain and 42 patients who did not. There were no differences in demographics between the two groups. Patients with drains showed increased operative time (100.1 vs 69.3 min, p < 0.001), hospital stay (38.9 vs. 31.7 hrs, p = 0.021), and blood loss (62.7 vs 29.1 mL, p < 0.001) compared to patients without drains. The frequency of wound complications, respiratory complications, and overall complications did not vary significantly between groups. Conclusions/Level of Evidence Cervical drains may not be necessary for patients undergoing one- and two-level cervical fusion. While there were no differences in incidence of complications between groups, patients treated with drains had significantly longer operative time and length of hospital stay. Clinical relevance This could contribute to excessive costs for patients treated with drains, despite the lack of compelling evidence of the advantages of this treatment in the literature and in the current study. PMID:25694927

Theoretical study of a consumable anode in a gas metal welding arc

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

Zhu, P.; Simpson, S.W.

1996-12-31

A better understanding of the behavior of the metal transfer process in a welding arc is important for further improvement of quality control for gas-metal-arc welding (GMAW). The problems related to the metal transfer are generally complicated because (a) the metal transfer process is strongly coupled with the arc plasma, which is not stable, for example, the length of the arc plasma varies during the formation and detachment of a metal droplet, and (b) the formation of the electrode droplet itself is influenced by energy transfer, the anode-plasma interface, and also the location of the liquid-solid interface inside the anode.more » This paper presents primary results of an investigation of the consumable anode in a gas metal welding arc. The study includes theoretical predictions of the properties related to metal transfer including moving anode temperature profile, welding arc length and arc current as a function of time for various wire feed rates, as well as numerical treatment of droplet formation. The anode temperature profile and the melting rate are analyzed by a metal transfer model which couples a two-dimensional arc model to a one-dimensional anode thermal model. The droplet formation is predicted by a quasi-one-dimensional dynamic model of a pendant drop which accounts for the electromagnet pinch effect, the surface tension, gravitation and the momentum transfer due to wire motion. Comparison between experimental observation and theoretical predictions will also be discussed.« less

Expert views on most suitable monetary incentives on food to stimulate healthy eating.

PubMed

Waterlander, Wilma E; Steenhuis, Ingrid H M; de Vet, Emely; Schuit, Albertine J; Seidell, Jacob C

2010-06-01

Pricing strategies are an important component in the marketing mix and may also be useful in stimulating healthier food choices. However, due to competing interests and feasibility problems, the introduction of pricing strategies is complicated. For successfully introducing food pricing strategies, it is essential to explore incentives that are not only promising but also realizable and being approved by different sectors. We aimed to assemble a list of pricing strategies by exploring expert views using the Delphi method. Subjects included experts from academia, industry, retail, agriculture, policymakers, consumers and non-governmental organizations. Data were collected in three rounds. In round one, experts designed promising pricing strategies. Based on a time-budget model incorporating Sleep, Leisure, Occupation, Transportation and Home-based activities, these strategies were in the subsequent rounds judged on several criteria. Results were analysed using median and interquartile deviations scores. We found fair consensus levels among experts and a varied list of promising pricing strategies. The panel agreed on the potential success of offering small presents, providing price-cuts on healthy foods and discounting healthier foods more frequently. Also, it was found that experts gave higher rates to pricing strategies for which the implementation responsibilities could be placed elsewhere. The resulted list of promising monetary incentives is an essential first step for the future design of pricing strategies. Following this study, it is important to determine how to make solid agreements on responsibility and implementation issues. Also, consumer perceptions regarding the proposed pricing strategies should be studied.

Stochastic and Statistical Analysis of Utility Revenues and Weather Data Analysis for Consumer Demand Estimation in Smart Grids

PubMed Central

Ali, S. M.; Mehmood, C. A; Khan, B.; Jawad, M.; Farid, U; Jadoon, J. K.; Ali, M.; Tareen, N. K.; Usman, S.; Majid, M.; Anwar, S. M.

2016-01-01

In smart grid paradigm, the consumer demands are random and time-dependent, owning towards stochastic probabilities. The stochastically varying consumer demands have put the policy makers and supplying agencies in a demanding position for optimal generation management. The utility revenue functions are highly dependent on the consumer deterministic stochastic demand models. The sudden drifts in weather parameters effects the living standards of the consumers that in turn influence the power demands. Considering above, we analyzed stochastically and statistically the effect of random consumer demands on the fixed and variable revenues of the electrical utilities. Our work presented the Multi-Variate Gaussian Distribution Function (MVGDF) probabilistic model of the utility revenues with time-dependent consumer random demands. Moreover, the Gaussian probabilities outcome of the utility revenues is based on the varying consumer n demands data-pattern. Furthermore, Standard Monte Carlo (SMC) simulations are performed that validated the factor of accuracy in the aforesaid probabilistic demand-revenue model. We critically analyzed the effect of weather data parameters on consumer demands using correlation and multi-linear regression schemes. The statistical analysis of consumer demands provided a relationship between dependent (demand) and independent variables (weather data) for utility load management, generation control, and network expansion. PMID:27314229

Stochastic and Statistical Analysis of Utility Revenues and Weather Data Analysis for Consumer Demand Estimation in Smart Grids.

PubMed

Ali, S M; Mehmood, C A; Khan, B; Jawad, M; Farid, U; Jadoon, J K; Ali, M; Tareen, N K; Usman, S; Majid, M; Anwar, S M

2016-01-01

In smart grid paradigm, the consumer demands are random and time-dependent, owning towards stochastic probabilities. The stochastically varying consumer demands have put the policy makers and supplying agencies in a demanding position for optimal generation management. The utility revenue functions are highly dependent on the consumer deterministic stochastic demand models. The sudden drifts in weather parameters effects the living standards of the consumers that in turn influence the power demands. Considering above, we analyzed stochastically and statistically the effect of random consumer demands on the fixed and variable revenues of the electrical utilities. Our work presented the Multi-Variate Gaussian Distribution Function (MVGDF) probabilistic model of the utility revenues with time-dependent consumer random demands. Moreover, the Gaussian probabilities outcome of the utility revenues is based on the varying consumer n demands data-pattern. Furthermore, Standard Monte Carlo (SMC) simulations are performed that validated the factor of accuracy in the aforesaid probabilistic demand-revenue model. We critically analyzed the effect of weather data parameters on consumer demands using correlation and multi-linear regression schemes. The statistical analysis of consumer demands provided a relationship between dependent (demand) and independent variables (weather data) for utility load management, generation control, and network expansion.

Complications in operative fixation of calcaneal fractures

PubMed Central

Li, Ying; Bao, Rong-Hua; Jiang, Zhi-Qiang; Wu, Huo-Yan

2016-01-01

Objective: The purpose of this study focused on a number of factors that have been implicated in calcaneal complications and find the incidence of wound complications. Methods: This was a retrospective study. A total of 162 patients (176 feet) who underwent calcaneal fractures between 2007 and 2012 were included. The patient’s personal details, age, time from injury to surgery, cause of injury, type of fracture, operative details, operating and tourniquet times were collected from hospital computers and paper records. Evidence of complications including wound infection, wound necrosis, pain, malunion, nonunion, impingement, loss of fixation, ect were studied. Results: Forty-seven of one hundred and seventy-six fractures (26.704%) had complications, wound infection was noted in seven fractures (3.977%), twelve fractures developed necrosis (6.818%), 14 fractures (7.955%) developed pain. Malunion was found in five fractures (2.841%), nonunion in two fractures (1.136%) and loss of fixation in four fractures (2.272%). Three neurologic injury was also seen in our study (1.705%). Operating time, time from injury to surgery and type of fracture had some association with complications in operative fixation of calcaneal fractures, which showed a statistically significant improvement (P=0.000, 0.031, 0.020, respectively), but there were no evidence that age and tourniquet time affect the incidence of complication after calcaneal fracture surgery (P=0.119, 0.682, respectively). Conclusions: Despite developments in the surgical treatment of calcaneal fracture, wound complications still remain inevitable. Advanced imaging techniques, less invasive surgical procedures, wealth of anatomical knowledge, surgical experience and better postoperative care should be ensured. PMID:27648028

Cost-of-Illness Analysis of Type 2 Diabetes Mellitus in Iran

PubMed Central

Javanbakht, Mehdi; Baradaran, Hamid R.; Mashayekhi, Atefeh; Haghdoost, Ali Akbar; Khamseh, Mohammad E.; Kharazmi, Erfan; Sadeghi, Aboozar

2011-01-01

Introduction Diabetes is a worldwide high prevalence chronic progressive disease that poses a significant challenge to healthcare systems. The aim of this study is to provide a detailed economic burden of diagnosed type 2 diabetes mellitus (T2DM) and its complications in Iran in 2009 year. Methods This is a prevalence-based cost-of-illness study focusing on quantifying direct health care costs by bottom-up approach. Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, laboratory test, education and non-medical cost were collected from two national registries. The human capital approach was used to calculate indirect costs separately in male and female and also among different age groups. Results The total national cost of diagnosed T2DM in 2009 is estimated at 3.78 billion USA dollars (USD) including 2.04±0.28 billion direct (medical and non-medical) costs and indirect costs of 1.73 million. Average direct and indirect cost per capita was 842.6±102 and 864.8 USD respectively. Complications (48.9%) and drugs (23.8%) were main components of direct cost. The largest components of medical expenditures attributed to diabetes's complications are cardiovascular disease (42.3% of total Complications cost), nephropathy (23%) and ophthalmic complications (14%). Indirect costs include temporarily disability (335.7 million), permanent disability (452.4 million) and reduced productivity due to premature mortality (950.3 million). Conclusions T2DM is a costly disease in the Iran healthcare system and consume more than 8.69% of total health expenditure. In addition to these quantified costs, T2DM imposes high intangible costs on society in terms of reduced quality of life. Identification of effective new strategies for the control of diabetes and its complications is a public health priority. PMID:22066013

Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy.

PubMed

Fukuda, Yasunari; Yamamoto, Kazuyoshi; Hirao, Motohiro; Nishikawa, Kazuhiro; Nagatsuma, Yukiko; Nakayama, Tamaki; Tanikawa, Sugano; Maeda, Sakae; Uemura, Mamoru; Miyake, Masakazu; Hama, Naoki; Miyamoto, Atsushi; Ikeda, Masataka; Nakamori, Shoji; Sekimoto, Mitsugu; Fujitani, Kazumasa; Tsujinaka, Toshimasa

2016-07-01

Malignancy is a secondary cause of sarcopenia, which is associated with impaired cancer treatment outcomes. The aim of this study was to investigate the prevalence of preoperative sarcopenia among elderly gastric cancer patients undergoing gastrectomy and the differences in preoperative dietary intake and postoperative complications between sarcopenic and non-sarcopenic patients. Ninety-nine patients over 65 years of age who underwent gastrectomy for gastric cancer were analyzed. All patients underwent gait and handgrip strength testing, and whole-body skeletal muscle mass was measured using a bioimpedance analysis technique based on the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm for the evaluation of sarcopenia before surgery. Preoperative dietary intake was assessed using a food frequency questionnaire. Of these patients, 21 (21.2 %) were diagnosed with sarcopenia. Sarcopenic patients consumed fewer calories and less protein preoperatively (23.9 vs. 27.8 kcal/kg ideal weight/day and 0.86 vs. 1.04 g/kg ideal weight/day; P = 0.001 and 0.0005, respectively). Although the overall incidence of postoperative complications was similar in the two groups (57.1 % vs. 35.9 %; P = 0.08), the incidence of severe (Clavien-Dindo grade ≥ IIIa) complications was significantly higher in the sarcopenic group than in the non-sarcopenic group (28.6 % vs. 9.0 %; P = 0.029). In the multivariate analysis, sarcopenia alone was identified as a risk factor for severe postoperative complications (odds ratio, 4.76; 95 % confidence interval, 1.03-24.30; P = 0.046). Preoperative sarcopenia as defined by the EWGSOP algorithm is a risk factor for severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy.

Nano metal-organic framework (NMOF)-based strategies for multiplexed microRNA detection in solution and living cancer cells

NASA Astrophysics Data System (ADS)

Wu, Yafeng; Han, Jianyu; Xue, Peng; Xu, Rong; Kang, Yuejun

2015-01-01

MiRNAs are an emerging type of biomarker for diagnostics and prognostics. A reliable sensing strategy that can monitor miRNA expression in living cancer cells would be critical in view of its extensive advantages for fundamental research related to miRNA-associated bioprocesses and biomedical applications. Conventional miRNA sensing methods include northern blot, microarrays and real-time quantitative PCR. However, none of them is able to monitor miRNA levels expressed in living cancer cells in a real-time fashion. Some fluorescennt biosensors developed recently from carbon nanomaterials, such as single-walled carbon nanotubes (SWNTs), graphene oxide (GO), and carbon nanoparticles, have been successfully used for assaying miRNA in vitro; however the preparation processes are often expensive, complicated and time-consuming, which have motivated the research on other substitute and novel materials. Herein we present a novel sensing strategy based on peptide nucleic acid (PNA) probes labeled with fluorophores and conjugated with an NMOF vehicle to monitor multiplexed miRNAs in living cancer cells. The NMOF works as a fluorescence quencher of the labelled PNA that is firmly bound with the metal center. In the presence of a target miRNA, PNA is hybridized and released from the NMOF leading to the recovery of fluorescence. This miRNA sensor not only enables the quantitative and highly specific detection of multiplexed miRNAs in living cancer cells, but it also allows the precise and in situ monitoring of the spatiotemporal changes of miRNA expression.MiRNAs are an emerging type of biomarker for diagnostics and prognostics. A reliable sensing strategy that can monitor miRNA expression in living cancer cells would be critical in view of its extensive advantages for fundamental research related to miRNA-associated bioprocesses and biomedical applications. Conventional miRNA sensing methods include northern blot, microarrays and real-time quantitative PCR. However, none of them is able to monitor miRNA levels expressed in living cancer cells in a real-time fashion. Some fluorescennt biosensors developed recently from carbon nanomaterials, such as single-walled carbon nanotubes (SWNTs), graphene oxide (GO), and carbon nanoparticles, have been successfully used for assaying miRNA in vitro; however the preparation processes are often expensive, complicated and time-consuming, which have motivated the research on other substitute and novel materials. Herein we present a novel sensing strategy based on peptide nucleic acid (PNA) probes labeled with fluorophores and conjugated with an NMOF vehicle to monitor multiplexed miRNAs in living cancer cells. The NMOF works as a fluorescence quencher of the labelled PNA that is firmly bound with the metal center. In the presence of a target miRNA, PNA is hybridized and released from the NMOF leading to the recovery of fluorescence. This miRNA sensor not only enables the quantitative and highly specific detection of multiplexed miRNAs in living cancer cells, but it also allows the precise and in situ monitoring of the spatiotemporal changes of miRNA expression. Electronic supplementary information (ESI) available: Extra figures and tables. See DOI: 10.1039/c4nr05447d

Strategies to improve palatability and increase consumption intentions for Momordica charantia (bitter melon): A vegetable commonly used for diabetes management

PubMed Central

2011-01-01

Background Although beneficial to health, dietary phytonutrients are bitter, acid and/or astringent in taste and therefore reduce consumer choice and acceptance during food selection. Momordica charantia, commonly known as bitter melon has been traditionally used in Ayurvedic and Chinese medicine to treat diabetes and its complications. The aim of this study was to develop bitter melon-containing recipes and test their palatability and acceptability in healthy individuals for future clinical studies. Methods A cross-sectional sensory evaluation of bitter melon-containing ethnic recipes was conducted among 50 healthy individuals. The primary endpoints assessed in this analysis were current consumption information and future intentions to consume bitter melon, before and after provision of attribute- and health-specific information. A convenience sample of 50, self-reported non-diabetic adults were recruited from the University of Hawaii. Sensory evaluations were compared using two-way ANOVA, while differences in stage of change (SOC) before and after receiving health information were analyzed by Chi-square (χ2) analyses. Results Our studies indicate that tomato-based recipes were acceptable to most of the participants and readily acceptable, as compared with recipes containing spices such as curry powder. Health information did not have a significant effect on willingness to consume bitter melon, but positively affected the classification of SOC. Conclusions This study suggests that incorporating bitter foods in commonly consumed food dishes can mask bitter taste of bitter melon. Furthermore, providing positive health information can elicit a change in the intent to consume bitter melon-containing dishes despite mixed palatability results. PMID:21794176

Risks and opportunities for plastic surgeons in a widening cosmetic medicine market: future demand, consumer preferences, and trends in practitioners' services.

PubMed

D'Amico, Richard A; Saltz, Renato; Rohrich, Rod J; Kinney, Brian; Haeck, Phillip; Gold, Alan H; Singer, Robert; Jewell, Mark L; Eaves, Felmont

2008-05-01

The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery launched a joint Cosmetic Medicine Task Force to address the growing trend of non-plastic surgeons entering the cosmetic medicine field. The task force commissioned two surveys in 2007 to determine consumer attitudes about choosing cosmetic medicine providers and to learn about the cosmetic services that plastic surgeons offer. The first survey obtained responses from 1015 women who had undergone a cosmetic procedure or were considering having one within 2 years. The second survey obtained responses from 260 members of the two societies. Compared with other practitioners, plastic surgeons enjoy higher rates of satisfaction among their patients who undergo noninvasive procedures. Injectables present a particularly promising market for plastic surgeons. Half of consumers surveyed said they were very concerned about complications associated with injectables, and generally, the higher the perceived risk of the procedure, the higher the likelihood that a patient would choose a plastic surgeon to perform it. In addition, injectables were among the noninvasive treatments most frequently being considered by consumers. However, almost half of consumers said that if they had a positive experience with a non-plastic surgeon core provider for a noninvasive procedure, that physician would likely be their first choice for a surgical procedure. These findings suggest that plastic surgeons, and especially those who are building young practices, must expand their offerings of nonsurgical cosmetic services to remain at the core of the cosmetic medicine field.

Predictors of thrombotic complications and mass effect exacerbation after pipeline embolization: The significance of adenosine diphosphate inhibition, fluoroscopy time, and aneurysm size.

PubMed

Raychev, Radoslav; Tateshima, Satoshi; Vinuela, Fernando; Sayre, Jim; Jahan, Reza; Gonzalez, Nestor; Szeder, Viktor; Duckwiler, Gary

2016-02-01

The mechanisms leading to delayed rupture, distal emboli and intraparenchymal hemorrhage in relation to pipeline embolization device (PED) placement remain debatable and poorly understood. The aim of this study was to identify clinical and procedural predictors of these perioperative complications. We conducted a retrospective review of consecutive patients who underwent PED placement. We utilized a non-commercial platelet aggregation method measuring adenosine diphosphate (ADP)% inhibition for evaluation of clopidogrel response. To our knowledge, this is the first study to test ADP in neurovascular procedures. Multivariable regression analysis was used to identify the strongest predictor of three separate outcomes: (1) thrombotic complications, (2) hemorrhagic complications, and (3) aneurysm mass effect exacerbation Permanent complication-related morbidity and mortality at 3 months was 6% (3/48). No specific predictors of hemorrhagic complications were identified. In the univariate analysis, the strongest predictors of thrombotic complications were: ADP% inhibition<49 (p=0.01), aneurysm size (p=0.04) and fluoroscopy time (p=0.002). In the final multivariate analysis, among all baseline variables, fluoroscopy time exceeding 52 min was the only factor associated with thrombotic complications (p=0.007). Aneurysm size≥18 mm was the single predictor of mass effect exacerbation (p=0.039). Procedural complexity, reflected by fluoroscopy time, is the strongest predictor of thrombotic complications in this study. ADP% inhibition is a reliable method of testing clopidogrel response in neurovascular procedures and values of <50% may predict thrombotic complications. Interval mass effect exacerbation after PED placement may be anticipated in large aneurysms exceeding 18 mm. © The Author(s) 2015.

Drug Safety: Managing Multiple Drugs

MedlinePlus

... you take the right pill at the right time. Resources To learn more about your drugs, visit: • www.ConsumerReportsHealth.org/BestBuyDrugs • www.medlineplus.gov This series is produced by Consumers Union and Consumer Reports ...

Functional foods and the biomedicalisation of everyday life: a case of germinated brown rice.

PubMed

Kim, Hyomin

2013-07-01

Germinated brown rice (GBR) is a functional food, whose benefits for chronic diseases have been demonstrated by scientific research on a single constituent of GBR, gamma aminobutyric acid. This article examines the processes through which the emphasis on biomedical rationality made during the production and consumption of functional foods is embedded in the complicated social contexts of the post-1990s. In the case of GBR, the Korean government, food scientists, mass media and consumers have added cultural accounts to the biomedical understanding of foods. In particular, consumers have transformed their households and online communities into a place for surveillance medicine. Functional foods are embedded in multiple actors' perspectives on what healthy foods mean and how and where the risks of chronic diseases should be managed. © 2012 The Author. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Botanicals and Hepatotoxicity.

PubMed

Roytman, Marina M; Poerzgen, Peter; Navarro, Victor

2018-06-19

The use of botanicals, often in the form of multi-ingredient herbal dietary supplements (HDS), has grown tremendously in the past three decades despite their unproven efficacy. This is paralleled by an increase in dietary supplement-related health complications, notably hepatotoxicity. This article reviews the demographics and motivations of dietary supplement (DS) consumers and the regulatory framework for DS in the US and other developed countries. It examines in detail three groups of multi-ingredient HDS associated with hepatotoxicity: OxyElite Pro (two formulations), green tea extract-based DS, and "designer anabolic steroids." These examples illustrate the difficulties in identifying and adjudicating causality of suspect compound(s) of multi-ingredient HDS-associated liver injury in the clinical setting. The article outlines future directions for further study of HDS-associated hepatotoxicity as well as measures to safeguard the consumer against it. © 2018, The American Society for Clinical Pharmacology and Therapeutics.

Reducing food's environmental impacts through producers and consumers.

PubMed

Poore, J; Nemecek, T

2018-06-01

Food's environmental impacts are created by millions of diverse producers. To identify solutions that are effective under this heterogeneity, we consolidated data covering five environmental indicators; 38,700 farms; and 1600 processors, packaging types, and retailers. Impact can vary 50-fold among producers of the same product, creating substantial mitigation opportunities. However, mitigation is complicated by trade-offs, multiple ways for producers to achieve low impacts, and interactions throughout the supply chain. Producers have limits on how far they can reduce impacts. Most strikingly, impacts of the lowest-impact animal products typically exceed those of vegetable substitutes, providing new evidence for the importance of dietary change. Cumulatively, our findings support an approach where producers monitor their own impacts, flexibly meet environmental targets by choosing from multiple practices, and communicate their impacts to consumers. Copyright © 2018 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

Does direct-to-consumer advertising affect patients' choice of pain medications?

PubMed

Liu, Yifei; Doucette, William R

2008-04-01

In the United States, direct-to-consumer advertising (DTCA) has grown rapidly to promote prescription medications, including analgesics. Few studies in the literature directly examine the association between DTCA and patients' choice of pain medications. This article discusses how DTCA affects such choice from a behavioral perspective, because DTCA-prompted behaviors are important indicators of DTCA's influence. After DTCA exposure, patients may request prescriptions, seek further medication information, and ask about advertised conditions. Patients who suffer from pain may seek more communication with their health care providers because they are cautious about the information quality of DTCA, mainly because of the recall of rofecoxib (Vioxx; Merck, Whitehouse Station, NJ). However, the availability and DTCA of over-the-counter analgesics complicate their treatment choice. Patients could use DTCA as a tool to launch health communication and make an informed treatment choice with the guidance of their health care providers.

Front-of-pack nutrition labels. Their effect on attention and choices when consumers have varying goals and time constraints.

PubMed

van Herpen, Erica; Trijp, Hans C M van

2011-08-01

Although front-of-pack nutrition labeling can help consumers make healthier food choices, lack of attention to these labels limits their effectiveness. This study examines consumer attention to and use of three different nutrition labeling schemes (logo, multiple traffic-light label, and nutrition table) when they face different goals and resource constraints. To understand attention and processing of labels, various measures are used including self-reported use, recognition, and eye-tracking measures. Results of two experiments in different countries show that although consumers evaluate the nutrition table most positively, it receives little attention and does not stimulate healthy choices. Traffic-light labels and especially logos enhance healthy product choice, even when consumers are put under time pressure. Additionally, health goals of consumers increase attention to and use of nutrition labels, especially when these health goals concern specific nutrients. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Time profile of serum THC levels in occasional and chronic marihuana smokers after acute drog use - implication for drivind motor vehicles].

PubMed

Balíková, Marie; Hložek, Tomáš; Páleníček, Tomáš; Tylš, Filip; Viktorinová, Michaela; Melicher, Tomáš; Androvičová, Renáta; Tomíček, Pavel; Roman, Michal; Horáček, Jiří

2014-01-01

Cannabis consumption has individual influence to cognitive and psychomotor functions of drivers and it has been generally accepted that driving under influence is risky in the perspective of traffic safety. However, rules how to assess fitness to drive are not quite clear. The psychoactive compound delta-9-tetrahydrocannabinol (THC) impairs cognition, psychomotor behaviour and driving performance in a dose-related manner approximately. After a single drug dose, THC blood concentration peaks within minutes, before the end of smoking, with a subsequent rapid decrease to the analytical limit of detection. Peak euphoria is delayed compared to THC peak blood concentration and physiological and behavioural effects return to baseline within 3-5 hours. In chronic users, the lipophilic THC accumulates in fat tissues, where its slow redistribution into blood is the rate limiting process in its terminal elimination. In our experimental study we have attempted to contribute to this discussion with results obtained from human volunteers - cannabis consumers in Czech Republic. Aim of our study was to document the time profile of serum THC level in occasional and chronic cannabis users. The observational interval covered the time immediately after the drug consumption (an own cigarette/joint) till 24 hours after. Our preliminary results have shown that in occasional users, THC serum levels cannot be detected already 4 hours after usual cannabis dose, whereas in chronic users measurable THC concentrations in serum persist longer. Moreover, some chronic consumers were practically with permanent THC detection during our observation period and also the chronic users consumed higher THC doses significantly related to doses in occasional ones. Presented results of the experimental study with human volunteers confirm a great individual variability of the kinetic profile of THC in blood due to complicated redistribution. The practical forensic question is how long the psychotropic effects of THC can persist after the last drug dose. In chronic users there are well documented indications of long term adverse effects to neurocognitive functions. THC blood level itself can not directly document the intensity of impairment of a driver. Moreover, the concentration of THC in blood at the time of driving is probably substantially higher than at the time of blood sampling. Therefore due to the prevention of traffic risk, some countries adopted per se traffic legislation based on analytical principle with minimum tolerance to illegal drugs in blood of drivers at driving. Low blood concentrations of THC close to the limit of detection of a specific toxicological method (GC-MS or LC-MS) are justified in an effective traffic legislation.

Timed Stair Climbing is the Single Strongest Predictor of Perioperative Complications in Patients Undergoing Abdominal Surgery

PubMed Central

Reddy, Sushanth; Contreras, Carlo M; Singletary, Brandon; Bradford, T Miller; Waldrop, Mary G; Mims, Andrew H; Smedley, W Andrew; Swords, Jacob A; Thomas N, Wang; Martin J, Heslin

2016-01-01

Background Current methods to predict patients' peri-operative morbidity utilize complex algorithms with multiple clinical variables focusing primarily on organ-specific compromise. The aim of the present study is to determine the value of a timed stair climb (SC) in predicting peri-operative complications for patients undergoing abdominal surgery. Study Design From March 2014 to July 2015, 362 patients attempted SC while being timed prior to undergoing elective abdominal surgery. Vital signs were measured before and after SC. Ninety day post-operative complications were assessed by the Accordion Severity Grading System. The prognostic value of SC was compared to the ACS NSQIP risk calculator. Results A total of 264 (97.4%) patients were able to complete SC. SC time directly correlated to changes in both mean arterial pressure and heart rate as an indicator of stress. An Accordion grade 2 or higher complication occurred in 84 (25%) patients. There were 8 mortalities (2.4%). Patients with slower SC times had an increased complication rate (P<0.0001). In multivariable analysis SC time was the single strongest predictor of complications (OR=1.029, P<0.0001), and no other clinical co-morbidity reached statistical significance. Receiver operative characteristic curves predicting post-operative morbidity by SC time was superior to that of the ACS risk calculator (AUC 0.81 vs. 0.62, P<0.0001). Additionally slower patients had a greater deviation from predicted length of hospital stay (P=0.034) Conclusions SC provides measurable stress, accurately predicts post-operative complications, and is easy to administer in patients undergoing abdominal surgery. Larger patient populations with a diverse group of operations will be needed to further validate the use of SC in risk prediction models. PMID:26920993

A modification of incisionless otoplasty for correcting the prominent ear deformity.

PubMed

Haytoglu, Suheyl; Haytoglu, Tahir Gokhan; Yildirim, Ilhami; Arikan, Osman Kursat

2015-11-01

This article describes a modification of the incisionless otoplasty. We investigated the complication rates, recurrence risks, and patient satisfaction with this modified procedure. In total, 26 patients (49 ears) complaining of prominent ear were operated on. Auriculocephalic distances were measured at three different levels, pre-operatively, at the end of the surgery, and at 4 weeks and 6 months after surgery to evaluate the efficacy of the technique. Patient satisfaction was evaluated using a visual analog scale and the global aesthetic improvement scale was applied by an independent non-participating plastic surgeon at 6 months after the surgery. The mean loss of medialization was ~1 mm at 4 weeks after surgery and 2 mm at 6 months after surgery for all levels. According to visual analog scale, patient or parent satisfaction increased significantly. The global aesthetic improvement scale rated the patients as 93.9% "improved" and 6.1% as "no change." No rating was "worse." There are many advantages of this technique. The operation is not time-consuming, does not require a dressing, and it can be performed in adults with local anesthesia under office conditions, with no need for hospitalization. After the operation, patients can return to their daily activities immediately. It is associated with a low complication rate and high patient satisfaction. This technique is a good option for otoplasty in patients with isolated, inadequate development of anti-helical ridge, and with soft auricular cartilage.

Licorice abuse: time to send a warning message

PubMed Central

Komarova, Irina; El-Ghonemi, Mohamed; Fathy, Ahmed; Rashad, Rania; Abdelmalak, Hany D.; Yerramadha, Muralidhar Reddy; Ali, Yaseen; Helal, Engy; Camporesi, Enrico M.

2012-01-01

Licorice extract has always been recognized as a sweetener and a thirst quencher. Its nutritive value is overrated by many who consume significant amounts and are prone to complications. Glycyrrhetic acid, the active metabolite in licorice, inhibits the enzyme 11-ß-hydroxysteroid dehydrogenase enzyme type 2 with a resultant cortisol-induced mineralocorticoid effect and the tendency towards the elevation of sodium and reduction of potassium levels. This aldosterone-like action is the fundamental basis for understanding its health benefits and the wide spectrum of adverse effects. Herein, we present a comprehensive review of licorice along with the reported complications related to excess intake. Despite its apparent use in a few clinical scenarios, the daily consumption of licorice is never justified because its benefits are minor compared to the adverse outcomes of chronic consumption. The review highlights the importance of investigating the dietary habits and herbal remedies which are being used worldwide on cultural and habitual bases rather than reliable scientific evidence. Licorice is a US Food and Drug Administration (FDA) approved food supplement used in many products without precise regulations to prevent toxicity. Increased awareness among the public is required through TV commercials, newspapers, internet sites, magazines and product labels regarding the upper limit of ingestion and health hazards associated with excess intake. We hope that this review will serve as a warning message that should be transmitted from physicians to patients to avoid excessive licorice intake as well as a message to the FDA to start regulating the use of this substance. PMID:23185686

Consumption patterns of sweet drinks in a population of Australian children and adolescents (2003–2008)

PubMed Central

2012-01-01

Background Intake of sweet drinks has previously been associated with the development of overweight and obesity among children and adolescents. The present study aimed to assess the consumption pattern of sweet drinks in a population of children and adolescents in Victoria, Australia. Methods Data on 1,604 children and adolescents (4–18 years) from the comparison groups of two quasi-experimental intervention studies from Victoria, Australia were analysed. Sweet drink consumption (soft drink and fruit juice/cordial) was assessed as one day’s intake and typical intake over the last week or month at two time points between 2003 and 2008 (mean time between measurement: 2.2 years). Results Assessed using dietary recalls, more than 70% of the children and adolescents consumed sweet drinks, with no difference between age groups (p = 0.28). The median intake among consumers was 500 ml and almost a third consumed more than 750 ml per day. More children and adolescents consumed fruit juice/cordial (69%) than soft drink (33%) (p < 0.0001) and in larger volumes (median intake fruit juice/cordial: 500 ml and soft drink: 375 ml). Secular changes in sweet drink consumption were observed with a lower proportion of children and adolescents consuming sweet drinks at time 2 compared to time 1 (significant for age group 8 to <10 years, p = 0.001). Conclusion The proportion of Australian children and adolescents from the state of Victoria consuming sweet drinks has been stable or decreasing, although a high proportion of this sample consumed sweet drinks, especially fruit juice/cordial at both time points. PMID:22966937

12 CFR 222.24 - Reasonable opportunity to opt out.

Code of Federal Regulations, 2010 CFR

2010-01-01

... at an Internet Web site at which the consumer has obtained a product or service. The consumer... consumer at the time of an electronic transaction, such as a transaction conducted on an Internet Web site... one that allows consumers to indicate that they do not want to opt out. (5) By including in a privacy...

An overview of consumer attitudes and beliefs about plant food supplements.

PubMed

Egan, Bernadette; Hodgkins, Charo; Shepherd, Richard; Timotijevic, Lada; Raats, Monique

2011-12-01

The use of dietary supplements is increasing globally and this includes the use of plant food supplements (PFS). A variety of factors may be influencing this increased consumption including the increasing number of older people in society, mistrust in conventional medicine and the perception that natural is healthy. Consumer studies in this area are limited, with a focus on dietary supplements in general, and complicated by the use of certain plant food supplements as herbal medicines. Research indicates that higher use of dietary supplements has been associated with being female, being more educated, having a higher income, being white and being older, however the drivers for consumption of supplements are complex, being influenced by both demographic and health-related factors. The aim of this paper is to provide an overview of current knowledge about the users and the determinants of usage of plant food supplements. With growing consumption of these products, the need for effective risk-benefit assessment becomes ever more important and an insight into who uses these types of products and why is an important starting point for any future science-based decisions made by policy makers, PFS manufacturers and ultimately by consumers themselves.

Biopesticides--towards increased consumer safety in the European Union.

PubMed

Czaja, Katarzyna; Góralczyk, Katarzyna; Struciński, Paweł; Hernik, Agnieszka; Korcz, Wojciech; Minorczyk, Maria; Łyczewska, Monika; Ludwicki, Jan K

2015-01-01

The introduction of new food safety regulations in the European Union has resulted in the withdrawal of many synthetic active substances used in plant protection products, in light of their potential or actual harmful effect on human and animal health, as well as on the environment. Alternatives to these compounds are being developed - naturally occurring pesticides, also referred to as biopesticides. The use of biopesticides in crop protection leads to decreased levels of pesticide residues in foods, and as a result to lower risk levels for the consumer. Biologically active agents defined as biopesticides are varied, and therefore application of the same environmental and consumer safety criteria to all of them is impossible. This presents serious complications in the approval of these pesticides as active plant protection products and in their registration. It needs to be stressed that, in the registration procedure of the European Union, biopesticides are subject to the same regulations as synthetic active substances. This situation has resulted in the need to introduce numerous new provisions in the legislation, as well as the preparation of new guidelines facilitating the registration of biopesticides. These activities aim to promote naturally originating pesticides. © 2014 Society of Chemical Industry.

77 FR 6310 - Electronic Fund Transfers (Regulation E)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-07

... a one-time transfer or the first in a series of preauthorized transfers to occur more than 10 days... disclosures and receipts where a consumer schedules a one-time transfer or the first in a series of... where a consumer schedules a one-time transfer or the first in a series of preauthorized transfers to...

Techniques for efficient, real-time, 3D visualization of multi-modality cardiac data using consumer graphics hardware.

PubMed

Levin, David; Aladl, Usaf; Germano, Guido; Slomka, Piotr

2005-09-01

We exploit consumer graphics hardware to perform real-time processing and visualization of high-resolution, 4D cardiac data. We have implemented real-time, realistic volume rendering, interactive 4D motion segmentation of cardiac data, visualization of multi-modality cardiac data and 3D display of multiple series cardiac MRI. We show that an ATI Radeon 9700 Pro can render a 512x512x128 cardiac Computed Tomography (CT) study at 0.9 to 60 frames per second (fps) depending on rendering parameters and that 4D motion based segmentation can be performed in real-time. We conclude that real-time rendering and processing of cardiac data can be implemented on consumer graphics cards.

Dietary practices among individuals with diabetes and hypertension are similar to those of healthy people: a population-based study.

PubMed

Ozcariz, Silvia G I; Bernardo, Carla de O; Cembranel, Francieli; Peres, Marco A; González-Chica, David A

2015-05-10

Currently, diabetes mellitus (DM) and systemic arterial hypertension (SAH) are among the top five global risks for mortality. Among the modifiable factors, careful dietary practice is one of the essential elements for the control of NCDs, since these diseases are often the result of unhealthy lifestyles. Thus, this study aimed to assess the frequency of dietary practices among adult males and females with DM and/or SAH, and compare whether or not they are more frequent than in healthy adults, through a population-based study conducted in the city of Florianópolis, southern Brazil. Cross-sectional population-based study, using as exposure self-reported DM and/or SAH status. Dietary practices were assessed using a semiquantitative food consumption questionnaire. The following were considered as adequate: regular intake (≥ 6 times/week) of fruit and vegetables, daily intake of fruit (≥ 3 times/day) and vegetables (≥ 2 times/day), intake lower than 2 times/week of meat fat, fried foods, and soda. Bivariate and adjusted analysis for sociodemographic variables were conducted using Poisson regression, stratified by gender. Florianópolis, southern Brazil, 2009. Representative sample of 20 to 59 year-old adults (n=1720). A total of 16.6% participants were diagnosed with DM and/or SAH. The most frequently consumed unhealthy foods were fried food (51.0%, 95% CI: 48.8-53.5) and soda (57.9% 95%CI: 55.5-60.2). Of healthy foods, fruit was the less consumed on a daily basis (11.1% 95%CI 9.6-12.5). In general, women showed better dietary practices than men. In adjusted analysis none of dietary practices was more frequent among diabetic and/or hypertensive adults compared with healthy individuals, regardless of gender. No differences were found between healthy and unhealthy adults, when the number of dietary practices was assessed. The frequency of dietary practices was low and did not differ between individuals with or without DM and/or SAH. It is fundamental to reinforce the need of healthy dietary practices as one of the essential elements for the control of chronic diseases and their complications.

New screening methodology for selection of polymeric materials for transdermal drug delivery devices

NASA Astrophysics Data System (ADS)

Falcone, Roberto P.

As medical advances extend the human lifespan, the level of chronic illnesses will increase and thus straining the needs of the health care system that, as a result, governments will need to balance expenses without upsetting national budgets. Therefore, the selection of a precise and affordable drug delivery technology is seen as the most practical solution for governments, health care professionals, and consumers. Transdermal drug delivery patches (TDDP) are one of the best economical technologies that are favored by pharmaceutical companies and physicians alike because it offers fewer complications when compared to other delivery technologies. TDDP provides increased efficiency, safety and convenience for the patient. The TDDP segment within the US and Global drug delivery markets were valued at 5.6 and 12.7 billion respectively in 2009. TDDP is forecasted to reach $31.5 billion in 2015. The present TDDP technology involves the fabrication of a patch that consists of a drug embedded in a polymeric matrix. The diffusion coefficient is determined from the slope of the cumulative drug release versus time. It is a trial and error method that is time and labor consuming. With all the advantages that TDDPs can offer, the methodology used to achieve the so-called optimum design has resulted in several incidents where the safety and design have been put to question in recent times (e.g. Fentanyl). A more logical screening methodology is needed. This work shows the use of a modified Duda Zielinsky equation (DZE). Experimental release curves from commercial are evaluated. The experimental and theoretical Diffusion Coefficient values are found to be within the limits specified in the patent literature. One interesting finding is that the accuracy of the DZE is closer to experimental values when the type of Molecular Shape and Radius are used. This work shows that the modified DZE could be used as an excellent screening tool to determine the optimal polymeric matrices that will yield the desired Diffusion Coefficient and thus effectively decreasing the amount of time and labor when developing TDDPs.

Roles of PAD4 and NETosis in Experimental Atherosclerosis and Arterial Injury: Implications for Superficial Erosion.

PubMed

Franck, Grégory; Mawson, Thomas L; Folco, Eduardo J; Molinaro, Roberto; Ruvkun, Victoria; Engelbertsen, Daniel; Liu, Xin; Tesmenitsky, Yevgenia; Shvartz, Eugenia; Sukhova, Galina K; Michel, Jean-Baptiste; Nicoletti, Antonino; Lichtman, Andrew; Wagner, Denisa; Croce, Kevin J; Libby, Peter

2018-06-22

Neutrophils likely contribute to the thrombotic complications of human atheromata. In particular, neutrophil extracellular traps (NETs) could exacerbate local inflammation and amplify and propagate arterial intimal injury and thrombosis. PAD4 (peptidyl arginine deiminase 4) participates in NET formation, but an understanding of this enzyme's role in atherothrombosis remains scant. This study tested the hypothesis that PAD4 and NETs influence experimental atherogenesis and in processes implicated in superficial erosion, a form of plaque complication we previously associated with NETs. Bone marrow chimeric Ldlr deficient mice reconstituted with either wild-type or PAD4-deficient cells underwent studies that assessed atheroma formation or procedures designed to probe mechanisms related to superficial erosion. PAD4 deficiency neither retarded fatty streak formation nor reduced plaque size or inflammation in bone marrow chimeric mice that consumed an atherogenic diet. In contrast, either a PAD4 deficiency in bone marrow-derived cells or administration of DNaseI to disrupt NETs decreased the extent of arterial intimal injury in mice with arterial lesions tailored to recapitulate characteristics of human atheroma complicated by erosion. These results indicate that PAD4 from bone marrow-derived cells and NETs do not influence chronic experimental atherogenesis, but participate causally in acute thrombotic complications of intimal lesions that recapitulate features of superficial erosion. © 2018 American Heart Association, Inc.

[THE CONDITION AND TENDENCIES OF DEVELOPMENT OF CLINICAL AND SANITARY MICROBIOLOGY IN THE RUSSIAN FEDERATION AND PROBLEM OF IMPORT SUBSTITUTION].

PubMed

Dyatlov, I A; Mironov, A Yu; Shepelin, A P; Aleshkin, V A

2015-08-01

The import substitution becomes one of the strategic tasks of national economy as a result of prolongation of economic sanctions concerning the Russian Federation of part of the USA, EU countries, Japan and number of other countries. It is not proper to be limited in import substitution only by goods because in conditions ofsanctions when access toforeign technologies is complicated Russia is needed to substitute foreign technologies by national designs in faster manner One of directions of effective import substitution is localization of production of laboratory equipment and consumables for clinical and sanitary microbiology on the territory ofthe Russian Federation and countries of Customs union. In Russia, in the field ofdiagnostic of dangerous and socially significant infections, all components for import substitution to implement gene diagnostic, immune diagnostic. bio-sensory and biochip approaches, isolation and storage of live microbial cultures, implementation of high-tech methods of diagnostic are available. At the same time, national diagnostic instrument-making industry for microbiology is factually absent. The few devices of national production more than on 50% consist of import components. The microbiological laboratories are to be equipped only with import devices of open type for applying national components. The most perspective national designs to be implemented are multiplex polimerase chain reaction test-systems and biochips on the basis of national plotters and readers. The modern development of diagnostic equipment and diagnostic instruments requires supplement of national collections of bacterial and viral pathogens and working-through of organizational schemes of supplying collections with strains. The presented data concerning justification of nomenclature of laboratory equipment and consumables permits to satisfy in fill scope the needs of clinical and sanitary microbiology in devices, growth mediums, consumables of national production and to refuse import deliveries without decreasing quality of microbiological analysis. This approach will ensure appropriate response to occurring challenges and new biological dangers and maintenance of biosecurity of the Russian Federation at proper level.

Management of Proximal Hypospadias with 2-Stage Repair: 20 Year Experience

PubMed Central

McNamara, Erin R.; Schaeffer, Anthony J.; Logvinenko, Tanya; Seager, Catherine; Rosoklija, Ilina; Nelson, Caleb P.; Retik, Alan B.; Diamond, David A.; Cendron, Marc

2015-01-01

Purpose To describe our experience with 2-stage proximal hypospadias repair and report outcomes. To look at patient and procedure characteristics associated with surgical complications. Materials and Methods This was a retrospective study of patients with proximal hypospadias who underwent staged repair from January 1993–December 2012. Demographics, preoperative management, and operative technique were reviewed. Complications included glans dehiscence, fistula, meatal stenosis, non-meatal stricture, urethrocele/diverticula, and residual chordee. Cox proportional hazards model was used to evaluate the associations between the time to surgery for complications and patient- and procedure level factors. Results There were 134 patients. The median age at time of first stage surgery was 8.8 months. The median age at time of second stage surgery was 17.1 months and median time between surgeries was 8 months. The median follow-up was 3.8 years. Complications were seen in 71/134 (53%), the most common being fistula in 39/134 (29.1%). Reoperation was performed in 66/134 (49%) patients. Median time from urethroplasty to surgery for complication was 14.9 months. Use of preoperative testosterone decreased risk of having surgery for complication by 27% (hazard ratio (HR)=0.73 95%CI:0.55–0.98, p=0.04). In addition, patients that identified as Hispanic had an increased risk of having surgery for complications (HR=2.40 95%CI:1.28–4.53, p=0.01). Conclusions This study reviews the largest cohort of patients undergoing 2-stage hypospadias repair at a single institution. Complications and reoperation are close to 50% in the setting of complex genital reconstruction. PMID:25963188

Efficient high-rate satellite clock estimation for PPP ambiguity resolution using carrier-ranges.

PubMed

Chen, Hua; Jiang, Weiping; Ge, Maorong; Wickert, Jens; Schuh, Harald

2014-11-25

In order to catch up the short-term clock variation of GNSS satellites, clock corrections must be estimated and updated at a high-rate for Precise Point Positioning (PPP). This estimation is already very time-consuming for the GPS constellation only as a great number of ambiguities need to be simultaneously estimated. However, on the one hand better estimates are expected by including more stations, and on the other hand satellites from different GNSS systems must be processed integratively for a reliable multi-GNSS positioning service. To alleviate the heavy computational burden, epoch-differenced observations are always employed where ambiguities are eliminated. As the epoch-differenced method can only derive temporal clock changes which have to be aligned to the absolute clocks but always in a rather complicated way, in this paper, an efficient method for high-rate clock estimation is proposed using the concept of "carrier-range" realized by means of PPP with integer ambiguity resolution. Processing procedures for both post- and real-time processing are developed, respectively. The experimental validation shows that the computation time could be reduced to about one sixth of that of the existing methods for post-processing and less than 1 s for processing a single epoch of a network with about 200 stations in real-time mode after all ambiguities are fixed. This confirms that the proposed processing strategy will enable the high-rate clock estimation for future multi-GNSS networks in post-processing and possibly also in real-time mode.

Cognitive and mood improvements of caffeine in habitual consumers and habitual non-consumers of caffeine.

PubMed

Haskell, Crystal F; Kennedy, David O; Wesnes, Keith A; Scholey, Andrew B

2005-06-01

The cognitive and mood effects of caffeine are well documented. However, the majority of studies in this area involve caffeine-deprived, habitual caffeine users. It is therefore unclear whether any beneficial findings are due to the positive effects of caffeine or to the alleviation of caffeine withdrawal. The present placebo-controlled, double-blind, balanced crossover study investigated the acute cognitive and mood effects of caffeine in habitual users and habitual non-users of caffeine. Following overnight caffeine withdrawal, 24 habitual caffeine consumers (mean=217 mg/day) and 24 habitual non-consumers (20 mg/day) received a 150 ml drink containing either 75 or 150 mg of caffeine or a matching placebo, at intervals of > or =48 h. Cognitive and mood assessments were undertaken at baseline and 30 min post-drink. These included the Cognitive Drug Research computerised test battery, two serial subtraction tasks, a sentence verification task and subjective visual analogue mood scales. There were no baseline differences between the groups' mood or performance. Following caffeine, there were significant improvements in simple reaction time, digit vigilance reaction time, numeric working memory reaction time and sentence verification accuracy, irrespective of group. Self-rated mental fatigue was reduced and ratings of alertness were significantly improved by caffeine independent of group. There were also group effects for rapid visual information processing false alarms and spatial memory accuracy with habitual consumers outperforming non-consumers. There was a single significant interaction of group and treatment effects on jittery ratings. Separate analyses of each groups' responses to caffeine revealed overlapping but differential responses to caffeine. Caffeine tended to benefit consumers' mood more while improving performance more in the non-consumers. These results do not support a withdrawal alleviation model. Differences in the patterns of responses to caffeine by habitual consumers and habitual non-consumers may go some way to explaining why some individuals become caffeine consumers.

Seasonal reproduction leads to population collapse and an Allee effect in a stage-structured consumer-resource biomass model when mortality rate increases

PubMed Central

de Roos, André M.

2017-01-01

Many populations collapse suddenly when reaching low densities even if they have abundant food conditions, a phenomenon known as an Allee effect. Such collapses can have disastrous consequences, for example, for loss of biodiversity. In this paper, we formulate a stage-structured consumer-resource biomass model in which adults only reproduce at the beginning of each growing season, and investigate the effect of an increasing stage-independent background mortality rate of the consumer. As the main difference with previously studied continuous-time models, seasonal reproduction can result in an Allee effect and consumer population collapses at high consumer mortality rate. However, unlike the mechanisms reported in the literature, in our model the Allee effect results from the time difference between the maturation of juveniles and the reproduction of adults. The timing of maturation plays a crucial role because it not only determines the body size of the individuals at maturation but also influences the duration of the period during which adults can invest in reproductive energy, which together determine the reproductive output at the end of the season. We suggest that there exists an optimal timing of maturation and that consumer persistence is promoted if individuals mature later in the season at a larger body size, rather than maturing early, despite high food availability supporting rapid growth. PMID:29088273

Laparoendoscopic single site (LESS) cholecystectomy.

PubMed

Hodgett, Steven E; Hernandez, Jonathan M; Morton, Connor A; Ross, Sharona B; Albrink, Michael; Rosemurgy, Alexander S

2009-02-01

The journey from conventional "open" operations to truly "minimally invasive" operations naturally includes progression from operations involving multiple trocars and multiple incisions to operations involving access through the umbilicus alone. Laparoscopic operations through the umbilicus alone, laparoendoscopic single site surgery (LESS), offer improved cosmesis and hopes for less pain and improved recovery. This study was undertaken to evaluate our initial experience with LESS cholecystectomy and to compare our initial experience to concurrent outcomes with more conventional multiport, multi-incision laparoscopic cholecystectomy. All patients referred for cholecystectomy over a 6-month period were offered LESS. Outcomes, including blood loss, operative time, complications, and length of stay were recorded. Outcomes with our first LESS cholecystectomies were compared to an uncontrolled group of concurrent patients undergoing multiport, multi-incision laparoscopic cholecystectomy at the same hospital by the same surgeon. Twenty-nine patients of median age 50 years undergoing LESS cholecystectomy from November 2007 until May 2008 were compared to 29* patients, median age 48 years, undergoing standard multiport, multiple-incision laparoscopic cholecystectomy over the same time period. Median operative time for patients undergoing LESS cholecystectomy was 72 min and was not different from that of patients undergoing multiport, multi-incision laparoscopic cholecystectomy (p = 0.81). Median length of hospital stay was 1.0 day for patients undergoing LESS cholecystectomy and was not different from patients undergoing standard laparoscopic cholecystectomy (p = 0.46). Operative estimated blood loss was less than 100 cc for all patients. No patients undergoing attempted LESS cholecystectomy had conversions to "open" operations; two patients had an additional trocar(s) placed distant from the umbilicus to aid in exposure. Three patients undergoing LESS cholecystectomy had complications: two were troubled by pain control and another had urinary retention. LESS cholecystectomy is a safe and effective alternative to standard laparoscopic cholecystectomy. It can be undertaken without the expense of added operative time and provides patients with minimal, if any, apparent scarring. We believe LESS cholecystectomy will be driven by consumer demand, and therefore, laparoscopic surgeons will need to become proficient with LESS procedures.

Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research.

PubMed

Meißner, Anne; Schnepp, Wilfried

2014-06-20

Since the introduction of electronic nursing documentation systems, its implementation in recent years has increased rapidly in Germany. The objectives of such systems are to save time, to improve information handling and to improve quality. To integrate IT in the daily working processes, the employee is the pivotal element. Therefore it is important to understand nurses' experience with IT implementation. At present the literature shows a lack of understanding exploring staff experiences within the implementation process. A systematic review and meta-ethnographic synthesis of primary studies using qualitative methods was conducted in PubMed, CINAHL, and Cochrane. It adheres to the principles of the PRISMA statement. The studies were original, peer-reviewed articles from 2000 to 2013, focusing on computer-based nursing documentation in Residential Aged Care Facilities. The use of IT requires a different form of information processing. Some experience this new form of information processing as a benefit while others do not. The latter find it more difficult to enter data and this result in poor clinical documentation. Improvement in the quality of residents' records leads to an overall improvement in the quality of care. However, if the quality of those records is poor, some residents do not receive the necessary care. Furthermore, the length of time necessary to complete the documentation is a prominent theme within that process. Those who are more efficient with the electronic documentation demonstrate improved time management. For those who are less efficient with electronic documentation the information processing is perceived as time consuming. Normally, it is possible to experience benefits when using IT, but this depends on either promoting or hindering factors, e.g. ease of use and ability to use it, equipment availability and technical functionality, as well as attitude. In summary, the findings showed that members of staff experience IT as a benefit when it simplifies their daily working routines and as a burden when it complicates their working processes. Whether IT complicates or simplifies their routines depends on influencing factors. The line between benefit and burden is semipermeable. The experiences differ according to duties and responsibilities.

Beyond consumer-driven health care: purchasers' expectations of all plans.

PubMed

Lee, Peter V; Hoo, Emma

2006-01-01

Skyrocketing health care costs and quality deficits can only be addressed through a broad approach of quality-based benefit design. Consumer-directed health plans that are built around better consumer information tools and support hold the promise of consumer engagement, but purchasers expect these features in all types of health plans. Regardless of plan type, simply shifting costs to consumers is a threat to access and adherence to evidence-based medicine. Comparative and interactive consumer information tools, coupled with provider performance transparency and payment reform, are needed to advance accountability and support consumers in getting the right care at the right time.

Diabetes complications in youth: qualitative analysis of parents' perspectives of family learning and knowledge.

PubMed

Buckloh, Lisa M; Lochrie, Amanda S; Antal, Holly; Milkes, Amy; Canas, J Atilio; Hutchinson, Sally; Wysocki, Tim

2008-08-01

Youth with type 1 diabetes face long-term risks of health complications of the disease. Little is known about patients' and parents' knowledge, acquisition of information, and family communication regarding these complications. This paper reports qualitative analyses of parental focus-group discussions of this topic. A total of 47 participants (30 mothers, 14 fathers, and 3 others) representing 33 children between the ages of 8 and 18 years with type 1 diabetes participated in 1 of 13 focus groups. Open-ended questions focused on the type and amount of information about long-term complications presented to parents by health care professionals at different time points, as well as the way that information was presented. Questions also elicited details about parent-child communication and exposure to misconceptions about diabetes complications. Qualitative analysis of the transcribed focus groups revealed that participants experienced significant anxiety about diabetes complications, with a shift from concern about daily management tasks to concern about long-term complications over time. Participants desired a flexible, collaborative educational approach, especially regarding the timing and type of information, relative to the child's age and duration of diabetes. Many parents wanted more sensitive communication and emotional support from health care providers. Motivating children appeared to be a particular challenge; family burnout with regard to diabetes care over time was reported. Knowledge was gained in many ways, yet misinformation was uncommon. Obtaining information about long-term complications is an important process that changes over the course of the disease and with the child's developmental level. More research is needed, especially regarding youth knowledge, learning, and beliefs about diabetes complications.

Lung ultrasound compared with chest X-ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study.

PubMed

Touw, H R; Parlevliet, K L; Beerepoot, M; Schober, P; Vonk, A; Twisk, J W; Elbers, P W; Boer, C; Tuinman, P R

2018-03-12

Postoperative pulmonary complications are common after cardiothoracic surgery and are associated with adverse outcomes. The ability to detect postoperative pulmonary complications using chest X-rays is limited, and this technique requires radiation exposure. Little is known about the diagnostic accuracy of lung ultrasound for the detection of postoperative pulmonary complications after cardiothoracic surgery, and we therefore aimed to compare lung ultrasound with chest X-ray to detect postoperative pulmonary complications in this group of patients. We performed this prospective, observational, single-centre study in a tertiary intensive care unit treating adult patients who had undergone cardiothoracic surgery. We recorded chest X-ray findings upon admission and on postoperative days 2 and 3, as well as rates of postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications that required therapy according to the treating physician as part of their standard clinical practice. Lung ultrasound was performed by an independent researcher at the time of chest X-ray. We compared lung ultrasound with chest X-ray for the detection of postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications. We also assessed inter-observer agreement for lung ultrasound, and the time to perform both imaging techniques. Subgroup analyses were performed to compare the time to detection of clinically-relevant postoperative pulmonary complications by both modalities. We recruited a total of 177 patients in whom both lung ultrasound and chest X-ray imaging were performed. Lung ultrasound identified 159 (90%) postoperative pulmonary complications on the day of admission compared with 107 (61%) identified with chest X-ray (p < 0.001). Lung ultrasound identified 11 out of 17 patients (65%) and chest X-ray 7 out of 17 patients (41%) with clinically-relevant postoperative pulmonary complications (p < 0.001). The clinically-relevant postoperative pulmonary complications were detected earlier using lung ultrasound compared with chest X-ray (p = 0.024). Overall inter-observer agreement for lung ultrasound was excellent (κ = 0.907, p < 0.001). Following cardiothoracic surgery, lung ultrasound detected more postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications than chest X-ray, and at an earlier time-point. Our results suggest lung ultrasound may be used as the primary imaging technique to search for postoperative pulmonary complications after cardiothoracic surgery, and will enhance bedside decision making. © 2018 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.

Effects of Differentially Time-Consuming Tests on Computer-Adaptive Test Scores

ERIC Educational Resources Information Center

Bridgeman, Brent; Cline, Frederick

2004-01-01

Time limits on some computer-adaptive tests (CATs) are such that many examinees have difficulty finishing, and some examinees may be administered tests with more time-consuming items than others. Results from over 100,000 examinees suggested that about half of the examinees must guess on the final six questions of the analytical section of the…

Optimal Consumption When Consumption Takes Time

ERIC Educational Resources Information Center

Miller, Norman C.

2009-01-01

A classic article by Gary Becker (1965) showed that when it takes time to consume, the first order conditions for optimal consumption require the marginal rate of substitution between any two goods to equal their relative full costs. These include the direct money price and the money value of the time needed to consume each good. This important…

Stapler Esophageal Closure During Total Laryngectomy.

PubMed

Ismi, Onur; Unal, Murat; Vayisoglu, Yusuf; Yesilova, Mesut; Helvaci, Ilter; Gorur, Kemal; Ozcan, Cengiz

2017-01-01

Mechanical esophageal closure with stapler during total laryngectomy has been used by various authors to decrease the surgical time and pharyngocutaneous fistula (PCF) rates. In a few of the studies, surgical site infection (SSI) rates are mentioned and none of the studies emphasize the effect of decreased surgical time on postoperative cardiovascular and cerebrovascular complications. In this study, the authors compared the PCF rates, SSI rates, operation times between 30 mechanical stapler and 40 manual esophageal closure during total laryngectomy for laryngeal cancer patients. National Nasocomial Infections Surveillance system (NNISS) scores were recorded and compared between groups. Total laryngectomy and total operation times were lower in the stapler group patients (P < 0.001 for total laryngectomy time, P = 0.024 for total operation time). There were lower rates of pharyngocutaneous fistula (P = 0.032), surgical site infection (P = 0.019), and NNISS scores (P = 0.009) in the stapler group. There was no statistically significant difference between groups regarding postoperative systemic complications (P = 0.451). In conclusion, stapler esophageal closure decreases operation time, PCF, SSI rates, and NNISS scores but not the systemic complication rates. Comorbid illnesses and prolonged surgical time are risk factors for postoperative systemic complications in total laryngectomy patients, but patients with additional illnesses must not encourage the surgeon to use stapler for decreasing postoperative systemic complications.

A history of drug advertising: the evolving roles of consumers and consumer protection.

PubMed

Donohue, Julie

2006-01-01

Direct-to-consumer advertising (DTCA) of prescription drugs in the United States is controversial. Underlying the debate are disagreements over the role of consumers in medical decision making, the appropriateness of consumers engaging in self-diagnosis, and the ethics of an industry promoting potentially dangerous drugs. Drug advertising and federal policy governing drug advertising have both responded to and reinforced changes in the consumer's role in health care and in the doctor-patient relationship over time. This article discusses the history of DTCA in the context of social movements to secure rights for health care patients and consumers, the modern trend toward consumer-oriented medicine, and the implications of DTCA and consumer-oriented medicine for contemporary health policy debates about improving the health care system.

A History of Drug Advertising: The Evolving Roles of Consumers and Consumer Protection

PubMed Central

Donohue, Julie

2006-01-01

Direct-to-consumer advertising (DTCA) of prescription drugs in the United States is controversial. Underlying the debate are disagreements over the role of consumers in medical decision making, the appropriateness of consumers engaging in self-diagnosis, and the ethics of an industry promoting potentially dangerous drugs. Drug advertising and federal policy governing drug advertising have both responded to and reinforced changes in the consumer's role in health care and in the doctor-patient relationship over time. This article discusses the history of DTCA in the context of social movements to secure rights for health care patients and consumers, the modern trend toward consumer-oriented medicine, and the implications of DTCA and consumer-oriented medicine for contemporary health policy debates about improving the health care system. PMID:17096638

Endoscopic placement of double-J ureteric stents in children as a treatment for primary hydronephrosis.

PubMed

Pogorelić, Zenon; Brković, Tomislava; Budimir, Dražen; Todorić, Jakov; Košuljandić, Đurđica; Jerončić, Ana; Biočić, Mihovil; Saraga, Marijan

2017-06-01

The aim of this study was to determine the efficacy and potential complications of double-J ureteric stents in the treatment of primary hydronephrosis in pediatric patients. A retrospective case-records review of 133 patients (45 girls and 88 boys) treated because of primary hydronephrosis with double-J ureteric stents, in Department of Pediatric Surgery, Split University Hospital, between December 1997 and December 2014, was performed. Success of treatment, results of follow up investigations and complications were recorded. Patients were followed up clinically and radiologically for a minimum of 2 years following stent insertion. In all, 133 endoscopic double-J ureteric stents insertions were performed. Of the total number of patients, left-sided hydronephrosis was found in 82 patients, right-sided in 38, and bilateral in 13 patients. The median age of children was 2 years (range 0-17 years). Mean hospital stay was 2 days (range 1-10 days). In primary hydronephrosis, double-J ureteric stenting alone was effective with resolution of hydronephrosis in 73% of cases (97/133 insertions). Regarding the age of the patients the highest success of 83.5% was achieved in age group 0-4 years. Success in groups 5-9 years; 10-14 years and 15-17 years were 47%; 33.5% and 0%, respectively. Several complications have been recorded: symptomatic infections, migration in the renal pelvis and bladder, progression of hydronephrosis, spontaneously prolapse of prosthesis, bleeding and perforation of the renal pelvis. A significant, decreasing trend in success rates by age of participants was observed (p < 0.001). Ureteric stenting is minimally invasive procedure that provides an alternative to open surgery in patients with primary hydronephrosis. Endoscopic placement of ureteric double-J stents should be considered as a first-line treatment in the management of primary hydronephrosis especially in children till 4 years of age, with success rate of 83.5% and without the need for conventional surgery. In a case of failure we are time-consuming to definitive surgery.

Is It Safe to Provide Abortion Pills over the Counter? A Study on Outcome Following Self-Medication with Abortion Pills

PubMed Central

Nivedita, K.

2015-01-01

Background: Medical abortion is a safe method of termination of pregnancy when performed as per guidelines with a success rate of 92-97 %. But self-administration of abortion pills is rampant throughout the country due to over the counter availability of these drugs and complications are not uncommon due to this practice. The society perceives unsupervised medical abortion as a very safe method of termination and women use this as a method of spacing. Aim of the Study: The aim of this study was to study the implications of self-administration of abortion pills by pregnant women. Materials and Methods: Retrospective observational study done in Sri Manakula Vinayagar Medical College & Hospital between the period of July 2013 to June2014. Case sheets were analysed to obtain data regarding self-administration of abortion pills and complications secondary to its administration. The following data were collected. Age, marital status, parity, duration of pregnancy as perceived by the women, confirmation of pregnancy, duration between pill intake and visit to hospital, whether any intervention done elsewhere, any known medical or surgical complications, Hb level on admission, whether patient was in shock, USG findings, evidence of sepsis, blood transfusion, treatment given and duration of hospital stay. Descriptive analysis of the collected data was done. Results: Among the 128 cases of abortion in the study period, 40 (31.25%) patients had self-administered abortion pills. Among these 40 patients 27.5% had consumed abortion pills after the approved time period of 63 days of which 17.5% had consumed pills after 12 weeks of gestation. The most common presentation was excessive bleeding (77.5%) Severe anaemia was found in 12.5% of the patients and 5% of patients presented with shock. The outcome was as follows : 62.5% of the patients were found to have incomplete abortion, 22.5% had failed abortion and 7.5% of patients had incomplete abortion with sepsis. Surgical evacuation was performed in 67.5% of the patients whereas 12.5% of the patients required surgical evacuation with blood transfusion. Medical methods were used in 15% of the patients whereas 2.5% required transfusion along with medical methods. Conclusion: Unsupervised medical abortion can lead to increased maternal morbidity and mortality. To curtail this harmful practice, strict legislations are required to monitor and also to restrict the sales of abortion pills over the counter and access to abortion pills for the public should be only through centers approved for MTP. Large scale prospective studies are required to assess the actual magnitude of this problem. PMID:25738038

[Safety of reducing the recovery time after percutaneous and laparoscopic liver biopsy].

PubMed

Nodarse-Pérez, Pablo Orlando; Pérez-Menéndez, Roberto; Heredia-Andrade, Enkly Dennys; Noa-Pedroso, Guillermo; Araluce-Cordoví, Roberto; Fernández-Sotolongo, José

2016-01-01

Liver biopsy is the main diagnostic tool for the study of the liver, and as such, its inherent complications have been minimised as much as possible over the years, through the modification of several factors regarding its procedure, including post-biopsy recovery time. The aim of this study was to evaluate the safety in the reduction of post-liver biopsy recovery time. A non-blinded, randomised clinical trial was conducted in the "Hermanos Ameijeiras" Hospital from November 2011 to October 2012, on 128 patients in order to assess safety when reducing post-biopsy recovery times. The patients were randomised into 2 groups. Group A was allowed a 6-hour recovery time, while Group B was allowed a 2-hour recovery time after liver biopsy. Complications were fully recorded. The Chi squared test of homogeneity and Student t test was used as appropriate, in the statistical analysis, a significance level of 0.05 was set. The main biopsy indication was elevated plasma transaminases. Pain in the puncture site was the most recurrent complication (67.2%), and the most serious complication was subcapsular liver haematoma in two cases (1.6%). There were no differences regarding the liver biopsy technique that could have caused complications in any group. There were no significant differences between 2 hours and 6 hours post-liver biopsy recovery time in terms of complications, so it is considered that after two hours the patient is incorporated more quickly into their activities, and the institution spends less material and human resources. Copyright © 2016. Published by Masson Doyma México S.A.

Impact of operative length on post-operative complications in meningioma surgery: a NSQIP analysis.

PubMed

Karhade, Aditya V; Fandino, Luis; Gupta, Saksham; Cote, David J; Iorgulescu, Julian B; Broekman, Marike L; Aglio, Linda S; Dunn, Ian F; Smith, Timothy R

2017-01-01

Many studies have implicated operative length as a predictor of post-operative complications, including venous thromboembolism [deep vein thrombosis (DVT) and pulmonary embolism (PE)]. We analyzed the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2014, to evaluate whether length of operation had a statistically significant effect on post-operative complications in patients undergoing surgical resection of meningioma. Patients were included for this study if they had a post-operative diagnosis of meningioma. Patient demographics, pre-operative comorbidities, and post-operative 30-day complications were analyzed. Of 3743 patients undergoing craniotomy for meningioma, 13.6 % experienced any complication. The most common complications and their median time to occurrence were urinary tract infection (2.6 %) at 10 days postoperatively (IQR 7-15), unplanned intubation (2.5 %) at 3 days (IQR 1-7), failure to wean from ventilator (2.4 %) at 2.0 days (IQR 2-4), and DVT (2.4 %) at 6 days (IQR 11-19). Postoperatively, 3.6 % developed VTE; 2.4 % developed DVT and 1.7 % developed PE. Multivariable analysis identified older age (third and upper quartile), obesity, preoperative ventilator dependence, preoperative steroid use, anemia, and longer operative time as significant risk factors for VTE. Separate multivariable logistic regression models demonstrated longer operative time as a significant risk factor for VTE, all complications, major complications, and minor complications. Meningioma resection is associated with various post-operative complications that increase patient morbidity and mortality risk. this large, multi-institutional patient sample, longer operative length was associated with increased risk for postoperative venous thromboembolisms, as well as major and minor complications.

Healthy-unhealthy weight and time preference. Is there an association? An analysis through a consumer survey.

PubMed

Cavaliere, Alessia; De Marchi, Elisa; Banterle, Alessandro

2014-12-01

Individual time preference has been recognized as key driver in explaining consumers' probability to have a healthy weight or to incur excess weight problems. The term time preference refers to the rate at which a person is disposed to trade a current satisfaction for a future benefit. This characteristic may affect the extent at which individuals invest in health and may influence diet choices. The purpose of this paper is to analyse which could be the role of time preference (measured in terms of diet-related behaviours) in explaining consumers' healthy or unhealthy body weight. The analysis also considers other drivers predicted to influence BMI, specifically information searching, health-related activities and socio-demographic conditions. The survey was based on face-to-face interviews on a sample of 240 consumers living in Milan. In order to test the hypothesis, we performed a set of seven ORM regressions, all having consumers' BMI as the dependent variable. Each ORM contains a different block of explanatory variables, while time preference is always included among the regressors. The results suggest that the healthy weight condition is associated with a high orientation to the future, with a high interest in nutrition claims, a low attention to health-related claims, and a high level of education. On the opposite, the probability to be overweight or obese increases when consumers are less future-concerned and is associated with a low searching for nutrition claims and to a high interest in health claims. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Controlling diabetes mellitus and its complications in Medellín, Colombia, 2001-2003].

PubMed

Villegas Perrasse, Alberto; Abad, Sol Beatriz; Faciolince, Santiago; Hernández, Nayeli; Maya, Camilo; Parra, Lucrecia; Rivas, Edison; Vallejo, Pilar

2006-12-01

To identify the principal sociodemographic, clinical, and behavioral characteristics of patients participating in diabetic care programs in the city of Medellín, Colombia, and to evaluate progress toward the goal of metabolic control and diabetic care standards. A cross-sectional, descriptive study was done, analyzing the clinical records of patients who had been participating for at least 6 months in the diabetic care programs of nine health care centers in Medellín. The study period ran from January 2001 to December 2003. The following data were collected: sociodemographic (age and sex), clinical (time since disease onset, diabetes type and treatment, and concurrent illnesses and their treatment), lifestyle habits (exercise routine, smoking, and sugar and fat consumption), chronic complications, and laboratory test results from the prior year. Questionable or missing data were categorized as unavailable. Of the 3 583 clinical histories evaluated, we were able to confirm the form of diabetes for 3 554 patients. Of those 3 554, 95.1% had type 2 diabetes. Overall, 56.9% (95% confidence interval (95% CI): 55.2% to 58.6%) of the patients exercised regularly, 15.1% (95% CI: 13.9% to 16.3%) were current smokers, 17.7% (95% CI: 16.4% to 19.0%) were former smokers, and 67.2% (95% CI: 65.6% to 68.8%) had never smoked. In all, 21.0% (95% CI: 19.6% to 22.5%) of the patients consumed sugar regularly, while 24.8% (95% CI: 23.3% to 26.3%) consumed fats and only 19.5% (95% CI: 17.8% to 21.3%) were self-monitoring their glucose levels at least weekly. Among the type 2 diabetics, 68.8% had high blood pressure, and 98.2% had dyslipidemia. The average body mass index was 28.0 kg/m(2) (95% CI: 27.8 to 28.2). The average number of medications that the patients were taking to treat type 2 diabetes was 1.3; to treat high blood pressure, 1.9; and to treat dyslipidemia, 0.6. There were no data on low-density lipoprotein (LDL) cholesterol in 44.8% of the clinical records, and no data on high-density lipoprotein (HDL) cholesterol in 16.4% of the records. Among the complications, the most common were ocular ones (31.8%; 95% CI: 30.1% to 33.5%), followed by renal ones (25.9%; 95% CI: 24.4% to 27.5%), and cardiovascular ones (22.5%; 95% CI: 21.1% to 23.8%). Cholesterol control achievement was inadequate for LDL (reached by only 14.2% of the patients), for triglycerides (36.9% of patients), and HDL (47.4% of patients). Among the study population in Medellín, the three chronic complications with the greatest impact on prognosis and health care costs of the diabetics were nephropathy, retinopathy, and dyslipidemia. The noticeable amount of unavailable data in the clinical records could be greatly reduced by standardizing the clinical record forms and by periodic quality checks of the records themselves.

12 CFR 205.7 - Initial disclosures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... TRANSFERS (REGULATION E) § 205.7 Initial disclosures. (a) Timing of disclosures. A financial institution shall make the disclosures required by this section at the time a consumer contracts for an electronic fund transfer service or before the first electronic fund transfer is made involving the consumer's...

12 CFR 205.7 - Initial disclosures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... TRANSFERS (REGULATION E) § 205.7 Initial disclosures. (a) Timing of disclosures. A financial institution shall make the disclosures required by this section at the time a consumer contracts for an electronic fund transfer service or before the first electronic fund transfer is made involving the consumer's...

Gender, Parenthood and Wage Differences: The Importance of Time-Consuming Job Characteristics.

PubMed

Magnusson, Charlotta; Nermo, Magnus

2017-01-01

Using data from the Swedish Level of Living Survey (2000, 2010), we investigate how the gender wage gap varies with occupational prestige and family status and also examine the extent to which this gap is explained by time-consuming working conditions. In addition, we investigate whether there is an association between parenthood, job characteristics and wage (as differentiated by gender). The analyses indicate that there are gender differences regarding prestige-based pay-offs among parents that are partly explained by fathers' greater access to employment characterized by time-consuming conditions. Separate analyses for men and women demonstrate the presence of a marriage wage premium for both genders, although only men have a parenthood wage premium. This fatherhood premium is however only present in high-prestigious occupations. Compared with childless men, fathers are also more advantaged in terms of access to jobs with time-consuming working conditions, but the wage gap between fathers and childless men is not explained by differences in access to such working conditions.

12 CFR 1005.7 - Initial disclosures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... disclosures required by this section at the time a consumer contracts for an electronic fund transfer service or before the first electronic fund transfer is made involving the consumer's account. (b) Content of... Banks and Banking BUREAU OF CONSUMER FINANCIAL PROTECTION ELECTRONIC FUND TRANSFERS (REGULATION E...

Enhancing provision of written medicine information in Australia: pharmacist, general practitioner and consumer perceptions of the barriers and facilitators.

PubMed

Hamrosi, Kim K; Raynor, David K; Aslani, Parisa

2014-04-23

Written medicine information can play an important role in educating consumers about their medicines. In Australia, standardised, comprehensive written information known as Consumer Medicine Information (CMI) is available for all prescription medicines. CMI is reportedly under-utilised by general practitioners (GPs) and community pharmacists in consultations, despite consumer desire for medicine information. This study aimed to determine consumers', GPs' and community pharmacists' preferences for CMI provision and identify barriers and facilitators to its use. Structured questionnaires were developed and administered to a national sample of Australian consumers (phone survey), community pharmacists and GPs (postal surveys) surrounding utilisation of CMI. Descriptive and comparative analyses were conducted. Half of consumers surveyed wanted to receive CMI for their prescription medicine, with spoken information preferable to written medicine information for many consumers and healthcare professionals. GPs and pharmacists remained a preferred source of medicine information for consumers, although package inserts were appealing to many among all three cohorts. Overall pharmacists were the preferred provider of CMI primarily due to their medicine expertise, accessibility and perceived availability. GPs preferred CMI dissemination through both the GP and pharmacist. Some consumers preferred GPs as the provider of medicines information because of their knowledge of the patients' medicines and/or medical history, regularity of seeing the patient and good relationship with the patient. Common barriers to CMI provision cited included: time constraints, CMI length and perceptions that patients are not interested in receiving CMI. Facilitators to enhance provision included: strategies to increase consumer awareness, longer consultation times and counseling appointments, and improvements to pharmacy software technology and workflow. Medicine information is important to consumers, whether as spoken, written or a combination of both. A tailored approach is needed to ascertain individual patient preference for delivery and scope of medicine information desired so that appropriate information is provided. The barriers of time and perceived attitudes of healthcare practitioners present challenges which may be overcome through changes to workplace practices, adoption of identified facilitators, and education about the positive benefits of CMI as a tool to engage and empower patients.

Dark chocolate acceptability: influence of cocoa origin and processing conditions.

PubMed

Torres-Moreno, Miriam; Tarrega, Amparo; Costell, Elvira; Blanch, Consol

2012-01-30

Chocolate properties can vary depending on cocoa origin, composition and manufacturing procedure, which affect consumer acceptability. The aim of this work was to study the effect of two cocoa origins (Ghana and Ecuador) and two processing conditions (roasting time and conching time) on dark chocolate acceptability. Overall acceptability and acceptability for different attributes (colour, flavour, odour and texture) were evaluated by 95 consumers. Differences in acceptability among dark chocolates were mainly related to differences in flavour acceptability. The use of a long roasting time lowered chocolate acceptability in Ghanaian samples while it had no effect on acceptability of Ecuadorian chocolates. This response was observed for most consumers (two subgroups with different frequency consumption of dark chocolate). However, for a third group of consumers identified as distinguishers, the most acceptable dark chocolate samples were those produced with specific combinations of roasting time and conching time for each of the cocoa geographical origin considered. To produce dark chocolates from a single origin it is important to know the target market preferences and to select the appropriate roasting and conching conditions. Copyright © 2011 Society of Chemical Industry.

Safety of robotic prostatectomy over time: a national study of in-hospital injury.

PubMed

Chughtai, Bilal; Isaacs, Abby J; Mao, Jialin; Lee, Richard; Te, Alexis; Kaplan, Steven; Sedrakyan, Art

2015-02-01

To assess national trends of iatrogenic complications and associated burden of care among patients undergoing open and minimally invasive prostatectomy using a population-based cohort. Using the nationally representative cohort, we identified patients who were diagnosed with prostate cancer, and underwent prostatectomy during 2001 and 2011. We determined the risk of iatrogenic complication and length of stay (LOS) over time among open and minimally invasive surgery (MIS) patients. Hierarchical multivariable logistic regression was performed to assess the changes over time and elucidate independent predictors of iatrogenic complications. We identified 556,932 and 219,434 prostate cancer patients undergoing open and minimally invasive prostatectomy. We found that iatrogenic complications for MIS were less frequent in later years (years 09-11 vs. year 01-02 odds ratio (OR), 0.21; 95% confidence intervals (CI), 0.09-0.40). MIS was associated with higher risk of iatrogenic complications in early period (years 01-02 OR, 3.81; 95% CI, 1.72-8.41), but lower risk in late period (years 09-11 OR 0.72 95% CI 0.61-0.86). Patients who experienced iatrogenic complications tended to have longer LOS (Median: Open vs. MIS, 4 days vs. 3 day) than those who didn't (Median: Open vs. MIS, 2 days vs. 1 day), regardless of procedure type. We found that minimally invasive prostatectomy is associated with lower risk of iatrogenic complications when compared with open surgery (OS). However, as "learning curve" is overcome over time, MIS becomes safer than OS. Iatrogenic complications are not benign and seem to be associated with higher burden of inpatient care.

[Evaluation of the burden of diabetes in Poland].

PubMed

Kissimova-Skarbek, K; Pach, D; Płaczkiewicz, E; Szurkowska, M; Szybiński, Z

2001-09-01

Burden of diabetes in terms of economic costs and life years lost due to premature deaths and disability in Poland is analyzed. This study calculates direct costs of type 1 and type 2 diabetes in Poland in 1998 and burden of diabetes in terms of years of life lost using Disability Adjusted Life Years (DALYs) measure within the Polish Multicenter Study of Diabetes Epidemiology (1998-1999). There is a consequent need to evaluate the burden of diabetes for the society and to develop affordable and cost-effective preventing strategies. The burden of diabetes is examined in terms of resources used by diabetic patients and time lost due to premature deaths and disability caused by diabetes. The profile of "a standard patient" (type 1 and type 2 diabetes) resource utilization is created using patient survey in Krakow. This includes main elements of cost associated with prevention, diagnosis and treatment: ambulatory care (visits); hospital care (bed/days and dialysis sessions); pharmaceuticals (goods consumed) and diagnosis (tests). This study calculates direct costs to the health sector of type 1 and type 2 diabetes in Poland 1998. Burden of diabetes in Poland in terms of time lost in 1998 is expressed in Disability Adjusted Life Years (DALYs) unit of measurement. DALY is a combination of two dimensions: YLL--number of years lost due to premature mortality; YLD--loss of healthy years due to disability caused by diabetes (with and without complications). The incidence approach is applied for the YLD caused by diabetes type 1 calculations by gender and age groups (0-29 years). Incidence rates are obtained from the prospective data collection [1, 2]. Other data as average age of onset, average duration of the disease (with or without complications), severity (age specific disability weight for treated or untreated forms of diabetes--with or without complications) are obtained from the GBD study for the Formerly Socialist Economies of Europe [9]. Discounting and age weighting procedure is applied. The prevalence approach is applied for YLD caused by diabetes type 2 calculations for treated and untreated forms of diabetes (with and without complications) by gender and age groups (35 years and more). Prevalence data are obtained from the Polish Multicenter Study on Diabetes Epidemiology. Age specific disability weights for treated or untreated forms of diabetes (with or without complication) are obtained from the GBD study for the Formerly Socialist Economies. Discounting procedure is not applied (duration of the disease is assumed 1 year). Years of Life Lost are calculated using Polish mortality data and life expectancy at the time of death in 1998. Cost of diabetes study is particularly useful in indicating the magnitude of the costs involved, which tend to be much higher than perceived by the general public. In 1998 the average diabetes type 1 patient's costs were 6.4 times and diabetes type 2 patient's costs 3 times higher than average public direct health care costs. The total costs of diabetes in Poland 1998 accounted for 9.3% of total public health care expenditures. The cost of diabetic patient's estimation indicates the potential benefits of effective medical interventions. Not only mortality rates should be taken into consideration in the creation of health policy and financial planning. Disability of the population is also an important factor, particularly in diseases which do not lead to fatalities. In 1998 112,584 DALYs (46% for males and 54% for females) were lost in Poland due to premature deaths and disability caused by diabetes. 72% of the total was due to disability. Secondary prevention is very important especially for diabetes type 2 patients. 95% of total time lost due to disability is caused by diabetes type 2. National burden of disease evaluation is helpful to develop a justifiable basis for setting priorities in purchasing and investing at central and local levels especially in prevention.

Risk factors for complications in donors at first and repeat whole blood donation: a cohort study with assessment of the impact on donor return.

PubMed

Wiersum-Osselton, Johanna C; Marijt-van der Kreek, Tanneke; Brand, Anneke; Veldhuizen, Ingrid; van der Bom, Johanna G; de Kort, Wim

2014-01-01

First-time donation is among recognised risk factors for vasovagal reactions to blood donation and reactions are known to reduce donor return. We assessed associations between potential risk factors and vasovagal reactions and needle-related complications in first-time whole blood donation in comparison to repeat donation and analysed the impact of complications on donor return. We performed a cohort study on whole blood donations in The Netherlands from 1/1/2010 to 31/12/2010 using data extracted from the blood service information system. Donation data up to 31/12/2011 were used to ascertain donor return. In 2010 28,786 donors made first whole blood donations and there were 522,958 repeat donations. Vasovagal reactions occurred in 3.9% of first donations by males and 3.5% of first donations by females compared to in 0.2% and 0.6%, respectively, of repeat donations. Associations of vasovagal reactions with other factors including age, body weight, systolic and diastolic blood pressure were similar in first-time and repeat donors. Needle-related complications occurred in 0.2% of male and 0.5% of female first-time donations and in 0.1% and 0.3%, respectively, of repeat donations. Among first-time donors, the return rate within 1 year was 82% following an uncomplicated first donation, but 55% and 61% following vasovagal reactions and needle-related complications, respectively; the corresponding percentages among repeat donors were 86%, 58% and 82%. Among first-time donors, females suffered less than males from vasovagal reactions. Other risk factors had similar associations among first-time and repeat donors. Vasovagal reactions and needle-related complications in both first-time and repeat donors are followed by reduced donor return.

Association of surgical approach with complication rate, progression-free survival time, and disease-specific survival time in cats with mammary adenocarcinoma: 107 cases (1991-2014).

PubMed

Gemignani, Francesco; Mayhew, Philipp D; Giuffrida, Michelle A; Palaigos, Jason; Runge, Jeffrey J; Holt, David E; Robertson, Nicholas A; Seguin, Bernard; Walker, Meaghan; Singh, Ameet; Liptak, Julius M; Romanelli, Giorgio; Martano, Marina; Boston, Sarah E; Lux, Cassie; Busetto, Roberto; Culp, William T N; Skorupski, Katherine A; Burton, Jenna H

2018-06-01

OBJECTIVE To evaluate potential associations between surgical approach and complication rate, progression-free survival time, and disease-specific survival time in cats with mammary adenocarcinoma. DESIGN Retrospective case series. ANIMALS 107 client-owned cats. PROCEDURES Medical records of cats that underwent surgical excision of mammary adenocarcinoma by means of a unilateral or bilateral (staged or single-session) mastectomy at 9 hospitals between 1991 and 2014 were reviewed. Relevant clinicopathologic data and details of surgical and adjuvant treatments were recorded. Outcome data were obtained, including postoperative complications, progression-free survival time, and disease-specific survival time. RESULTS Complications occurred in 12 of 61 (19.7%) cats treated with unilateral mastectomy, 5 of 14 (35.7%) cats treated with staged bilateral mastectomy, and 13 of 32 (40.6%) cats treated with single-session bilateral mastectomy. Complications were significantly more likely to occur in cats undergoing bilateral versus unilateral mastectomy. Median progression-free survival time was longer for cats treated with bilateral mastectomy (542 days) than for cats treated with unilateral mastectomy (289 days). Significant risk factors for disease progression included unilateral mastectomy, tumor ulceration, lymph node metastasis, and tumors arising in the fourth mammary gland. Significant risk factors for disease-specific death included lymph node metastasis and development of regional or distant metastasis. Among cats that did not develop metastasis, unilateral mastectomy was a significant risk factor for disease-specific death. Treatment with chemotherapy was associated with a significantly decreased risk of disease-specific death. CONCLUSIONS AND CLINICAL RELEVANCE Results supported bilateral mastectomy for the treatment of mammary adenocarcinoma in cats to improve progression-free and disease-specific survival time. Performing bilateral mastectomy in a staged fashion may help to decrease the complication rate.

Consumer-based technology for distribution of surgical videos for objective evaluation.

PubMed

Gonzalez, Ray; Martinez, Jose M; Lo Menzo, Emanuele; Iglesias, Alberto R; Ro, Charles Y; Madan, Atul K

2012-08-01

The Global Operative Assessment of Laparoscopic Skill (GOALS) is one validated metric utilized to grade laparoscopic skills and has been utilized to score recorded operative videos. To facilitate easier viewing of these recorded videos, we are developing novel techniques to enable surgeons to view these videos. The objective of this study is to determine the feasibility of utilizing widespread current consumer-based technology to assist in distributing appropriate videos for objective evaluation. Videos from residents were recorded via a direct connection from the camera processor via an S-video output via a cable into a hub to connect to a standard laptop computer via a universal serial bus (USB) port. A standard consumer-based video editing program was utilized to capture the video and record in appropriate format. We utilized mp4 format, and depending on the size of the file, the videos were scaled down (compressed), their format changed (using a standard video editing program), or sliced into multiple videos. Standard available consumer-based programs were utilized to convert the video into a more appropriate format for handheld personal digital assistants. In addition, the videos were uploaded to a social networking website and video sharing websites. Recorded cases of laparoscopic cholecystectomy in a porcine model were utilized. Compression was required for all formats. All formats were accessed from home computers, work computers, and iPhones without difficulty. Qualitative analyses by four surgeons demonstrated appropriate quality to grade for these formats. Our preliminary results show promise that, utilizing consumer-based technology, videos can be easily distributed to surgeons to grade via GOALS via various methods. Easy accessibility may help make evaluation of resident videos less complicated and cumbersome.

Summary of Utility Studies: Smart Grid Investment Grant Consumer Behavior Study Analysis

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

Cappers, Peter; Todd, Annika; Goldamn, Charles A.

2013-05-01

The U.S. Department of Energy’s (DOE’s) Smart Grid Investment Grant (SGIG) program is working with a subset of the 99 SGIG projects to assess the response of mass market consumers (i.e., residential and small commercial customers) to time-varying electricity prices (referred to herein as time-based rate programs) in conjunction with the deployment of advanced metering infrastructure (AMI) and associated technologies. The effort provides an opportunity to advance the electric industry’s understanding of consumer behavior. In addition, DOE is attempting to apply a consistent study design and analysis framework for the SGIG Consumer Behavior Studies (CBS). The aim is to collectmore » information across the studies on variables and impacts that have been defined in a consistent manner. This will enable Lawrence Berkeley National Lab (LBNL), as DOE’s principal investigator for these Consumer Behavior Studies, to leverage the data from the individual studies and conduct comparative analysis of the impacts of AMI, time-based rate programs and enabling technologies that facilitate customer control, automation and information/feedback on customer energy usage.« less

Piracy in cyber space: consumer complicity, pirates and enterprise enforcement

NASA Astrophysics Data System (ADS)

Chaudhry, Peggy E.; Chaudhry, Sohail S.; Stumpf, Stephen A.; Sudler, Hasshi

2011-05-01

This article presents an overview of the growth of internet piracy in the global marketplace. The ethical perceptions (or lack of) of the younger generation is addressed, in terms of their willingness to consume counterfeit goods on the web. Firms face the task of educating the consumer that downloading music, software, movies and the like, without compensation, is unethical. This awareness is critical for decreasing the demand for counterfeit goods in the virtual marketplace, where a consumer can exhibit a rogue behaviour with a limited fear of prosecution. We address the pyramid of internet piracy, which encompasses sophisticated suppliers/facilitators, such as the Warez group. Recent sting operations, such as Operation Buccaneer, are also depicted to highlight successful tactical manoeuvres of enforcement agencies. An overview of the Digital Millennium Copyright Act and the No Electronic Theft Act is included to debate the controversy surrounding this legislation. A discussion of enterprise enforcement mechanisms and novel anti-piracy technology for cyberspace is provided to reveal some of the tools used to fight the pirates, such as innovations in digital watermarking and NEC's recently announced video content identification technology. Enterprise information systems and its interdependence on the internet are also demanding new technologies that enable internet investigators to rapidly search, verify and potentially remove pirated content using web services. The quality of service of web services designed to efficiently detect pirated content is a growing consideration for new anti-piracy technology.

Calibration of Attenuation Structure in Eurasia to Improve Discrimination and Yield

DTIC Science & Technology

2010-09-01

and travel-times over large and tectonically complicated regions. As a result regional discrimination methods (e.g., high-frequency P/S, Ms:mb) and...a poor job of predicting both regional amplitudes and travel-times over large and tectonically complicated regions. As a result regional...regions. Earthquake-explosion discrimination using high-frequency regional P/S amplitude ratios over large and tectonically complicated regions can only

The attitude-behavior relationship in consumer conduct: the role of norms, past behavior, and self-identity.

PubMed

Smith, Joanne R; Terry, Deborah J; Manstead, Antony S R; Louis, Winnifred R; Kotterman, Diana; Wolfs, Jacqueline

2008-06-01

The authors used a revised planned behavior model in the consumer domain. The revised model incorporated separate measures of descriptive and injunctive/ prescriptive norms, self-identity, and past behavior in an effort to improve the predictive power of the theory of planned behavior (TPB; I. Ajzen, 1985) in relation to a self-reported consumer behavior: purchasing one's preferred soft drink. At Time 1, respondents (N = 112) completed self-report measures of (a) attitudes, (b) perceived behavioral control, (c) descriptive and injunctive/prescriptive norms, (d) self-identity, (e) past behavior, and (f) intentions. The authors assessed self-reported behavior 1 week later (Time 2). Attitudes, injunctive/prescriptive norms, descriptive norms, past behavior, and self-identity were all positively related to purchase intentions, and intentions were predictive of self-reported behavior at Time 2. These findings highlight the utility of the TPB in the consumer domain.

Differential responsiveness to caffeine and perceived effects of caffeine in moderate and high regular caffeine consumers.

PubMed

Attwood, A S; Higgs, S; Terry, P

2007-03-01

Individual differences in responsiveness to caffeine occur even within a caffeine-consuming population, but the factors that mediate differential responsiveness remain unclear. To compare caffeine's effects on performance and mood in a group of high vs moderate consumers of caffeine and to examine the potential role of subjective awareness of the effects of caffeine in mediating any differential responsiveness. Two groups of regular caffeine consumers (<200 mg/day and >200 mg/day) attended two sessions at which mood and cognitive functions were measured before and 30 min after consumption of 400-mg caffeine or placebo in a capsule. Cognitive tests included visual information processing, match-to-sample visual search (MTS) and simple and choice reaction times. Post-session questionnaires asked participants to describe any perceived effect of capsule consumption. High consumers, but not moderate consumers, demonstrated significantly faster simple and choice reaction times after caffeine relative to placebo. These effects were not attributable to obvious group differences in withdrawal or tolerance because there were no group differences in baseline mood or in reports of negative affect after caffeine. Instead, the high consumers were more likely to report experiencing positive effects of caffeine, whereas the moderate consumers were more likely to report no effect. The sensitivity of caffeine consumers to the mood- and performance-enhancing effects of caffeine is related to their levels of habitual intake. High caffeine consumers are more likely than moderate consumers to perceive broadly positive effects of caffeine, and this may contribute to their levels of use.

The multiplicative effect of combining alcohol with energy drinks on adolescent gambling.

PubMed

Vieno, Alessio; Canale, Natale; Potente, Roberta; Scalese, Marco; Griffiths, Mark D; Molinaro, Sabrina

2018-07-01

There has been increased concern about the negative effects of adolescents consuming a combination of alcohol mixed with energy drinks (AmED). To date, few studies have focused on AmED use and gambling. The present study analyzed the multiplicative effect of AmED consumption, compared to alcohol alone, on the likelihood of at-risk or problem gambling during adolescence. Data from the ESPAD®Italia 2015 study, a cross-sectional survey conducted in a nationally representative sample of students (ages 15 to 19years) were used to examine the association between self-reported AmED use (≥6 times,≥10 times, and ≥20 times during the last month) and self-reported gambling severity. Multivariate models were used to calculate adjusted prevalence ratios to evaluate the association between alcohol use, AmED use, and gambling among a representative sample of adolescents who reported gambling in the last year and completed a gambling severity scale (n=4495). Among the 19% students classed as at-risk and problem gamblers, 43.9% were classed as AmED consumers, while 23.6% were classed as alcohol consumers (i.e. did not mix alcohol with energy drinks). In multivariate analyses that controlled for covariates, AmED consumers were three times more likely to be at-risk and problem gamblers (OR=3.05) compared to non-consuming adolescents, while the effect became less pronounced with considering those who consumed alcohol without the addition of energy drinks (OR=1.37). The present study clearly established that consuming AmED might pose a significantly greater risk of experiencing gambling-related problems among adolescents. Copyright © 2018 Elsevier Ltd. All rights reserved.

Family Consumer Behaviors, Adolescent Prediabetes and Diabetes in the National Health and Nutrition Examination Survey (2007-2010).

PubMed

Nagarajan, Sairaman; Khokhar, Aditi; Holmes, Danielle Sweetnam; Chandwani, Sheenu

2017-01-01

Prediabetes or diabetes (characterized by hemoglobin A1c [HbA1c] levels ≥ 5.7 gm%) has been associated with numerous long-term complications. Family consumer behaviors are important risk factors that lead to impaired glucose tolerance or diabetes. However, few studies have studied the association between the family consumer environment and prediabetes and diabetes in adolescents. The aim of this study was to examine the association between family consumer behaviors (healthy food availability and supermarket spending) and adolescent prediabetes and diabetes (ClinicalTrials.gov identifier #NCT03136289.) Methods: Data from a nationwide survey conducted by the Centers for Disease Control and Prevention (National Health and Nutrition Examination Survey [NHANES] 2007-2010 data) were used for these analyses. Adolescents aged 12-19 years were selected for this study. Bivariate analyses and logistic regression models assessed the relationship between family consumer behaviors and the prevalence of adolescent prediabetes and diabetes. Multivariable models adjusted for age, gender, ethnicity, physical activity, education, income, and household size. A total of 2520 adolescents were eligible for this study. Adolescents with healthier household food availability had negative odds (odds ratio [OR] = 0.74, 95% confidence interval [CI], 0.55-1.00), as did higher log supermarket spending (OR = 0.69; 95% CI, 0.57-0.85). Interaction models demonstrated that adolescent females had more negative odds of prediabetes/diabetes for both healthier food availability (OR = 0.79, 95% CI, 0.39-1.29) and for greater log supermarket spending (OR = 0.69, 95% CI, 0.57-0.85). This study shows that both healthy food availability and an increase in supermarket spending were associated with a decreased adjusted prevalence of prediabetes and diabetes in adolescents, with a greater effect in females. These results suggest the need for policy and dietary interventions targeting the consumer environment.

Health care costs: the other point of view.

PubMed

Beck, D F; Dempsey, J

1990-12-01

Health care delivery in America is not efficient. Hospitals are not efficient and many are still wasteful. Some of the most blatant wastes in hospitals are staffing patterns that developed during the years of cost reports. Spending patterns become the norm, rather than excess, when they continue unabated for years. There are many reasons for cost increases in health care and specifically in hospitals. However, it is difficult to make these reasons add up to the total cost increase. No one has the answers; observation can only be made of what has been occurring and what continues to occur. Whatever the reason for the increase in health care costs, the consumer will bear the burden because of the circular flow of income and expenditures between the business sector and the household sector. Increased health care costs are passed on to the consumer in the form of increased expenditures for household goods and services or taxes. Ford Motor Company President Mr. Peterson says that $1,500 of every new automobile represents employee health care costs. The American consumer created the demand for health care services, and only the consumer can control the demand. One solution would be to let the consumer bear health care costs directly and remove the inefficiencies created by third party insurance carriers. This hypothesizes that the health care consumer is the most efficient shopper for health care services, and that third party insurance carriers are an important source of inefficiency in the health care delivery system. Many other solutions have been proposed by the government and by the insurance and health care industries, but most have only increased the cost of health care. Perhaps some day the health care industry will learn how to control the dynamics of this four-party purchasing decision. Until then, costs will continue to grow dramatically, and the executives of the industries who compete in the two-party purchasing system will wonder why the process is so complicated.

Mathematical imaging methods for mitosis analysis in live-cell phase contrast microscopy.

PubMed

Grah, Joana Sarah; Harrington, Jennifer Alison; Koh, Siang Boon; Pike, Jeremy Andrew; Schreiner, Alexander; Burger, Martin; Schönlieb, Carola-Bibiane; Reichelt, Stefanie

2017-02-15

In this paper we propose a workflow to detect and track mitotic cells in time-lapse microscopy image sequences. In order to avoid the requirement for cell lines expressing fluorescent markers and the associated phototoxicity, phase contrast microscopy is often preferred over fluorescence microscopy in live-cell imaging. However, common specific image characteristics complicate image processing and impede use of standard methods. Nevertheless, automated analysis is desirable due to manual analysis being subjective, biased and extremely time-consuming for large data sets. Here, we present the following workflow based on mathematical imaging methods. In the first step, mitosis detection is performed by means of the circular Hough transform. The obtained circular contour subsequently serves as an initialisation for the tracking algorithm based on variational methods. It is sub-divided into two parts: in order to determine the beginning of the whole mitosis cycle, a backwards tracking procedure is performed. After that, the cell is tracked forwards in time until the end of mitosis. As a result, the average of mitosis duration and ratios of different cell fates (cell death, no division, division into two or more daughter cells) can be measured and statistics on cell morphologies can be obtained. All of the tools are featured in the user-friendly MATLAB®Graphical User Interface MitosisAnalyser. Copyright © 2017. Published by Elsevier Inc.

Resonance Rayleigh scattering method for determination of 2-mercaptobenzothiazole using gold nanoparticles probe.

PubMed

Parham, Hooshang; Pourreza, Nahid; Marahel, Farzaneh

2015-01-01

A sensitive, simple and novel method was developed to determine 2-mercaptobenzothiazole (2MBT) in water samples. This method was based on the interaction between gold nanoparticles (AuNPs) and 2MBT followed by increasing of the resonance Rayleigh scattering (RRS) intensity of nanoparticles. The change in RRS intensity (ΔIRRS) was linearly correlated to the concentration of 2MBT over the ranges of 5.0-100.0 and 100.0-300.0 μg L(-1). 2MBT can be measured in a short time (5 min) without any complicated or time-consuming sample pretreatment process. Parameters that affect the RRS intensities such as pH, concentration of AuNPs, standing time, electrolyte concentration, and coexisting substances were systematically investigated and optimized. Interference tests showed that the developed method has a very good selectivity and could be used conveniently for determination of 2MBT. The limit of detection (LOD) and limit of quantification (LOQ) were 1.0 and 3.0 μg L(-1), respectively. Relative standard deviations (RSD) for 20.0 and 80.0 μg L(-1) of 2MBT were 1.1 and 2.3, respectively. Possible mechanisms for the RRS changes of AuNPs in the presence of 2MBT were discussed and the method was successfully applied for the analysis of real water samples. Copyright © 2015 Elsevier B.V. All rights reserved.

Using Performance Measures to Allocate Consumable Funding

DTIC Science & Technology

2007-06-01

The Air Force is now using the Customer Oriented Leveling Technique (COLT) to determine levels for consumable items at its bases. COLT is an...Overview • COLT is a system to set AF retail stock levels for DLA-managed consumable parts to minimize expected customer wait time (ECWT) • COLT...changed please list both.) Original title on 712 A/B: Using Performance Measures to Allocate Consumable Funding If the title was revised

Effect of sertraline on complications and survival after hematopoietic stem-cell transplantation, a double-blind, placebo-controlled clinical study.

PubMed

Tavakoli-Ardakani, Maria; Kheshti, Raziyeh; Maryam, Mehrpooya

2017-12-01

Previous studies have found a connection between psychiatric problems and post-hematopoietic stem-cell transplantation (HSCT) complications. We sought to evaluate the effect of sertraline on engraftment time, hospitalization period, mortality, and post-transplantation complications in HSCT recipients with depression and/or anxiety. We recruited adults aged 18-60, who were candidates for autologous or allogeneic HSCT with major depression and/or anxiety disorder. They were administered 50 mg of sertraline or placebo daily for the first week, and then 100 mg for the following seven weeks. We documented occurrence and severity of early post-HSCT complications, including infection, mucositis, nausea and vomiting, diarrhea, pain, renal toxicities and liver complications, acute graft-versus-host disease, and veno-occlusive disease, as well as time to engraftment, length of hospitalization and 6-month mortality. Overall, 56 patients participated in the study (sertraline group n = 30, placebo group n = 26). Of the complications, only mortality and readmission up to 6 months post-transplantation were significantly higher in the placebo group compared to sertraline group (P values = 0.040, 0.028, respectively). There were no significant differences for other complications between the groups. Mean engraftment time was significantly lower in the sertraline group (P value = 0.048). This study provides evidence that sertraline positively influences engraftment time, readmission, and mortality after HSCT.

Diet and nutrition of western rock lobsters, Panulirus cygnus, in shallow coastal waters: the role of habitat

EPA Science Inventory

Generalist consumers often have diets that vary considerably over time and space, which reflects changes in resource availability. Predicting diets of consumers can therefore be difficult. The western rock lobster, Panulirus cygnus, is an omnivorous generalist consumer that uses ...

Predicting Exposure to Consumer-Products Using Agent-Based Models Embedded with Needs-Based Artificial Intelligence and Empirically -Based Scheduling Models

EPA Science Inventory

Information on human behavior and consumer product use is important for characterizing exposures to chemicals in consumer products and in indoor environments. Traditionally, exposure-assessors have relied on time-use surveys to obtain information on exposure-related behavior. In ...

Factors predictive of complicated appendicitis in children.

PubMed

Pham, Xuan-Binh D; Sullins, Veronica F; Kim, Dennis Y; Range, Blake; Kaji, Amy H; de Virgilio, Christian M; Lee, Steven L

2016-11-01

The ability to predict whether a child has complicated appendicitis at initial presentation may influence clinical management. However, whether complicated appendicitis is associated with prehospital or inhospital factors is not clear. We also investigate whether hyponatremia may be a novel prehospital factor associated with complicated appendicitis. A retrospective review of all pediatric patients (≤12 y) with appendicitis treated with appendectomy from 2000 to 2013 was performed. The main outcome measure was intraoperative confirmation of gangrenous or perforated appendicitis. A multivariable analysis was performed, and the main predictors of interest were age <5 y, symptom duration >24 h, leukocytosis (white blood cell count >12 × 10 3 /mL), hyponatremia (sodium ≤135 mEq/L), and time from admission to appendectomy. Of 392 patients, 179 (46%) had complicated appendicitis at the time of operation. Univariate analysis demonstrated that patients with complicated appendicitis were younger, had a longer duration of symptoms, higher white blood cell count, and lower sodium levels than patients with noncomplicated appendicitis. Multivariable analysis confirmed that symptom duration >24 h (odds ratio [OR] = 5.5, 95% confidence interval [CI] = 3.5-8.9, P < 0.01), hyponatremia (OR = 3.1, 95% CI = 2.0-4.9, P < 0.01), age <5 y (OR = 2.3, 95% CI = 1.3-4.0, P < 0.01), and leukocytosis (OR = 1.9, 95% CI = 1.0-3.5, P = 0.04) were independent predictors of complicated appendicitis. Increased time from admission to appendectomy was not a predictor of complicated appendicitis (OR = 0.8, 95% CI = 0.5-1.2, P = 0.2). Prehospital factors can predict complicated appendicitis in children with suspected appendicitis. Hyponatremia is a novel marker associated with complicated appendicitis. Delaying appendectomy does not increase the risk of complicated appendicitis once intravenous antibiotics are administered. This information may help guide resource/personnel allocation, timing of appendectomy, and decision for nonoperative management of appendicitis in children. Copyright © 2016 Elsevier Inc. All rights reserved.

Timing of cranioplasty after decompressive craniectomy for ischemic or hemorrhagic stroke.

PubMed

Piedra, Mark P; Ragel, Brian T; Dogan, Aclan; Coppa, Nicholas D; Delashaw, Johnny B

2013-01-01

The optimal timing of cranioplasty after decompressive craniectomy for stroke is not known. Case series suggest that early cranioplasty is associated with higher rates of infection while delaying cranioplasty may be associated with higher rates of bone resorption. The authors examined whether the timing of cranioplasty after decompressive craniectomy for stroke affects postoperative complication rates. A retrospective cohort study was undertaken to evaluate complication rates in patients undergoing cranioplasty at early (within 10 weeks of craniectomy) or late (≥ 10 weeks) stages. Multivariate logistic regression analysis was used to determine characteristics that would predict complications in patients undergoing cranioplasty after decompressive craniectomy for stroke. While the overall complication rate was higher in the early cranioplasty cohort (22% vs 16% in the late cranioplasty cohort), the difference was not statistically significant (p = 0.5541). Patients in the early cranioplasty cohort had lower rates of postoperative hematoma but higher rates of infection. Presence of a CSF shunt was the only significant predictor of complications (OR 8.96, 95% CI 1.84-43.6). Complications rates for early cranioplasty (within 10 weeks of craniectomy) are similar to those encountered when cranioplasty is delayed, although the cohort size in this study was too small to state equivalence. Patients with a ventriculoperitoneal shunt are at higher risk for complications after cranioplasty.

Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding Patients.

PubMed

Chang, Shen Shong; Hu, Hsiao-Yun

2015-05-23

The connection between Helicobacter pylori and complicated peptic ulcer disease in peptic ulcer bleeding (PUB) patients taking nonsteroidal anti-inflammatory drugs has not been established. In this study, we sought to determine whether delayed H. pylori eradication therapy in PUB patients increases complicated recurrent peptic ulcers. We identified inpatient PUB patients using the Taiwan National Health Insurance Research Database. We categorized patients into early (time lag ≤120 days after peptic ulcer diagnosis) and late H. pylori eradication therapy groups. The Cox proportional hazards model was used. The primary outcome was rehospitalization for patients with complicated recurrent peptic ulcers. Our data indicated that the late H. pylori eradication therapy group had a higher rate of complicated recurrent peptic ulcers (hazard ratio [HR], 1.52; p=0.006), with time lags of more than 120 days. However, our results indicated a similar risk of complicated recurrent peptic ulcers (HR, 1.20; p=0.275) in time lags of more than 1 year and (HR, 1.10; p=0.621) more than 2 years. H. pylori eradication within 120 days was associated with decreased complicated recurrent peptic ulcers in patients with PUB. We recommend that H. pylori eradication should be conducted within 120 days in patients with PUB.

Ringer's lactate, but not hydroxyethyl starch, prolongs the food intolerance time after major abdominal surgery; an open-labelled clinical trial.

PubMed

Li, Yuhong; He, Rui; Ying, Xiaojiang; Hahn, Robert G

2015-05-06

The infusion of large amounts of Ringer's lactate prolongs the functional gastrointestinal recovery time and increases the number of complications after open abdominal surgery. We performed an open-labelled clinical trial to determine whether hydroxyethyl starch or Ringer's lactate exerts these adverse effects when the surgery is performed by laparoscopy. Eighty-eight patients scheduled for major abdominal cancer surgery (83% by laparoscopy) received a first-line fluid treatment with 9 ml/kg of either 6% hydroxyethyl starch 130/0.4 (Voluven) or Ringer's lactate, just after induction of anaesthesia; this was followed by a second-line infusion with 12 ml/kg of either starch or Ringer's lactate over 1 hour. Further therapy was managed at the discretion of the attending anaesthetist. Outcome data consisted of postoperative gastrointestinal recovery time, complications and length of hospital stay. The order of the infusions had no impact on the outcome. Both the administration of ≥ 2 L of Ringer's lactate and the development of a surgical complication were associated with a longer time period of paralytic ileus and food intolerance (two-way ANOVA, P < 0.02), but only surgical complications prolonged the length of hospital stay (P < 0.001). The independent effect of Ringer's lactate and complications of food intolerance time amounted to 2 days each. The infusion of ≥ 1 L of hydroxyethyl starch did not adversely affect gastrointestinal recovery. Ringer's lactate, but not hydroxyethyl starch, prolonged the gastrointestinal recovery time in patients undergoing laparoscopic cancer surgery. Surgical complications prolonged the hospital stay.

Why climate change will invariably alter selection pressures on phenology.

PubMed

Gienapp, Phillip; Reed, Thomas E; Visser, Marcel E

2014-10-22

The seasonal timing of lifecycle events is closely linked to individual fitness and hence, maladaptation in phenological traits may impact population dynamics. However, few studies have analysed whether and why climate change will alter selection pressures and hence possibly induce maladaptation in phenology. To fill this gap, we here use a theoretical modelling approach. In our models, the phenologies of consumer and resource are (potentially) environmentally sensitive and depend on two different but correlated environmental variables. Fitness of the consumer depends on the phenological match with the resource. Because we explicitly model the dependence of the phenologies on environmental variables, we can test how differential (heterogeneous) versus equal (homogeneous) rates of change in the environmental variables affect selection on consumer phenology. As expected, under heterogeneous change, phenotypic plasticity is insufficient and thus selection on consumer phenology arises. However, even homogeneous change leads to directional selection on consumer phenology. This is because the consumer reaction norm has historically evolved to be flatter than the resource reaction norm, owing to time lags and imperfect cue reliability. Climate change will therefore lead to increased selection on consumer phenology across a broad range of situations. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Set up to fail? Consumer participation in the mental health service system.

PubMed

Stewart, Sarah; Watson, Sandy; Montague, Roslyn; Stevenson, Caroline

2008-10-01

The aim of this paper is to present the findings of a survey of consumers of mental health services who are working (in either paid or unpaid positions) in NSW Health and in the Non Government Organisation sector in NSW. A survey was distributed through the NSW Consumer Advisory Group newsletter to elicit the roles and assess the training needs of consumer employees, as well as those who were working in voluntary capacities as consumer representatives, within the mental health system in NSW. Many mental health consumers have been placed in the untenable position of being engaged in representation and/or advocacy roles with unclear job descriptions and no training. The majority of consumers want a code of ethics and performance standards for consumer workers. The rhetoric of consumer participation is not matched by effective and timely strategies that ensure that consumer involvement is underpinned by relevant training and supportive infrastructure. The goal of meaningful consumer participation in mental health services, as outlined in policy, is yet to be achieved.

Skin complications in deep brain stimulation for Parkinson's disease: frequency, time course, and risk factors.

PubMed

Sixel-Döring, Friederike; Trenkwalder, Claudia; Kappus, Christoph; Hellwig, Dieter

2010-02-01

Deep brain stimulation (DBS) has been recognized as an efficacious treatment for movement disorders. Its beneficial effects however may be lost due to skin complications such as erosions or infections over the implanted foreign material. We sought to document skin complications in the entire Parkinson's disease patient population who received a DBS system at the Marburg/Kassel implantation centre since the start of our DBS program in January 2002 to analyze frequency, time course, and possible risk factors. We investigated 85 consecutive patients with Parkinson's disease (PD) from a single center/single surgeon DBS series for the occurrence of skin complications and analyzed localization, time course, and possible risk factors. Mean follow-up was 3 years (range 1-7 years). In total, 21/85 patients (24.7%) suffered a total of 30 single skin complications. Sixty percent of all incidents occurred within the first post-operative year. Forty percent of all incidents occurred later than the first year following primary implantation. Complications involved the burr hole cap in 37%, the course of the cables in 33%, and the impulse generator (IPG) site in 30%. Six of 21 patients suffered recurring skin complications. Eight patients permanently lost their DBS system. Factor analysis for age, gender, disease duration, disease severity, the incidence of hypertension or diabetes as well as a 2-day period with externalized electrodes for continuous test stimulation did not have any statistically significant impact on skin complications. We conclude that (1) PD patients have a risk for skin complications after DBS as long as the system remains in situ and (2) there are at present no identifiable risk factors for skin complications after DBS, other than PD itself.

Single-Institution Experience With Component Separation for Ventral Hernia Repair: A Retrospective Review.

PubMed

Hill, Brian; Kambeyanda, Rohan; Fewell, Donna; Bryant, Stewart; Delaney, Kevin O; Herrera, Fernando A

2018-06-01

In this study, we reviewed our institution's experience using component separation for repair of ventral hernias. This was a retrospective review of all component separations for ventral hernia between July 2009 and December 2015. Recorded data included body mass index (BMI), preoperative albumin, smoking history, comorbidities, additional procedures, length of surgery, hospitalization, recurrence, and postoperative complications. One hundred ninety-six component separations were performed in the study period. The average patient age was 56 years, and 65.3% of patients were female. The average BMI was 32.6 kg/m; preoperative albumin was 3.59; 18.4% were current smokers; 28.1% were diabetic; and 14.3% had heart disease. Postoperative complications developed in 16.8% of patients. Recurrence developed in 8.7% of patients. Patients who developed a postoperative complication had a higher BMI (P = 0.025) and lower albumin (P = 0.047) compared with patients who did not develop complications. Current smokers were more likely to develop complications (P = 0.008). More than one third of patients had additional procedures at the time of the ventral hernia repair. The addition of a plastic surgery procedure was not associated with an increased risk of developing a complication (P = 0.25). Patients who developed complications had a significantly longer hospital course (P < 0.001) but no difference in total operative time (P = 0.975). Increased number of comorbidities did not statistically correlate with an increased complication rate (P = 0.65) or length of hospital stay (P = 0.43). We identified risk factors that increase the likelihood of postoperative complications and length of hospital stay. In addition, this study suggests that more comorbidities and additional procedures at the time of the hernia repair may not have as large of impact on complication risk as previously thought.

A study of serum sodium level among Hong Kong runners.

PubMed

Au-Yeung, Kwan Leong; Wu, Wing Cheung; Yau, Wah Hon; Ho, Hiu Fai

2010-11-01

Hyponatremia and the associated life-threatening complications have emerged as an important issue among marathon runners. This study was conducted to estimate the serum sodium level among local marathon runners and to identify the associated risk factors of dysnatremia. Prospective observational cohort study. Hong Kong Marathon 2008. Subjects were approached at their convenience to participate in the study. Only full-marathon runners were recruited. They were to have had an unremarkable medical and drug history. Demographic data, training information, previous marathon experience, anticipated drinking strategy, details of fluid consumption throughout the race, weight change, finishing time, and physical complaint. Post-race serum sodium level. Of the 6488 entries to the race, 370 runners (5.7%) were recruited. Among them, 272 (73.5%) completed the race and attended for blood sampling and data collection. One runner (0.4%) had hyponatremia (133 mmol/L) and 35 runners (12.9%) had hypernatremia (>145 mmol/L), whereas 236 runners (86.7%) had normal serum sodium (135-145 mmol/L) after the race. No symptomatic dysnatremia was found. A mean weight reduction of 0.70 kg was found after the race. An average of 1.9 L of fluid was consumed during the race and 2.5 L if the fluid consumed immediately before and after the race was also included. Hypernatremia was seen in runners who were better trained before the race, those who performed better, and those who drank less water after the race. This is the largest prospective observational cohort study of dysnatremia conducted on athletes completing a standard marathon in Asia. No case of symptomatic dysnatremia was found.

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

Anthony Leonard; Phillippe Chatelain; Michael Rebel

Heavy ground vehicles, especially those involved in long-haul freight transportation, consume a significant part of our nation's energy supply. it is therefore of utmost importance to improve their efficiency, both to reduce emissions and to decrease reliance on imported oil. At highway speeds, more than half of the power consumed by a typical semi truck goes into overcoming aerodynamic drag, a fraction which increases with speed and crosswind. Thanks to better tools and increased awareness, recent years have seen substantial aerodynamic improvements by the truck industry, such as tractor/trailer height matching, radiator area reduction, and swept fairings. However, there remainsmore » substantial room for improvement as understanding of turbulent fluid dynamics grows. The group's research effort focused on vortex particle methods, a novel approach for computational fluid dynamics (CFD). Where common CFD methods solve or model the Navier-Stokes equations on a grid which stretches from the truck surface outward, vortex particle methods solve the vorticity equation on a Lagrangian basis of smooth particles and do not require a grid. They worked to advance the state of the art in vortex particle methods, improving their ability to handle the complicated, high Reynolds number flow around heavy vehicles. Specific challenges that they have addressed include finding strategies to accurate capture vorticity generation and resultant forces at the truck wall, handling the aerodynamics of spinning bodies such as tires, application of the method to the GTS model, computation time reduction through improved integration methods, a closest point transform for particle method in complex geometrics, and work on large eddy simulation (LES) turbulence modeling.« less

Postoperative complications of contemporary open and robot-assisted laparoscopic radical prostatectomy using standardized reporting systems.

PubMed

Pompe, Raisa S; Beyer, Burkhard; Haese, Alexander; Preisser, Felix; Michl, Uwe; Steuber, Thomas; Graefen, Markus; Huland, Hartwig; Karakiewicz, Pierre I; Tilki, Derya

2018-05-04

To analyze time trends and contemporary rates of postoperative complications after RP and to compare the complication profile of ORP and RALP using standardized reporting systems. Retrospective analysis of 13,924 RP patients in a single institution (2005 to 2015). Complications were collected during hospital stay and via standardized questionnaire 3 months after and grouped into eight schemes. Since 2013, the revised Clavien-Dindo classification was used (n = 4,379). Annual incidence rates of different complications were graphically displayed. Multivariable logistic regression analyses compared complications between ORP and RALP after inverse probability of treatment weighting (IPTW). After introduction of standardized classification systems, complication rates have increased with a contemporary rate of 20.6% (2013 - 2015). While minor Clavien-Dindo grades represented the majority (I: 10.6%; II: 7.9%), severe complications (grades IV-V) were rare (<1%). In logistic regression analyses after IPTW, RALP was associated with less blood loss, shorter catheterization time and lower risk for Clavien-Dindo grade II and III complications. Our results emphasize the importance of standardized reporting systems for quality control and comparison across approaches or institutions. Contemporary complication rates in a high volume center remain low and are most frequently minor Clavien-Dindo grades. RALP had a slightly better complication profile compared to ORP. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Enhancing provision of written medicine information in Australia: pharmacist, general practitioner and consumer perceptions of the barriers and facilitators

PubMed Central

2014-01-01

Background Written medicine information can play an important role in educating consumers about their medicines. In Australia, standardised, comprehensive written information known as Consumer Medicine Information (CMI) is available for all prescription medicines. CMI is reportedly under-utilised by general practitioners (GPs) and community pharmacists in consultations, despite consumer desire for medicine information. This study aimed to determine consumers’, GPs’ and community pharmacists’ preferences for CMI provision and identify barriers and facilitators to its use. Method Structured questionnaires were developed and administered to a national sample of Australian consumers (phone survey), community pharmacists and GPs (postal surveys) surrounding utilisation of CMI. Descriptive and comparative analyses were conducted. Results Half of consumers surveyed wanted to receive CMI for their prescription medicine, with spoken information preferable to written medicine information for many consumers and healthcare professionals. GPs and pharmacists remained a preferred source of medicine information for consumers, although package inserts were appealing to many among all three cohorts. Overall pharmacists were the preferred provider of CMI primarily due to their medicine expertise, accessibility and perceived availability. GPs preferred CMI dissemination through both the GP and pharmacist. Some consumers preferred GPs as the provider of medicines information because of their knowledge of the patients’ medicines and/or medical history, regularity of seeing the patient and good relationship with the patient. Common barriers to CMI provision cited included: time constraints, CMI length and perceptions that patients are not interested in receiving CMI. Facilitators to enhance provision included: strategies to increase consumer awareness, longer consultation times and counseling appointments, and improvements to pharmacy software technology and workflow. Conclusion Medicine information is important to consumers, whether as spoken, written or a combination of both. A tailored approach is needed to ascertain individual patient preference for delivery and scope of medicine information desired so that appropriate information is provided. The barriers of time and perceived attitudes of healthcare practitioners present challenges which may be overcome through changes to workplace practices, adoption of identified facilitators, and education about the positive benefits of CMI as a tool to engage and empower patients. PMID:24754890

Effect of foods and Mediterranean diet during pregnancy and first years of life on wheezing, rhinitis and dermatitis in preschoolers.

PubMed

Castro-Rodriguez, J A; Ramirez-Hernandez, M; Padilla, O; Pacheco-Gonzalez, R M; Pérez-Fernández, V; Garcia-Marcos, L

2016-01-01

There is a conflictive position if some foods and Mediterranean diet (MedDiet) consumed by the mother during pregnancy and by the child during the first years of life can be protective for current wheezing, rhinitis and dermatitis at preschool age. Questionnaires of epidemiological factors and food intake by the mother during pregnancy and later by the child were filled in by parents in two surveys at two different time points (1.5 yrs and 4 yrs of life) in 1000 preschoolers. The prevalences of current wheezing, rhinitis and dermatitis were 18.8%, 10.4%, and 17.2%, respectively. After multiple logistic analysis children who were low fruit consumers (never/occasionally) and high fast-food consumers (≥3 times/week) had a higher risk for current wheezing; while intermediate consumption of meat (1 or 2 times/week) and low of pasta by mothers in pregnancy were protected. For current rhinitis, low fruit consumer children were at higher risk; while those consuming meat <3 times/week were protected. For current dermatitis, high fast food consumption by mothers in pregnancy; and low or high consumption of fruit, and high of potatoes in children were associated to higher prevalence. Children consuming fast food >1 times/week were protected for dermatitis. MedDiet adherence by mother and child did not remain a protective factor for any outcome. Low consumption of fruits and high of meat by the child, and high consumption of potatoes and pasta by the mother had a negative effect on wheezing, rhinitis or dermatitis; while fast food consumption was inconsistent. Copyright © 2016 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

Intervention time until discharge for newborns on transition from gavage to exclusive oral feeding.

PubMed

Medeiros, Andréa Monteiro Correia; Ramos, Blenda Karen Batista; Bomfim, Déborah Letticia Santana Santos; Alvelos, Conceição Lima; Silva, Talita Cardoso da; Barreto, Ikaro Daniel de Carvalho; Santos, Felipe Batista; Gurgel, Ricardo Queiroz

2018-01-01

Purpose Measure the intervention time required for transition from gavage to exclusive oral feeding, comparing newborns exposed exclusively to the mother's breast with those who, in addition to breastfeeding, received supplementation using a cup or baby bottle. Methods Analytical, longitudinal, cohort study conducted with 165 newborns (NB) divided into groups according to severity of medical complications (G1-with no complications; G2-with significant complications), and into subgroups according to feeding mechanism (A and B). All NBs were low birth weight, on Kangaroo Mother Care, and breast stimulated according to medical prescription and hospital routine. Regarding feeding pattern, subgroup A comprised NBs exclusively breastfed at hospital discharge, whereas subgroup B was composed of NBs fed through cup/bottle at some time during hospitalization. The number of days spent in each stage of transition was recorded for each NB. Results History of clinical complications significantly influenced total intervention time. Study participants in subgroups G1-A (10 days), G1-B (9 days), and G2-A (12 days) displayed greater chances of early discharge compared with those in subgroup G2-B (16 days). Conclusion NBs with no important history of clinical complications displayed greater chances of early hospital discharge. NBs with significant history of clinical complications that underwent gavage to exclusive breastfeeding transition presented smaller intervention time than those that required supplementation using cup/bottle. Feeding transition using the gavage-to-exclusive oral feeding technique is recommended for Speech-language Pathology practice in Neonatology.

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

Haghighat, A.; Sjoden, G.E.; Wagner, J.C.

In the past 10 yr, the Penn State Transport Theory Group (PSTTG) has concentrated its efforts on developing accurate and efficient particle transport codes to address increasing needs for efficient and accurate simulation of nuclear systems. The PSTTG's efforts have primarily focused on shielding applications that are generally treated using multigroup, multidimensional, discrete ordinates (S{sub n}) deterministic and/or statistical Monte Carlo methods. The difficulty with the existing public codes is that they require significant (impractical) computation time for simulation of complex three-dimensional (3-D) problems. For the S{sub n} codes, the large memory requirements are handled through the use of scratchmore » files (i.e., read-from and write-to-disk) that significantly increases the necessary execution time. Further, the lack of flexible features and/or utilities for preparing input and processing output makes these codes difficult to use. The Monte Carlo method becomes impractical because variance reduction (VR) methods have to be used, and normally determination of the necessary parameters for the VR methods is very difficult and time consuming for a complex 3-D problem. For the deterministic method, the authors have developed the 3-D parallel PENTRAN (Parallel Environment Neutral-particle TRANsport) code system that, in addition to a parallel 3-D S{sub n} solver, includes pre- and postprocessing utilities. PENTRAN provides for full phase-space decomposition, memory partitioning, and parallel input/output to provide the capability of solving large problems in a relatively short time. Besides having a modular parallel structure, PENTRAN has several unique new formulations and features that are necessary for achieving high parallel performance. For the Monte Carlo method, the major difficulty currently facing most users is the selection of an effective VR method and its associated parameters. For complex problems, generally, this process is very time consuming and may be complicated due to the possibility of biasing the results. In an attempt to eliminate this problem, the authors have developed the A{sup 3}MCNP (automated adjoint accelerated MCNP) code that automatically prepares parameters for source and transport biasing within a weight-window VR approach based on the S{sub n} adjoint function. A{sup 3}MCNP prepares the necessary input files for performing multigroup, 3-D adjoint S{sub n} calculations using TORT.« less

Real-time complication monitoring in pediatric cardiac surgery.

PubMed

Belliveau, Daniel; Burton, Hayley J; O'Blenes, Stacy B; Warren, Andrew E; Hancock Friesen, Camille L

2012-11-01

As overall mortality rates have fallen in pediatric cardiac surgical procedures, complication monitoring is becoming an increasingly important metric of patient outcome. Currently there is no standardized method available to monitor severity-adjusted complications in congenital cardiac surgical procedures. Complications associated with pediatric cardiac surgical procedures were prospectively collected from consecutive cases in a single pediatric cardiac surgical unit from October 1, 2009 to September 31, 2011. Complications were accounted for by frequency and severity and then stratified by surgical complexity, using the Risk Adjustment for Congenital Heart Surgery (RACHS) method, giving an average morbidity burden per RACHS category. "Expected" morbidity burden for each RACHS category was derived from year 1 (2009-2010) data. Observed minus expected (O:E) plots were then generated for the entire series of complications from year 2 (2010-2011) data. Separate O:E plots were also created for 5 complication classes and monitored for increases. There were 181 index surgical procedures performed in 178 patients. Two hundred and seventeen complications occurred in 80 procedures. The frequency and severity of complications increased with surgical complexity. The overall O:E plot was flagged twice for unanticipated increases in severity-adjusted complications. When the class-specific O:E plots were monitored for increases, the overall flags were found to originate from increased rates of infections and cardiac/operative complications. The O:E plot provides a simple and effective system to monitor complication rates over time based on severity-adjusted complication data. Grouping complications into classes allows us to identify specific subsets of complications that can be focused on to improve patient outcomes. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Food, mechanic and septic complications in patients enterally nutritioned in home conditions.

PubMed

Kalita, Monika; Majewska, Krystyna; Gradowska, Aleksandra; Karwowska, Katarzyna; Ławiński, Michał

2015-02-03

Home enteral nutrition (HEN for short) allows practically normal living for patients who cannot be fed orally but at the same time do not have to stay in hospitals, which is often found to decrease their mental condition, increase of probability of complications and costs of medical treatment. The aim of the study was to analyze the frequency of nutritional, mechanical and septic complications in patients fed enterally in home conditions. The study performed using retrospective analysis of study results and reports from control visits for patients in the period between 2012-2013. 147 patients fed enterally using HEN method participated in the study, including 70 men and 77 women aged 19 to 99 years (average 65 years). The following type of gastrointestinal tract access was used for patients: PEG in 113 (76.5%), feeding jejunostomy - 21 (1.4%), PEG-PEJ - 5 (3.5%), in case of the remaining 8 patients the nasogastric gavage (5.5%) was used. The most common complication were infections (of gastric tract, skin soft tissue in the region of nutritional fistula entry, in three cases the aspiration pneumonia was diagnosed) found in 55 (49.1%) of cases. Mechanical complications were found out in 29 (25.9% of all complications), nutritional complications were present 28 times, which constituted 25% of all complications. In the studied group of patients with an implemented HEN procedure, septic complications were the most common problem. The longest average nutrition time with PEG-PEJ probably results from the effective protection of the patient against aspiration pneumonia.

Peri-operative morbidity associated with radical cystectomy in a multicenter database of community and academic hospitals.

PubMed

Lavallée, Luke T; Schramm, David; Witiuk, Kelsey; Mallick, Ranjeeta; Fergusson, Dean; Morash, Christopher; Cagiannos, Ilias; Breau, Rodney H

2014-01-01

To characterize the frequency and timing of complications following radical cystectomy in a cohort of patients treated at community and academic hospitals. Radical cystectomy patients captured from NSQIP hospitals from January 1 2006 to December 31 2012 were included. Baseline information and complications were abstracted by study surgical clinical reviewers through a validated process of medical record review and direct patient contact. We determined the incidence and timing of each complication and calculated their associations with patient and operative characteristics. 2303 radical cystectomy patients met inclusion criteria. 1115 (48%) patients were over 70 years old and 1819 (79%) were male. Median hospital stay was 8 days (IQR 7-13 days). 1273 (55.3%) patients experienced at least 1 post-operative complication of which 191 (15.6%) occurred after hospital discharge. The most common complication was blood transfusion (n = 875; 38.0%), followed by infectious complications with 218 (9.5%) urinary tract infections, 193 (8.4%) surgical site infections, and 223 (9.7%) sepsis events. 73 (3.2%) patients had fascial dehiscence, 82 (4.0%) developed a deep vein thrombosis, and 67 (2.9%) died. Factors independently associated with the occurrence of any post-operative complication included: age, female gender, ASA class, pre-operative sepsis, COPD, low serum albumin concentration, pre-operative radiotherapy, pre-operative transfusion >4 units, and operative time >6 hours (all p<0.05). Complications remain common following radical cystectomy and a considerable proportion occur after discharge from hospital. This study identifies risk factors for complications and quality improvement needs.

USSR Report, Consumer Goods and Domestic Trade, No. 77.

DTIC Science & Technology

1983-10-24

above all to the prices of clothing, knitwear and other products manufactured by consumer service enterprises on custom or- der for individuals. In...light of the fact that filling custom orders is more time- consuming , other things being equal, than large-scale industrial produc- tion of the same...340033 JPRS 84592 24 October 1983 USSR Report CONSUMER GOODS AND DOMESTIC TRADE No. 77 flätöltö FBIS FOREIGN BROADCAST INFORMATION SERVICE

Differential use of salmon by vertebrate consumers: implications for conservation

PubMed Central

Wheat, Rachel E.; Allen, Jennifer M.; Wilmers, Christopher C.

2015-01-01

Salmon and other anadromous fish are consumed by vertebrates with distinct life history strategies to capitalize on this ephemeral pulse of resource availability. Depending on the timing of salmon arrival, this resource may be in surplus to the needs of vertebrate consumers if, for instance, their populations are limited by food availability during other times of year. However, the life history of some consumers enables more efficient exploitation of these ephemeral resources. Bears can deposit fat and then hibernate to avoid winter food scarcity, and highly mobile consumers such as eagles, gulls, and other birds can migrate to access asynchronous pulses of salmon availability. We used camera traps on pink, chum, and sockeye salmon spawning grounds with various run times and stream morphologies, and on individual salmon carcasses, to discern potentially different use patterns among consumers. Wildlife use of salmon was highly heterogeneous. Ravens were the only avian consumer that fed heavily on pink salmon in small streams. Eagles and gulls did not feed on early pink salmon runs in streams, and only moderately at early sockeye runs, but were the dominant consumers at late chum salmon runs, particularly on expansive river flats. Brown bears used all salmon resources far more than other terrestrial vertebrates. Notably, black bears were not observed on salmon spawning grounds despite being the most frequently observed vertebrate on roads and trails. From a conservation and management perspective, all salmon species and stream morphologies are used extensively by bears, but salmon spawning late in the year are disproportionately important to eagles and other highly mobile species that are seasonally limited by winter food availability. PMID:26339539

Sensory quality of broiler breast meat influenced by low atmospheric pressure stunning, deboning time and cooking methods.

PubMed

Schilling, M W; Radhakrishnan, V; Vizzier-Thaxton, Y; Christensen, K; Williams, J B; Joseph, P

2015-06-01

Stunning method (low atmospheric pressure stunning, LAPS and electrical stunning, ES), deboning time (0.75 h and 4 h), and cooking method (baking, frying, and sous vide) were evaluated for their impact on the descriptive sensory characteristics and consumer acceptability of breast meat (n=576, 144 birds per stunning × deboning time combination). Sensory evaluation was conducted by trained descriptive (n=8) and consumer (n=185) panels. On average, no differences (P>0.05) existed in the sensory acceptability of fried and sous vide cooked broiler breast treatment combinations. However, for oven-baking, the LAPS treatment that was deboned at 4 h was more acceptable (P<0.05) than other treatments and the ES and LAPS 4 h samples had greater (P<0.05) acceptability for texture than their ES and LAPS 0.75 h counterparts. Since consumers were highly variable in their liking of chicken breast treatments, consumers were grouped into clusters for each cooking method based on liking and preference. Cluster analysis data revealed that the largest groups of consumers liked (score≥6.0) all chicken breast treatments, but a larger proportion of consumers liked the 4 h LAPS and ES treatments when compared to the 0.75 h LAPS and ES treatments for all cooking methods. In addition, the consumers who indicated that baked chicken breast was highly acceptable preferred (P<0.05) 4 h LAPS over the 4 h ES samples. Based on sensory results, chicken breast meat from all stunning and deboning method combinations was highly acceptable to the majority of consumers, but the LAPS 4 h treatment had enhanced sensory characteristics when baked. © 2015 Poultry Science Association Inc.

Medicaid payer status is linked to increased rates of complications after treatment of proximal humerus fractures.

PubMed

Sabesan, Vani J; Petersen-Fitts, Graysen; Lombardo, Daniel; Briggs, Daniel; Whaley, James

2017-06-01

Low socioeconomic status and Medicaid insurance as a primary payer have been associated with major disparities in resource utilization and risk-adjusted outcomes for patients undergoing total joint arthroplasty. With the expansion of Medicaid through the Affordable Care Act in 2014, examination of these disparities has become increasingly relevant for the treatment of proximal humerus fracture (PHF). The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to identify patients who were treated for PHF from 2002 to 2012. Primary outcomes included treatment type, surgical fixation method, in-hospital complications, mean length of stay, and mean total charges for Medicaid patients vs. a matched privately insured cohort. In an effort to minimize confounding variables, each Medicaid patient was matched to a privately insured patient on the basis of gender, race, year of procedure, and age. Of the 678,831 patients treated with PHF, 4.9% (33,263) had Medicaid as the primary payer during the 10-year period. Medicaid patients were found to have a significantly higher risk (P < .05) of postoperative in-hospital complications, including postoperative infection (odds ratio [OR], 2.00 [1.37-2.93]), wound complications (OR, 1.69 [1.04-2.75]), and acute respiratory distress syndrome (OR, 1.34 [1.15-1.59]). Medicaid patients have a significantly higher risk for certain postoperative hospital complications and consume more resources after treatment for PHFs. Additional work is needed to understand the optimal treatment type for Medicaid patients and to understand the complex interplay between socioeconomic status and outcomes to ensure appropriate resource allocation and risk stratification. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Correcting for dependent censoring in routine outcome monitoring data by applying the inverse probability censoring weighted estimator.

PubMed

Willems, Sjw; Schat, A; van Noorden, M S; Fiocco, M

2018-02-01

Censored data make survival analysis more complicated because exact event times are not observed. Statistical methodology developed to account for censored observations assumes that patients' withdrawal from a study is independent of the event of interest. However, in practice, some covariates might be associated to both lifetime and censoring mechanism, inducing dependent censoring. In this case, standard survival techniques, like Kaplan-Meier estimator, give biased results. The inverse probability censoring weighted estimator was developed to correct for bias due to dependent censoring. In this article, we explore the use of inverse probability censoring weighting methodology and describe why it is effective in removing the bias. Since implementing this method is highly time consuming and requires programming and mathematical skills, we propose a user friendly algorithm in R. Applications to a toy example and to a medical data set illustrate how the algorithm works. A simulation study was carried out to investigate the performance of the inverse probability censoring weighted estimators in situations where dependent censoring is present in the data. In the simulation process, different sample sizes, strengths of the censoring model, and percentages of censored individuals were chosen. Results show that in each scenario inverse probability censoring weighting reduces the bias induced in the traditional Kaplan-Meier approach where dependent censoring is ignored.

Fully automated, real-time 3D ultrasound segmentation to estimate first trimester placental volume using deep learning.

PubMed

Looney, Pádraig; Stevenson, Gordon N; Nicolaides, Kypros H; Plasencia, Walter; Molloholli, Malid; Natsis, Stavros; Collins, Sally L

2018-06-07

We present a new technique to fully automate the segmentation of an organ from 3D ultrasound (3D-US) volumes, using the placenta as the target organ. Image analysis tools to estimate organ volume do exist but are too time consuming and operator dependant. Fully automating the segmentation process would potentially allow the use of placental volume to screen for increased risk of pregnancy complications. The placenta was segmented from 2,393 first trimester 3D-US volumes using a semiautomated technique. This was quality controlled by three operators to produce the "ground-truth" data set. A fully convolutional neural network (OxNNet) was trained using this ground-truth data set to automatically segment the placenta. OxNNet delivered state-of-the-art automatic segmentation. The effect of training set size on the performance of OxNNet demonstrated the need for large data sets. The clinical utility of placental volume was tested by looking at predictions of small-for-gestational-age babies at term. The receiver-operating characteristics curves demonstrated almost identical results between OxNNet and the ground-truth). Our results demonstrated good similarity to the ground-truth and almost identical clinical results for the prediction of SGA.

Predicting bacteremia based on nurse-assessed food consumption at the time of blood culture.

PubMed

Komatsu, Takayuki; Onda, Toshihito; Murayama, Go; Yamanouchi, Masashi; Inukai, Minori; Sakai, Ai; Kikuta, Masumi; Branch, Joel; Aoki, Makoto; Tierney, Lawrence M; Inoue, Kenji

2012-01-01

Bacteremia and its complications are important causes of morbidity and mortality in hospitalized patients. However, the yield of blood cultures is relatively low, with many false-positive results from bacterial contamination. We investigated the relationship between patient food consumption and the presence of bacteremia. This was an observational analysis of a cohort of 1179 patients who underwent blood culture analysis between January 2005 and December 2009. Patients with anorexia-inducing conditions, such as gastrointestinal illness and malignant disease treated with chemotherapy, were excluded. Food consumption was rated by nurses as the percentage of food consumed during the meal preceding the blood culture. Groupings were as follows: low consumption (<50%), moderate (>50% to <80%), and high (>80%). Low consumption was observed in 39.8% of patients, moderate in 17.8%, and high in 41.6%. The average body temperature was 38.1 ± 1.1°C. Bacteremia was present in 18.5%, 3.9%, and 1.4% of patients in the low, moderate, and high food consumption groups, respectively. The negative predictive value was 98.3%, suggesting that bacteremia is very unlikely in the setting of good food intake. Bacteremia is an unlikely occurrence in hospitalized patients who maintain adequate food consumption at the time of blood culture. Copyright © 2012 Society of Hospital Medicine.

Rapid Analysis of Microalgal Triacylglycerols with Direct-Infusion Mass Spectrometry

DOE PAGES

Christensen, Earl; Sudasinghe, Nilusha; Dandamudi, Kodanda Phani Raj; ...

2015-09-01

Cultivation of microalgae has the potential to provide lipid-derived feedstocks for conversion to liquid transportation fuels. Lipid extracts from microalgae are significantly more complex than those of traditional seed oils, and their composition changes significantly throughout the microalgal growth period. With three acyl side chains per molecule, triglycerides (TAGs) are an important fuel precursor, and the distribution of acyl chain composition for TAGs has a significant impact on fuel properties and processing. Therefore, determination of the distribution of microalgal TAG production is needed to assess the value of algal extracts designed for fuel production and to optimize strain, cultivation, andmore » harvesting practices. Methods utilized for TAG speciation commonly involve complicated and time-consuming chromatographic techniques. Here we present a method for TAG speciation and quantification based on direct-infusion mass spectrometry, which provides rapid characterization of TAG profiles without chromatographic separation. Specifically, we utilize Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) to provide a reference library of TAGs for the microalgae Nannochloropsis sp. that provides the basis for high-throughput TAG quantitation by time-of-flight mass spectrometry (TOF MS). In conclusion, we demonstrate the application of this novel approach for lipid characterization with respect to TAG compound distribution, which informs both immediate and future strain and process optimization strategies.« less

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

Christensen, Earl; Sudasinghe, Nilusha; Dandamudi, Kodanda Phani Raj

Cultivation of microalgae has the potential to provide lipid-derived feedstocks for conversion to liquid transportation fuels. Lipid extracts from microalgae are significantly more complex than those of traditional seed oils, and their composition changes significantly throughout the microalgal growth period. With three acyl side chains per molecule, triglycerides (TAGs) are an important fuel precursor, and the distribution of acyl chain composition for TAGs has a significant impact on fuel properties and processing. Therefore, determination of the distribution of microalgal TAG production is needed to assess the value of algal extracts designed for fuel production and to optimize strain, cultivation, andmore » harvesting practices. Methods utilized for TAG speciation commonly involve complicated and time-consuming chromatographic techniques. Here we present a method for TAG speciation and quantification based on direct-infusion mass spectrometry, which provides rapid characterization of TAG profiles without chromatographic separation. Specifically, we utilize Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) to provide a reference library of TAGs for the microalgae Nannochloropsis sp. that provides the basis for high-throughput TAG quantitation by time-of-flight mass spectrometry (TOF MS). In conclusion, we demonstrate the application of this novel approach for lipid characterization with respect to TAG compound distribution, which informs both immediate and future strain and process optimization strategies.« less

Wireless connection of continuous glucose monitoring system to the electronic patient record

NASA Astrophysics Data System (ADS)

Murakami, Alexandre; Gutierrez, Marco A.; Lage, Silvia G.; Rebelo, Marina S.; Granja, Luiz A. R.; Ramires, Jose A. F.

2005-04-01

The control of blood sugar level (BSL) at near-normal levels has been documented to reduce both acute and chronic complications of diabetes mellitus. Recent studies suggested, the reduction of mortality in a surgical intensive care unit (ICU), when the BSL are maintained at normal levels. Despite of the benefits appointed by these and others clinical studies, the strict BSL control in critically ill patients suffers from some difficulties: a) medical staff need to measure and control the patient"s BSL using blood sample at least every hour. This is a complex and time consuming task; b) the inaccuracy of standard capillary glucose monitoring (fingerstick) in hypotensive patients and, if frequently used to sample arterial or venous blood, may lead to excess phlebotomy; c) there is no validated procedure for continuously monitoring of BSL levels. This study used the MiniMed CGMS in ill patients at ICU to send, in real-time, BSL values to a Web-Based Electronic Patient Record. The BSL values are parsed and delivered through a wireless network as an HL7 message. The HL7 messages with BSL values are collected, stored into the Electronic Patient Record and presented into a bed-side monitor at the ICU together with other relevant patient information.

Choice of electricity provider in California after deregulation

NASA Astrophysics Data System (ADS)

Keanini, Rasa Ilze

Surveys often ask consumers how much they are willing to pay for certain goods and services, without requiring the consumer to actually pay for the good or service. Such surveys, termed stated preference studies, find that consumers value renewable electricity. This result is in contrast to actual experiences in recently deregulated electricity markets in several states, including California. When given the opportunity to choose in California, only one to two percent of the population opted for renewable electricity products. This dissertation used data from residential customers who chose an alternative electricity product in California's deregulated electricity market to determine the value placed on the renewable attribute of electricity products. This dissertation begins by taking a historical look at the electricity market of the nation and specifically California. From 1998 through 2001, California's electricity market was deregulated to include retail competition. This dissertation used data from electric service providers to reveal the factors influencing residential customer's choice of electricity product. Discrete choice models were used to determine the factors influencing electricity product choice. The results indicated that both price and renewable content had an effect on choice of product. Additionally, a more complicated model jointly estimating the discrete choice of electricity product with the continuous choice of electricity consumption (kWh) was specified and estimated.

Outcomes mapping study for childhood vaccination communication: too few concepts were measured in too many ways.

PubMed

Kaufman, Jessica; Ryan, Rebecca; Bosch-Capblanch, Xavier; Cartier, Yuri; Cliff, Julie; Glenton, Claire; Lewin, Simon; Rada, Gabriel; Ames, Heather; Muloliwa, Artur Manuel; Oku, Afiong; Oyo-Ita, Angela; Hill, Sophie

2016-04-01

The objectives of this article are to (1) comprehensively catalog outcomes measured in trials of childhood vaccination communication interventions and (2) analyze patterns and trends in outcome selection. To achieve these objectives, we developed a Trial Outcomes Map for vaccination communication. We searched the Cochrane Central Register of Controlled Trials for trials of childhood vaccination communication interventions, extracting verbatim all outcome information from included trials. Through thematic grouping, we categorized outcomes based on conceptual similarities, forming a Trial Outcomes Map. We identified 112 relevant trials containing 209 outcomes. Thematic analysis revealed three overarching Outcome Categories: consumer-, vaccination-, and health system-related outcomes. These categories contain 21 Outcome Types (eg, "knowledge," "cost"), measured using 66 different Outcome Variables. Vaccination outcomes were measured most frequently and health system-related outcomes least frequently. Consumer outcomes are increasingly measured in more recent trials. The number of measures used for the same outcomes complicates data synthesis and interpretation. Despite recent trends toward including consumer outcomes, intermediate outcome measurement is lacking, hampering understanding of how and why vaccination communication interventions do or do not work. This Map may improve outcome consistency in future trials and will contribute to a forthcoming core outcome set. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

[Addiction to cocaine and other stimulants].

PubMed

Lacoste, Jérôme; Delavenne-Garcia, Héloïse; Charles-Nicolas, Aimé; Duarte Garcia, Frederico; Jehel, Louis

2012-12-01

Due to many available forms (powder, pasta base, freebase and crack…) and because of multiple routes of administration (intranasal, intravenous, or smoked), cocaine has become in 30 years one of the most consumed illegal drugs worldwide, after cannabis. While the frequency of consumption decreases in North America, it continues to rise in Europe, and in some countries in South America, including Brazil, despite a growing knowledge of its specific effects, physical complications and psychiatric consequences. Elsewhere (notably in Asia and Indian Ocean), amphetamine and other stimulants (including methamphetamine), whose properties and patterns of use are very similar to those of cocaine, tend to replace it. Another amphetamine derivative, MDMA or ecstasy, is also consumed by many young people of less than 25 years, in Europe and North America, in a festive setting, with specific consequences and special procedures of care. Although there is currently no consensus for a specific medication, the most appropriate therapeutic approach seems to involve a psychosocial treatment associated with an anticraving medication, which will reduce compulsive desire to consume, in order to facilitate the psychotherapeutic and social care. However, pharmacological research remains very active, and many options are explored (GABAergic or dopaminergic agonists, amphetamine derivatives with long half-life, vaccine…), whether to treat addiction to cocaine or to methamphetamine. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Beyond Yellow Curry: Assessing Commercial Curcumin Absorption Technologies

PubMed Central

Douglass, Brad J.; Clouatre, Dallas L.

2015-01-01

BACKGROUND: Few natural products have demonstrated the range of protective and therapeutic promise as have turmeric and its principal bioactive components: curcumin, demethoxycurcumin, and bisdemethoxycurcumin. Success in translating this potential into tangible benefits has been limited by inherently poor intestinal absorption, rapid metabolism, and limited systemic bioavailability. Seeking to overcome these limitations, food ingredient formulators have begun to employ a variety of approaches to enhance absorption and bioactivity. Many of these strategies improve upon the age-old practice of consuming turmeric in fat-based sauces, such as in a fat-rich yellow curry. However, there exists uncertainty as to how the various commercially available offerings compare to each other in terms of either uptake or efficacy, and this uncertainty leaves physicians and nutritionists with a dearth of data for making recommendations to interested patients and consumers. Further complicating the issue are recent data suggesting that formulation strategies may not equally enhance the absorption of individual curcuminoids, a significant issue in that these curcuminoids exhibit somewhat different physiologic properties. OBJECTIVE: This review introduces needed order to the curcumin marketplace by examining bioavailability studies on a number of commercial curcumin ingredients and evaluating them on a level playing field. METHODS: The comparative analysis includes standard pharmacokinetic parameters and a new metric, relative mass efficiency (E). Relative mass efficiency allows for the comparison of different formulations even in cases in which the weight percentage of curcuminoids is vastly different. RESULTS: A hydrophilic carrier dispersed curcuminoid formula exhibits 45.9 times the bioavailability of the standard purified 95 percent curcuminoid preparation and, based on relative mass efficiency, 1.5 times the bioavailability of the next best commercial ingredient, a cyclodextrin complex. CONCLUSIONS: Delivery strategies can significantly improve the bioavailability of curcuminoids. Total formula mass is important for making practical formulation decisions about dosing, cost and space. PMID:25856323

Identification of potential biomarkers for post-traumatic complications released after trauma-hemorrhage from murine Kupffer cells and its investigation in lung and liver.

PubMed

Schultze, Cornelia; Hildebrand, Frank; Noack, Sandra; Krettek, Christian; Zeckey, Christian; Neunaber, Claudia

2016-11-01

Early diagnosis of complications after severe trauma by specific biomarkers remains difficult. Identify potential new biomarkers for early diagnosis of post-traumatic complications. Mice underwent pressure-controlled hemorrhage or sham procedure. Four hours later, genome-wide expression of isolated Kupffer cells was compared with controls using Affymetrix-Genechip-Expression-Analysis and real-time-PCR. Expression analysis and real-time-PCR revealed a significant increase of gene expression of Cxcl10, Il4ra, Csf2rb2, Lcn2, and Gbp5. Cxcl10, Il4ra, Csf2rb2, Lcn2, and Gbp5 might represent new biomarkers for early diagnosis of post-traumatic complications, if they are linked to the development of post-traumatic complications.

Nuclear Safety via Commercial Grade Dedication - Hitting the Right Target - 12163

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

Kindred, Greg

2012-07-01

S.A.Technology has developed and implemented a highly effective Commercial Grade Dedication program that has been used to qualify a variety of equipment to the rigorous requirements of ASTM NQA-1. In specific cases, S.A.Technology personnel have worked closely with clients to develop complex Commercial Grade Dedication plans that satisfy the scrutiny of the US Department of Energy. These projects have been as simple as Passive Mechanical systems, and as complicated as Active Mechanical and Electrical systems. S.A.Technology's Commercial Grade Dedication plans have even been used as presentation materials to a client's internal departments encompassing Engineering, Quality and Procurement. This is themore » new target of today's CGD: exposing the reasoning behind the dedication process. Previously, only test and inspection results were expected. Today's CGD now needs to show how the decisions presented are the right decisions to make. We must be willing to undergo the process of learning how each new piece of equipment is affected by the system it is placed into, as well as understanding how that equipment can affect the system itself. It is a much more complicated and time-consuming endeavor to undertake. On top of it all, we must be able to voice those discoveries and rationalizations in a clear and concise manner. Unless we effectively communicate our intentions to the reader, we will not be understood. If researched correctly and presented properly, today's Commercial Grade Dedication plans will answer the appropriate questions before they are asked. (authors)« less

Initial experience with a dedicated coronary re-entry device for revascularization of chronic total occlusions.

PubMed

Whitlow, Patrick L; Lombardi, William L; Araya, Mario; Michael Wyman, R; Torres, Humberto; Dauvergne, Christian; Tsuchikane, Etsuo; Lansky, Alexandra; Thompson, Craig A

2012-11-01

The aim of this registry was to evaluate a new device designed to facilitate antegrade guidewire re-entry into the true lumen of a chronic total coronary occlusion (CTO) from the adjacent subintimal space. Successful recanalization of CTOs results in clinical improvement in appropriately selected patients. CTO intervention is time- and resource-consuming, and a simplified approach enabling antegrade guidewire re-entry into the distal true lumen might improve success. Patients with CTO and ischemia were entered into a prospective registry regardless of lesion characteristics. If wire manipulation resulted in subintimal wire entrapment, a new re-entry tool (a 2.5-mm flat subintimal balloon with two exit ports offset by 180°) was used as a platform to attempt guidewire penetration into the distal true lumen. The primary endpoint assessed was successful device-guided re-entry. Standard techniques were then utilized to open the CTO. In 40 consecutive CTO lesions attempted, 19 resulted in subintimal wire entrapment (mean occlusion length 44 mm). Sixteen of these 19 were successfully crossed with an antegrade guidewire into the distal true lumen using the new device (84%). One patient with unsuccessful re-entry was subsequently recanalized with a retrograde technique. All crossed lesions were stented (17/17), resulting in TIMI 3 flow without major complications. Two cases were unsuccessful. One patient had a grade I coronary perforation requiring no treatment. A new device to recanalize CTOs complicated by subintimal wire entrapment can be used successfully by experienced operators. Further study of this coronary re-entry device is ongoing. Copyright © 2011 Wiley Periodicals, Inc.

Geometry Modeling and Grid Generation for Design and Optimization

NASA Technical Reports Server (NTRS)

Samareh, Jamshid A.

1998-01-01

Geometry modeling and grid generation (GMGG) have played and will continue to play an important role in computational aerosciences. During the past two decades, tremendous progress has occurred in GMGG; however, GMGG is still the biggest bottleneck to routine applications for complicated Computational Fluid Dynamics (CFD) and Computational Structures Mechanics (CSM) models for analysis, design, and optimization. We are still far from incorporating GMGG tools in a design and optimization environment for complicated configurations. It is still a challenging task to parameterize an existing model in today's Computer-Aided Design (CAD) systems, and the models created are not always good enough for automatic grid generation tools. Designers may believe their models are complete and accurate, but unseen imperfections (e.g., gaps, unwanted wiggles, free edges, slivers, and transition cracks) often cause problems in gridding for CSM and CFD. Despite many advances in grid generation, the process is still the most labor-intensive and time-consuming part of the computational aerosciences for analysis, design, and optimization. In an ideal design environment, a design engineer would use a parametric model to evaluate alternative designs effortlessly and optimize an existing design for a new set of design objectives and constraints. For this ideal environment to be realized, the GMGG tools must have the following characteristics: (1) be automated, (2) provide consistent geometry across all disciplines, (3) be parametric, and (4) provide sensitivity derivatives. This paper will review the status of GMGG for analysis, design, and optimization processes, and it will focus on some emerging ideas that will advance the GMGG toward the ideal design environment.

Vegetarian Diet in Chronic Kidney Disease—A Friend or Foe

PubMed Central

Gluba-Brzózka, Anna; Franczyk, Beata; Rysz, Jacek

2017-01-01

Healthy diet is highly important, especially in patients with chronic kidney disease (CKD). Proper nutrition provides the energy to perform everyday activities, prevents infection, builds muscle, and helps to prevent kidney disease from getting worse. However, what does a proper diet mean for a CKD patient? Nutrition requirements differ depending on the level of kidney function and the presence of co-morbid conditions, including hypertension, diabetes, and cardiovascular disease. The diet of CKD patients should help to slow the rate of progression of kidney failure, reduce uremic toxicity, decrease proteinuria, maintain good nutritional status, and lower the risk of kidney disease-related secondary complications (cardiovascular disease, bone disease, and hypertension). It has been suggested that plant proteins may exert beneficial effects on blood pressure, proteinuria, and glomerular filtration rate, as well as results in milder renal tissue damage when compared to animal proteins. The National Kidney Foundation recommends vegetarianism, or part-time vegetarian diet as being beneficial to CKD patients. Their recommendations are supported by the results of studies demonstrating that a plant-based diet may hamper the development or progression of some complications of chronic kidney disease, such as heart disease, protein loss in urine, and the progression of kidney damage. However, there are sparse reports suggesting that a vegan diet is not appropriate for CKD patients and those undergoing dialysis due to the difficulty in consuming enough protein and in maintaining proper potassium and phosphorus levels. Therefore, this review will focus on the problem as to whether vegetarian diet and its modifications are suitable for chronic kidney disease patients. PMID:28394274

Vegetarian Diet in Chronic Kidney Disease-A Friend or Foe.

PubMed

Gluba-Brzózka, Anna; Franczyk, Beata; Rysz, Jacek

2017-04-10

Healthy diet is highly important, especially in patients with chronic kidney disease (CKD). Proper nutrition provides the energy to perform everyday activities, prevents infection, builds muscle, and helps to prevent kidney disease from getting worse. However, what does a proper diet mean for a CKD patient? Nutrition requirements differ depending on the level of kidney function and the presence of co-morbid conditions, including hypertension, diabetes, and cardiovascular disease. The diet of CKD patients should help to slow the rate of progression of kidney failure, reduce uremic toxicity, decrease proteinuria, maintain good nutritional status, and lower the risk of kidney disease-related secondary complications (cardiovascular disease, bone disease, and hypertension). It has been suggested that plant proteins may exert beneficial effects on blood pressure, proteinuria, and glomerular filtration rate, as well as results in milder renal tissue damage when compared to animal proteins. The National Kidney Foundation recommends vegetarianism, or part-time vegetarian diet as being beneficial to CKD patients. Their recommendations are supported by the results of studies demonstrating that a plant-based diet may hamper the development or progression of some complications of chronic kidney disease, such as heart disease, protein loss in urine, and the progression of kidney damage. However, there are sparse reports suggesting that a vegan diet is not appropriate for CKD patients and those undergoing dialysis due to the difficulty in consuming enough protein and in maintaining proper potassium and phosphorus levels. Therefore, this review will focus on the problem as to whether vegetarian diet and its modifications are suitable for chronic kidney disease patients.

News Media Industry

DTIC Science & Technology

2007-01-01

convergence of media types, rapidly evolving technology, changing consumer behavior , and traditionalists ensconced in the ways of the past all...changing consumer behavior have all contributed to uncertain times for these media icons. Newspaper readership and subscriptions levels continue to...consistently center on changing technologies, corporate pressures, changing consumer behavior and revenue generation (advertising). Because it’s

Planning Consumer Education Programs for Residents of Prisons and Pre-Release Centers.

ERIC Educational Resources Information Center

Southern Illinois Univ., Carbondale. Dept. of Family Economics and Management.

The pamphlet describes the development of a consumer education program for prison inmates, and presents 12 curriculum guides on consumer topics relevant to prisoners. Because prison inmates spend time removed from the changing economic marketplace, and because many crimes stem from financial and economic problems, it is important to educate and…

Consumer trait variation influences tritrophic interactions in salt marsh communities.

PubMed

Hughes, Anne Randall; Hanley, Torrance C; Orozco, Nohelia P; Zerebecki, Robyn A

2015-07-01

The importance of intraspecific variation has emerged as a key question in community ecology, helping to bridge the gap between ecology and evolution. Although much of this work has focused on plant species, recent syntheses have highlighted the prevalence and potential importance of morphological, behavioral, and life history variation within animals for ecological and evolutionary processes. Many small-bodied consumers live on the plant that they consume, often resulting in host plant-associated trait variation within and across consumer species. Given the central position of consumer species within tritrophic food webs, such consumer trait variation may play a particularly important role in mediating trophic dynamics, including trophic cascades. In this study, we used a series of field surveys and laboratory experiments to document intraspecific trait variation in a key consumer species, the marsh periwinkle Littoraria irrorata, based on its host plant species (Spartina alterniflora or Juncus roemerianus) in a mixed species assemblage. We then conducted a 12-week mesocosm experiment to examine the effects of Littoraria trait variation on plant community structure and dynamics in a tritrophic salt marsh food web. Littoraria from different host plant species varied across a suite of morphological and behavioral traits. These consumer trait differences interacted with plant community composition and predator presence to affect overall plant stem height, as well as differentially alter the density and biomass of the two key plant species in this system. Whether due to genetic differences or phenotypic plasticity, trait differences between consumer types had significant ecological consequences for the tritrophic marsh food web over seasonal time scales. By altering the cascading effects of the top predator on plant community structure and dynamics, consumer differences may generate a feedback over longer time scales, which in turn influences the degree of trait divergence in subsequent consumer populations.

Cause and effect: the linkage between the health information seeking behavior and the online environment--a review.

PubMed

Bratucu, R; Gheorghe, I R; Purcarea, R M; Gheorghe, C M; Popa Velea, O; Purcarea, V L

2014-09-15

Today, health care consumers are taking more control over their health care problems, investing more time in finding and getting information as well as looking for proper methods in order to investigate more closely the health care information received from their physicians. Unfortunately, in health care consumers' views, the trustworthiness of health authorities and institutions has declined in the last years. So, consumers have found a new solution to their health problems, that is, the Internet. Recently, studies revealed that consumers seeking for health information have more options to look for data in comparison to the methods used a few years ago. Therefore, due to the available technology, consumers have more outlets to search for information. For instance, the Internet is a source that has revolutionized the way consumers seek data due its customized methods of assessing both quantitative and qualitative information which may be achieved with minimal effort and low costs, offering at the same time, several advantages such as making the decision process more efficient.

Complications and adequacy of transplant kidney biopsies: A comparison of techniques.

PubMed

Plattner, Brett W; Chen, Pauline; Cross, Richard; Leavitt, Matthew A; Killen, Paul D; Heung, Michael

2018-05-01

Kidney biopsies are an essential tool in the diagnosis and management of kidney diseases, particularly in kidney transplant recipients. Biopsies carry a risk for serious complications and not all biopsies achieve adequate tissue. We examined the impact of kidney biopsy technique on complications and biopsy adequacy. The cohort consisted of consecutive kidney transplant patients undergoing biopsy by one of three techniques: ultrasound localization, real-time ultrasound guidance, and ultrasound-guided trocar placement. Variables of interest included patient characteristics and procedural characteristics. The primary outcome was serious complication attributable to kidney biopsy, and the secondary outcome was biopsy adequacy as defined by Banff criteria. Among 263 patients undergoing biopsy, 27 (10.3%) had a complication (14 with gross hematuria, 10 requiring blood transfusion, 3 requiring an unplanned interventional radiology procedure, 1 kidney loss; no deaths). Complications were more common among patients biopsied using ultrasound-guided trocar compared to real-time ultrasound and ultrasound localization (21.4% vs 7.9% vs 7.1%, respectively, p = 0.008). After adjusting for patient and procedure characteristics, technique was no longer significantly associated with complication. Biopsy adequacy was significantly higher when using ultrasound localization and real-time ultrasound compared to ultrasound-guided trocar (84.6% vs 86.8% vs 69.6%, p = 0.029), and this finding persisted in adjusted analysis. Kidney biopsy complications appear to be similar when using any of the three techniques examined in our study. However, ultrasound-guided trocar technique may yield lower biopsy adequacy when compared to non-trocar techniques.

Long-Term Outcome and Complications Following Prophylactic Laparoscopic-Assisted Gastropexy in Dogs.

PubMed

Loy Son, Natasha K; Singh, Ameet; Amsellem, Pierre; Kilkenny, Jessica; Brisson, Brigitte A; Oblak, Michelle L; Ogilvie, Adam T

2016-11-01

To characterize the short- and long-term outcome (>12 months), complications, and owner satisfaction following prophylactic laparoscopic-assisted gastropexy (LAG) in dogs. Retrospective study. Client-owned dogs (n = 49). Dogs that underwent prophylactic LAG at 2 veterinary academic hospitals were studied. Surgical time, anesthesia time, concurrent intra- and extra-abdominal procedures, and intraoperative and postoperative complications were recorded following review of medical records. Veterinarian and/or owner follow-up was obtained to determine outcome and satisfaction with LAG. Five of 49 dogs (10%) experienced complications related to abdominal access during LAG. Four percent (2/49) of dogs experienced an intraoperative complication. Follow-up information was available for 89% of dogs (44/49). Four dogs died of causes unrelated to LAG or gastric dilatation volvulus (GDV) in the follow-up period. Two dogs experienced major postoperative complications requiring additional veterinary intervention. Thirty percent (13 dogs) experienced a minor postoperative self-limiting wound-related complication. Median follow-up time was 698 days (range, 411-1825). No dogs experienced GDV. One hundred percent of dog owners were satisfied with LAG, would repeat the procedure in a future pet, and would recommend the procedure to a friend or family member. LAG was an effective procedure for prevention of GDV and was associated with high client satisfaction in this cohort of dogs. A moderate rate of postoperative wound complications occurred that were minor and self-limiting in nature. © Copyright 2016 by The American College of Veterinary Surgeons.

Assessment of cost of illness for diabetic patients in South Indian tertiary care hospital.

PubMed

Acharya, Leelavathi D; Rau, N R; Udupa, N; Rajan, M Surulivel; Vijayanarayana, K

2016-01-01

The impact of diabetes on health-care expenditures has been increasingly recognized. To formulate an effective health planning and resource allocation, it is important to determine economic burden. The objective of this study is to assess the cost of illness (COI) for diabetic inpatients with or without complications. The study was conducted in the medicine wards of tertiary care hospital after ethical approval by the Institutional Ethical Committee. A total of 116 each diabetic with or without complications were selected and relevant data were collected using COI questionnaire and data were analyzed using SPSS version 20. Mann-Whitney U test is used to assess the statistical significant difference in the cost of treatment of diabetes alone and with complications'. P ≤ 0.05 was considered statistically significant. Total COI includes the cost of treatment, investigation, consultation fee, intervention cost, transportation, days lost due to work, and hospitalization. The median of total COI for diabetic care without any complication was Rs. 22,456.97/- per patient per annum and with complication was Rs. 30,634.45/-. Patients on dialysis had to spend 7.3 times higher, and patients with cardiac intervention had to spend 7.4 times higher than diabetic patients without any complication. Treatment costs were many times higher in patients with complications and with cardiac and renal interventions. Complications in diabetic patients will increase the economic burden to family and also to the society.

Intake of Dietary Supplements and Malnutrition in Patients in Intensive Care Unit

PubMed Central

Samadi, Mehnoosh; Zeinali, Fahime; Habibi, Nahal; Ghotbodin-Mohammadi, Shirin

2016-01-01

Background: Malnutrition is prevalent among patients hospitalized in Intensive Care Units (ICUs) and causes various complications. Dietary supplementation to provide appropriate nutritional support may reduce the malnutrition and complications through improvement in nutritional status. This study was carried out to assess the association between dietary supplementation and malnutrition among patients in ICUs. Methods: A case–control study was conducted on 180 male patients aged 20–60 years in the ICUs of the hospitals in Ahvaz, Iran in 2013. Data of two groups including 83 patients (cases) who had consumed regular hospital meals and dietary supplements and 97 patients (controls) who had received regular hospital meals were compared. Anthropometric measurements, laboratory values, and dietary intakes were extracted from medical records, and Maastricht index (MI) was calculated. Data were analyzed using the IBM SPSS Statistics 21. T-test and paired-sample t-test were used to determine the difference between groups. Results: Taking supplements increased daily energy intake, carbohydrate, and protein in case group (n = 83) significantly (P < 0.05). MI changed to 3.1 ± 3.8 and 4.3 ± 4.2 in case (n = 83) and control (n = 97) groups, respectively. Although the MI fell in both groups, it showed a greater reduction in case group (from 6.3 ± 5.3 to 3.1 ± 3.8). Conclusions: Since consuming dietary supplements besides the regular hospital meals increased intake of energy and macronutrients and reduced the MI significantly, it was concluded that it helped supply nutritional requirements more effectively and improved the malnutrition in ICU. PMID:27512556

12 CFR 229.18 - Additional disclosure requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... consumer accounts a notice that sets forth the time periods applicable to the availability of funds deposited in a consumer account. (c) Automated teller machines. (1) A depositary bank shall post or provide... than two times each week, as described in § 229.19(a)(4), shall disclose at or on the ATM the days on...

12 CFR 229.18 - Additional disclosure requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... deposits to consumer accounts a notice that sets forth the time periods applicable to the availability of funds deposited in a consumer account. (c) Automated teller machines. (1) A depositary bank shall post... removed not more than two times each week, as described in § 229.19(a)(4), shall disclose at or on the ATM...

26 CFR 1.280F-6 - Special rules and definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... consumer research business. Because E's business use percentage for the computer does not exceed 50 percent... percent of the time to manage her investments and 60 percent of the time in her consumer research business... by the employee, even for personal purposes, is a qualified business use the respect to X. (e) Method...

Estimating true hospital morbidity of complications associated with mumps outbreak, England, 2004/05

PubMed Central

Yung, CF; Ramsay, M

2016-01-01

Mumps outbreaks in highly vaccinated populations continue to be reported globally. Therefore, quantifying the burden of mumps morbidity accurately will be necessary to better assess the impact of mumps vaccination programmes. We aim to estimate the true morbidity resulting from mumps complications in terms of hospitalised orchitis, meningitis, oophoritis and pancreatitis in England during the outbreak in 2004/05. This outbreak in England led to a clear increase in hospitalisations coded to mumps for complications of orchitis in those born in the 1970s and 1980s and possibly for meningitis in those born in the 1980s. A simple statistical model, based on analysing time trends for diagnosed complications in hospital databases with routine laboratory surveillance data, found that the actual morbidity was much higher. There were 2.5 times (166 cases) more mumps orchitis cases in the 1970s cohort and 2.0 times (708 cases) more mumps orchitis cases in the 1980s cohort than complications coded to mumps in hospital databases. Our study demonstrated that the mumps outbreak in England 2004/05 resulted in a substantial increase in hospitalised mumps complications, and the model we used can improve the ascertainment of morbidity from a mumps outbreak. PMID:27562958

Quantifying the Impacts of Timebased Rates, Enabling Technology, and Other Treatments in Consumer Behavior Studies: Protocols and Guidelines

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

Cappers, Peter; Todd, Annika; Perry, Michael

2013-06-27

This report offers guidelines and protocols for measuring the effects of time-based rates, enabling technology, and various other treatments on customers’ levels and patterns of electricity usage. Although the focus is on evaluating consumer behavior studies (CBS) that involve field trials and pilots, the methods can be extended to assessing the large-scale programs that may follow. CBSs are undertaken to resolve uncertainties and ambiguities about how consumers respond to inducements to modify their electricity demand. Those inducements include price structures; feedback and information; and enabling technologies embedded in programs such as: critical peak, time-of use, real-time pricing; peak time rebatemore » or critical peak rebate; home energy reports and in-home displays; and all manner of device controls for appliances and plug loads. Although the focus of this report is on consumer studies—where the subjects are households—the behavioral sciences principles discussed and many of the methods recommended apply equally to studying commercial and industrial customer electricity demand.« less

Recruiting patients to clinical trials: lessons from studies of growth hormone treatment in renal failure.

PubMed

Postlethwaite, R J; Reynolds, J M; Wood, A J; Evans, J H; Lewis, M A; Eminson, D M

1995-07-01

Issues raised by the recruitment of children to trials of growth hormone treatment for short stature in chronic renal failure are reported. Information needs of parents and children are discussed, the latter should take account of the children's developmental level and anticipated involvement in decision making. When the incidence of certain side effects is low and probably unquantifiable there are particular problems; failure to include these in information sheets may compromise informed consent but inclusion will, at least for some families, make an already difficult decision even more complicated. A process of recruitment is described which attempts to protect against bias and which balances the requirement to impart neutral information with appropriate clinical involvement in the decision to enter the study. Other functions of the recruitment process are identified. Analysis of understanding and decision making demonstrates that good understanding is neither necessary nor sufficient for ease of decision making. The recruitment process was time consuming and needs planning and funding in future studies. Many of these issues are of general importance for trials of treatment in children.

The Challenges of Dysphagia Management and Rehabilitation in Two Complex Cases Post Chemical Ingestion Injury.

PubMed

Rumbach, Anna F; Cremer, Rebecca; Chatwood, Astra; Fink, Sari; Haider, Sadaf; Yee, Michelle

2016-11-01

Dysphagia is common sequelae of chemical ingestion injury, resulting from damage to critical swallowing structures. From a speech-language pathology perspective, this study outlines the physiological deficits in 2 individuals with severe injury (1 woman, acid; 1 man, alkali) and the pattern of dysphagia rehabilitation and recovery. A retrospective chart review of clinical and instrumental assessments was conducted to examine swallow characteristics and speech-language pathology management (compensatory and rehabilitation strategies) at multiple time points. Chemical ingestion injury resulted in severe pharyngeal dysphagia for both participants, warranting speech-language pathology management. Dysphagia was characterized by poor base of tongue mobility and reduced laryngeal excursion. Decreased airway patency and protection, secondary to mucosal sloughing, widespread edema, and structural deficits necessitated tracheostomy. Recovery was complicated by physical alterations of pharyngeal and laryngeal structures (e.g., interarytenoid adhesions) and esophageal strictures. Participant 1 was discharged (Day 135) consuming a texture-modified diet; Participant 2 remained nil by mouth (Day 329). Dysphagia recovery subsequent to chemical ingestion is protracted and complex. Clinical outcomes may be improved through individualized and intensive rehabilitation by speech-language pathologists.

Orthodontics: computer-aided diagnosis and treatment planning

NASA Astrophysics Data System (ADS)

Yi, Yaxing; Li, Zhongke; Wei, Suyuan; Deng, Fanglin; Yao, Sen

2000-10-01

The purpose of this article is to introduce the outline of our newly developed computer-aided 3D dental cast analyzing system with laser scanning, and its preliminary clinical applications. The system is composed of a scanning device and a personal computer as a scanning controller and post processor. The scanning device is composed of a laser beam emitter, two sets of linear CCD cameras and a table which is rotatable by two-degree-of-freedom. The rotating is controlled precisely by a personal computer. The dental cast is projected and scanned with a laser beam. Triangulation is applied to determine the location of each point. Generation of 3D graphics of the dental cast takes approximately 40 minutes. About 170,000 sets of X,Y,Z coordinates are store for one dental cast. Besides the conventional linear and angular measurements of the dental cast, we are also able to demonstrate the size of the top surface area of each molar. The advantage of this system is that it facilitates the otherwise complicated and time- consuming mock surgery necessary for treatment planning in orthognathic surgery.

Applications of microfluidics in microalgae biotechnology: A review.

PubMed

Juang, Yi-Je; Chang, Jo-Shu

2016-03-01

Microalgae have been one of the important sources for biofuel production owing to their competitive advantages such as no need to tap into the global food supply chain, higher energy density, and absorbing carbon dioxide to mitigate global warming. One of the key factors to ensure successful biofuel production is that it requires not only bioprospecting of the microalgae with high lipid content, high growth rate and tolerance to environmental parameters but also on-site monitoring of the cultivation process and optimization of the culturing conditions. However, as the conventional techniques usually involve in complicated procedures, or are time-consuming or labor intensive, microfluidics technology offers an attractive alternative to resolve these issues. In this review, applications of microfluidics to bioprospecting in microalgae biotechnology were discussed such as cell identification, cell sorting/screening, cell culturing and cell disruption. In addition, utilization of microalgae in micro-sized fuel cells and microfluidic platforms for biosensing was addressed. This review reports the recent studies and offers a look into how microfluidics is exploited to tackle the issues encountered in the microalgae biotechnology. Copyright © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Implementation of Competency-Based Pharmacy Education (CBPE)

PubMed Central

Koster, Andries; Schalekamp, Tom; Meijerman, Irma

2017-01-01

Implementation of competency-based pharmacy education (CBPE) is a time-consuming, complicated process, which requires agreement on the tasks of a pharmacist, commitment, institutional stability, and a goal-directed developmental perspective of all stakeholders involved. In this article the main steps in the development of a fully-developed competency-based pharmacy curriculum (bachelor, master) are described and tips are given for a successful implementation. After the choice for entering into CBPE is made and a competency framework is adopted (step 1), intended learning outcomes are defined (step 2), followed by analyzing the required developmental trajectory (step 3) and the selection of appropriate assessment methods (step 4). Designing the teaching-learning environment involves the selection of learning activities, student experiences, and instructional methods (step 5). Finally, an iterative process of evaluation and adjustment of individual courses, and the curriculum as a whole, is entered (step 6). Successful implementation of CBPE requires a system of effective quality management and continuous professional development as a teacher. In this article suggestions for the organization of CBPE and references to more detailed literature are given, hoping to facilitate the implementation of CBPE. PMID:28970422

A Comparative Analysis of Taguchi Methodology and Shainin System DoE in the Optimization of Injection Molding Process Parameters

NASA Astrophysics Data System (ADS)

Khavekar, Rajendra; Vasudevan, Hari, Dr.; Modi, Bhavik

2017-08-01

Two well-known Design of Experiments (DoE) methodologies, such as Taguchi Methods (TM) and Shainin Systems (SS) are compared and analyzed in this study through their implementation in a plastic injection molding unit. Experiments were performed at a perfume bottle cap manufacturing company (made by acrylic material) using TM and SS to find out the root cause of defects and to optimize the process parameters for minimum rejection. Experiments obtained the rejection rate to be 8.57% from 40% (appx.) during trial runs, which is quiet low, representing successful implementation of these DoE methods. The comparison showed that both methodologies gave same set of variables as critical for defect reduction, but with change in their significance order. Also, Taguchi methods require more number of experiments and consume more time compared to the Shainin System. Shainin system is less complicated and is easy to implement, whereas Taguchi methods is statistically more reliable for optimization of process parameters. Finally, experimentations implied that DoE methods are strong and reliable in implementation, as organizations attempt to improve the quality through optimization.

Microextraction by packed sorbent: an emerging, selective and high-throughput extraction technique in bioanalysis.

PubMed

Pereira, Jorge; Câmara, José S; Colmsjö, Anders; Abdel-Rehim, Mohamed

2014-06-01

Sample preparation is an important analytical step regarding the isolation and concentration of desired components from complex matrices and greatly influences their reliable and accurate analysis and data quality. It is the most labor-intensive and error-prone process in analytical methodology and, therefore, may influence the analytical performance of the target analytes quantification. Many conventional sample preparation methods are relatively complicated, involving time-consuming procedures and requiring large volumes of organic solvents. Recent trends in sample preparation include miniaturization, automation, high-throughput performance, on-line coupling with analytical instruments and low-cost operation through extremely low volume or no solvent consumption. Micro-extraction techniques, such as micro-extraction by packed sorbent (MEPS), have these advantages over the traditional techniques. This paper gives an overview of MEPS technique, including the role of sample preparation in bioanalysis, the MEPS description namely MEPS formats (on- and off-line), sorbents, experimental and protocols, factors that affect the MEPS performance, and the major advantages and limitations of MEPS compared with other sample preparation techniques. We also summarize MEPS recent applications in bioanalysis. Copyright © 2014 John Wiley & Sons, Ltd.

The health system cost of post-abortion care in Uganda

PubMed Central

Vlassoff, Michael; Mugisha, Frederick; Sundaram, Aparna; Bankole, Akinrinola; Singh, Susheela; Amanya, Leo; Kiggundu, Charles; Mirembe, Florence

2014-01-01

This article presents estimates based on the research conducted in 2010 of the cost to the Ugandan health system of providing post-abortion care (PAC), filling a gap in knowledge of the cost of unsafe abortion. Thirty-nine public and private health facilities were sampled representing three levels of health care, and data were collected on drugs, supplies, material, personnel time and out-of-pocket expenses. In addition, direct non-medical costs in the form of overhead and capital costs were also measured. Our results show that the average annual PAC cost per client, across five types of abortion complications, was $131. The total cost of PAC nationally, including direct non-medical costs, was estimated to be $13.9 million per year. Satisfying all demand for PAC would raise the national cost to $20.8 million per year. This shows that PAC consumes a substantial portion of the total expenditure in reproductive health in Uganda. Investing more resources in family planning programmes to prevent unwanted and mistimed pregnancies would help reduce health systems costs. PMID:23274438

3D Microfabrication Using Emulsion Mask Grayscale Photolithography Technique

NASA Astrophysics Data System (ADS)

Lee, Tze Pin; Mohamed, Khairudin

2016-02-01

Recently, the rapid development of technology such as biochips, microfluidic, micro-optical devices and micro-electromechanical-systems (MEMS) demands the capability to create complex design of three-dimensional (3D) microstructures. In order to create 3D microstructures, the traditional photolithography process often requires multiple photomasks to form 3D pattern from several stacked photoresist layers. This fabrication method is extremely time consuming, low throughput, costly and complicated to conduct for high volume manufacturing scale. On the other hand, next generation lithography such as electron beam lithography (EBL), focused ion beam lithography (FIB) and extreme ultraviolet lithography (EUV) are however too costly and the machines require expertise to setup. Therefore, the purpose of this study is to develop a simplified method in producing 3D microstructures using single grayscale emulsion mask technique. By using this grayscale fabrication method, microstructures of thickness as high as 500μm and as low as 20μm are obtained in a single photolithography exposure. Finally, the fabrication of 3D microfluidic channel has been demonstrated by using this grayscale photolithographic technique.

Dynamic model based on voltage transfer curve for pattern formation in dielectric barrier glow discharge

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

Li, Ben; He, Feng; Ouyang, Jiting, E-mail: jtouyang@bit.edu.cn

2015-12-15

Simulation work is very important for understanding the formation of self-organized discharge patterns. Previous works have witnessed different models derived from other systems for simulation of discharge pattern, but most of these models are complicated and time-consuming. In this paper, we introduce a convenient phenomenological dynamic model based on the basic dynamic process of glow discharge and the voltage transfer curve (VTC) to study the dielectric barrier glow discharge (DBGD) pattern. VTC is an important characteristic of DBGD, which plots the change of wall voltage after a discharge as a function of the initial total gap voltage. In the modeling,more » the combined effect of the discharge conditions is included in VTC, and the activation-inhibition effect is expressed by a spatial interaction term. Besides, the model reduces the dimensionality of the system by just considering the integration effect of current flow. All these greatly facilitate the construction of this model. Numerical simulations turn out to be in good accordance with our previous fluid modeling and experimental result.« less

Dynamic Stiffness Transfer Function of an Electromechanical Actuator Using System Identification

NASA Astrophysics Data System (ADS)

Kim, Sang Hwa; Tahk, Min-Jea

2018-04-01

In the aeroelastic analysis of flight vehicles with electromechanical actuators (EMAs), an accurate prediction of flutter requires dynamic stiffness characteristics of the EMA. The dynamic stiffness transfer function of the EMA with brushless direct current (BLDC) motor can be obtained by conducting complicated mathematical calculations of control algorithms and mechanical/electrical nonlinearities using linearization techniques. Thus, system identification approaches using experimental data, as an alternative, have considerable advantages. However, the test setup for system identification is expensive and complex, and experimental procedures for data collection are time-consuming tasks. To obtain the dynamic stiffness transfer function, this paper proposes a linear system identification method that uses information obtained from a reliable dynamic stiffness model with a control algorithm and nonlinearities. The results of this study show that the system identification procedure is compact, and the transfer function is able to describe the dynamic stiffness characteristics of the EMA. In addition, to verify the validity of the system identification method, the simulation results of the dynamic stiffness transfer function and the dynamic stiffness model were compared with the experimental data for various external loads.

Production Maintenance Infrastructure

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

Jason Gabler, David Skinner

2005-11-01

PMI is a XML framework for formulating tests of software and software environments which operate in a relatively push button manner, i.e., can be automated, and that provide results that are readily consumable/publishable via RSS. Insofar as possible the tests are carried out in manner congruent with real usage. PMI drives shell scripts via a perl program which is charge of timing, validating each test, and controlling the flow through sets of tests. Testing in PMI is built up hierarchically. A suite of tests may start by testing basic functionalities (file system is writable, compiler is found and functions, shellmore » environment behaves as expected, etc.) and work up to large more complicated activities (execution of parallel code, file transfers, etc.) At each step in this hierarchy a failure leads to generation of a text message or RSS that can be tagged as to who should be notified of the failure. There are two functionalities that PMI has been directed at. 1) regular and automated testing of multi user environments and 2) version-wise testing of new software releases prior to their deployment in a production mode.« less

Numerical integration of detector response functions via Monte Carlo simulations

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

Kelly, Keegan John; O'Donnell, John M.; Gomez, Jaime A.

Calculations of detector response functions are complicated because they include the intricacies of signal creation from the detector itself as well as a complex interplay between the detector, the particle-emitting target, and the entire experimental environment. As such, these functions are typically only accessible through time-consuming Monte Carlo simulations. Furthermore, the output of thousands of Monte Carlo simulations can be necessary in order to extract a physics result from a single experiment. Here we describe a method to obtain a full description of the detector response function using Monte Carlo simulations. We also show that a response function calculated inmore » this way can be used to create Monte Carlo simulation output spectra a factor of ~1000× faster than running a new Monte Carlo simulation. A detailed discussion of the proper treatment of uncertainties when using this and other similar methods is provided as well. Here, this method is demonstrated and tested using simulated data from the Chi-Nu experiment, which measures prompt fission neutron spectra at the Los Alamos Neutron Science Center.« less

Understanding and responding the students in learning mathematics through the differentiated instruction

NASA Astrophysics Data System (ADS)

Hapsari, T.; Darhim; Dahlan, J. A.

2018-05-01

This research discusses the differentiated instruction, a mathematic learning which is as expected by the students in connection with the differentiated instruction itself, its implementation, and the students’ responses. This research employs a survey method which involves 62 students as the research respondents. The mathematics learning types required by the students and their responses to the differentiated instruction are examined through questionnaire and interview. The mathematics learning types in orderly required by the students, from the highest frequency cover the easily understood instructions, slowly/not rushing teaching, fun, not complicated, interspersed with humour, various question practices, not too serious, and conducive class atmosphere for the instructions. Implementing the differentiated instruction is not easy. The teacher should be able to constantly assess the students, s/he should have good knowledge of relevant materials and instructions, and properly prepare the instructions, although it is time-consuming. The differentiated instruction is implemented on the instructions of numerical pattern materials. The strategies implemented are flexible grouping, tiered assignment, and compacting. The students positively respond the differentiated learning instruction that they become more motivated and involved in the instruction.

The Upside of Failure: How Regional Student Groups Learn from Their Mistakes

PubMed Central

Mishra, Tarun; Parra, R. Gonzalo; Abeel, Thomas

2014-01-01

Success is the result of planning, hard work, determination, foresight, and a little bit of luck. Unfortunately, nobody has thought to pave the road to success. Although failure can be discouraging and time-consuming, it presents incredible learning opportunities—the biggest difference between those who succeed and those who abandon their projects lies in their response to adversity. This article reviews events undertaken by the Regional Student Groups (RSGs) in India and Argentina, the problems they encountered, and what can be learned from them. RSG-India attempted to organize an online scientific meeting (also known as a virtual conference) with geographically dispersed stakeholders, a totally new concept for them. RSG-Argentina tackled the challenge of organizing a two-day symposium, their first event ever. Some of the complications they faced were easy to fix, others led to the cancellation of activities, and all of them resulted in valuable lessons. The main goal of this article is to highlight, through their experiences, the universal importance of a healthy panel of contingency plans. PMID:25101799

A new cable-tie based sternal closure system: description of the device, technique of implantation and first clinical evaluation

PubMed Central

2012-01-01

Background Wire closure still remains the preferred technique despite reasonable disadvantages. Associated complications, such as infection and sternal instability, cause time- and cost-consuming therapies. We present a new tool for sternal closure with its first clinical experience and results. Methods The sternal ZipFixTM System is based on the cable-tie principle. It primarily consists of biocompatible Poly-Ether-Ether-Ketone implants and is predominantly used peristernally through the intercostal space. The system provides a large implant-to-bone contact for better force distribution and for avoiding bone cut through. Results 50 patients were closed with the ZipFixTM system. No sternal instability was observed at 30 days. Two patients developed a mediastinitis that necessitated the removal of the device; however, the ZipFixTM were intact and the sternum remained stable. Conclusions In our initial evaluation, the short-term results have shown that the sternal ZipFixTM can be used safely and effectively. It is fast, easy to use and serves as a potential alternative for traditional wire closure. PMID:22731778

Numerical integration of detector response functions via Monte Carlo simulations

NASA Astrophysics Data System (ADS)

Kelly, K. J.; O'Donnell, J. M.; Gomez, J. A.; Taddeucci, T. N.; Devlin, M.; Haight, R. C.; White, M. C.; Mosby, S. M.; Neudecker, D.; Buckner, M. Q.; Wu, C. Y.; Lee, H. Y.

2017-09-01

Calculations of detector response functions are complicated because they include the intricacies of signal creation from the detector itself as well as a complex interplay between the detector, the particle-emitting target, and the entire experimental environment. As such, these functions are typically only accessible through time-consuming Monte Carlo simulations. Furthermore, the output of thousands of Monte Carlo simulations can be necessary in order to extract a physics result from a single experiment. Here we describe a method to obtain a full description of the detector response function using Monte Carlo simulations. We also show that a response function calculated in this way can be used to create Monte Carlo simulation output spectra a factor of ∼ 1000 × faster than running a new Monte Carlo simulation. A detailed discussion of the proper treatment of uncertainties when using this and other similar methods is provided as well. This method is demonstrated and tested using simulated data from the Chi-Nu experiment, which measures prompt fission neutron spectra at the Los Alamos Neutron Science Center.

Numerical integration of detector response functions via Monte Carlo simulations

DOE PAGES

Kelly, Keegan John; O'Donnell, John M.; Gomez, Jaime A.; ...

2017-06-13

Calculations of detector response functions are complicated because they include the intricacies of signal creation from the detector itself as well as a complex interplay between the detector, the particle-emitting target, and the entire experimental environment. As such, these functions are typically only accessible through time-consuming Monte Carlo simulations. Furthermore, the output of thousands of Monte Carlo simulations can be necessary in order to extract a physics result from a single experiment. Here we describe a method to obtain a full description of the detector response function using Monte Carlo simulations. We also show that a response function calculated inmore » this way can be used to create Monte Carlo simulation output spectra a factor of ~1000× faster than running a new Monte Carlo simulation. A detailed discussion of the proper treatment of uncertainties when using this and other similar methods is provided as well. Here, this method is demonstrated and tested using simulated data from the Chi-Nu experiment, which measures prompt fission neutron spectra at the Los Alamos Neutron Science Center.« less

Tab2, a novel recombinant polypeptide tag offering sensitive and specific protein detection and reliable affinity purification.

PubMed

Crusius, Kerstin; Finster, Silke; McClary, John; Xia, Wei; Larsen, Brent; Schneider, Douglas; Lu, Hong-Tao; Biancalana, Sara; Xuan, Jian-Ai; Newton, Alicia; Allen, Debbie; Bringmann, Peter; Cobb, Ronald R

2006-10-01

The detection and purification of proteins are often time-consuming and frequently involve complicated protocols. The addition of a peptide tag to recombinant proteins can make this process more efficient. Many of the commonly used tags, such as Flagtrade mark, Myc, HA and V5 are recognized by specific monoclonal antibodies and therefore, allow immunoaffinity-based purification. Enhancing the current scope of flexibility in using diverse peptide tags, we report here the development of a novel, short polypeptide tag (Tab2) for detection and purification of recombinant proteins. The Tab2 epitope corresponds to the NH2-terminal seven amino acid residues of human TGFalpha. A monoclonal anti-Tab2 antibody was raised and characterized. To investigate the potential of this peptide sequence as a novel tag for recombinant proteins, we expressed several different recombinant proteins containing this tag in E. coli, baculovirus, and mammalian cells. The data presented demonstrates the Tab2 tag-anti-Tab2 antibody combination is a reliable tool enabling specific Western blot detection, FACS analysis, and immunoprecipitation as well as non-denaturing protein affinity purification.

Interactions among infections, nutrients and xenobiotics.

PubMed

Ilbäck, Nils-Gunnar; Friman, Göran

2007-01-01

During recent years there have been several incidents in which symptoms of disease have been linked to consumption of food contaminated by chemical substances (e.g., 2,3,7,8-tetrachlorodibenzo-p-dioxin, TCDD). Furthermore, outbreaks of infections in food-producing animals have attracted major attention regarding the safety of consumers, e.g., Bovine Spongiform Encephalitis (BSE) and influenza in chicken. As shown for several xenobiotics in an increasing number of experimental studies, even low-dose xenobiotic exposure may impair immune function over time, as well as microorganism virulence, resulting in more severe infectious diseases and associated complications. Moreover, during ongoing infection, xenobiotic uptake and distribution are often changed resulting in increased toxic insult to the host. The interactions among infectious agents, nutrients, and xenobiotics have thus become a developing concern and new avenue of research in food toxicology as well as in food-borne diseases. From a health perspective, in the risk assessment of xenobiotics in our food and environment, synergistic effects among microorganisms, nutrients, and xenobiotics will have to be considered. Otherwise, such effects may gradually change the disease panorama in society.

An integrated and pragmatic approach: Global plant safety management

NASA Astrophysics Data System (ADS)

McNutt, Jack; Gross, Andrew

1989-05-01

The Bhopal disaster in India in 1984 has compelled manufacturing companies to review their operations in order to minimize their risk exposure. Much study has been done on the subject of risk assessment and in refining safety reviews of plant operations. However, little work has been done to address the broader needs of decision makers in the multinational environment. The corporate headquarters of multinational organizations are concerned with identifying vulnerable areas to assure that appropriate risk-minimization measures are in force or will be taken. But the task of screening global business units for safety prowess is complicated and time consuming. This article takes a step towards simplifying this process by presenting the decisional model developed by the authors. Beginning with an overview of key issues affecting global safety management, the focus shifts to the multinational vulnerability model developed by the authors, which reflects an integration of approaches. The article concludes with a discussion of areas for further research. While the global chemical industry and major incidents therein are used for illustration, the procedures and solutions suggested here are applicable to all manufacturing operations.

End of the chain? Rugosity and fine-scale bathymetry from existing underwater digital imagery using structure-from-motion (SfM) technology

USGS Publications Warehouse

Storlazzi, Curt; Dartnell, Peter; Hatcher, Gerry; Gibbs, Ann E.

2016-01-01

The rugosity or complexity of the seafloor has been shown to be an important ecological parameter for fish, algae, and corals. Historically, rugosity has been measured either using simple and subjective manual methods such as ‘chain-and-tape’ or complicated and expensive geophysical methods. Here, we demonstrate the application of structure-from-motion (SfM) photogrammetry to generate high-resolution, three-dimensional bathymetric models of a fringing reef from existing underwater video collected to characterize the seafloor. SfM techniques are capable of achieving spatial resolution that can be orders of magnitude greater than large-scale lidar and sonar mapping of coral reef ecosystems. The resulting data provide finer-scale measurements of bathymetry and rugosity that are more applicable to ecological studies of coral reefs than provided by the more expensive and time-consuming geophysical methods. Utilizing SfM techniques for characterizing the benthic habitat proved to be more effective and quantitatively powerful than conventional methods and thus might portend the end of the ‘chain-and-tape’ method for measuring benthic complexity.

Robust visual tracking via multiscale deep sparse networks

NASA Astrophysics Data System (ADS)

Wang, Xin; Hou, Zhiqiang; Yu, Wangsheng; Xue, Yang; Jin, Zefenfen; Dai, Bo

2017-04-01

In visual tracking, deep learning with offline pretraining can extract more intrinsic and robust features. It has significant success solving the tracking drift in a complicated environment. However, offline pretraining requires numerous auxiliary training datasets and is considerably time-consuming for tracking tasks. To solve these problems, a multiscale sparse networks-based tracker (MSNT) under the particle filter framework is proposed. Based on the stacked sparse autoencoders and rectifier linear unit, the tracker has a flexible and adjustable architecture without the offline pretraining process and exploits the robust and powerful features effectively only through online training of limited labeled data. Meanwhile, the tracker builds four deep sparse networks of different scales, according to the target's profile type. During tracking, the tracker selects the matched tracking network adaptively in accordance with the initial target's profile type. It preserves the inherent structural information more efficiently than the single-scale networks. Additionally, a corresponding update strategy is proposed to improve the robustness of the tracker. Extensive experimental results on a large scale benchmark dataset show that the proposed method performs favorably against state-of-the-art methods in challenging environments.

Endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms

PubMed Central

Zhai, Ya-Qi; Li, Hui-Kai; Linghu, En-Qiang

2016-01-01

Endoscopic submucosal dissection (ESD) is a well-established treatment for superficial esophageal squamous cell neoplasms (SESCNs) with no risk of lymphatic metastasis. However, for large SESCNs, especially when exceeding two-thirds of the esophageal circumference, conventional ESD is time-consuming and has an increased risk of adverse events. Based on the submucosal tunnel conception, endoscopic submucosal tunnel dissection (ESTD) was first introduced by us to remove large SESCNs, with excellent results. Studies from different centers also reported favorable results. Compared with conventional ESD, ESTD has a more rapid dissection speed and R0 resection rate. Currently in China, ESTD for large SESCNs is an important part of the digestive endoscopic tunnel technique, as is peroral endoscopic myotomy for achalasia and submucosal tunnel endoscopic resection for submucosal tumors of the muscularis propria. However, not all patients with SESCNs are candidates for ESTD, and postoperative esophageal strictures should also be taken into consideration, especially for lesions with a circumference greater than three-quarters. In this article, we describe our experience, review the literature of ESTD, and provide detailed information on indications, standard procedures, outcomes, and complications of ESTD. PMID:26755889

Deep-Learning-Enabled On-Demand Design of Chiral Metamaterials.

PubMed

Ma, Wei; Cheng, Feng; Liu, Yongmin

2018-06-11

Deep-learning framework has significantly impelled the development of modern machine learning technology by continuously pushing the limit of traditional recognition and processing of images, speech, and videos. In the meantime, it starts to penetrate other disciplines, such as biology, genetics, materials science, and physics. Here, we report a deep-learning-based model, comprising two bidirectional neural networks assembled by a partial stacking strategy, to automatically design and optimize three-dimensional chiral metamaterials with strong chiroptical responses at predesignated wavelengths. The model can help to discover the intricate, nonintuitive relationship between a metamaterial structure and its optical responses from a number of training examples, which circumvents the time-consuming, case-by-case numerical simulations in conventional metamaterial designs. This approach not only realizes the forward prediction of optical performance much more accurately and efficiently but also enables one to inversely retrieve designs from given requirements. Our results demonstrate that such a data-driven model can be applied as a very powerful tool in studying complicated light-matter interactions and accelerating the on-demand design of nanophotonic devices, systems, and architectures for real world applications.

Added sugars and risk factors for obesity, diabetes and heart disease.

PubMed

Rippe, J M; Angelopoulos, T J

2016-03-01

The effects of added sugars on various chronic conditions are highly controversial. Some investigators have argued that added sugars increase the risk of obesity, diabetes and cardiovascular disease. However, few randomized controlled trials are available to support these assertions. The literature is further complicated by animal studies, as well as studies which compare pure fructose to pure glucose (neither of which is consumed to any appreciable degree in the human diet) and studies where large doses of added sugars beyond normal levels of human consumption have been administered. Various scientific and public health organizations have offered disparate recommendations for upper limits of added sugar. In this article, we will review recent randomized controlled trials and prospective cohort studies. We conclude that the normal added sugars in the human diet (for example, sucrose, high-fructose corn syrup and isoglucose) when consumed within the normal range of normal human consumption or substituted isoenergetically for other carbohydrates, do not appear to cause a unique risk of obesity, diabetes or cardiovascular disease.

Alkali Burn of the Ocular Surface Associated With a Commonly Used Antifog Agent for Eyewear: Two Cases and a Review of Previous Reports.

PubMed

Welling, John D; Pike, Evan C; Mauger, Thomas F

2016-02-01

To report 2 cases of ocular chemical burns associated with the use of a swim goggle antifog agent and to review the literature for this and similar antifog products. Case reports and systematic review of the medical literature, material safety data, product safety reports, and consumer reviews. Two males, one 46 years and the other 41 years, were referred to our clinic with chemical burns of the ocular surface after using the same goggle antifog agent while swimming in a triathlon. Both sustained significant epithelial defects. Fortunately, with prompt treatment, both of our patients returned to their baseline vision within a few weeks without suffering sight-threatening complications. These are the first cases of ocular chemical burn secondary to use of an eyewear antifog agent to be reported in the medical literature. Similar reports found in consumer forums suggest that our cases are not isolated and these products may have the potential to cause vision-threatening chemical burns.

Complications of unsafe abortion in sub-Saharan Africa: a review.

PubMed

Benson, J; Nicholson, L A; Gaffikin, L; Kinoti, S N

1996-06-01

The Commonwealth Regional Health Community Secretariat undertook a study in 1994 to document the magnitude of abortion complications in Commonwealth member countries. The results of the literature review component of that study, and research gaps identified as a result of the review, are presented in this article. The literature review findings indicate a significant public health problem in the region, as measured by a high proportion of incomplete abortion patients among all hospital gynaecology admissions. The most common complications of unsafe abortion seen at health facilities were haemorrhage and sepsis. Studies on the use of manual vacuum aspiration for treating abortion complications found shorter lengths of hospital stay (and thus, lower resource costs) and a reduced need for a repeat evacuation. Very few articles focused exclusively on the cost of treating abortion complications, but authors agreed that it consumes a disproportionate amount of hospital resources. Studies on the role of men in supporting a woman's decision to abort or use contraception were similarly lacking. Articles on contraceptive behaviour and abortion reported that almost all patients suffering from abortion complications had not used an effective, or any, method of contraception prior to becoming pregnant, especially among the adolescent population; studies on post-abortion contraception are virtually nonexistent. Almost all articles on the legal aspect of abortion recommended law reform to reflect a public health, rather than a criminal, orientation. Research needs that were identified include: community-based epidemiological studies; operations research on decentralization of post-abortion care and integration of treatment with post-abortion family planning services; studies on system-wide resource use for treatment of incomplete abortion; qualitative research on the role of males in the decision to terminate pregnancy and use contraception; clinical studies on pain control medications and procedures; and case studies on the provision of safe abortion services where legally allowed.

Outfit Planning

DTIC Science & Technology

1979-12-01

ETC.ronments where, in most cases, it is difficult or time consum - ing to get tools and materials. The natural result is more lost-time accidents, increased...is already on-hand and the time consuming vendor-drawing approval cycle is eliminated from the pro- curement process. The flow of design information...SYSTEM/STAGE TO SPECIFICATION BY MATERIA !L/DELIVERY DATE - TO PLAN MATERIAL PROCUREMENT ON SCHEOULE - TO MINIMIZE ST0CKED MATERIAL MATERIAL CONTROL

Formulation of detailed consumables management models for the development (preoperational) period of advanced space transportation system. Volume 2: Consumables data base workbook

NASA Technical Reports Server (NTRS)

Zamora, M. A.

1976-01-01

The consumables characteristic data associated with the performance of the mission activities required by the mission planning processor are defined to calculate the consumables requirements. The activity data is defined in terms of discrete time periods having a distinct rate for each consumable required to support the performance of a given operation. The data is structured in a series of consumable data worksheets for each activity that includes a profile of its operations and the rate of each consumable required to support the given activity. The data worksheets provide for the uniform specification of consumables data, allows for the ready identification of the consumables affected by a given activity, and facilitates the updating process. An activity and the data that must be included in the data worksheets are defined and an example of its use and application the consumables data requirements for the performance of the EVA are presented.

[Chronic complications of diabetes mellitus. What is the prevalence of diabetes in a family medical unit?].

PubMed

Sabag-Ruiz, Enrique; Alvarez-Félix, Andrés; Celiz-Zepeda, Sergio; Gómez-Alcalá, Alejandro V

2006-01-01

The role of the family doctor in fundamental in the prevention of diabetic complications, because these complications will be minor if there is good glycemic control during life. Determine the frequency of late complications of diabetes mellitus (DM) among IMSS-insured population in Ciudad Obregón, Sonora, México. A retrospective analysis included 252 diabetic patients selected by a systematized and stratified randomized sampling including all patient files available in the Family Medicine Unit 1 in Ciudad Obregón, Sonora. The information was taken from the clinical charts got by family physicians and specialists. We used descriptive statistics and correlation of Pearson looking for the association between glicemia's level and enough time to produce complications. Arterial hypertension was found in 168 cases (67%), hypertriglyceridemia in 148 (59.4%), neuropathy in 106 (42.6%), hypercholesterolemia in 89 (35.7%), retinopathy in 69 (27.5%), nephropathy in 51 (20.5%), diabetic foot in 27 (10.8%), ischemic cardiopathy in 25 (10%), cerebral thrombosis in 11 (4.4%). The period between DM diagnosis and the appearance of complications was 3.2 to 13.1 years. The correlations were high and significant in every complication. The frequency of DM complications in this study was very high, with an increasing tendency of developing complications throughout the time.

Effect of a maternity consumer representative training program on participants' confidence and engagement.

PubMed

Jenkinson, Bec M; Smethurst, Joanne; Boorman, Rhonda; Creedy, Debra K

2014-06-01

This paper describes the effects of a maternity consumer representative training program on participants' confidence to fulfil this role and engagement in representative activities. The present study was a descriptive, pre-post evaluation design with a 3-month follow-up. Fifty-eight people completed the program and 55 agreed to participate in the evaluation. Participants completed questionnaires to assess confidence to undertake consumer representative roles and reported on their engagement with consumer activities. Participants' perceived confidence to function in the role of consumer representative differed significantly before and after the workshop (F(2,18)=7.057, P<0.001), as did confidence in decision making (F(2,16)=7.615, P=0.005), confidence in negotiating outcomes and liaising with key people (F(2,18)=7.154, P=0.005), and confidence in making use of relevant networks (F(2,18)=4.319, P=0.029). There was a decline in confidence at 3 months, with confidence at this time no longer significantly different from that at the time of recruitment. Engagement with consumer organisations increased by 45% compared with rates at commencement of the project. The program enhanced participants' confidence to fulfil a maternity consumer representative role but was not sustained. Further research is needed as to how to best support maternity consumer representatives and assess their contribution to promoting woman-centred care.

Safe and rapid isolation of pulmonary veins using a novel circular ablation catheter and duty-cycled RF generator.

PubMed

Fredersdorf, Sabine; Weber, Stefan; Jilek, Clemens; Heinicke, Norbert; VON Bary, Christian; Jungbauer, Carsten; Riegger, Günter A; Hamer, Okka W; Jeron, Andreas

2009-10-01

Ablation of atrial fibrillation (AF) has been one of the most difficult and time-consuming electrophysiological procedures. Due to the rapidly increasing demand for ablation procedures, technical advances would be helpful to reduce complexity and procedure time in AF ablation. Therefore, we investigated the feasibility of a single-catheter technique for pulmonary vein (PV) isolation utilizing a decapolar catheter combined with a duty-cycled, unipolar-bipolar radiofrequency (RF) generator. AF mapping and ablation was performed in 21 consecutive patients (mean age 59 +/- 12 years, 9 males) with paroxysmal AF (n = 17) and persistent AF (n = 4). The ablation catheter was forwarded to the LA via single-transseptal puncture. All electrodes were energized in 2 to 5 applications per vein, followed by segmental RF applications, as needed, to achieve electrical isolation. To assess left atrial anatomy for purposes of catheter manipulation, and later evaluate the possibility of asymptomatic PV-stenosis, CT or MR imaging was performed both prior to ablation and at 6-month follow-up. Isolation could be achieved in 85/86 veins (99%). Procedure time for ablation was 81 +/- 13 minutes, and fluoroscopy time was 30 +/- 11 minutes. There were no procedural complications. Success rate at 6 months was 86% (18/21). MR or CT imaging excluded asymptomatic PV-stenosis. Mapping and ablation of PVs can be performed in a safe and efficient manner using a single-catheter technique, with short procedure times and minimal learning curve. Thus, this system may be of high interest not only for high volume but all centers performing AF ablation.

Treatment of forgotten ureteral stents: how much does it really cost? A cost-effectiveness study in 27 patients.

PubMed

Sancaktutar, Ahmet Ali; Söylemez, Haluk; Bozkurt, Yasar; Penbegül, Necmettin; Atar, Murat

2012-08-01

Aim of study was to present costs of forgotten ureteral stents extraction so as to distract attentions of the urologists on this issue. Medical files of 27 accessible patients who referred to our clinics between 2001 and 2010 because of forgotten ureteral stent were retrospectively analyzed. The indwelling time of double-j stents (DJS) was calculated from the time of its insertion. Costs related to radiological investigations, all invasive, and noninvasive interventions, duration of hospital stay, and medical treatments used were calculated. These estimations were based on 2010 prices determined by Turkey Ministry of Health. Mean age of the patients was 31.2 (8-86 years) years. Mean indwelling time of ureteral DJSs was 36.7 months (14-84 months). Seventy-one [extracorporeal shock wave lithotripsy (ESWL), n = 26; invasive/noninvasive interventions, n = 32] procedures were applied for 27 patients. In six patients without incrustation, after a single session of ESWL DJSs could be removed cystoscopically. A various combination of a multimodal therapy was used for other 21 patients. Total financial burden of 27 patients was US $ 34,300. Cost of treatment was estimated to be 6.9-fold (1.8- to 21-fold) higher than an average timely stent extraction. Financial burden of the treatments increased in parallel with the duration of the stent retention (p = 0.001). Management of forgotten DJS is time consuming, difficult, complicated, risky, and costly. Therefore; financial burden, increased labour loss, and impaired quality of life brought by the application of these modalities must not be forgotten.

Factors affecting the visual outcome in hyphema management in Guinness Eye Center Onitsha.

PubMed

Onyekwe, L O

2008-12-01

This study aims of determining the complications, outcome of hyphema treatment and recommend ways of enhancing good visual outcome. The records of all cases of hyphema seen from 1st January 2001 to 31st December 2005 were reviewed retrospectively. The variables analyzed were the biodata of all the patients, the agents causing hyphema, associated injuries and complications. Visual acuity at presentation, discharge and last visit was analyzed. Seventy four patients that had hyphema were reviewed. The male:female ratio was 3.5:1. Trauma was predominantly main cause of hyphema. The common agents of injury include whip (23.2%) and fist (18.8%). The common complications were secondary glaucoma (52.5%), corneal siderosis (30.0%) and rebleeding (10%). Visual outcome is related to time ofpresentation, complications and treatment. Significant improvement was achieved following treatment. Hyphema is a common complication of eye injuries. It is commonly associated with other eye injuries like vitreous haemorrhage and cataract. Common complications include secondary glaucoma, corneal siderosis and rebleeding. Visual outcome is dependent on time of presentation, severity and nature of complications. Visual outcome can be improved by early presentation and detection of complications and appropriate treatment.

A Retrospective Analysis of Complication Rates in Mohs Micrographic Surgery Patients With Clinically Large Tumors and Tumors With Aggressive Subclinical Extension.

PubMed

Cowan, Natasha; Goldenberg, Alina; Basu, Pallavi; Eilers, Robert; Hau, Jennifer; I Brian Jiang, Shang

2018-05-01

Clinically large cutaneous tumors and those with aggressive subclinical extension (ASE) often require wider margins and increased operative time during Mohs micrographic surgery (MMS). Our goal is to improve dermatologic surgeons' counseling information on complication risks for aggressive tumors. To examine the incidence of postoperative complications in MMS patients, with a focus on differences between aggressive and non-aggressive tumors. We performed a retrospective cross-sectional chart review of 4151 MMS cases at the University of California, San Diego. A postoperative complication was defined as an adverse event directly related to MMS reported within 6 weeks of the procedure. Clinically, large tumors had 50 times the odds of postoperative complication as compared to all other tumors (P less than 0.001). ASE was not found to be significantly associated with higher rates of postoperative complications when controlled for other factors. Clinically, large tumors may be at higher risk for complications following MMS due to their increased size and need for repair with methods other than linear closures. Tumors with ASE were not found to be at higher risk for postoperative complications. J Drugs Dermatol. 2018;17(5):511-515.

Comparisons of vegetarian and beef-containing diets on hematological indexes and iron stores during a period of resistive training in older men

PubMed Central

Wells, Amanda M.; Haub, Mark D.; Fluckey, James; Williams, D. Keith; Chernoff, Ronni; Campbell, Wayne W.

2008-01-01

Objective To test the hypothesis that older men who consumed a vegetarian (lacto-ovo) diet would develop a lower iron status compared with older men who consumed a beef-containing diet during a period of resistive training (RT). Design Experimental, repeated measures study. Subjects Twenty-one healthy men aged 59 to 78 years, with a BMI range of 24 to 33 kg/m2, completed the study. Intervention All men consumed a vegetarian diet for 2 weeks (baseline). After this, the men were randomly assigned to one of two dietary groups. Eleven men consumed a beef-containing diet, and 10 men continued to consume a vegetarian diet for 12 weeks. During this time all subjects participated in RT three days per week, designated as RT1 to RT12. Main outcome measures Serum ferritin and serum iron concentrations, transferrin saturation, transferrin receptor, total iron binding capacity, and selected hematological variables, as well as selected nutrient intakes and estimated iron bioavailability from three-day diet records, were determined at baseline, RT5, and RT12. Statistical analyses A general linear model repeated-measures ANOVA was used to examine the effects of group, time, and group×time interactions for iron status and dietary data. Results Total iron intake was not different between the two groups; however, the beef group had a three to four times greater intake of bioavailable iron (P<.01) than the vegetarian group. Serum iron, total iron binding capacity, transferrin saturation, and transferrin receptor were not significantly different between the beef and vegetarian groups, or changed over time with RT. Serum ferritin decreased over time in both the beef and vegetarian groups during RT (P<.01). Re-introduction of beef into the diets of the beef group increased hemoglobin concentration and hematocrit compared with the vegetarian group during the 12 weeks of RT (group×time, P<.05). These changes were within clinically normal limits. Applications/Conclusions Older men who consume a beef-containing, higher-bioavailable-iron diet, compared with a vegetarian, lower-bioavailable-iron diet, have an increased hematological profile during a 12-week period of RT. Older men who consume either a beef-containing or a vegetarian diet maintain a hematological profile within clinically normal limits during 12 weeks of RT. PMID:12728219

One-Stage Cleft Lip and Palate Repair in an Older Population.

PubMed

Guneren, Ethem; Canter, Halil Ibrahim; Yildiz, Kemalettin; Kayan, Resit Burak; Ozpur, Mustafa Aykut; Baygol, Emre Gonenc; Sagir, Haci Omer; Kuzu, Ismail Melih; Akman, Onur; Arslan, Serap

2015-07-01

In underdeveloped countries one-stage definitive repair of cleft lip and palate is considered for late-presenting patients. A total of 25 patients with unoperated cleft lip and palate more than 2 years of age were enrolled in this study for one-stage simultaneous repair of cleft lip and palate. According to Veau-Wardill-Kilner push-back technique, 2 flap palatoplasties were performed for palatal repairs; all of the lips were repaired with the Millard II rotation-advancement technique. The authors experienced no perioperative or postoperative life-threatening complications. With respect to the registered operation periods, longer times were required to perform these double operations, but this elongation is shorter than the sum of the periods if the 2 operations had been performed separately. Although the authors were unable to evaluate the late postoperative results because the authors could not follow-up the patients after they were discharged the day after surgery, the early results related to the success of the operation without any surgical complication were prone to meet the parents' and patients' expectations. The authors presented their experiences with many volunteer cleft lip and palate trips to third world countries; however the structure of this article is not a new hypothesis and data based to support a scientific study, but observations are objective to get a conclusion. To perform one-stage definitive repair of the cleft lip and palate in late-presented patients was the reality that they had only 1 chance to undergo these operations. According to the terms and conditions of this challenging operation, one-stage simultaneous repair of cleft lip and palate is a more demanding and time-consuming procedure than is isolated cleft lip repair or cleft palate repair. Although technically challenging, single-stage repair of the whole deformity in late-presenting patients is a feasible, reliable, successful, and safe procedure in authors' experience.

Peripherally InSerted CEntral catheter dressing and securement in patients with cancer: the PISCES trial. Protocol for a 2x2 factorial, superiority randomised controlled trial.

PubMed

Rickard, Claire M; Marsh, Nicole M; Webster, Joan; Gavin, Nicole C; Chan, Raymond J; McCarthy, Alexandra L; Mollee, Peter; Ullman, Amanda J; Kleidon, Tricia; Chopra, Vineet; Zhang, Li; McGrail, Matthew R; Larsen, Emily; Choudhury, Md Abu; Keogh, Samantha; Alexandrou, Evan; McMillan, David J; Mervin, Merehau Cindy; Paterson, David L; Cooke, Marie; Ray-Barruel, Gillian; Castillo, Maria Isabel; Hallahan, Andrew; Corley, Amanda; Geoffrey Playford, E

2017-06-15

Around 30% of peripherally inserted central catheters (PICCs) fail from vascular, infectious or mechanical complications. Patients with cancer are at highest risk, and this increases morbidity, mortality and costs. Effective PICC dressing and securement may prevent PICC failure; however, no large randomised controlled trial (RCT) has compared alternative approaches. We designed this RCT to assess the clinical and cost-effectiveness of dressing and securements to prevent PICC failure. Pragmatic, multicentre, 2×2 factorial, superiority RCT of (1) dressings (chlorhexidine gluconate disc (CHG) vs no disc) and (2) securements (integrated securement dressing (ISD) vs securement device (SED)). A qualitative evaluation using a knowledge translation framework is included. Recruitment of 1240 patients will occur over 3 years with allocation concealment until randomisation by a centralised service. For the dressing hypothesis, we hypothesise CHG discs will reduce catheter-associated bloodstream infection (CABSI) compared with no CHG disc. For the securement hypothesis, we hypothesise that ISD will reduce composite PICC failure (infection (CABSI/local infection), occlusion, dislodgement or thrombosis), compared with SED. types of PICC failure; safety; costs; dressing/securement failure; dwell time; microbial colonisation; reversible PICC complications and consumer acceptability. Relative incidence rates of CABSI and PICC failure/100 devices and/1000 PICC days (with 95% CIs) will summarise treatment impact. Kaplan-Meier survival curves (and log rank Mantel-Haenszel test) will compare outcomes over time. Secondary end points will be compared between groups using parametric/non-parametric techniques; p values <0.05 will be considered to be statistically significant. Ethical approval from Queensland Health (HREC/15/QRCH/241) and Griffith University (Ref. No. 2016/063). Results will be published. Trial registration number is: ACTRN12616000315415. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding Patients

PubMed Central

Chang, Shen Shong; Hu, Hsiao-Yun

2015-01-01

Background/Aims The connection between Helicobacter pylori and complicated peptic ulcer disease in peptic ulcer bleeding (PUB) patients taking nonsteroidal anti-inflammatory drugs has not been established. In this study, we sought to determine whether delayed H. pylori eradication therapy in PUB patients increases complicated recurrent peptic ulcers. Methods We identified inpatient PUB patients using the Taiwan National Health Insurance Research Database. We categorized patients into early (time lag ≤120 days after peptic ulcer diagnosis) and late H. pylori eradication therapy groups. The Cox proportional hazards model was used. The primary outcome was rehospitalization for patients with complicated recurrent peptic ulcers. Results Our data indicated that the late H. pylori eradication therapy group had a higher rate of complicated recurrent peptic ulcers (hazard ratio [HR], 1.52; p=0.006), with time lags of more than 120 days. However, our results indicated a similar risk of complicated recurrent peptic ulcers (HR, 1.20; p=0.275) in time lags of more than 1 year and (HR, 1.10; p=0.621) more than 2 years. Conclusions H. pylori eradication within 120 days was associated with decreased complicated recurrent peptic ulcers in patients with PUB. We recommend that H. pylori eradication should be conducted within 120 days in patients with PUB. PMID:25167793

Risk factors for complications in donors at first and repeat whole blood donation: a cohort study with assessment of the impact on donor return

PubMed Central

Wiersum-Osselton, Johanna C.; Marijt-van derKreek, Tanneke; Brand, Anneke; Veldhuizen, Ingrid; van der Bom, Johanna G.; de Kort, Wim

2014-01-01

Background First-time donation is among recognised risk factors for vasovagal reactions to blood donation and reactions are known to reduce donor return. We assessed associations between potential risk factors and vasovagal reactions and needle-related complications in first-time whole blood donation in comparison to repeat donation and analysed the impact of complications on donor return. Materials and methods We performed a cohort study on whole blood donations in The Netherlands from 1/1/2010 to 31/12/2010 using data extracted from the blood service information system. Donation data up to 31/12/2011 were used to ascertain donor return. Results In 2010 28,786 donors made first whole blood donations and there were 522,958 repeat donations. Vasovagal reactions occurred in 3.9% of first donations by males and 3.5% of first donations by females compared to in 0.2% and 0.6%, respectively, of repeat donations. Associations of vasovagal reactions with other factors including age, body weight, systolic and diastolic blood pressure were similar in first-time and repeat donors. Needle-related complications occurred in 0.2% of male and 0.5% of female first-time donations and in 0.1% and 0.3%, respectively, of repeat donations. Among first-time donors, the return rate within 1 year was 82% following an uncomplicated first donation, but 55% and 61% following vasovagal reactions and needle-related complications, respectively; the corresponding percentages among repeat donors were 86%, 58% and 82%. Discussion Among first-time donors, females suffered less than males from vasovagal reactions. Other risk factors had similar associations among first-time and repeat donors. Vasovagal reactions and needle-related complications in both first-time and repeat donors are followed by reduced donor return. PMID:23867173

[Research on the Application of Lean Management in Medical Consumables Material Logistics Management].

PubMed

Yang, Chai; Zhang, Wei; Gu, Wei; Shen, Aizong

2016-11-01

Solve the problems of high cost, low utilization rate of resources, low medical care quality problem in medical consumables material logistics management for scientific of medical consumables management. Analysis of the problems existing in the domestic medical consumables material logistics management in hospital, based on lean management method, SPD(Supply, Processing, Distribution) for specific applications, combined HBOS(Hospital Business Operation System), HIS (Hospital Information System) system for medical consumables material management. Achieve the lean management in medical consumables material purchase, warehouse construction, push, clinical use and retrospect. Lean management in medical consumables material can effectively control the cost in logistics management, optimize the alocation of resources, liberate unnecessary time of medical staff, improve the quality of medical care. It is a scientific management method.

Mechanism and Design Analysis of Articulated Ankle Foot Orthoses for Drop-Foot

PubMed Central

Choudhury, Imtiaz Ahmed; Mamat, Azuddin Bin

2014-01-01

Robotic technologies are being employed increasingly in the treatment of lower limb disabilities. Individuals suffering from stroke and other neurological disorders often experience inadequate dorsiflexion during swing phase of the gait cycle due to dorsiflexor muscle weakness. This type of pathological gait, mostly known as drop-foot gait, has two major complications, foot-slap during loading response and toe-drag during swing. Ankle foot orthotic (AFO) devices are mostly prescribed to resolve these complications. Existing AFOs are designed with or without articulated joint with various motion control elements like springs, dampers, four-bar mechanism, series elastic actuator, and so forth. This paper examines various AFO designs for drop-foot, discusses the mechanism, and identifies limitations and remaining design challenges. Along with two commercially available AFOs some designs possess promising prospective to be used as daily-wear device. However, the design and mechanism of AFO must ensure compactness, light weight, low noise, and high efficiency. These entailments present significant engineering challenges to develop a new design with wide consumer adoption. PMID:24892102

New consumer load prototype for electricity theft monitoring

NASA Astrophysics Data System (ADS)

Abdullateef, A. I.; Salami, M. J. E.; Musse, M. A.; Onasanya, M. A.; Alebiosu, M. I.

2013-12-01

Illegal connection which is direct connection to the distribution feeder and tampering of energy meter has been identified as a major process through which nefarious consumers steal electricity on low voltage distribution system. This has contributed enormously to the revenue losses incurred by the power and energy providers. A Consumer Load Prototype (CLP) is constructed and proposed in this study in order to understand the best possible pattern through which the stealing process is effected in real life power consumption. The construction of consumer load prototype will facilitate real time simulation and data collection for the monitoring and detection of electricity theft on low voltage distribution system. The prototype involves electrical design and construction of consumer loads with application of various standard regulations from Institution of Engineering and Technology (IET), formerly known as Institution of Electrical Engineers (IEE). LABVIEW platform was used for data acquisition and the data shows a good representation of the connected loads. The prototype will assist researchers and power utilities, currently facing challenges in getting real time data for the study and monitoring of electricity theft. The simulation of electricity theft in real time is one of the contributions of this prototype. Similarly, the power and energy community including students will appreciate the practical approach which the prototype provides for real time information rather than software simulation which has hitherto been used in the study of electricity theft.

Inhibition of Aldose Reductase by Gentiana lutea Extracts

PubMed Central

Akileshwari, Chandrasekhar; Muthenna, Puppala; Nastasijević, Branislav; Joksić, Gordana; Petrash, J. Mark; Reddy, Geereddy Bhanuprakash

2012-01-01

Accumulation of intracellular sorbitol due to increased aldose reductase (ALR2) activity has been implicated in the development of various secondary complications of diabetes. Thus, ALR2 inhibition could be an effective strategy in the prevention or delay of certain diabetic complications. Gentiana lutea grows naturally in the central and southern areas of Europe. Its roots are commonly consumed as a beverage in some European countries and are also known to have medicinal properties. The water, ethanol, methanol, and ether extracts of the roots of G. lutea were subjected to in vitro bioassay to evaluate their inhibitory activity on the ALR2. While the ether and methanol extracts showed greater inhibitory activities against both rat lens and human ALR2, the water and ethanol extracts showed moderate inhibitory activities. Moreover, the ether and methanol extracts of G. lutea roots significantly and dose-dependently inhibited sorbitol accumulation in human erythrocytes under high glucose conditions. Molecular docking studies with the constituents commonly present in the roots of G. lutea indicate that a secoiridoid glycoside, amarogentin, may be a potential inhibitor of ALR2. This is the first paper that shows G. lutea extracts exhibit inhibitory activity towards ALR2 and these results suggest that Gentiana or its constituents might be useful to prevent or treat diabetic complications. PMID:22844269

Inhibition of aldose reductase by Gentiana lutea extracts.

PubMed

Akileshwari, Chandrasekhar; Muthenna, Puppala; Nastasijević, Branislav; Joksić, Gordana; Petrash, J Mark; Reddy, Geereddy Bhanuprakash

2012-01-01

Accumulation of intracellular sorbitol due to increased aldose reductase (ALR2) activity has been implicated in the development of various secondary complications of diabetes. Thus, ALR2 inhibition could be an effective strategy in the prevention or delay of certain diabetic complications. Gentiana lutea grows naturally in the central and southern areas of Europe. Its roots are commonly consumed as a beverage in some European countries and are also known to have medicinal properties. The water, ethanol, methanol, and ether extracts of the roots of G. lutea were subjected to in vitro bioassay to evaluate their inhibitory activity on the ALR2. While the ether and methanol extracts showed greater inhibitory activities against both rat lens and human ALR2, the water and ethanol extracts showed moderate inhibitory activities. Moreover, the ether and methanol extracts of G. lutea roots significantly and dose-dependently inhibited sorbitol accumulation in human erythrocytes under high glucose conditions. Molecular docking studies with the constituents commonly present in the roots of G. lutea indicate that a secoiridoid glycoside, amarogentin, may be a potential inhibitor of ALR2. This is the first paper that shows G. lutea extracts exhibit inhibitory activity towards ALR2 and these results suggest that Gentiana or its constituents might be useful to prevent or treat diabetic complications.

Effectiveness of Green Tea in a Randomized Human Cohort: Relevance to Diabetes and Its Complications

PubMed Central

Aruoma, Okezie I.; Gunness, Teeluck K.; Kowlessur, Sudhir; Dambala, Venkatesh; Murad, Fatima; Googoolye, Kreshna; Daus, Diana; Indelicato, Joseph; Rondeau, Philippe

2013-01-01

Epidemiological studies have argued that green tea could mitigate diabetes and its complications. This study investigated the phytophenolic profile of Mauritian green tea and its antioxidant propensity. The effect of green tea on the risk factors: waist-hip ratio, glucose level, arterial pressure, antioxidant status, and alanine aminotransferase (ALT) in prediabetics was assessed. The experimental group consumed 3 cups of green tea daily for 14 weeks followed by a 2-week washout period. The control group followed a water regimen. Green tea contained high level of phenolics related to its antioxidant power. Green tea suppressed waist-hip ratio of women from a significant increase and suppressed mean arterial pressure of men and women from a significant decrease after week 14. It reduced ALT level in women by 13.0% (P < 0.1) while increasing the antioxidant potential of men and women sera by 2.7% (P < 0.1) and 5.1% (P < 0.1). The study timescale may have been too short to enable demonstration of effects on fasting plasma glucose and HbA1c outcomes. Green tea regimen could form part of a healthy lifestyle that might ameliorate features of metabolic syndrome and subsequent risks for diabetes and its complications. This trial is registered with ClinicalTrials.gov NCT01248143. PMID:24102055

Lessons Learned With Laparoscopic Management of Complicated Grades of Acute Appendicitis

PubMed Central

Gomes, Carlos Augusto; Junior, Cleber Soares; Costa, Evandro de Freitas Campos; Alves, Paula de Assis Pereira; de Faria, Carolina Vieira; Cangussu, Igor Vitoi; Costa, Luisa Pires; Gomes, Camila Couto; Gomes, Felipe Couto

2014-01-01

Background Laparoscopy has not been consolidated as the approach of first choice in the management of complicated appendicitis. Methodological flaws and absence of disease stratification criteria have been implicated in that less evidence. The objective is to study the safe and effectiveness of laparoscopy in the management of complicated appendicitis according to laparoscopic grading system. Method From January 2008 to January 2011, 154 consecutive patients who underwent a laparoscopic appendectomy for complicated appendicitis were evaluated in the prospective way. The patient’s age ranged from 12 to 75 years old (31.7 ± 13.3) and 58.3% were male. Complicated appendicitis refers to gangrenous and/or perforated appendix and were graded as 3A (segmental necrosis), 3B (base necrosis), 4A (abscess), 4B (regional peritonitis) and 5 (diffuse peritonitis). The outcomes including operative time, infection complication, operative complications and conversion rate were chosen to evaluate the procedure. Results The grade 3A was the most frequent with 50 (32.4%) patients. The mean operative time was 69.4 ± 26.3 minutes. The grade 4A showed the highest mean operative time (80.1 ± 26.7 minutes). The wound and intra-abdominal infection rates were 2.6 and 4.6%, respectively. The base necrosis was the most important factor associated with the conversion (5.2%). The grades 4A and 5 were associated with greater possibility of intra-abdominal collection. There were no operative complications. Conclusion The laparoscopic management of all complicated grades of acute appendicitis is safe and effective and should be the procedure of first choice. The laparoscopic grading system allows us to assess patients in the same disease stage. PMID:24883151

Temporal trends in safety and complication rates of catheter ablation for atrial fibrillation.

PubMed

Muthalaly, Rahul G; John, Roy M; Schaeffer, Benjamin; Tanigawa, Shinichi; Nakamura, Tomofumi; Kapur, Sunil; Zei, Paul C; Epstein, Laurence M; Tedrow, Usha B; Michaud, Gregory F; Stevenson, William G; Koplan, Bruce A

2018-06-01

Atrial fibrillation (AF) ablation is increasingly common, but is associated with potential major complications. Technology, experience, and protocols have evolved significantly in recent times, and may have impacted procedural safety. We sought to compare AF ablation safety profiles, including complication rates and fluoroscopy times in a "modern" versus "historical" cohort. We evaluated consecutive patients undergoing AF ablation from a modern cohort (MC) from 2014 to 2015 and a historic cohort (HC) from 2009 to 2011 for complications. Major complications were categorized according to Heart Rhythm Society guidelines. We included 1,425 patients, 726 in the HC and 699 in the MC. The MC was older, had more OSA and less valvular AF. Fifty-two (3.5%) procedures suffered major complications across the cohorts, with significantly fewer in the MC (5.0% vs. 2.3%, P  =  0.007). The largest reductions were seen in vascular, hemorrhagic, ischemic stroke, and perforation/tamponade related complications. Periprocedural antiplatelets drugs (aHR 2.1 [95 CI 1.1-3.9], P  =  0.02) and force-sensing catheters (aHR 0.4 [95 CI 0.2-0.9], P  =  0.03) were independently related to major complication rates. Direct oral anticoagulants and uninterrupted anticoagulation were not associated with complications. There was a decrease in both fluoroscopy (-17.4 minutes [95 CI 19.2-15.6], P < 0.0001) and radiofrequency ablation times (-561 seconds [95CI -750 to -371], P < 0.0001). The safety profile of AF ablation has improved significantly in less than a decade. © 2018 Wiley Periodicals, Inc.

Cybersecurity: Authoritative Reports and Resources

DTIC Science & Technology

2013-10-25

Security Technologies Reporting Data Breaches: Is Federal Legislation Needed to Protect Consumers ? July 18, 2013 Energy and Commerce Commerce ...Protect Consumers ? July 18, 2013 Energy and Commerce Oversight and Investigation Cyber Espionage and the Theft of U.S. Intellectual Property and...protection for sensitive consumer data and timely notification in case of breach June 15, 2011 Energy and Commerce Commerce , Manufacturing, and

Cybersecurity: Authoritative Reports and Resources

DTIC Science & Technology

2013-04-17

Consumer Credit Cybersecurity: An Overview of Risks to Critical Infrastructure July 26, 2011 Energy and Commerce Oversight and Investigations...require greater protection for sensitive consumer data and timely notification in case of breach June 15, 2011 Energy and Commerce Commerce ...Financial Sector June 21, 2011 Commerce , Science and Transportation Privacy and Data Security: Protecting Consumers in the Modern World June 29, 2011

77 FR 21277 - Customer Clearing Documentation, Timing of Acceptance for Clearing, and Clearing Member Risk...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-09

... implement new statutory provisions enacted by Title VII of the Dodd-Frank Wall Street Reform and Consumer...-Frank Wall Street Reform and Consumer Protection Act (``Dodd-Frank Act'').\\1\\ Title VII of the Dodd... Commission (``SEC''). \\1\\ See Dodd-Frank Wall Street Reform and Consumer Protection Act, Public Law 111-203...

Association mapping of SSR markers to sweet, bitter and roasted peanut sensory attributes in cultivated peanut

USDA-ARS?s Scientific Manuscript database

Certain roasted peanut quality sensory attributes are very important breeding objectives for peanut manufactory and consumers. Currently the only means of measuring these traits is the use of a trained sensory panel. This is a costly and time-consuming process. It is desirable, from a cost, time an...

A Comparison of Height-Accumulation and Volume-Equation Methods for Estimating Tree and Stand Volumes

Treesearch

R.B. Ferguson; V. Clark Baldwin

1995-01-01

Estimating tree and stand volume in mature plantations is time consuming, involving much manpower and equipment; however, several sampling and volume-prediction techniques are available. This study showed that a well-constructed, volume-equation method yields estimates comparable to those of the often more time-consuming, height-accumulation method, even though the...

The Netherlands Chlamydia cohort study (NECCST) protocol to assess the risk of late complications following Chlamydia trachomatis infection in women.

PubMed

Hoenderboom, B M; van Oeffelen, A A M; van Benthem, B H B; van Bergen, J E A M; Dukers-Muijrers, N H T M; Götz, H M; Hoebe, C J P A; Hogewoning, A A; van der Klis, F R M; van Baarle, D; Land, J A; van der Sande, M A B; van Veen, M G; de Vries, F; Morré, S A; van den Broek, I V F

2017-04-11

Chlamydia trachomatis (CT), the most common bacterial sexually transmitted infection (STI) among young women, can result in serious sequelae. Although the course of infection is often asymptomatic, CT may cause pelvic inflammatory disease (PID), leading to severe complications, such as prolonged time to pregnancy, ectopic pregnancy, and tubal factor subfertility. The risk of and risk factors for complications following CT-infection have not been assessed in a long-term prospective cohort study, the preferred design to define infections and complications adequately. In the Netherlands Chlamydia Cohort Study (NECCST), a cohort of women of reproductive age with and without a history of CT-infection is followed over a minimum of ten years to investigate (CT-related) reproductive tract complications. This study is a follow-up of the Chlamydia Screening Implementation (CSI) study, executed between 2008 and 2011 in the Netherlands. For NECCST, female CSI participants who consented to be approached for follow-up studies (n = 14,685) are invited, and prospectively followed until 2022. Four data collection moments are foreseen every two consecutive years. Questionnaire data and blood samples for CT-Immunoglobulin G (IgG) measurement are obtained as well as host DNA to determine specific genetic biomarkers related to susceptibility and severity of infection. CT-history will be based on CSI test outcomes, self-reported infections and CT-IgG presence. Information on (time to) pregnancies and the potential long-term complications (i.e. PID, ectopic pregnancy and (tubal factor) subfertility), will be acquired by questionnaires. Reported subfertility will be verified in medical registers. Occurrence of these late complications and prolonged time to pregnancy, as a proxy for reduced fertility due to a previous CT-infection, or other risk factors, will be investigated using longitudinal statistical procedures. In the proposed study, the occurrence of late complications following CT-infection and its risk factors will be assessed. Ultimately, provided reliable risk factors and/or markers can be identified for such late complications. This will contribute to the development of a prognostic tool to estimate the risk of CT-related complications at an early time point, enabling targeted prevention and care towards women at risk for late complications. Dutch Trial Register NTR-5597 . Retrospectively registered 14 February 2016.

Comparison of consumer derived evidence with an omaha system evidence-based practice guideline for community dwelling older adults.

PubMed

Pruinelli, Lisiane; Fu, Helen; Monsen, Karen A; Westra, Bonnie L

2014-01-01

Consumer involvement in healthcare is critical to support continuity of care for consumers to manage their health while transitioning from one care setting to another. Validation of evidence-based practice (EBP) guideline by consumers is essential to achieving consumer health goals over time that is consistent with their needs and preferences. The purpose of this study was to compare an Omaha System EBP guideline for community dwelling older adults with consumer-derived evidence of their ongoing needs, resources, and strategies after home care discharge. All identified problems were relevant for all patients except for Neglect and Substance use. Ten additional problems were identified from the interviews, five of which affected at least 10% of the participants. Consumer derived evidence both validated and expanded EBP guidelines; thus further emphasizing the importance of consumer involvement in the delivery of home healthcare.

Understanding Housing Delays and Relocations Within the Housing First Model.

PubMed

Zerger, Suzanne; Pridham, Katherine Francombe; Jeyaratnam, Jeyagobi; Hwang, Stephen W; O'Campo, Patricia; Kohli, Jaipreet; Stergiopoulos, Vicky

2016-01-01

This study explores factors contributing to delays and relocations during the implementation of the Housing First model in Toronto, Ontario. While interruptions in housing tenure are expected en route to recovery and housing stability, consumer and service provider views on finding and keeping housing remain largely unknown. In-person interviews and focus groups were conducted with 48 study participants, including 23 case managers or housing workers and 25 consumers. The following three factors contributed to housing delays and transfers: (1) the effectiveness of communication and collaboration among consumers and service providers, (2) consumer-driven preferences and ambivalence, and (3) provider prioritization of consumer choice over immediate housing access. Two strategies--targeted communications and consumer engagement in housing searches--supported the housing process. Several factors affect the timing and stability of housing. Communication between and among providers and consumers, and a shared understanding of consumer choice, can further support choice and recovery.

Consumer Satisfaction with Antipsychotic Medication Monitoring Appointments: The Role of Consumer-Prescriber Communication Patterns

PubMed Central

Reich, Catherine M.; Hack, Samantha M.; Klingaman, Elizabeth A.; Brown, Clayton H.; Fang, Li Juan; Dixon, Lisa B.; Jahn, Danielle R.; Kreyenbuhl, Julie A.

2017-01-01

Objective The study was designed to explore patterns of prescriber communication behaviors as they relate to consumer satisfaction among a serious mental illness sample. Methods Recordings from 175 antipsychotic medication-monitoring appointments between veterans with psychiatric disorders and their prescribers were coded using the Roter Interaction Analysis System (RIAS) for communication behavioral patterns. Results The frequency of prescriber communication behaviors (i.e., facilitation, rapport, procedural, psychosocial, biomedical, and total utterances) did not reliably predict consumer satisfaction. The ratio of prescriber to consumer utterances did predict consumer satisfaction. Conclusion Consistent with client-centered care theory, antipsychotic medication consumers were more satisfied with their encounters when their prescriber did not dominate the conversation. Practice Implications Therefore, one potential recommendation from these findings could be for medication prescribers to spend more of their time listening to, rather than speaking with, their SMI consumers. PMID:28920491

Can facility delivery reduce the risk of intrapartum complications-related perinatal mortality? Findings from a cohort study.

PubMed

Khanam, Rasheda; Baqui, Abdullah H; Syed, Mamun Ibne Moin; Harrison, Meagan; Begum, Nazma; Quaiyum, Abdul; Saha, Samir K; Ahmed, Saifuddin

2018-06-01

Intrapartum complications increase the risk of perinatal deaths. However, population-based data from developing countries assessing the contribution of intrapartum complications to perinatal deaths is scarce. Using data from a cohort of pregnant women followed between 2011 and 2013 in Bangladesh, this study examined the rate and types of intrapartum complications, the association of intrapartum complications with perinatal mortality, and if facility delivery modified the risk of intrapartum-related perinatal deaths. Trained community health workers (CHWs) made two-monthly home visits to identify pregnant women, visited them twice during pregnancy and 10 times in the first two months postpartum. During prenatal visits, CHWs collected data on women's prior obstetric history, socio-demographic status, and complications during pregnancy. They collected data on intrapartum complications, delivery care, and pregnancy outcome during the first postnatal visit within 7 days of delivery. We examined the association of intrapartum complications and facility delivery with perinatal mortality by estimating odds ratios (OR) and 95% confidence intervals (CI) adjusting for covariates using multivariable logistic regression analysis. The overall facility delivery rate was low (3922/24 271; 16.2%). Any intrapartum complications among pregnant women were 20.9% (5,061/24,271) and perinatal mortality was 64.7 per 1000 birth. Compared to women who delivered at home, the risk of perinatal mortality was 2.4 times higher (OR = 2.40; 95% CI = 2.08-2.76) when delivered in a public health facility and 1.3 times higher (OR = 1.32, 95% CI = 1.06-1.64) when delivered in a private health facility. Compared to women who had no intrapartum complications and delivered at home, women with intrapartum complications who delivered at home had a substantially higher risk of perinatal mortality (OR = 3.45; 95% CI = 3.04-3.91). Compared to women with intrapartum complications who delivered at home, the risk of perinatal mortality among women with intrapartum complications was 43.0% lower for women who delivered in a public health facility (OR = 0.57; 95% CI = 0.42-0.78) and 58.0% lower when delivered in a private health facility (OR = 0.42; 95% CI = 0.28-0.63). Maternal health programs need to promote timely recognition of intrapartum complications and delivery in health facilities to improve perinatal outcomes, particularly in populations where overall facility delivery rates are low. The differential risk between public and private health facilities may be due to differences in quality of care. Efforts should be made to improve the quality of care in all health facilities.

Effective Presentation of Metabolic Rate Information for Lunar Extravehicular Activity (EVA)

NASA Technical Reports Server (NTRS)

Mackin, Michael A.; Gonia, Philip; Lombay-Gonzalez, Jose

2010-01-01

During human exploration of the lunar surface, a suited crewmember needs effective and accurate information about consumable levels remaining in their life support system. The information must be presented in a manner that supports real-time consumable monitoring and route planning. Since consumable usage is closely tied to metabolic rate, the lunar suit must estimate metabolic rate from life support sensors, such as oxygen tank pressures, carbon dioxide partial pressure, and cooling water inlet and outlet temperatures. To provide adequate warnings that account for traverse time for a crewmember to return to a safe haven, accurate forecasts of consumable depletion rates are required. The forecasts must be presented to the crewmember in a straightforward, effective manner. In order to evaluate methods for displaying consumable forecasts, a desktop-based simulation of a lunar Extravehicular Activity (EVA) has been developed for the Constellation lunar suite s life-support system. The program was used to compare the effectiveness of several different data presentation methods.

Control Aspects of Highly Constrained Guidance Techniques

DTIC Science & Technology

1978-02-01

cycle. The advantages of this approach are (1) it requires only one time- consuming computation of the platform-to-body transformation matrix from...of steering gain corresponding to the three autopilot configurations, Kchange is KFCS change 2 0.0006 5 0.00156 8 0.00256 2.7 Terminal Steering As...a time- consuming process that it is desirable to consider ways of reducing the com- putation time by approximating the elements of B and/or updating

Transforming War Fighting through the Use of Service Based Architecture (SBA) Technology

DTIC Science & Technology

2006-05-04

near-real-time video & telemetry to users on network using standard web-based protocols – Provides web-based access to archived video files MTI...Target Tracks Service Capabilities – Disseminates near-real-time MTI and Target Tracks to users on network based on consumer specified geographic...filter IBS SIGINT Service Capabilities – Disseminates near-real-time IBS SIGINT data to users on network based on consumer specified geographic filter

Unsafe abortion in Kenya: a cross-sectional study of abortion complication severity and associated factors.

PubMed

Ziraba, Abdhalah Kasiira; Izugbara, Chimaraoke; Levandowski, Brooke A; Gebreselassie, Hailemichael; Mutua, Michael; Mohamed, Shukri F; Egesa, Caroline; Kimani-Murage, Elizabeth W

2015-02-15

Complications due to unsafe abortion cause high maternal morbidity and mortality, especially in developing countries. This study describes post-abortion complication severity and associated factors in Kenya. A nationally representative sample of 326 health facilities was included in the survey. All regional and national referral hospitals and a random sample of lower level facilities were selected. Data were collected from 2,625 women presenting with abortion complications. A complication severity indicator was developed as the main outcome variable for this paper and described by women's socio-demographic characteristics and other variables. Ordered logistic regression models were used for multivariable analyses. Over three quarters of abortions clients presented with moderate or severe complications. About 65% of abortion complications were managed by manual or electronic vacuum aspiration, 8% by dilation and curettage, 8% misoprostol and 19% by forceps and fingers. The odds of having moderate or severe complications for mistimed pregnancies were 43% higher than for wanted pregnancies (OR, 1.43; CI 1.01-2.03). For those who never wanted any more children the odds for having a severe complication was 2 times (CI 1.36-3.01) higher compared to those who wanted the pregnancy then. Women who reported inducing the abortion had 2.4 times higher odds of having a severe complication compared to those who reported that it was spontaneous (OR, 2.39; CI 1.72-3.34). Women who had a delay of more than 6 hours to get to a health facility had at least 2 times higher odds of having a moderate/severe complication compared to those who sought care within 6 hours from onset of complications. A delay of 7-48 hours was associated with OR, 2.12 (CI 1.42-3.17); a delay of 3-7 days OR, 2.01 (CI 1.34-2.99) and a delay of more than 7 days, OR 2.35 (CI 1.45-3.79). Moderate and severe post-abortion complications are common in Kenya and a sizeable proportion of these are not properly managed. Factors such as delay in seeking care, interference with pregnancy, and unwanted pregnancies are important determinants of complication severity and fortunately these are amenable to targeted interventions.

Value of blood culture time to positivity in identifying complicated nontyphoidal Salmonella bacteremia.

PubMed

Chen, Shang-Yu; Weng, Tzu-Hua; Tseng, Wen-Pin; Fu, Chia-Ming; Lin, Hui-Wen; Liao, Chun-Hsing; Lee, Tai-Fen; Hsueh, Po-Ren; Fang, Cheng-Chung; Chen, Shey-Ying

2018-02-13

Few studies analyzed the association between blood culture time to positivity (TTP) and risk of complicated nontyphoidal Salmonella (NTS) bacteremia. We conducted a retrospective study of 206 patients (aged 60.4 ± 17.4 years) with NTS bacteremia during a 30-month period. Complicated NTS bacteremia was defined as the presence of 30-day mortality, complicated infection requiring surgery or abscess drainage, or requirement of intensive care unit admission. Serogroup D (75.7%) was the predominant isolates. Malignancy (44.7%) was the most prevalent comorbidity. Patients with rapid TTP (<10 h) were more likely to have thrombocytopenia, septic shock, persistent bacteremia, complicated infection, and a higher intensive care unit admission rate. In multivariate logistic regression model, a TTP <10 h was an independent predictor for complicated NTS bacteremia (adjusted odd ratio, 5.683, 95% confidence interval, 2.396-13.482). Our study showed that blood culture TTP provides important diagnostic and prognostic information in the treatment of NTS bacteremia patients. Copyright © 2018. Published by Elsevier Inc.

Porcupine quill injuries in dogs: A retrospective of 296 cases (1998–2002)

PubMed Central

Johnson, Matthew D.; Magnusson, Kristenn D.; Shmon, Cindy L.; Waldner, Cheryl

2006-01-01

Abstract The purpose of this retrospective study was to identify factors associated with quill injury in dogs. A second objective was to determine the risk of complications and any factors that would predict the likelihood of complications. Hospital records of 296 porcupine quill injuries in dogs from 1998 to 2002 were studied. There was an increased occurrence of porcupine encounters in the spring and fall months; Siberian huskies, rottweilers, and German shepherd crosses were significantly overrepresented for quill injuries. There was no association between risk of complications and either number of quills or antimicrobial use. Increasing time between quill injury and presentation was associated with an increased risk of complications. Because of the increased frequency of complication with a longer interval until presentation, clients should be strongly encouraged to bring the dog in as soon as the quill injury is discovered. Patients presented after 24 hours should be monitored closely during the first 3 weeks after injury, as most complications occurred during this time. PMID:16898110

Procedure times, complication rates, and survival times associated with single-chamber versus dual-chamber pacemaker implantation in dogs with clinical signs of bradyarrhythmia: 54 cases (2004-2009).

PubMed

Genovese, David W; Estrada, Amara H; Maisenbacher, Herbert W; Heatwole, Bonnie A; Powell, Melanie A

2013-01-15

To compare procedure times and major and minor complication rates associated with single-chamber versus dual-chamber pacemaker implantation and with 1-lead, 2-lead, and 3-lead pacemaker implantation in dogs with clinical signs of bradyarrhythmia. Retrospective case series. 54 dogs that underwent pacemaker implantation because of clinical signs of bradyarrhythmia. Medical records of dogs that received pacemakers between July 2004 and December 2009 were reviewed for information regarding signalment, diagnosis, pacemaker implantation, pacemaker type, complications, and survival time. Analyses were performed to determine significant differences in anesthesia time, procedure time, and outcome for dogs on the basis of pacing mode and number of pacing leads. 28 of 54 (51.9%) dogs received single-chamber pacemakers and 26 (48.1%) received dual-chamber pacemakers. Mean ± SD procedural time was significantly longer for patients with dual-chamber pacemakers (133.5 ± 51.3 minutes) than for patients with single-chamber pacemakers (94.9 ± 37.0 minutes), and procedure time increased significantly as the number of leads increased (1 lead, 102.3 ± 51.1 minutes; 2 leads, 114.9 ± 24.8 minutes; 3 leads, 158.2 ± 8.5 minutes). Rates of major and minor complications were not significantly different between dogs that received single-chamber pacemakers and those that received dual-chamber pacemakers or among dogs grouped on the basis of the number of pacing leads placed. Although dual-chamber pacemaker implantation did result in increased procedural and anesthesia times, compared with single-chamber pacemaker implantation, this did not result in a higher complication rate.

Getting satisfaction: drivers of surgical Hospital Consumer Assessment of Health care Providers and Systems survey scores.

PubMed

Iannuzzi, James C; Kahn, Steven A; Zhang, Linlin; Gestring, Mark L; Noyes, Katia; Monson, John R T

2015-07-01

Hospital consumer assessment of health care providers and systems (HCAHPS) survey scores formally recognize that patients are central to health care, shifting quality metrics from the physician to patient perspective. This study describes clinical predictors of patient satisfaction in surgical patients. Analysis of a single institution's Surgical Department HCAHPS responses was performed from March 2011-October 2012. The end points were top box satisfaction on two global domains. Multivariable regression was used to determine satisfaction predictors including HCAHPS domains, demographics, and clinical variables such as comorbidities, intensive care unit stay, emergency case, discharge day, floor transfers, complications, and ancillary procedures. In total, 978 surveys were evaluated representing admissions to Acute care and/or Trauma (n = 177, 18.1%), Thoracic (n = 169, 17.3%), Colorectal (n = 107, 10.9%), Transplant (n = 95, 9.7%), Vascular (n = 92, 9.4%), Oncology (n = 88, 9.0%), Plastic (n = 49, 5.0%), and Cardiac (n = 201, 20.6%) divisions. Overall, 658 patients (67.3%) had high satisfaction and 733 (74.9%) gave definite hospital recommendations. Hospital satisfaction was positively associated with an intensive care unit admission (odds ratio [OR] = 1.64, confidence interval [CI]: 1.20-2.23, P = 0.002) and satisfaction with provider and pain domains. Factors associated with decreased satisfaction were race (non-black minority compared with whites; OR = 0.41, CI: 0.21-0.83, P = 0.012), self-reported poor health (OR = 0.43, CI: 0.27-0.68, P < 0.001), ≥ 2 floor transfers (OR = 0.50, CI: 0.25-0.99, P = 0.046), and postoperative complications (OR = 0.67, CI: 0.55-0.82, P < 0.0001). In addition, weekend discharge (OR = 1.76, CI: 1.02-3.02, P = 0.041) was associated with hospital recommendation. Clinical course, particularly complications, impacts patient satisfaction. However, more important than what happens is how it happens, as evidenced by the much greater influence of surgeon and nurse-patient interactions. These results help inform future quality improvement and resource allocation. Copyright © 2015 Elsevier Inc. All rights reserved.

Promotion of prescription drugs to consumers.

PubMed

Rosenthal, Meredith B; Berndt, Ernst R; Donohue, Julie M; Frank, Richard G; Epstein, Arnold M

2002-02-14

Spending on prescription drugs is the fastest growing component of the health care budget. There is public concern about the possibility that direct-to-consumer advertising of prescription drugs will result in inappropriate prescribing and higher costs of care. Guidelines issued in 1997 by the Food and Drug Administration (FDA) regarding advertising to consumers through electronic media are considered by some to be responsible for unleashing a flood of direct-to-consumer advertising. Using data on spending for promotional purposes and sales of prescription drugs, we examined industrywide trends for various types of promotion. We also tracked the relation between promotional efforts and sales over time. Finally, we documented the variation in direct-to-consumer advertising among and within five therapeutic classes of drugs and compared the variation in the intensity of such advertising with variation in the intensity of promotion to health care professionals. Annual spending on direct-to-consumer advertising for prescription drugs tripled between 1996 and 2000, when it reached nearly $2.5 billion. Despite this increase, such advertising accounts for only 15 percent of the money spent on drug promotion and is highly concentrated on a subgroup of products. Within a therapeutic class, there is marked variation in the intensity of direct-to-consumer advertising, and the amount of such advertising for specific products fluctuates over time. The initial surge in direct-to-consumer advertising preceded the 1997 FDA guidelines that clarified the rules for electronic direct-to-consumer advertising, and thus the 1997 guidelines may not have been the most important reason for the overall increase. Although the use of direct-to-consumer advertising has grown disproportionately to other forms of promotion, it continues to account for a small proportion of total promotional efforts. Nevertheless, physicians must assist patients in evaluating health-related information obtained through direct advertising.

Ballpoint pen ingestion in a 2-year-old child.

PubMed

Rameau, Anaïs; Anand, Sumeet M; Nguyen, Lily H

2011-07-01

A 2-year-old girl ingested a ballpoint pen, which was found on chest x-ray to have lodged in the lower esophagus and stomach. The pen, which measured nearly 15 cm in length, was removed via rigid esophagoscopy without complication. To the best of our knowledge, this is the longest nonflexible foreign body ingested by a young child ever reported in the English-language literature. We describe the presentation of this case and the current guidelines for safety as enumerated in the Small Parts Regulations established by the U.S. Consumer Product Safety Commission.

Retail prescription drug spending in the National Health Accounts.

PubMed

Smith, Cynthia

2004-01-01

Recent rapid spending growth for retail drugs has largely arisen from increased use of new drugs, rather than from increasing prices of existing drugs. A sizable shift in the payment from consumers to third parties has also contributed to faster growth. Strategies such as negotiating for rebates and using tiered copayments have sought to slow spending growth but simultaneously have complicated the estimation of spending in the National Health Accounts (NHA). NHA estimates show that retail pharmaceuticals' share of health spending is not much different than it was in 1960, although its share of gross domestic product (GDP) has tripled.

Ocular complications of diabetes mellitus

PubMed Central

Sayin, Nihat; Kara, Necip; Pekel, Gökhan

2015-01-01

Diabetes mellitus (DM) is a important health problem that induces ernestful complications and it causes significant morbidity owing to specific microvascular complications such as, retinopathy, nephropathy and neuropathy, and macrovascular complications such as, ischaemic heart disease, and peripheral vasculopathy. It can affect children, young people and adults and is becoming more common. Ocular complications associated with DM are progressive and rapidly becoming the world’s most significant cause of morbidity and are preventable with early detection and timely treatment. This review provides an overview of five main ocular complications associated with DM, diabetic retinopathy and papillopathy, cataract, glaucoma, and ocular surface diseases. PMID:25685281

Variables influencing food perception reviewed for consumer-oriented product development.

PubMed

Sijtsema, Siet; Linnemann, Anita; van Gaasbeek, Ton; Dagevos, Hans; Jongen, Wim

2002-01-01

Consumer wishes have to be translated into product characteristics to implement consumer-oriented product development. Before this step can be made, insight in food-related behavior and perception of consumers is necessary to make the right, useful, and successful translation. Food choice behavior and consumers' perception are studied in many disciplines. Models of food behavior and preferences therefore were studied from a multidisciplinary perspective. Nearly all models structure the determinants related to the person, the food, and the environment. Consequently, the overview of models was used as a basis to structure the variables influencing food perception into a model for consumer-oriented product development. To this new model, referred to as food perception model, other variables like time and place as part of consumption moment were added. These are important variables influencing consumers' perception, and therefore of increasing importance to consumer-oriented product development nowadays. In further research, the presented food perception model is used as a tool to implement successful consumer-oriented product development.

Community-based evaluation of laparoscopic versus open simple closure of perforated peptic ulcers.

PubMed

Kuwabara, Kazuaki; Matsuda, Shinya; Fushimi, Kiyohide; Ishikawa, Koichi B; Horiguchi, Hiromasa; Fujimori, Kenji

2011-11-01

Several studies have advocated laparoscopic simple closure (LSC) as the treatment of choice for perforated peptic ulcer disease (PUD). However, there has been no comprehensive community-based evaluation of the advantages of using LSC over open simple closure (OSC). Using an administrative database, we evaluated LSC versus OSC for patients with perforated ulcers. From 6,334 patients with perforated ulcers, we identified 2,909 simple closure cases between 2006 and 2010. Study variables were demographics, mortality, co-morbidities, complications, ulcer location, surgical timing, blood transfusion, postoperative ventilation, operating room (OR) time, time to resumption of oral food intake, length of stay (LOS), and total charges. After matching patient baseline variables between OSC and LSC, we performed multivariate analyses to assess the impacts of LSC on mortality, complications, and ventilation administration. A total of 2,073 OSC cases and 836 LSC cases were identified in 670 hospitals. Younger age, duodenal ulcer, and pre-existing PUD were indicators for selection of LSC. Matching analysis indicated a correlation between LSC and lower mortality, less frequent postoperative and overall blood transfusion, shorter LOS, earlier return to oral intake, and longer OR time. There was no difference between OSC and LSC in complication rate or mortality. Longer OR time was correlated with a higher complication rate and the need for ventilation, the latter of which was independently associated with an increase in mortality. Because longer OR time was associated with more frequent complications and ventilation, surgeons should obtain the skills and strategies necessary to accomplish LSC without extending OR time improperly.