Incorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization.

PubMed

Schwartz, Jennifer; Wang, Yongfei; Qin, Li; Schwamm, Lee H; Fonarow, Gregg C; Cormier, Nicole; Dorsey, Karen; McNamara, Robert L; Suter, Lisa G; Krumholz, Harlan M; Bernheim, Susannah M

2017-11-01

The Centers for Medicare & Medicaid Services publicly reports a hospital-level stroke mortality measure that lacks stroke severity risk adjustment. Our objective was to describe novel measures of stroke mortality suitable for public reporting that incorporate stroke severity into risk adjustment. We linked data from the American Heart Association/American Stroke Association Get With The Guidelines-Stroke registry with Medicare fee-for-service claims data to develop the measures. We used logistic regression for variable selection in risk model development. We developed 3 risk-standardized mortality models for patients with acute ischemic stroke, all of which include the National Institutes of Health Stroke Scale score: one that includes other risk variables derived only from claims data (claims model); one that includes other risk variables derived from claims and clinical variables that could be obtained from electronic health record data (hybrid model); and one that includes other risk variables that could be derived only from electronic health record data (electronic health record model). The cohort used to develop and validate the risk models consisted of 188 975 hospital admissions at 1511 hospitals. The claims, hybrid, and electronic health record risk models included 20, 21, and 9 risk-adjustment variables, respectively; the C statistics were 0.81, 0.82, and 0.79, respectively (as compared with the current publicly reported model C statistic of 0.75); the risk-standardized mortality rates ranged from 10.7% to 19.0%, 10.7% to 19.1%, and 10.8% to 20.3%, respectively; the median risk-standardized mortality rate was 14.5% for all measures; and the odds of mortality for a high-mortality hospital (+1 SD) were 1.51, 1.52, and 1.52 times those for a low-mortality hospital (-1 SD), respectively. We developed 3 quality measures that demonstrate better discrimination than the Centers for Medicare & Medicaid Services' existing stroke mortality measure, adjust for stroke severity, and could be implemented in a variety of settings. © 2017 American Heart Association, Inc.

Self-esteem is associated with premorbid adjustment and positive psychotic symptoms in early psychosis

PubMed Central

2011-01-01

Background Low levels of self-esteem have been implicated as both a cause and a consequence of severe mental disorders. The main aims of the study were to examine whether premorbid adjustment has an impact on the subject's self-esteem, and whether lowered self-esteem contributes to the development of delusions and hallucinations. Method A total of 113 patients from the Thematically Organized Psychosis research study (TOP) were included at first treatment. The Positive and Negative Syndrome Scale (PANSS) was used to assess present symptoms. Premorbid adjustment was measured with the Premorbid Adjustment Scale (PAS) and self-esteem by the Rosenberg Self-Esteem Scale (RSES). Results Premorbid social adjustment was significantly related to lower self-esteem and explained a significant proportion of the variance in self-esteem. Self-esteem was significantly associated with the levels of persecutory delusions and hallucinations experienced by the patient and explained a significant proportion of the variance even after adjusting for premorbid functioning and depression. Conclusion There are reasons to suspect that premorbid functioning is an important aspect in the development of self- esteem, and, furthermore, that self-esteem is associated with the development of delusions and hallucinations. PMID:21854599

Severity of illness and ambulatory care-sensitive conditions.

PubMed

Yuen, Elaine J

2004-09-01

This study describes how severity of illness may refine the definition of ambulatory care-sensitive conditions, or ACSCs. Hospital discharge abstract data from Philadelphia were combined with census data to develop population-based adjusted rates of hospitalization for diabetes and asthma, two ACSCs. By stratifying ACSC hospitalization by severity of illness, variations were observed by age, race, and gender. Minority groups may be at higher risk for less access to outpatient primary care and were observed to have higher rates of more severely ill, Stage 3 hospitalization. Geographic map displays indicated wide ranges of age-sex-adjusted rates for high-severity hospitalization in the five-county Philadelphia region. This refined ACSC measure may help to identify specific groups and clinical conditions within a population to assist health care planners estimate health care resources such as facilities, manpower, and programs, as well as to evaluate their outcomes.

Not all those who wander are lost: examining the impact of sojourner adjustment and drinking motives on alcohol consequences experienced by Americans studying in foreign countries.

PubMed

Pedersen, Eric R; Neighbors, Clayton; Lee, Christine M; Larimer, Mary E

2012-11-01

American students studying in foreign countries represent a unique group at risk for increased and problematic drinking. Examination of risk and protective factors for negative alcohol-related consequences can lead to the development of efficacious preventive interventions for reducing high-risk drinking while abroad. The present study examined the relationship between sojourner adjustment (i.e., the sociocultural and psychological adjustment of short-term residents in foreign environments), drinking motives, and alcohol-related consequences. Participants were 248 college students (81% women) who recently completed study-abroad trips and completed online surveys about their drinking motives and behavior, alcohol-related consequences, and sojourner adjustment. In general, positive sojourner adjustment (i.e., social interaction with host nationals, language development and use, and host culture identification) was protective against negative consequences, whereas negative sojourner adjustment (i.e., social interaction with co-nationals and homesickness/feeling out of place) was associated with increased reporting of consequences. Unexpectedly, the positive sojourner adjustment factor of cultural understanding and participation was associated with greater alcohol-related consequences. Social motives for drinking also predicted consequences. Drinking motives moderated several of the relationships between sojourner adjustment and consequences. Interest in and adoption of the host country culture may protect against problematic alcohol use; however, this may vary based on students' reasons for drinking. These findings support the need for further examination of sojourner adjustment in college students abroad and indicate potential areas for development of preventive interventions.

Developing a stroke severity index based on administrative data was feasible using data mining techniques.

PubMed

Sung, Sheng-Feng; Hsieh, Cheng-Yang; Kao Yang, Yea-Huei; Lin, Huey-Juan; Chen, Chih-Hung; Chen, Yu-Wei; Hu, Ya-Han

2015-11-01

Case-mix adjustment is difficult for stroke outcome studies using administrative data. However, relevant prescription, laboratory, procedure, and service claims might be surrogates for stroke severity. This study proposes a method for developing a stroke severity index (SSI) by using administrative data. We identified 3,577 patients with acute ischemic stroke from a hospital-based registry and analyzed claims data with plenty of features. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). We used two data mining methods and conventional multiple linear regression (MLR) to develop prediction models, comparing the model performance according to the Pearson correlation coefficient between the SSI and the NIHSS. We validated these models in four independent cohorts by using hospital-based registry data linked to a nationwide administrative database. We identified seven predictive features and developed three models. The k-nearest neighbor model (correlation coefficient, 0.743; 95% confidence interval: 0.737, 0.749) performed slightly better than the MLR model (0.742; 0.736, 0.747), followed by the regression tree model (0.737; 0.731, 0.742). In the validation cohorts, the correlation coefficients were between 0.677 and 0.725 for all three models. The claims-based SSI enables adjusting for disease severity in stroke studies using administrative data. Copyright © 2015 Elsevier Inc. All rights reserved.

Development Status of Adjustable X-Ray Optics with 0.5 Arcsecond Resolution

NASA Technical Reports Server (NTRS)

Reid, P. B.; ODell, Stephen; Elsner, Ron; Ramsey, Brian; Gubarev, Misha; Aldcroft, T.; Allured, R.; Cotroneo, V.; Johnson-Wilke, R. L.; McMuldroch, S.;

A risk-model for hospital mortality among patients with severe sepsis or septic shock based on German national administrative claims data

PubMed Central

Fleischmann-Struzek, Carolin; Rüddel, Hendrik; Reinhart, Konrad; Thomas-Rüddel, Daniel O.

2018-01-01

Background Sepsis is a major cause of preventable deaths in hospitals. Feasible and valid methods for comparing quality of sepsis care between hospitals are needed. The aim of this study was to develop a risk-adjustment model suitable for comparing sepsis-related mortality between German hospitals. Methods We developed a risk-model using national German claims data. Since these data are available with a time-lag of 1.5 years only, the stability of the model across time was investigated. The model was derived from inpatient cases with severe sepsis or septic shock treated in 2013 using logistic regression with backward selection and generalized estimating equations to correct for clustering. It was validated among cases treated in 2015. Finally, the model development was repeated in 2015. To investigate secular changes, the risk-adjusted trajectory of mortality across the years 2010–2015 was analyzed. Results The 2013 deviation sample consisted of 113,750 cases; the 2015 validation sample consisted of 134,851 cases. The model developed in 2013 showed good validity regarding discrimination (AUC = 0.74), calibration (observed mortality in 1st and 10th risk-decile: 11%-78%), and fit (R2 = 0.16). Validity remained stable when the model was applied to 2015 (AUC = 0.74, 1st and 10th risk-decile: 10%-77%, R2 = 0.17). There was no indication of overfitting of the model. The final model developed in year 2015 contained 40 risk-factors. Between 2010 and 2015 hospital mortality in sepsis decreased from 48% to 42%. Adjusted for risk-factors the trajectory of decrease was still significant. Conclusions The risk-model shows good predictive validity and stability across time. The model is suitable to be used as an external algorithm for comparing risk-adjusted sepsis mortality among German hospitals or regions based on administrative claims data, but secular changes need to be taken into account when interpreting risk-adjusted mortality. PMID:29558486

A risk-model for hospital mortality among patients with severe sepsis or septic shock based on German national administrative claims data.

PubMed

Schwarzkopf, Daniel; Fleischmann-Struzek, Carolin; Rüddel, Hendrik; Reinhart, Konrad; Thomas-Rüddel, Daniel O

2018-01-01

Sepsis is a major cause of preventable deaths in hospitals. Feasible and valid methods for comparing quality of sepsis care between hospitals are needed. The aim of this study was to develop a risk-adjustment model suitable for comparing sepsis-related mortality between German hospitals. We developed a risk-model using national German claims data. Since these data are available with a time-lag of 1.5 years only, the stability of the model across time was investigated. The model was derived from inpatient cases with severe sepsis or septic shock treated in 2013 using logistic regression with backward selection and generalized estimating equations to correct for clustering. It was validated among cases treated in 2015. Finally, the model development was repeated in 2015. To investigate secular changes, the risk-adjusted trajectory of mortality across the years 2010-2015 was analyzed. The 2013 deviation sample consisted of 113,750 cases; the 2015 validation sample consisted of 134,851 cases. The model developed in 2013 showed good validity regarding discrimination (AUC = 0.74), calibration (observed mortality in 1st and 10th risk-decile: 11%-78%), and fit (R2 = 0.16). Validity remained stable when the model was applied to 2015 (AUC = 0.74, 1st and 10th risk-decile: 10%-77%, R2 = 0.17). There was no indication of overfitting of the model. The final model developed in year 2015 contained 40 risk-factors. Between 2010 and 2015 hospital mortality in sepsis decreased from 48% to 42%. Adjusted for risk-factors the trajectory of decrease was still significant. The risk-model shows good predictive validity and stability across time. The model is suitable to be used as an external algorithm for comparing risk-adjusted sepsis mortality among German hospitals or regions based on administrative claims data, but secular changes need to be taken into account when interpreting risk-adjusted mortality.

Application of separate pressure test in oilfield development

NASA Astrophysics Data System (ADS)

Jingjun, Guo

2018-06-01

Based on the analysis of separate pressure testing data of injection wells and the actual situations of oilfield development, this paper discusses several application examples of these testing data in evaluating the effect of reservoir development, optimizating injection wells scheme adjustment, guiding oil and water wells to increase production and injection and preventing casing damage.

Simulation-based coefficients for adjusting climate impact on energy consumption of commercial buildings

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

Wang, Na; Makhmalbaf, Atefe; Srivastava, Viraj

This paper presents a new technique for and the results of normalizing building energy consumption to enable a fair comparison among various types of buildings located near different weather stations across the U.S. The method was developed for the U.S. Building Energy Asset Score, a whole-building energy efficiency rating system focusing on building envelope, mechanical systems, and lighting systems. The Asset Score is calculated based on simulated energy use under standard operating conditions. Existing weather normalization methods such as those based on heating and cooling degrees days are not robust enough to adjust all climatic factors such as humidity andmore » solar radiation. In this work, over 1000 sets of climate coefficients were developed to separately adjust building heating, cooling, and fan energy use at each weather station in the United States. This paper also presents a robust, standardized weather station mapping based on climate similarity rather than choosing the closest weather station. This proposed simulated-based climate adjustment was validated through testing on several hundreds of thousands of modeled buildings. Results indicated the developed climate coefficients can isolate and adjust for the impacts of local climate for asset rating.« less

Not All Those Who Wander Are Lost: Examining the Impact of Sojourner Adjustment and Drinking Motives on Alcohol Consequences Experienced by Americans Studying in Foreign Countries

PubMed Central

Pedersen, Eric R.; Neighbors, Clayton; Lee, Christine M.; Larimer, Mary E.

2012-01-01

Objective American students studying in foreign countries represent a unique group at risk for increased and problematic drinking. Examination of risk and protective factors for negative alcohol-related consequences can lead to the development of efficacious preventive interventions for reducing high-risk drinking while abroad. The present study examined the relationship between sojourner adjustment (i.e., the sociocultural and psychological adjustment of short-term residents in foreign environments), drinking motives, and alcohol-related consequences. Method Participants were 248 college students (81% women) who recently completed study-abroad trips and completed online surveys about their drinking motives and behavior, alcohol-related consequences, and sojourner adjustment. Results In general, positive sojourner adjustment (i.e., social interaction with host nationals, language development and use, and host culture identification) was protective against negative consequences, whereas negative sojourner adjustment (i.e., social interaction with co-nationals and homesickness/feeling out of place) was associated with increased reporting of consequences. Unexpectedly, the positive sojourner adjustment factor of cultural understanding and participation was associated with greater alcohol-related consequences. Social motives for drinking also predicted consequences. Drinking motives moderated several of the relationships between sojourner adjustment and consequences. Conclusions Interest in and adoption of the host country culture may protect against problematic alcohol use; however, this may vary based on students' reasons for drinking. These findings support the need for further examination of sojourner adjustment in college students abroad and indicate potential areas for development of preventive interventions. PMID:23036220

Including information about comorbidity in estimates of disease burden: Results from the WHO World Mental Health Surveys

PubMed Central

Alonso, Jordi; Vilagut, Gemma; Chatterji, Somnath; Heeringa, Steven; Schoenbaum, Michael; Üstün, T. Bedirhan; Rojas-Farreras, Sonia; Angermeyer, Matthias; Bromet, Evelyn; Bruffaerts, Ronny; de Girolamo, Giovanni; Gureje, Oye; Haro, Josep Maria; Karam, Aimee N.; Kovess, Viviane; Levinson, Daphna; Liu, Zhaorui; Mora, Maria Elena Medina; Ormel, J.; Posada-Villa, Jose; Uda, Hidenori; Kessler, Ronald C.

2010-01-01

Background The methodology commonly used to estimate disease burden, featuring ratings of severity of individual conditions, has been criticized for ignoring comorbidity. A methodology that addresses this problem is proposed and illustrated here with data from the WHO World Mental Health Surveys. Although the analysis is based on self-reports about one’s own conditions in a community survey, the logic applies equally well to analysis of hypothetical vignettes describing comorbid condition profiles. Methods Face-to-face interviews in 13 countries (six developing, nine developed; n = 31,067; response rate = 69.6%) assessed 10 classes of chronic physical and 9 of mental conditions. A visual analog scale (VAS) was used to assess overall perceived health. Multiple regression analysis with interactions for comorbidity was used to estimate associations of conditions with VAS. Simulation was used to estimate condition-specific effects. Results The best-fitting model included condition main effects and interactions of types by numbers of conditions. Neurological conditions, insomnia, and major depression were rated most severe. Adjustment for comorbidity reduced condition-specific estimates with substantial between-condition variation (.24–.70 ratios of condition-specific estimates with and without adjustment for comorbidity). The societal-level burden rankings were quite different from the individual-level rankings, with the highest societal-level rankings associated with conditions having high prevalence rather than high individual-level severity. Conclusions Plausible estimates of disorder-specific effects on VAS can be obtained using methods that adjust for comorbidity. These adjustments substantially influence condition-specific ratings. PMID:20553636

Kinematic synthesis of adjustable robotic mechanisms

NASA Astrophysics Data System (ADS)

Chuenchom, Thatchai

1993-01-01

Conventional hard automation, such as a linkage-based or a cam-driven system, provides high speed capability and repeatability but not the flexibility required in many industrial applications. The conventional mechanisms, that are typically single-degree-of-freedom systems, are being increasingly replaced by multi-degree-of-freedom multi-actuators driven by logic controllers. Although this new trend in sophistication provides greatly enhanced flexibility, there are many instances where the flexibility needs are exaggerated and the associated complexity is unnecessary. Traditional mechanism-based hard automation, on the other hand, neither can fulfill multi-task requirements nor are cost-effective mainly due to lack of methods and tools to design-in flexibility. This dissertation attempts to bridge this technological gap by developing Adjustable Robotic Mechanisms (ARM's) or 'programmable mechanisms' as a middle ground between high speed hard automation and expensive serial jointed-arm robots. This research introduces the concept of adjustable robotic mechanisms towards cost-effective manufacturing automation. A generalized analytical synthesis technique has been developed to support the computational design of ARM's that lays the theoretical foundation for synthesis of adjustable mechanisms. The synthesis method developed in this dissertation, called generalized adjustable dyad and triad synthesis, advances the well-known Burmester theory in kinematics to a new level. While this method provides planar solutions, a novel patented scheme is utilized for converting prescribed three-dimensional motion specifications into sets of planar projections. This provides an analytical and a computational tool for designing adjustable mechanisms that satisfy multiple sets of three-dimensional motion specifications. Several design issues were addressed, including adjustable parameter identification, branching defect, and mechanical errors. An efficient mathematical scheme for identification of adjustable member was also developed. The analytical synthesis techniques developed in this dissertation were successfully implemented in a graphic-intensive user-friendly computer program. A physical prototype of a general purpose adjustable robotic mechanism has been constructed to serve as a proof-of-concept model.

Development of a time-variable nuclear pulser for half life measurements

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

Zahn, Guilherme S.; Domienikan, Claudio; Carvalhaes, Roberto P. M.

2013-05-06

In this work a time-variable pulser system with an exponentially-decaying pulse frequency is presented, which was developed using the low-cost, open-source Arduino microcontroler plataform. In this system, the microcontroller produces a TTL signal in the selected rate and a pulse shaper board adjusts it to be entered in an amplifier as a conventional pulser signal; both the decay constant and the initial pulse rate can be adjusted using a user-friendly control software, and the pulse amplitude can be adjusted using a potentiometer in the pulse shaper board. The pulser was tested using several combinations of initial pulse rate and decaymore » constant, and the results show that the system is stable and reliable, and is suitable to be used in half-life measurements.« less

Assessing gully widening and its control in the Debri-Mawi Watershed, northern Ethiopia

USDA-ARS?s Scientific Manuscript database

The highlands of northern Ethiopia suffer from severe land degradation manifested by widespread gully and channel erosion and network development. Research on the geomorphic adjustment of similar landscapes in the midcontinental United States has resulted in the development of the computer models BS...

Plasma cytokines IL-6, IL-8, and IL-10 are associated with the development of acute respiratory distress syndrome in patients with severe traumatic brain injury.

PubMed

Aisiku, Imo P; Yamal, Jose-Miguel; Doshi, Pratik; Benoit, Julia S; Gopinath, Shankar; Goodman, Jerry C; Robertson, Claudia S

2016-09-15

Patients with severe traumatic brain injury (TBI) are at risk of the development of acute respiratory distress syndrome (ARDS). TBI and ARDS pathophysiologic mechanisms are known to independently involve significant inflammatory responses. The literature on the association between plasma inflammatory cytokines and ARDS in patients with TBI is sparse. The study was a secondary analysis of the safety of a randomized trial of erythropoietin and transfusion threshold in patients with severe TBI. Inflammatory markers within the first 24 hours after injury were compared in patients who developed ARDS and patients without ARDS, using Cox proportional hazards models. There were 200 patients enrolled in the study. The majority of plasma and cerebrospinal fluid (CSF) cytokine levels were obtained within 6 hours. Plasma proinflammatory markers IL-6 and IL-8 and anti-inflammatory marker IL-10 were associated with the development of ARDS (adjusted hazard ratio (HR) = 1.55, confidence interval (CI) = 1.14, 2.11, P = 0.005 for IL-6; adjusted HR = 1.32, CI = 1.10, 1.59, P = 0.003 for IL-8). Plasma markers of IL-6, IL-8, and IL-10 are associated with ARDS in patients with severe TBI. NCT00313716 registered 4/2006.

A Severe Sepsis Mortality Prediction Model and Score for Use with Administrative Data

PubMed Central

Ford, Dee W.; Goodwin, Andrew J.; Simpson, Annie N.; Johnson, Emily; Nadig, Nandita; Simpson, Kit N.

2016-01-01

Objective Administrative data is used for research, quality improvement, and health policy in severe sepsis. However, there is not a sepsis-specific tool applicable to administrative data with which to adjust for illness severity. Our objective was to develop, internally validate, and externally validate a severe sepsis mortality prediction model and associated mortality prediction score. Design Retrospective cohort study using 2012 administrative data from five US states. Three cohorts of patients with severe sepsis were created: 1) ICD-9-CM codes for severe sepsis/septic shock, 2) ‘Martin’ approach, and 3) ‘Angus’ approach. The model was developed and internally validated in ICD-9-CM cohort and externally validated in other cohorts. Integer point values for each predictor variable were generated to create a sepsis severity score. Setting Acute care, non-federal hospitals in NY, MD, FL, MI, and WA Subjects Patients in one of three severe sepsis cohorts: 1) explicitly coded (n=108,448), 2) Martin cohort (n=139,094), and 3) Angus cohort (n=523,637) Interventions None Measurements and Main Results Maximum likelihood estimation logistic regression to develop a predictive model for in-hospital mortality. Model calibration and discrimination assessed via Hosmer-Lemeshow goodness-of-fit (GOF) and C-statistics respectively. Primary cohort subset into risk deciles and observed versus predicted mortality plotted. GOF demonstrated p>0.05 for each cohort demonstrating sound calibration. C-statistic ranged from low of 0.709 (sepsis severity score) to high of 0.838 (Angus cohort) suggesting good to excellent model discrimination. Comparison of observed versus expected mortality was robust although accuracy decreased in highest risk decile. Conclusions Our sepsis severity model and score is a tool that provides reliable risk adjustment for administrative data. PMID:26496452

Multiple large solar lentigos on the upper back as clinical markers of past severe sunburn: a case-control study.

PubMed

Derancourt, C; Bourdon-Lanoy, E; Grob, J-J; Guillaume, J-C; Bernard, P; Bastuji-Garin, S

2007-01-01

Multiple solar lentigos commonly seen on the upper back and shoulders of adults are classically considered as a sign of photodamage, although epidemiological studies are scarce. To assess whether these lesions are clinical markers of past severe sunburn. A case-control study in two outpatient dermatology clinics in French university hospitals. Past episodes of moderate and severe sunburn were compared between 145 adult patients with multiple solar lentigos on the upper back and 145 matched controls. In multivariate analysis adjusted for potential confounders, recalled episodes of sunburn during childhood, adolescence and adulthood were independently associated with the presence of multiple solar lentigos (adjusted odds ratios, 95% confidence intervals: 2.3 (1.1-5.2) and 28.1 (10.4-75.6) for moderate and severe sunburn, respectively). Multiple solar lentigos on the upper back and shoulders of adults are potential clinical markers of past severe sunburn which may thus be used to identify a population at higher risk of developing cutaneous malignant melanoma.

Development of bovine serum albumin-water partition coefficients predictive models for ionogenic organic chemicals based on chemical form adjusted descriptors.

PubMed

Ding, Feng; Yang, Xianhai; Chen, Guosong; Liu, Jining; Shi, Lili; Chen, Jingwen

2017-10-01

The partition coefficients between bovine serum albumin (BSA) and water (K BSA/w ) for ionogenic organic chemicals (IOCs) were different greatly from those of neutral organic chemicals (NOCs). For NOCs, several excellent models were developed to predict their logK BSA/w . However, it was found that the conventional descriptors are inappropriate for modeling logK BSA/w of IOCs. Thus, alternative approaches are urgently needed to develop predictive models for K BSA/w of IOCs. In this study, molecular descriptors that can be used to characterize the ionization effects (e.g. chemical form adjusted descriptors) were calculated and used to develop predictive models for logK BSA/w of IOCs. The models developed had high goodness-of-fit, robustness, and predictive ability. The predictor variables selected to construct the models included the chemical form adjusted averages of the negative potentials on the molecular surface (V s-adj - ), the chemical form adjusted molecular dipole moment (dipolemoment adj ), the logarithm of the n-octanol/water distribution coefficient (logD). As these molecular descriptors can be calculated from their molecular structures directly, the developed model can be easily used to fill the logK BSA/w data gap for other IOCs within the applicability domain. Furthermore, the chemical form adjusted descriptors calculated in this study also could be used to construct predictive models on other endpoints of IOCs. Copyright © 2017 Elsevier Inc. All rights reserved.

Psychosocial work environment and incidence of severe depressive symptoms: prospective findings from a 5-year follow-up of the Danish work environment cohort study.

PubMed

Rugulies, Reiner; Bültmann, Ute; Aust, Birgit; Burr, Hermann

2006-05-15

The authors analyzed the impact of psychosocial work characteristics on the incidence of severe depressive symptoms among 4,133 (49% women) employees from a representative sample of the Danish workforce between 1995 and 2000. Psychosocial work characteristics at baseline included quantitative demands, influence at work, possibilities for development, social support from supervisors and coworkers, and job insecurity. Severe depressive symptoms were measured with the five-item Mental Health Inventory of the 36-item Short-Form Health Survey, with a cutoff point of 52. Women with low influence at work (relative risk (RR) = 2.17, 95% confidence interval (CI): 1.23, 3.82) and low supervisor support (RR = 2.03, 95% CI: 1.20, 3.43) were at increased risk for severe depressive symptoms after exclusion of cases at baseline and adjustment for sociodemographic factors, baseline depression score, and health behaviors. Further adjustments for socioeconomic position did not change the result substantially. Additional analyses showed that a one-standard deviation increase on the influence scale resulted in a 27% decreased risk of severe depressive symptoms. Among men, job insecurity predicted severe depressive symptoms (RR = 2.04, 95% CI: 1.02, 4.07). The findings indicate that the work environment influences the risk of developing severe depressive symptoms and that different factors play a role for men and women.

Famine Exposure in the Young and the Risk of Type 2 Diabetes in Adulthood

PubMed Central

van Abeelen, Annet F.M.; Elias, Sjoerd G.; Bossuyt, Patrick M.M.; Grobbee, Diederick E.; van der Schouw, Yvonne T.; Roseboom, Tessa J.; Uiterwaal, Cuno S.P.M.

2012-01-01

The developmental origins hypothesis proposes that undernutrition during early development is associated with an increased type 2 diabetes risk in adulthood. We investigated the association between undernutrition during childhood and young adulthood and type 2 diabetes in adulthood. We studied 7,837 women from Prospect-EPIC (European Prospective Investigation Into Cancer and Nutrition) who were exposed to the 1944–1945 Dutch famine when they were between age 0 and 21 years. We used Cox proportional hazards regression models to explore the effect of famine on the risk of subsequent type 2 diabetes in adulthood. We adjusted for potential confounders, including age at famine exposure, smoking, and level of education. Self-reported famine exposure during childhood and young adulthood was associated with an increased type 2 diabetes risk in a dose-dependent manner. In those who reported moderate famine exposure, the age-adjusted type 2 diabetes hazard ratio (HR) was 1.36 (95% CI [1.09–1.70]); in those who reported severe famine exposure, the age-adjusted HR was 1.64 (1.26–2.14) relative to unexposed women. These effects did not change after adjustment for confounders. This study provides the first direct evidence, using individual famine exposure data, that a short period of moderate or severe undernutrition during postnatal development increases type 2 diabetes risk in adulthood. PMID:22648386

An evaluation of multiple trauma severity indices created by different index development strategies.

PubMed

Gustafson, D H; Fryback, D G; Rose, J H; Prokop, C T; Detmer, D E; Rossmeissl, J C; Taylor, C M; Alemi, F; Carnazzo, A J

1983-07-01

Evaluation of the effectiveness of emergency trauma care systems is complicated by the need to adjust for the widely variable case mix found in trauma patient populations. Several strategies have been advanced to construct the severity indices that can control for these population differences. This article describes a validity and reliability comparison of trauma severity indices developed under three different approaches: 1) use of a multi-attribute utility (MAU) model; 2) an actuarial approach relying on empirical data bases; and 3) an "ad hoc" approach. Seven criteria were identified to serve as standards of comparison for four different indices. The study's findings indicate that the index developed using the MAU theory approach associates most closely with physician judgments of trauma severity. When correlated with a morbidity outcome measure, the MAU-based index shows higher levels of agreement than the other indices. The index development approach based on the principles of MAU theory has several advantages and it appears to be a powerful tool in the creation of effective severity indices.

The Risk Factors for Hydrocephalus and Subdural Hygroma after Decompressive Craniectomy in Head Injured Patients.

PubMed

Ki, Hee Jong; Lee, Hyung-Jin; Lee, Hong-Jae; Yi, Jin-Seok; Yang, Ji-Ho; Lee, Il-Woo

2015-09-01

The present study aims to investigate 1) the risk factors for hydrocephalus and subdural hygroma (SDG) occurring after decompressive craniectomy (DC), and 2) the association between the type of SDG and hydrocephalus. We retrospectively reviewed the clinical and radiological features of 92 patients who underwent DC procedures after severe head injuries. The risk factors for developing post-traumatic hydrocephalus (PTH) and SDG were analyzed. Types of SDGs were classified according to location and their relationship with hydrocephalus was investigated. Ultimately, 26.09% (24/92) of these patients developed PTH. In the univariate analyses, hydrocephalus was statically associated with large bone flap diameter, large craniectomy area, bilateral craniectomy, intraventricular hemorrhage, contralateral or interhemisheric SDGs, and delayed cranioplasty. However, in the multivariate analysis, only large craniectomy area (adjusted OR=4.66; p=0.0239) and contralateral SDG (adjusted OR=6.62; p=0.0105) were significant independent risk factors for developing hydrocephalus after DC. The incidence of overall SDGs after DC was 55.43% (51/92). Subgroup analysis results were separated by SDG types. Statistically significant associations between hydrocephalus were found in multivariate analysis in the contralateral (adjusted OR=5.58; p=0.0074) and interhemispheric (adjusted OR=17.63; p=0.0113) types. For patients who are subjected to DC following severe head trauma, hydrocephalus is associated with a large craniectomy area and contralateral SDG. For SDGs after DC that occur on the interhemispherical or controlateral side of the craniectomy, careful follow-up monitoring for the potential progression into hydrocephalus is needed.

[Neurodevelopmental Outcomes of Very Preterm or Very Low Birth Weigth Infants: Comparison of Monochorionic and Dichorionic Twins with Singletons].

PubMed

Taborda, Adelaide; Oliveira, Guiomar

2016-11-01

Twins are associated with a delayed development and cerebral palsy. The purpose of this work was to compare the neurologic morbidity in very preterm or very low birth weight dichorionic and monochorionic twins with singletons. We conducted a retrospective cohort study of livebirths lowest through 32 weeks of gestation or very low weight infants admitted to Neonatal Intensive Care Unit of a level III hospital, between 2006 and 2010. Development was evaluated with the Growing Skills II Scale at 24 months of age. Cerebral palsy was defined by predetermined criteria by Surveillance of Cerebral Palsy in Europe. Infants were analyzed as twins and singletons cohort. Within the twin category the infants were further separated as dichorionic and monochorionic and were compared with singletons infants. Logistic regression models were used to control for demographic and clinical factors. The cohort of infants who were assessed for neurodevelopmental impaired, consisted of 194 singletons infants and 89 twins (50 dichorionic; 39 monochorionic). Monochorionic twins, when compared with the singletons, showed an increased risk of severe developmental delay in these areas: locomotion (adjusted OR 12.2) language (adjusted OR 6.5) and autonomy (adjusted OR 7.2). Cerebral palsy was diagnosed in 4.1% of singleton infants and 15.4% of monochorionic twins. The adjusted risk of severe developmental delay and cerebral palsy in monochorionic twins was 3.6 and 4.2, respectively. This work showed higher rate of moderate and severe neurodevelopment delay including cerebral palsy in monochorionic twins compared to singletons infants. Analysis by groups stratified according to gestational age and comparison of monochorionic and dichorionic twins displayed the role of chorionicity for these neurodevelopmental disorders. In our sample the monochorionic twins are associated with an independent risk of neurodevelopmental delay.

On-orbit figure sensing and figure correction control for 0.5 arc-second adjustable X-ray optics

NASA Astrophysics Data System (ADS)

Reid, Paul

This investigation seeks to develop the technology to directly monitor on-orbit changes to imaging performance of adjustable X-ray optics so as to be able to efficiently correct adverse changes at a level consistent with 0.5 arc-second X-ray telescope imaging. Adjustable X-ray optics employ thin film piezoelectric material deposited on the back of a thin glass Wolter mirror segment to introduce localized stresses in the mirror. These stresses are used in a deterministic way to improve mirror figure from 10 arc-sec, half power diameter (HPD), to 0.5 arc-sec, HPD, without the need for a heavy reaction structure. This is a realizable technology for potential future X-ray telescope missions with 0.5 arc-second resolution and several square meters effective area, such as SMART-X. We are pursuing such mirror development under an existing APRA grant. Here we propose a new investigation to accomplish the monitoring and control of the mirrors by monitoring the health of the piezoelectric actuators of the adjustable optics to a level consistent with 0.5 arcsec imaging. Such measurements are beyond the capability of conventional, thin metal film strain gauges using DC measurements. Instead, we propose to develop the technology to deposit different types of strain gauges (metal film, semiconductor) directly on the piezoelectric cells; to investigate the use of additional thin layers of piezoelectric materials such as lead zirconate titanate or zinc oxide as strain and temperature gauges; and to use AC measurement of strain gauges for precise measurement of piezoelectric adjuster performance. The intent is to use this information to correct changes in mirror shape by adjusting the voltages on the piezoelectric adjustors. Adjustable X-ray optics are designed to meet the challenge of large collecting area and high angular resolution. The mirrors are called adjustable rather than active as mirror figure error is corrected (adjusted) once or infrequently, as opposed to being changed constantly at several cycles/sec (active). In our approach, the mirror figure is corrected based on ground measurements, accounting for figure errors due to mirror manufacturing, mounting induced deformations, modeled gravity release, and modeled on-orbit thermal effects. The piezoelectric strain monitoring we seek to develop in this program extends adjustable mirror technology development, as it enables efficient adjustment and correction of mirror figure on-orbit, as required. This unprecedented level of system robustness will make telescopes less expensive to build because requirements for the non-optical systems can be looser, and it will also make the system more resistant to degradation, promoting mission success. The largest drivers for changes from ground calibration to on-orbit performance are piezoelectric material aging and an unexpected thermal environment (i.e., larger gradients than modeled or other thermal control system problem). Developing the capability to accurately monitor the health of each piezoelectric cell and the local mirror surface temperature will enable the real time sensing of any of these potential issues, help determine the cause, and enable corrections via updating models of on-orbit conditions and re-optimizing the required piezoelectric cell voltages for mirror figure correction. Our 3 year research program includes the development of the strain monitoring technology, its deposition on the adjustable optics, modeling and performance simulation, accelerated lifetime testing, and optical and electrical metrology of sample adjustable optics that incorporate monitoring sensors. Development of the capability to remotely monitor piezo performance and temperature to necessary precision will vastly improve reliability of the SMART-X mission concept, or the sub-arc-second X-ray Surveyor mission described in the 2013 NASA Astrophysics Roadmap, Enduring Quests Daring Visions.

Natural killer cell function predicts severe infection in kidney transplant recipients.

PubMed

Dendle, Claire; Gan, Poh-Yi; Polkinghorne, Kevan R; Ngui, James; Stuart, Rhonda L; Kanellis, John; Thursky, Karin; Mulley, William R; Holdsworth, Stephen

2018-04-30

The aim of this study was to determine if natural killer cell number (CD3 - /CD16 ± /CD56 ± ) and cytotoxic killing function predicts severity and frequency of infection in kidney transplant recipients. A cohort of 168 kidney transplant recipients with stable graft function underwent assessment of natural killer cell number and functional killing capacity immediately prior to entry into this prospective study. Participants were followed for 2 years for development of severe infection, defined as hospitalization for infection. Area under receiver operating characteristic (AUROC) curves were used to evaluate the accuracy of natural killer cell number and function for predicting severe infection. Adjusted odds ratios were determined by logistic regression. Fifty-nine kidney transplant recipients (35%) developed severe infection and 7 (4%) died. Natural killer cell function was a better predictor of severe infection than natural killer cell number: AUROC 0.84 and 0.75, respectively (P = .018). Logistic regression demonstrated that after adjustment for age, transplant function, transplant duration, mycophenolate use, and increasing natural killer function (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.74-0.90; P < .0001) but not natural killer number (OR 0.96, 95% CI 0.93-1.00; P = .051) remained significantly associated with a reduced likelihood of severe infection. Natural killer cell function predicts severe infection in kidney transplant recipients. © 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.

Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury.

PubMed

Vavilala, Monica S; Kernic, Mary A; Wang, Jin; Kannan, Nithya; Mink, Richard B; Wainwright, Mark S; Groner, Jonathan I; Bell, Michael J; Giza, Christopher C; Zatzick, Douglas F; Ellenbogen, Richard G; Boyle, Linda Ng; Mitchell, Pamela H; Rivara, Frederick P

2014-10-01

The effect of the 2003 severe pediatric traumatic brain injury (TBI) guidelines on outcomes has not been examined. We aimed to develop a set of acute care guideline-influenced clinical indicators of adherence and tested the relationship between these indicators during the first 72 hours after hospital admission and discharge outcomes. Retrospective multicenter cohort study. Five regional pediatric trauma centers affiliated with academic medical centers. Children under 18 years with severe traumatic brain injury (admission Glasgow Coma Scale score ≤ 8, International Classification of Diseases, 9th Edition, diagnosis codes of 800.0-801.9, 803.0-804.9, 850.0-854.1, 959.01, 950.1-950.3, 995.55, maximum head abbreviated Injury Severity Score ≥ 3) who received tracheal intubation for at least 48 hours in the ICU between 2007 and 2011 were examined. None. Total percent adherence to the clinical indicators across all treatment locations (prehospital, emergency department, operating room, and ICU) during the first 72 hours after admission to study center were determined. Main outcomes were discharge survival and Glasgow Outcome Scale score. Total adherence rate across all locations and all centers ranged from 68% to 78%. Clinical indicators of adherence were associated with survival (adjusted hazard ratios, 0.94; 95% CI, 0.91-0.96). Three indicators were associated with survival: absence of prehospital hypoxia (adjusted hazard ratios, 0.20; 95% CI, 0.08-0.46), early ICU start of nutrition (adjusted hazard ratios, 0.06; 95% CI, 0.01-0.26), and ICU PaCO2 more than 30 mm Hg in the absence of radiographic or clinical signs of cerebral herniation (adjusted hazard ratios, 0.22; 95% CI, 0.06-0.8). Clinical indicators of adherence were associated with favorable Glasgow Outcome Scale among survivors (adjusted hazard ratios, 0.99; 95% CI, 0.98-0.99). Three indicators were associated with favorable discharge Glasgow Outcome Scale: all operating room cerebral perfusion pressure more than 40 mm Hg (adjusted relative risk, 0.61; 95% CI, 0.58-0.64), all ICU cerebral perfusion pressure more than 40 mm Hg (adjusted relative risk, 0.73; 95% CI, 0.63-0.84), and no surgery (any type; adjusted relative risk, 0.68; 95% CI, 0.53- 0.86). Acute care clinical indicators of adherence to the Pediatric Guidelines were associated with significantly higher discharge survival and improved discharge Glasgow Outcome Scale. Some indicators were protective, regardless of treatment location, suggesting the need for an interdisciplinary approach to the care of children with severe traumatic brain injury.

Preeclampsia and Retinopathy of Prematurity in Very-Low-Birth-Weight Infants: A Population-Based Study.

PubMed

Huang, Hsin-Chung; Yang, Hwai-I; Chou, Hung-Chieh; Chen, Chien-Yi; Hsieh, Wu-Shiun; Tsou, Kuo-Inn; Tsao, Po-Nien

2015-01-01

Preeclampsia and retinopathy of prematurity (ROP) are associated with impaired angiogenesis. Previous studies on the relationship between preeclampsia and ROP have produced conflicting results. The goal of this study was to evaluate the association between maternal preeclampsia and ROP using a large population-based cohort of very-low-birth-weight (VLBW) infants from 21 neonatal departments registered in the database of the Premature Baby Foundation of Taiwan. Multivariable logistic regression analysis was used to estimate the adjusted odds ratios (OR) and 95% confidence intervals (CI) for preeclampsia with reference to ROP and severe ROP. A total of 5,718 VLBW infants (844 cases with maternal preeclampsia) were included for analysis. The overall incidences of mild and severe ROP were 36.0% and 12.2%, respectively. Univariable analysis showed lower GA and lower birth weight, vaginal delivery, non-SGA, RDS, PDA, sepsis, transfusion, and absence of maternal preeclampsia to be associated with mild and severe ROP development. However, OR (95% CI) adjusted for the variables that were significant according to univariable analysis showed the risks of developing any-stage ROP and severe ROP for maternal preeclampsia to be 1.00 (0.84-1.20) and 0.89 (0.63-1.25), respectively. The results remained unchanged in stratified analyses according to SGA status. Our data showed that maternal preeclampsia was not associated with the subsequent development of any stage or severe ROP in VLBW infants.

Geographic disparities in colorectal cancer survival

PubMed Central

Henry, Kevin A; Niu, Xiaoling; Boscoe, Francis P

2009-01-01

Background Examining geographic variation in cancer patient survival can help identify important prognostic factors that are linked by geography and generate hypotheses about the underlying causes of survival disparities. In this study, we apply a recently developed spatial scan statistic method, designed for time-to-event data, to determine whether colorectal cancer (CRC) patient survival varies by place of residence after adjusting survival times for several prognostic factors. Methods Using data from a population-based, statewide cancer registry, we examined a cohort of 25,040 men and women from New Jersey who were newly diagnosed with local or regional stage colorectal cancer from 1996 through 2003 and followed to the end of 2006. Survival times were adjusted for significant prognostic factors (sex, age, stage at diagnosis, race/ethnicity and census tract socioeconomic deprivation) and evaluated using a spatial scan statistic to identify places where CRC survival was significantly longer or shorter than the statewide experience. Results Age, sex and stage adjusted survival times revealed several areas in the northern part of the state where CRC survival was significantly different than expected. The shortest and longest survival areas had an adjusted 5-year survival rate of 73.1% (95% CI 71.5, 74.9) and 88.3% (95% CI 85.4, 91.3) respectively, compared with the state average of 80.0% (95% CI 79.4, 80.5). Analysis of survival times adjusted for age, sex and stage as well as race/ethnicity and area socioeconomic deprivation attenuated the risk of death from CRC in several areas, but survival disparities persisted. Conclusion The results suggest that in areas where additional adjustments for race/ethnicity and area socioeconomic deprivation changed the geographic survival patterns and reduced the risk of death from CRC, the adjustment factors may be contributing causes of the disparities. Further studies should focus on specific and modifiable individual and neighborhood factors in the high risk areas that may affect a person's chance of surviving cancer. PMID:19627576

Determining triglyceride reductions needed for clinical impact in severe hypertriglyceridemia.

PubMed

Christian, Jennifer B; Arondekar, Bhakti; Buysman, Erin K; Jacobson, Terry A; Snipes, Rose G; Horwitz, Ralph I

2014-01-01

Patients with severe hypertriglyceridemia have an increased risk of cardiovascular disease and pancreatitis. Target triglyceride levels associated with clinical benefit for patients with severe hypertriglyceridemia are not currently known. This study evaluates the association between lower follow-up triglyceride levels and incidence of clinical events for patients with severe hypertriglyceridemia. By using claims data from 2 large US healthcare databases, we conducted a retrospective cohort study and identified 41,210 adults with severe hypertriglyceridemia (triglycerides ≥ 500 mg/dL) between June 2001 and September 2010. The date of the first severe hypertriglyceridemia laboratory result was the index date. Patients were categorized into 1 of 5 triglyceride ranges (<200 mg/dL, 200-299 mg/dL, 300-399 mg/dL, 400-499 mg/dL, and ≥ 500 mg/dL) based on a follow-up triglyceride level assessed 6 to 24 weeks after initial triglyceride levels were measured. Adjusted Cox regression models were developed to evaluate the impact of follow-up triglyceride levels on rates of pancreatitis episodes and cardiovascular events. The mean age of patients was 50 years, 72% were male, and the mean follow-up was 825 days. Patients with severe hypertriglyceridemia with follow-up triglyceride levels <200 mg/dL experienced a lower rate of pancreatitis episodes (adjusted incidence rate ratio, 0.45; 95% confidence interval, 0.34-0.60) and cardiovascular events (adjusted incidence rate ratio, 0.71; 95% confidence interval, 0.64-0.78) with some clinical benefit in adults with severe hypertriglyceridemia with follow-up triglyceride levels 200 to 299 mg/dL and 300 to 399 mg/dL (P < .001 for trend). We observed the greatest impact on clinical events among patients with severe hypertriglyceridemia with the lowest follow-up triglyceride levels. Copyright © 2014 Elsevier Inc. All rights reserved.

The continuum of maternal sepsis severity: incidence and risk factors in a population-based cohort study.

PubMed

Acosta, Colleen D; Knight, Marian; Lee, Henry C; Kurinczuk, Jennifer J; Gould, Jeffrey B; Lyndon, Audrey

2013-01-01

To investigate the incidence and risk factors associated with uncomplicated maternal sepsis and progression to severe sepsis in a large population-based birth cohort. This retrospective cohort study used linked hospital discharge and vital statistics records data for 1,622,474 live births in California during 2005-2007. Demographic and clinical factors were adjusted using multivariable logistic regression with robust standard errors. 1598 mothers developed sepsis; incidence of all sepsis was 10 per 10,000 live births (95% CI = 9.4-10.3). Women had significantly increased adjusted odds (aOR) of developing sepsis if they were older (25-34 years: aOR = 1.29; ≥35 years: aOR = 1.41), had ≤high-school education (aOR = 1.63), public/no-insurance (aOR = 1.22) or a cesarean section (primary: aOR = 1.99; repeat: aOR = 1.25). 791 women progressed to severe sepsis; incidence of severe sepsis was 4.9 per 10,000 live births (95% CI = 4.5-5.2). Women had significantly increased adjusted odds of progressing to severe sepsis if they were Black (aOR = 2.09), Asian (aOR = 1.59), Hispanic (aOR = 1.42), had public/no-insurance (aOR = 1.52), delivered in hospitals with <1,000 births/year (aOR = 1.93), were primiparous (aOR = 2.03), had a multiple birth (aOR = 3.5), diabetes (aOR = 1.47), or chronic hypertension (aOR = 8.51). Preeclampsia and postpartum hemorrhage were also significantly associated with progression to severe sepsis (aOR = 3.72; aOR = 4.18). For every cumulative factor, risk of uncomplicated sepsis increased by 25% (95% CI = 17.4-32.3) and risk of progression to severe sepsis/septic shock increased by 57% (95% CI = 40.8-74.4). The rate of severe sepsis was approximately twice the 1991-2003 national estimate. Risk factors identified are relevant to obstetric practice given their cumulative risk effect and the apparent increase in severe sepsis incidence.

Severe anemia in Malawian children.

PubMed

Calis, Job Cj; Phiri, Kamija S; Faragher, E Brian; Brabin, Bernard J; Bates, Imelda; Cuevas, Luis E; de Haan, Rob J; Phiri, Ajib I; Malange, Pelani; Khoka, Mirriam; Hulshof, Paul Jm; van Lieshout, Lisette; Beld, Marcel Ghm; Teo, Yik Y; Rockett, Kirk A; Richardson, Anna; Kwiatkowski, Dominic P; Molyneux, Malcolm E; van Hensbroek, Michaël Boele

2016-09-01

Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. We conducted a case-control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757 preschool children without severe anemia in urban and rural settings in Malawi. Causal factors previously associated with severe anemia were studied. The data were examined by multivariate analysis and structural equation modeling. Bacteremia (adjusted odds ratio, 5.3; 95% confidence interval [CI], 2.6 to 10.9), malaria (adjusted odds ratio, 2.3; 95% CI, 1.6 to 3.3), hookworm (adjusted odds ratio, 4.8; 95% CI, 2.0 to 11.8), human immunodeficiency virus infection (adjusted odds ratio, 2.0; 95% CI, 1.0 to 3.8), the G6PD -202/-376 genetic disorder (adjusted odds ratio, 2.4; 95% CI, 1.3 to 4.4), vitamin A deficiency (adjusted odds ratio, 2.8; 95% CI, 1.3 to 5.8), and vitamin B 12 deficiency (adjusted odds ratio, 2.2; 95% CI, 1.4 to 3.6) were associated with severe anemia. Folate deficiency, sickle cell disease, and laboratory signs of an abnormal inflammatory response were uncommon. Iron deficiency was not prevalent in case patients (adjusted odds ratio, 0.37; 95% CI, 0.22 to 0.60) and was negatively associated with bacteremia. Malaria was associated with severe anemia in the urban site (with seasonal transmission) but not in the rural site (where malaria was holoendemic). Seventy-six percent of hookworm infections were found in children under 2 years of age. There are multiple causes of severe anemia in Malawian preschool children, but folate and iron deficiencies are not prominent among them. Even in the presence of malaria parasites, additional or alternative causes of severe anemia should be considered.

Occupational burnout and severe injuries: an eight-year prospective cohort study among Finnish forest industry workers.

PubMed

Ahola, Kirsi; Salminen, Simo; Toppinen-Tanner, Salla; Koskinen, Aki; Väänänen, Aki

2013-01-01

Burnout is a psychological consequence of prolonged work stress. Studies have shown that it is related to physical and mental disorders. The safety outcomes of burnout have been studied to a lesser extent and only in the work context. This study explored the effect of burnout on future severe injuries regardless of their context. A total of 10,062 forest industry employees (77% men, 63% manual workers) without previous injuries participated in 1996 or 2000 in the "Still Working" study examining the work-related antecedents of health and mortality. Burnout was assessed using the Maslach Burnout Inventory-General Survey. Injuries leading to death or hospitalization were regarded as severe. We extracted such injuries from independent national registers. The relationship between burnout and new injuries was analyzed using Cox proportional regression. The analyses were adjusted for age, sex, marital status, and occupational status. There were 788 new injuries over eight years. Injuries were more common among male and manual workers. After adjustments, each one-unit increase in the burnout score was related to a 9% increase in the risk of injury (95% confidence interval: 1.2-1.17). Experiencing symptoms at least monthly was related to a 1.18-fold adjusted injury risk (95% CI: 1.2-1.36). Of the subscales of burnout, exhaustion and cynicism but not lack of professional efficacy predicted injuries after adjustments. In addition to mental and physical disorders, burnout predicts severe injuries. Developing work conditions and optimizing workload may enhance safety and decrease health expenses related to all injuries.

The Effects of Divorce on Children and Implications for Court Custody Cases.

ERIC Educational Resources Information Center

Khoe, Lynn

In the last decade, the rising number of divorces has resulted in large numbers of children lviing in one-parent homes. A review of the literature on the impact of divorce on children's psychosocial adjustment, cognitive development, school peformance, and sex role development revealed several interesting findings. Age of children at time of…

The use of lactic acid-producing, malic acid-producing, or malic acid-degrading yeast strains for acidity adjustment in the wine industry.

PubMed

Su, Jing; Wang, Tao; Wang, Yun; Li, Ying-Ying; Li, Hua

2014-03-01

In an era of economic globalization, the competition among wine businesses is likely to get tougher. Biotechnological innovation permeates the entire world and intensifies the severity of the competition of the wine industry. Moreover, modern consumers preferred individualized, tailored, and healthy and top quality wine products. Consequently, these two facts induce large gaps between wine production and wine consumption. Market-orientated yeast strains are presently being selected or developed for enhancing the core competitiveness of wine enterprises. Reasonable biological acidity is critical to warrant a high-quality wine. Many wild-type acidity adjustment yeast strains have been selected all over the world. Moreover, mutation breeding, metabolic engineering, genetic engineering, and protoplast fusion methods are used to construct new acidity adjustment yeast strains to meet the demands of the market. In this paper, strategies and concepts for strain selection or improvement methods were discussed, and many examples based upon selected studies involving acidity adjustment yeast strains were reviewed. Furthermore, the development of acidity adjustment yeast strains with minimized resource inputs, improved fermentation, and enological capabilities for an environmentally friendly production of healthy, top quality wine is presented.

Severe Extraarticular Manifestations in a Community-based Cohort of Patients with Rheumatoid Arthritis: Risk Factors and Incidence in Relation to Treatment with Tumor Necrosis Factor Inhibitors.

PubMed

Theander, Lisa; Nyhäll-Wåhlin, Britt-Marie; Nilsson, Jan-Åke; Willim, Minna; Jacobsson, Lennart T H; Petersson, Ingemar F; Turesson, Carl

2017-07-01

The aims of this study were to evaluate whether treatment with tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA) affects the risk of developing severe extraarticular rheumatoid arthritis (ExRA) manifestations and to investigate potential predictors for developing ExRA. A dynamic community-based cohort of patients with RA was studied (n = 1977). Clinical records were reviewed and cases of severe ExRA were identified. Information on exposure to TNF inhibitors was obtained from a regional register. Exposure to TNF inhibitors was analyzed in a time-dependent fashion and the incidence of severe ExRA in exposed patients was compared with the incidence in unexposed patients. Cox regression models were used to assess potential predictors of severe ExRA. During treatment with TNF inhibitors, there were 17 patients with new onset of severe ExRA in 2400 person-years at risk (PY; 0.71/100 PY, 95% CI 0.41-1.13) compared with 104 in 15,599 PY (0.67/100 PY, 95% CI 0.54-0.81) in patients without TNF inhibitors. This corresponded to an incidence rate ratio of 1.06 (95% CI 0.60-1.78). The age- and sex-adjusted HR for ExRA in anti-TNF-treated patients was 1.21 (95% CI 1.02-1.43), with similar findings in models adjusted for time-dependent Health Assessment Questionnaire and propensity for anti-TNF treatment. Male sex, positive rheumatoid factor (RF), long disease duration, and greater disability were predictors for ExRA. This study suggests that patients treated with TNF inhibitors are at a slightly increased risk of developing severe ExRA. RF-positive patients with disabling disease of long duration were more likely to develop severe ExRA.

Funding issues for Victorian hospitals: the risk-adjusted vision beyond casemix funding.

PubMed

Antioch, K; Walsh, M

2000-01-01

This paper discusses casemix funding issues in Victoria impacting on teaching hospitals. For casemix payments to be acceptable, the average price and cost weights must be set at an appropriate standard. The average price is based on a normative, policy basis rather than benchmarking. The 'averaging principle' inherent in cost weights has resulted in some AN-DRG weights being too low for teaching hospitals that are key State-wide providers of high complexity services such as neurosurgery and trauma. Casemix data have been analysed using international risk adjustment methodologies to successfully negotiate with the Victorian State Government for specified grants for several high complexity AN-DRGs. A risk-adjusted capitation funding model has also been developed for cystic fibrosis patients treated by The Alfred, called an Australian Health Maintenance Organisation (AHMO). This will facilitate the development of similar models by both the Victorian and Federal governments.

Association Between Severity of Obstructive Sleep Apnea and Blood Markers of Liver Injury.

PubMed

Trzepizur, Wojciech; Boursier, Jérôme; Mansour, Yasmina; Le Vaillant, Marc; Chollet, Sylvaine; Pigeanne, Thierry; Bizieux-Thaminy, Acya; Humeau, Marie-Pierre; Alizon, Claire; Goupil, François; Meslier, Nicole; Priou, Pascaline; Calès, Paul; Gagnadoux, Frédéric

2016-11-01

Obstructive sleep apnea (OSA) may contribute to the development of nonalcoholic fatty liver disease. We performed a multisite cross-sectional study to evaluate the association between the severity of OSA and blood markers of liver steatosis (using the hepatic steatosis index), cytolysis (based on alanine aminotransferase activity), and significant liver fibrosis (based on the FibroMeter [Echosens] nonalcoholic fatty liver disease score) in 1285 patients with suspected OSA in France. After adjusting for confounders including central obesity, the risk of liver steatosis increased with the severity of OSA (P for trend < .0001) and sleep-related hypoxemia (P for trend < .0003 for mean oxygen saturation). Decreasing mean oxygen saturation during sleep also was associated independently with a higher risk of liver cytolysis (P for trend < .0048). Severe OSA conferred an approximate 2.5-fold increase in risk for significant liver fibrosis compared with patients without OSA, but the association between OSA severity and liver fibrosis was not maintained after adjusting for confounders. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Validation of a modified table to map the 1998 Abbreviated Injury Scale to the 2008 scale and the use of adjusted severities.

PubMed

Tohira, Hideo; Jacobs, Ian; Mountain, David; Gibson, Nick; Yeo, Allen; Ueno, Masato; Watanabe, Hiroaki

2011-12-01

The Abbreviated Injury Scale 2008 (AIS 2008) is the most recent injury coding system. A mapping table from a previous AIS 98 to AIS 2008 is available. However, AIS 98 codes that are unmappable to AIS 2008 codes exist in this table. Furthermore, some AIS 98 codes can be mapped to multiple candidate AIS 2008 codes with different severities. We aimed to modify the original table to adjust the severities and to validate these changes. We modified the original table by adding links from unmappable AIS 98 codes to AIS 2008 codes. We applied the original table and our modified table to AIS 98 codes for major trauma patients. We also assigned candidate codes with different severities the weighted averages of their severities as an adjusted severity. The proportion of cases whose injury severity scores (ISSs) were computable were compared. We also compared the agreement of the ISS and New ISS (NISS) between manually determined AIS 2008 codes (MAN) and mapped codes by using our table (MAP) with unadjusted or adjusted severities. All and 72.3% of cases had their ISSs computed by our modified table and the original table, respectively. The agreement between MAN and MAP with respect to the ISS and NISS was substantial (intraclass correlation coefficient = 0.939 for ISS and 0.943 for NISS). Using adjusted severities, the agreements of the ISS and NISS improved to 0.953 (p = 0.11) and 0.963 (p = 0.007), respectively. Our modified mapping table seems to allow more ISSs to be computed than the original table. Severity scores exhibited substantial agreement between MAN and MAP. The use of adjusted severities improved these agreements further.

Intensity of factor VIII treatment and the development of inhibitors in non-severe hemophilia A patients: results of the INSIGHT case-control study.

PubMed

van Velzen, A S; Eckhardt, C L; Peters, M; Leebeek, F W G; Escuriola-Ettingshausen, C; Hermans, C; Keenan, R; Astermark, J; Male, C; Peerlinck, K; le Cessie, S; van der Bom, J G; Fijnvandraat, K

2017-07-01

Essentials Research suggests that intensive treatment episodes may increase the risk to develop inhibitors. We performed an international nested case-control study with 298 non-severe hemophilia A patients. Surgery and a high dose of factor VIII concentrate were associated with increased inhibitor risk. Physicians need to review arguments for factor VIII dose and elective surgery extra critically. Background Inhibitor development is a major complication of treatment with factor VIII concentrates in hemophilia. Findings from studies among severe hemophilia A patients suggest that intensive treatment episodes increase the risk of developing inhibitors. Objectives We set out to assess whether intensive treatment is also associated with an increased risk of inhibitor development among non-severe hemophilia A patients. Patients/Methods We performed a nested case-control study. A total of 75 inhibitor patients (cases) and 223 control patients were selected from 2709 non-severe hemophilia A patients (FVIII:C, 2-40%) of the INSIGHT cohort study. Cases and controls were matched for date of birth and cumulative number of exposure days (EDs) to FVIII concentrates. Conditional logistic regression was used to calculate both unadjusted and adjusted odds ratios (aOR); the latter were adjusted for a priori specified confounders. Results Peak treatment of 5 or 10 consecutive EDs did not increase inhibitor risk (aOR, 1.0; 95% confidence interval (CI), 0.4-2.5; and aOR, 1.8; CI, 0.6-5.5, respectively). Both surgical intervention (aOR, 4.2; CI, 1.7-10.3) and a high mean dose (> 45 IU kg -1 /ED) of FVIII concentrate (aOR, 7.5; CI, 1.6-35.6) were associated with an increased inhibitor risk. Conclusions Our findings suggest that high-dose FVIII treatment and surgery increase the risk of inhibitor development in non-severe hemophilia A. Together with the notion that non-severe hemophilia A patients are at a lifelong risk of inhibitor development, we suggest that in the future physicians will review the arguments for the FVIII dose and elective surgery extra critically. © 2017 International Society on Thrombosis and Haemostasis.

Relationship Between Resilience, Adjustment, and Psychological Functioning After Traumatic Brain Injury: A Preliminary Report.

PubMed

Lukow, Herman R; Godwin, Emilie E; Marwitz, Jennifer H; Mills, Ana; Hsu, Nancy H; Kreutzer, Jeffrey S

2015-01-01

To examine the relationship between resilience, psychological distress, adjustment, and community participation after traumatic brain injury (TBI). Large university health system. Adult survivors of mild to severe TBI (N = 96). Descriptive, preliminary. The Connor-Davidson Resilience Scale (10-item version) was used to assess resilience, the Brief Symptom Inventory (BSI-18) was used to characterize psychological distress, and the Mayo-Portland Adaptability Index (MPAI-4) was used to measure ability, adjustment, and participation. Resilience scores were substantially lower than those of the general population. Significant relationships were found between resilience, psychological distress, and adjustment. Partial correlations (adjusting for the other MPAI-4 indices) showed significant correlation (P < .05) between MPAI-4 Adjustment and resilience. Partial correlations (adjusting for the other BSI-18 scales) also showed significance for Depression (P < .01) and resilience. Resilience scores differed significantly (P < .001) between individuals meeting BSI-18 caseness criteria for psychological distress (n = 55) and those not meeting criteria (n = 41). Individuals with TBI are at risk for low resilience, which was found to correlate with psychological distress and psychosocial maladjustment. Developing interventions to strengthen resilience skills has the potential to improve postinjury psychosocial adjustment, an important area for future research.

Economic impact of Clostridium difficile infection in a multihospital cohort of academic health centers.

PubMed

Pakyz, Amy; Carroll, Norman V; Harpe, Spencer E; Oinonen, Michael; Polk, Ronald E

2011-06-01

To assess the economic impact of Clostridium difficile infection (CDI) in a large multihospital cohort. Retrospective case-control study. Administrative claims data from 45 academic medical centers. A total of 10,857 patients who developed health care-associated CDI and were discharged between April 1, 2002, and March 31, 2007 (cases); each case patient was matched by hospital, age, quarter and year of hospital discharge, and diagnosis related group to at least one control patient who did not develop health care-associated CDI (19,214 controls). Patients with health care-associated CDI were identified by using a previously validated method combining the International Classification of Diseases, Ninth Revision, Clinical Modification code for CDI with specific CDI drug therapy (oral or intravenous metronidazole, or oral vancomycin). Costs were determined from charges by using standardized cost:charges ratios and were adjusted for age, All Patient Refined-Diagnosis Related Group (APR-DRG) severity of illness level, race, and sex with use of multivariable linear regression. The adjusted mean cost for cases was significantly higher than that for controls ($55,769 vs $28,609), and adjusted mean length of stay was twice as long (21.1 vs 10.0 days). The interaction between CDI and APR-DRG severity of illness level was significant; the effect of CDI on costs and length of stay decreased as severity of illness increased. This large CDI economic evaluation confirms that health care-associated cases of CDI are associated with significantly higher mean cost and longer length of stay than those of matched controls, with the greatest effect on costs at the lowest level of severity of illness.

The New York Sepsis Severity Score: Development of a Risk-Adjusted Severity Model for Sepsis.

PubMed

Phillips, Gary S; Osborn, Tiffany M; Terry, Kathleen M; Gesten, Foster; Levy, Mitchell M; Lemeshow, Stanley

2018-05-01

In accordance with Rory's Regulations, hospitals across New York State developed and implemented protocols for sepsis recognition and treatment to reduce variations in evidence informed care and preventable mortality. The New York Department of Health sought to develop a risk assessment model for accurate and standardized hospital mortality comparisons of adult septic patients across institutions using case-mix adjustment. Retrospective evaluation of prospectively collected data. Data from 43,204 severe sepsis and septic shock patients from 179 hospitals across New York State were evaluated. Prospective data were submitted to a database from January 1, 2015, to December 31, 2015. None. Maximum likelihood logistic regression was used to estimate model coefficients used in the New York State risk model. The mortality probability was estimated using a logistic regression model. Variables to be included in the model were determined as part of the model-building process. Interactions between variables were included if they made clinical sense and if their p values were less than 0.05. Model development used a random sample of 90% of available patients and was validated using the remaining 10%. Hosmer-Lemeshow goodness of fit p values were considerably greater than 0.05, suggesting good calibration. Areas under the receiver operator curve in the developmental and validation subsets were 0.770 (95% CI, 0.765-0.775) and 0.773 (95% CI, 0.758-0.787), respectively, indicating good discrimination. Development and validation datasets had similar distributions of estimated mortality probabilities. Mortality increased with rising age, comorbidities, and lactate. The New York Sepsis Severity Score accurately estimated the probability of hospital mortality in severe sepsis and septic shock patients. It performed well with respect to calibration and discrimination. This sepsis-specific model provides an accurate, comprehensive method for standardized mortality comparison of adult patients with severe sepsis and septic shock.

Risk-adjusted models for adverse obstetric outcomes and variation in risk-adjusted outcomes across hospitals.

PubMed

Bailit, Jennifer L; Grobman, William A; Rice, Madeline Murguia; Spong, Catherine Y; Wapner, Ronald J; Varner, Michael W; Thorp, John M; Leveno, Kenneth J; Caritis, Steve N; Shubert, Phillip J; Tita, Alan T; Saade, George; Sorokin, Yoram; Rouse, Dwight J; Blackwell, Sean C; Tolosa, Jorge E; Van Dorsten, J Peter

2013-11-01

Regulatory bodies and insurers evaluate hospital quality using obstetrical outcomes, however meaningful comparisons should take preexisting patient characteristics into account. Furthermore, if risk-adjusted outcomes are consistent within a hospital, fewer measures and resources would be needed to assess obstetrical quality. Our objective was to establish risk-adjusted models for 5 obstetric outcomes and assess hospital performance across these outcomes. We studied a cohort of 115,502 women and their neonates born in 25 hospitals in the United States from March 2008 through February 2011. Hospitals were ranked according to their unadjusted and risk-adjusted frequency of venous thromboembolism, postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite neonatal adverse outcome. Correlations between hospital risk-adjusted outcome frequencies were assessed. Venous thromboembolism occurred too infrequently (0.03%; 95% confidence interval [CI], 0.02-0.04%) for meaningful assessment. Other outcomes occurred frequently enough for assessment (postpartum hemorrhage, 2.29%; 95% CI, 2.20-2.38, peripartum infection, 5.06%; 95% CI, 4.93-5.19, severe perineal laceration at spontaneous vaginal delivery, 2.16%; 95% CI, 2.06-2.27, neonatal composite, 2.73%; 95% CI, 2.63-2.84). Although there was high concordance between unadjusted and adjusted hospital rankings, several individual hospitals had an adjusted rank that was substantially different (as much as 12 rank tiers) than their unadjusted rank. None of the correlations between hospital-adjusted outcome frequencies was significant. For example, the hospital with the lowest adjusted frequency of peripartum infection had the highest adjusted frequency of severe perineal laceration. Evaluations based on a single risk-adjusted outcome cannot be generalized to overall hospital obstetric performance. Copyright © 2013 Mosby, Inc. All rights reserved.

Postoperative sleep-disordered breathing in patients without preoperative sleep apnea.

PubMed

Chung, Frances; Liao, Pu; Yang, Yiliang; Andrawes, Maged; Kang, Weimin; Mokhlesi, Babak; Shapiro, Colin M

2015-06-01

Recently published data show that postoperative apnea-hypopnea index (AHI) is significantly increased in some patients without preoperative sleep apnea. These patients may be at risk of developing perioperative adverse events related to sleep-disordered breathing (SDB). The objective of this study was to investigate the incidence and predictors of postoperative moderate-to-severe SDB (AHI > 15 events/h) in patients without sleep apnea preoperatively. In a prospective observational fashion, patients were invited to undergo sleep studies with a portable device (Embletta X100) preoperatively at home and postoperatively on the first and third night after surgery in the hospital or at home. The primary outcome was the incidence of postoperative moderate-to-severe SDB (AHI > 15 events/h) in non-sleep apnea patients (preoperative AHI ≤ 5 events/h). Logistic regression was used to evaluate the association of clinical factors and preoperative sleep parameters with the occurrence of postoperative moderate-to-severe SDB. A total of 120 non-sleep apnea patients completed the study, of which 31 (25.8% [95% confidence interval: 18.3%-34.6%]) patients were found to have AHI > 15 events/h on postoperative night 1 and/or postoperative night 3 (postoperative SDB group), and 89 (74%) patients had an AHI ≤ 15 events/h on both postoperative night 1 and 3 (postoperative non-SDB group). The patients in the postoperative SDB group were older (60 ± 13 vs 53 ± 12 years, P = 0.008) with more smokers (32.3% vs 15.7%, P = 0.048) and had a greater increase in the obstructive apnea index (adjusted P = 0.0003), central apnea index (adjusted P = 0.0012), and hypopnea index (adjusted P = 0.0004). Multivariate logistic regression analysis found that age and preoperative respiratory disturbance index (RDI) were significantly associated with the occurrence of postoperative moderate-to-severe SDB, P = 0.018 and P = 0.006, respectively. The sensitivity privilege cutoff of RDI at 4.9 events/h identified 70.2% to 96.4%patients developing postoperative moderate-to-severe SDB. At least 18.3% of non-sleep apnea patients developed moderate-to-severe SDB after surgery. Age and preoperative RDI were associated with the occurrence of postoperative moderate-to-severe SDB.

A Review of Sex Differences in Peer Relationship Processes: Potential Trade-Offs for the Emotional and Behavioral Development of Girls and Boys

ERIC Educational Resources Information Center

Rose, Amanda J.; Rudolph, Karen D.

2006-01-01

Theory and research on sex differences in adjustment focus largely on parental, societal, and biological influences. However, it also is important to consider how peers contribute to girls' and boys' development. This article provides a critical review of sex differences in several peer relationship processes, including behavioral and…

Phenology, growth and physiological adjustments of oil palm (Elaeis guineensis) to sink limitation induced by fruit pruning

PubMed Central

Legros, S.; Mialet-Serra, I.; Caliman, J.-P.; Siregar, F. A.; Clement-Vidal, A.; Fabre, D.; Dingkuhn, M.

2009-01-01

Background and Aims Despite its simple architecture and small phenotypic plasticity, oil palm has complex phenology and source–sink interactions. Phytomers appear in regular succession but their development takes years, involving long lag periods between environmental influences and their effects on sinks. Plant adjustments to resulting source–sink imbalances are poorly understood. This study investigated oil palm adjustments to imbalances caused by severe fruit pruning. Methods An experiment with two treatments (control and complete fruit pruning) during 22 months in 2006–2008) and six replications per treatment was conducted in Indonesia. Phenology, growth of above-ground vegetative and reproductive organs, leaf morphology, inflorescence sex differentiation, dynamics of non-structural carbohydrate reserves and light-saturated net photosynthesis (Amax) were monitored. Key Results Artificial sink limitation by complete fruit pruning accelerated development rate, resulting in higher phytomer, leaf and inflorescence numbers. Leaf size and morphology remained unchanged. Complete fruit pruning also suppressed the abortion of male inflorescences, estimated to be triggered at about 16 months before bunch maturity. The number of female inflorescences increased after an estimated lag of 24–26 months, corresponding to time from sex differentiation to bunch maturity. The most important adjustment process was increased assimilate storage in the stem, attaining nearly 50 % of dry weight in the stem top, mainly as starch, whereas glucose, which in controls was the most abundant non-structural carbohydrate stored in oil palm, decreased. Conclusions The development rate of oil palm is in part controlled by source–sink relationships. Although increased rate of development and proportion of female inflorescences constituted observed adjustments to sink limitation, the low plasticity of plant architecture (constant leaf size, absence of branching) limited compensatory growth. Non-structural carbohydrate storage was thus the main adjustment process. PMID:19748908

The ankle brachial index and change in lower extremity functioning over time: the Women's Health and Aging Study.

PubMed

McDermott, Mary McGrae; Ferrucci, Luigi; Simonsick, Eleanor M; Balfour, Jennifer; Fried, Linda; Ling, Shari; Gibson, Daniel; Guralnik, Jack M

2002-02-01

To define the association between baseline ankle brachial index (ABI) level and subsequent onset of severe disability. Prospective cohort study. Baltimore community. Eight hundred forty-seven disabled women aged 65 and older participating in the Women's Health and Aging Study. At baseline, participants underwent measurement of ABI and lower extremity functioning. Measures of lower extremity functioning included patient's report of their ability to walk one-quarter of a mile, number of city blocks walked last week, number of stair flights climbed last week, and performance-based measures including walking speed over 4 meters, five repeated chair stands, and a summary performance score. Functioning was remeasured every 6 months for 3 years. Definitions of severe disability were developed a priori, and participants who met these definitions at baseline were excluded from subsequent analyses. Participants with an ABI of less than 0.60 at baseline had significantly higher cumulative probabilities of developing severe disability than participants with a baseline ABI of 0.90 to 1.50 for walking-specific outcomes (ability to walk a quarter of a mile, number of city blocks walked last week, and walking velocity) but not for the remaining functional outcomes. In age-adjusted Cox proportional hazards analyses, hazard ratios for participants with a baseline ABI of less than 0.60 were 1.63 for becoming unable to walk a quarter of a mile (P = .044), 2.00 for developing severe disability in the number of blocks walked last week (P = .004), and 1.61 for developing severe disability in walking speed (P = .041), compared with participants with a baseline ABI of 0.90 to 1.50. Adjusting for age, race, baseline performance, and comorbidities, an ABI of less than 0.60 remained associated with becoming severely disabled in the number of blocks walked last week (hazard ratio = 1.97, P = .009) and nearly significantly associated with becoming unable to walk a quarter of a mile (hazard ratio = 1.54, P = .09). In fully adjusted random effects models, a baseline ABI of less than 0.60 was associated with significantly greater decline in walking speed per year (P = .019) and nearly significantly greater decline in number of blocks walked last week per year (P = .053) compared with a baseline ABI of 0.90 to 1.50. In community-dwelling disabled older women, a low ABI is associated with a greater incidence of severe disability in walking-specific but not other lower extremity functional outcomes, compared with persons with a normal ABI over 3 years.

Relation between Severity of Chronic Illness and Adjustment in Children and Adolescents with Sickle Cell Disease.

ERIC Educational Resources Information Center

Hurtig, Anita Landau; And Others

1989-01-01

The study with 70 children and adolescents with sickle cell disease did not support the hypothesis that illness severity (measured by frequency of hospitalization) would affect adjustment (measured by IQ, self-esteem, social and personal adjustment, behavioral problems, school performance, and peer relations). (Author/DB)

"Weekend effect" on stroke mortality revisited: Application of a claims-based stroke severity index in a population-based cohort study.

PubMed

Hsieh, Cheng-Yang; Lin, Huey-Juan; Chen, Chih-Hung; Li, Chung-Yi; Chiu, Meng-Jun; Sung, Sheng-Feng

2016-06-01

Previous studies have yielded inconsistent results on whether weekend admission is associated with increased mortality after stroke, partly because of differences in case mix. Claims-based studies generally lack sufficient information on disease severity and, thus, suffer from inadequate case-mix adjustment. In this study, we examined the effect of weekend admission on 30-day mortality in patients with ischemic stroke by using a claims-based stroke severity index.This was an observational study using a representative sample of the National Health Insurance claims data linked to the National Death Registry. We identified patients hospitalized for ischemic stroke, and examined the effect of weekend admission on 30-day mortality with vs without adjustment for stroke severity by using multilevel logistic regression analysis adjusting for patient-, physician-, and hospital-related factors. We analyzed 46,007 ischemic stroke admissions, in which weekend admissions accounted for 23.0%. Patients admitted on weekends had significantly higher 30-day mortality (4.9% vs 4.0%, P < 0.001) and stroke severity index (7.8 vs 7.4, P < 0.001) than those admitted on weekdays. In multivariate analysis without adjustment for stroke severity, weekend admission was associated with increased 30-day mortality (odds ratio (OR), 1.20; 95% confidence interval [CI], 1.08-1.34). This association became null after adjustment for stroke severity (OR, 1.07; 95% CI, 0.95-1.20).The "weekend effect" on stroke mortality might be attributed to higher stroke severity in weekend patients. While claims data are useful for examining stroke outcomes, adequate adjustment for stroke severity is warranted.

Development of an index to define overall disease severity in IBD.

PubMed

Siegel, Corey A; Whitman, Cynthia B; Spiegel, Brennan M R; Feagan, Brian; Sands, Bruce; Loftus, Edward V; Panaccione, Remo; D'Haens, Geert; Bernstein, Charles N; Gearry, Richard; Ng, Siew C; Mantzaris, Gerassimos J; Sartor, Balfour; Silverberg, Mark S; Riddell, Robert; Koutroubakis, Ioannis E; O'Morain, Colm; Lakatos, Peter L; McGovern, Dermot P B; Halfvarson, Jonas; Reinisch, Walter; Rogler, Gerhard; Kruis, Wolfgang; Tysk, Curt; Schreiber, Stefan; Danese, Silvio; Sandborn, William; Griffiths, Anne; Moum, Bjorn; Gasche, Christoph; Pallone, Francesco; Travis, Simon; Panes, Julian; Colombel, Jean-Frederic; Hanauer, Stephen; Peyrin-Biroulet, Laurent

2018-02-01

Disease activity for Crohn's disease (CD) and UC is typically defined based on symptoms at a moment in time, and ignores the long-term burden of disease. The aims of this study were to select the attributes determining overall disease severity, to rank the importance of and to score these individual attributes for both CD and UC. Using a modified Delphi panel, 14 members of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) selected the most important attributes related to IBD. Eighteen IOIBD members then completed a statistical exercise (conjoint analysis) to create a relative ranking of these attributes. Adjusted utilities were developed by creating proportions for each level within an attribute. For CD, 15.8% of overall disease severity was attributed to the presence of mucosal lesions, 10.9% to history of a fistula, 9.7% to history of abscess and 7.4% to history of intestinal resection. For UC, 18.1% of overall disease severity was attributed to mucosal lesions, followed by 14.0% for impact on daily activities, 11.2% C reactive protein and 10.1% for prior experience with biologics. Overall disease severity indices were created on a 100-point scale by applying each attribute's average importance to the adjusted utilities. Based on specialist opinion, overall CD severity was associated more with intestinal damage, in contrast to overall UC disease severity, which was more dependent on symptoms and impact on daily life. Once validated, disease severity indices may provide a useful tool for consistent assessment of overall disease severity in patients with IBD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The burden of hypoxic-ischaemic encephalopathy in Malaysian neonatal intensive care units.

PubMed

Boo, Nem-Yun; Cheah, Irene Guat-Sim

2016-08-01

This study aimed to determine the incidence of hypoxic-ischaemic encephalopathy (HIE) and predictors of HIE mortality in Malaysian neonatal intensive care units (NICUs). This was a retrospective study of data from 37 NICUs in the Malaysian National Neonatal Registry in 2012. All newborns with gestational age ≥ 36 weeks, without major congenital malformations and fulfilling the criteria of HIE were included. There were 285,454 live births in these hospitals. HIE was reported in 919 newborns and 768 of them were inborn, with a HIE incidence of 2.59 per 1,000 live births/hospital (95% confidence interval [CI] 2.03, 3.14). A total of 144 (15.7%) affected newborns died. Logistic regression analysis showed that the significant predictors of death were: chest compression at birth (adjusted odds ratio [OR] 2.27, 95% CI 1.27, 4.05; p = 0.003), being outborn (adjusted OR 2.65, 95% CI 1.36, 5.13; p = 0.004), meconium aspiration syndrome (MAS) (adjusted OR 2.16, 95% CI 1.05, 4.47; p = 0.038), persistent pulmonary hypertension of the newborn (PPHN) (adjusted OR 4.39, 95% CI 1.85, 10.43; p = 0.001), sepsis (adjusted OR 4.46, 95% CI 1.38, 14.40; p = 0.013), pneumothorax (adjusted OR 4.77, 95% CI 1.76, 12.95; p = 0.002) and severe HIE (adjusted OR 42.41, 95% CI 18.55, 96.96; p < 0.0001). The incidence of HIE in Malaysian NICUs was similar to that reported in developed countries. Affected newborns with severe grade of HIE, chest compression at birth, MAS, PPHN, sepsis or pneumothorax, and those who were outborn were more likely to die before discharge. Copyright: © Singapore Medical Association.

The burden of hypoxic-ischaemic encephalopathy in Malaysian neonatal intensive care units

PubMed Central

Boo, Nem-Yun; Cheah, Irene Guat-Sim

2016-01-01

INTRODUCTION This study aimed to determine the incidence of hypoxic-ischaemic encephalopathy (HIE) and predictors of HIE mortality in Malaysian neonatal intensive care units (NICUs). METHODS This was a retrospective study of data from 37 NICUs in the Malaysian National Neonatal Registry in 2012. All newborns with gestational age ≥ 36 weeks, without major congenital malformations and fulfilling the criteria of HIE were included. RESULTS There were 285,454 live births in these hospitals. HIE was reported in 919 newborns and 768 of them were inborn, with a HIE incidence of 2.59 per 1,000 live births/hospital (95% confidence interval [CI] 2.03, 3.14). A total of 144 (15.7%) affected newborns died. Logistic regression analysis showed that the significant predictors of death were: chest compression at birth (adjusted odds ratio [OR] 2.27, 95% CI 1.27, 4.05; p = 0.003), being outborn (adjusted OR 2.65, 95% CI 1.36, 5.13; p = 0.004), meconium aspiration syndrome (MAS) (adjusted OR 2.16, 95% CI 1.05, 4.47; p = 0.038), persistent pulmonary hypertension of the newborn (PPHN) (adjusted OR 4.39, 95% CI 1.85, 10.43; p = 0.001), sepsis (adjusted OR 4.46, 95% CI 1.38, 14.40; p = 0.013), pneumothorax (adjusted OR 4.77, 95% CI 1.76, 12.95; p = 0.002) and severe HIE (adjusted OR 42.41, 95% CI 18.55, 96.96; p < 0.0001). CONCLUSION The incidence of HIE in Malaysian NICUs was similar to that reported in developed countries. Affected newborns with severe grade of HIE, chest compression at birth, MAS, PPHN, sepsis or pneumothorax, and those who were outborn were more likely to die before discharge. PMID:27549510

Adjustment of regional regression equations for urban storm-runoff quality using at-site data

USGS Publications Warehouse

Barks, C.S.

1996-01-01

Regional regression equations have been developed to estimate urban storm-runoff loads and mean concentrations using a national data base. Four statistical methods using at-site data to adjust the regional equation predictions were developed to provide better local estimates. The four adjustment procedures are a single-factor adjustment, a regression of the observed data against the predicted values, a regression of the observed values against the predicted values and additional local independent variables, and a weighted combination of a local regression with the regional prediction. Data collected at five representative storm-runoff sites during 22 storms in Little Rock, Arkansas, were used to verify, and, when appropriate, adjust the regional regression equation predictions. Comparison of observed values of stormrunoff loads and mean concentrations to the predicted values from the regional regression equations for nine constituents (chemical oxygen demand, suspended solids, total nitrogen as N, total ammonia plus organic nitrogen as N, total phosphorus as P, dissolved phosphorus as P, total recoverable copper, total recoverable lead, and total recoverable zinc) showed large prediction errors ranging from 63 percent to more than several thousand percent. Prediction errors for 6 of the 18 regional regression equations were less than 100 percent and could be considered reasonable for water-quality prediction equations. The regression adjustment procedure was used to adjust five of the regional equation predictions to improve the predictive accuracy. For seven of the regional equations the observed and the predicted values are not significantly correlated. Thus neither the unadjusted regional equations nor any of the adjustments were appropriate. The mean of the observed values was used as a simple estimator when the regional equation predictions and adjusted predictions were not appropriate.

The Relationship of PTSD and Communication with Intimate Partners in a Sample of Vietnam Veterans

DTIC Science & Technology

2011-08-08

developed reactions simply in response to daily life stressors. They also noted that married veterans were typically better adjusted than unmarried men...sequences were compared based on PTSD severity, status (PTSD vs non-PTSD), and conversation topic. Increasing PTSD severity was related to fewer overall...self- report, and by coding the richer details of communication instead of relying entirely on positive vs . negative variables. This introduction

Profile of vemurafenib-induced severe skin toxicities.

PubMed

Peuvrel, L; Quéreux, G; Saint-Jean, M; Brocard, A; Nguyen, J M; Khammari, A; Knol, A C; Varey, E; Dréno, B

2016-02-01

Vemurafenib, a BRAF inhibitor, is commonly associated with skin toxicity. The impact of severe forms is unknown. To determine the rate of permanent vemurafenib discontinuation due to grade 3-4 skin toxicity, features of these toxicities, their recurrence rate after a switch to dabrafenib and their impact on overall survival. Retrospective cohort study of 131 patients treated with vemurafenib for melanoma between November 2010 and December 2014. Data on skin toxicities, the need for vemurafenib adjustment and the impact of switching to dabrafenib were collected. Regarding survival analysis, a conditional landmark analysis was performed to correct lead-time bias. Among the 131 vemurafenib-treated patients, 26% developed grade 3-4 skin toxicity. Forty-four percent of them permanently discontinued their treatment, mainly due to rash and classic skin adverse reactions (Steven-Johnson syndrome, Drug Reaction with Eosinophilia and Systemic Symptoms). Conversely, photosensitivity and carcinomas rarely required treatment adjustment. Grade 3-4 rashes were associated with clinical or biological abnormalities in 94% of patients. Among the 10 patients who subsequently switched to dabrafenib, skin toxicity recurred only in one patient. Overall survival was significantly prolonged in case of severe skin toxicity emerging within the first 4 (P = 0.014) and 8 weeks (P = 0.038) on vemurafenib, with only a trend at 12 weeks (P = 0.052). Median overall survival was also prolonged in case of severe rash. In this study, vemurafenib was continued in 56% of patients with grade 3-4 skin toxicity, which was associated with prolonged overall survival when emerging within the first 4 and 8 weeks of treatment. While developing severe skin adverse reactions permanently contraindicates vemurafenib use, other rashes should lead to retreatment attempts with dose reduction. In case of recurrence, dabrafenib seems to be an interesting option. For other skin toxicities, including photosensitivity and cutaneous carcinoma, treatment adjustment is usually not needed. © 2015 European Academy of Dermatology and Venereology.

Alcohol consumption in late adolescence is associated with an increased risk of severe liver disease later in life.

PubMed

Hagström, Hannes; Hemmingsson, Tomas; Discacciati, Andrea; Andreasson, Anna

2018-03-01

High alcohol consumption is associated with an increased risk of severe liver disease. Current recommendations suggest it is safe for men to consume 30 grams of alcohol per day. We investigated the association between alcohol consumption early in life and later development of severe liver disease. We used data on alcohol consumption at conscription to military service from 43,296 men (18-20 years) in Sweden between 1969 and 1970. Outcomes were defined as incident diagnoses of severe liver disease from systematic national registration of clinical events until the end of 2009. A Cox regression model adjusted for body mass index, smoking, use of narcotics, cognitive ability and cardiovascular capacity was applied. During a mean follow-up of 37.8 years, 383 men developed severe liver disease. Alcohol consumption was associated with an increased risk of development of severe liver disease in a dose-response pattern (adjusted hazard ratio for every one gram/day increase 1.02; 95% CI 1.01-1.02). No evidence of a threshold effect was found. Importantly, a clear trend pointed towards an increased risk of severe liver disease in men who consumed less than 30 grams of alcohol per day. Alcohol consumption in young men is associated with an increased risk of severe liver disease, up to 39 years later in life. The risk was dose-dependent, with no sign of a threshold effect. Current guidelines for safe alcohol intake in men might have to be revised. We investigated more than 43,000 Swedish men in their late teens enlisted for conscription in 1969-1970. After almost 40 years of follow-up, we found that alcohol consumption was a significant risk factor for developing severe liver disease, independent of confounders. This risk was dose-dependent, and was most pronounced in men consuming two drinks per day or more. Copyright © 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Executive functions and theory of mind as predictors of social adjustment in childhood traumatic brain injury.

PubMed

Robinson, Kristen E; Fountain-Zaragoza, Stephanie; Dennis, Maureen; Taylor, H Gerry; Bigler, Erin D; Rubin, Kenneth; Vannatta, Kathryn; Gerhardt, Cynthia A; Stancin, Terry; Yeates, Keith Owen

2014-11-15

This study examined whether executive function and theory of mind mediate the effects of pediatric traumatic brain injury (TBI) on social adjustment, relative to children with orthopedic injury (OI). Participants included 19 children with severe TBI, 41 children with complicated mild/moderate TBI, and 57 children with OI. They completed measures of executive function, as well as cognitive, affective, and conative theory of mind. Parents provided ratings of children's social adjustment. Children with severe TBI performed more poorly than children with OI on executive function and theory of mind tasks and were rated by parents as having more behavioral symptoms and worse communication and social skills. Executive function and theory of mind were positively correlated with social skills and communication skills, and negatively correlated with behavioral symptoms. In multiple mediator models, theory of mind and executive function were not significant direct predictors of any measure of social adjustment, but mediated the association between injury and adjustment for children with severe TBI. Theory of mind was a significant independent mediator when predicting social skills, but executive function was not. TBI in children, particularly severe injury, is associated with poor social adjustment. The impact of TBI on children's social adjustment is likely mediated by its effects on executive function and theory of mind.

Executive Functions and Theory of Mind as Predictors of Social Adjustment in Childhood Traumatic Brain Injury

PubMed Central

Fountain-Zaragoza, Stephanie; Dennis, Maureen; Taylor, H. Gerry; Bigler, Erin D.; Rubin, Kenneth; Vannatta, Kathryn; Gerhardt, Cynthia A.; Stancin, Terry; Yeates, Keith Owen

2014-01-01

Abstract This study examined whether executive function and theory of mind mediate the effects of pediatric traumatic brain injury (TBI) on social adjustment, relative to children with orthopedic injury (OI). Participants included 19 children with severe TBI, 41 children with complicated mild/moderate TBI, and 57 children with OI. They completed measures of executive function, as well as cognitive, affective, and conative theory of mind. Parents provided ratings of children's social adjustment. Children with severe TBI performed more poorly than children with OI on executive function and theory of mind tasks and were rated by parents as having more behavioral symptoms and worse communication and social skills. Executive function and theory of mind were positively correlated with social skills and communication skills, and negatively correlated with behavioral symptoms. In multiple mediator models, theory of mind and executive function were not significant direct predictors of any measure of social adjustment, but mediated the association between injury and adjustment for children with severe TBI. Theory of mind was a significant independent mediator when predicting social skills, but executive function was not. TBI in children, particularly severe injury, is associated with poor social adjustment. The impact of TBI on children's social adjustment is likely mediated by its effects on executive function and theory of mind. PMID:25003478

The Association of Teacher-Student Relationship Quality and Teacher Support with Students' School Satisfaction, Classroom Adjustment, and Academic Achievement

ERIC Educational Resources Information Center

Omae, Hilda Nyougo

2010-01-01

As children grow, they transition from home to school environments, where they acquire and master knowledge and skills, and develop an image of themselves as learners and develop several types of relationships with adults as they grow. As they enter and remain in school, these relationships expand from being solely with parents and caretakers to…

Welfare and Generational Equity in Sustainable Unfunded Pension Systems

PubMed Central

Auerbach, Alan J.; Lee, Ronald

2011-01-01

Using stochastic simulations we analyze how public pension structures spread the risks arising from demographic and economic shocks across generations. We consider several actual and hypothetical sustainable PAYGO pension structures, including: (1) versions of the US Social Security system with annual adjustments of taxes or benefits to maintain fiscal balance; (2) Sweden’s Notional Defined Contribution system and several variants developed to improve fiscal stability; and (3) the German system, which also includes annual adjustments to maintain fiscal balance. For each system, we present descriptive measures of uncertainty in representative outcomes for a typical generation and across generations. We then estimate expected utility for generations based on simplifying assumptions and incorporate these expected utility calculations in an overall social welfare measure. Using a horizontal equity index, we also compare the different systems’ performance in terms of how neighboring generations are treated. While the actual Swedish system smoothes stochastic fluctuations more than any other and produces the highest degree of horizontal equity, it does so by accumulating a buffer stock of assets that alleviates the need for frequent adjustments. In terms of social welfare, this accumulation of assets leads to a lower average rate of return that more than offsets the benefits of risk reduction, leaving systems with more frequent adjustments that spread risks broadly among generations as those most preferred. PMID:21818166

Implications of Resolving the Diagnosis of PKU for Parents and Children

PubMed Central

Ungerer, Judy; Wastell, Colin

2008-01-01

Objective To examine resolution of the diagnosis among parents of children with phenylketonuria (PKU) as a mechanism of adjustment for parents and children. Methods Reaction to diagnosis interviews were conducted with 52 mothers and 47 fathers of 55 children with PKU aged 2–12 years. The parents also completed questionnaires assessing their personal adjustment (stress symptoms), their child's adjustment (behavior problems), and coping variables (personal hopefulness and coping strategies). Results Most mothers (69%) and fathers (77%) were resolved to their child's diagnosis. Lower levels of parent stress were explained by higher personal hopefulness (14% of the variance for mothers and 21% for fathers) and resolution of the diagnosis (15% of the variance for mothers and 6% for fathers) after taking account of demographic variables and severity of the child's PKU. Parent resolution, however, did not contribute independently to the variance explained in child behavior problems after taking account of coping variables and severity of PKU. Conclusions Resolution of the diagnosis of PKU is a strong indicator of parent adjustment, and assessment of parent reactions should be considered an integral component of clinical care. Further research is warranted in relation to the implications of parent resolution for the child's response to PKU through different development stages and the effectiveness of interventions in aiding parent resolution. PMID:18339641

Implications of resolving the diagnosis of PKU for parents and children.

PubMed

Lord, Bruce; Ungerer, Judy; Wastell, Colin

2008-09-01

To examine resolution of the diagnosis among parents of children with phenylketonuria (PKU) as a mechanism of adjustment for parents and children. Reaction to diagnosis interviews were conducted with 52 mothers and 47 fathers of 55 children with PKU aged 2-12 years. The parents also completed questionnaires assessing their personal adjustment (stress symptoms), their child's adjustment (behavior problems), and coping variables (personal hopefulness and coping strategies). Most mothers (69%) and fathers (77%) were resolved to their child's diagnosis. Lower levels of parent stress were explained by higher personal hopefulness (14% of the variance for mothers and 21% for fathers) and resolution of the diagnosis (15% of the variance for mothers and 6% for fathers) after taking account of demographic variables and severity of the child's PKU. Parent resolution, however, did not contribute independently to the variance explained in child behavior problems after taking account of coping variables and severity of PKU. Resolution of the diagnosis of PKU is a strong indicator of parent adjustment, and assessment of parent reactions should be considered an integral component of clinical care. Further research is warranted in relation to the implications of parent resolution for the child's response to PKU through different development stages and the effectiveness of interventions in aiding parent resolution.

Characterization of the CALIBAN Critical Assembly Neutron Spectra using Several Adjustment Methods Based on Activation Foils Measurement

NASA Astrophysics Data System (ADS)

Casoli, Pierre; Grégoire, Gilles; Rousseau, Guillaume; Jacquet, Xavier; Authier, Nicolas

2016-02-01

CALIBAN is a metallic critical assembly managed by the Criticality, Neutron Science and Measurement Department located on the French CEA Center of Valduc. The reactor is extensively used for benchmark experiments dedicated to the evaluation of nuclear data, for electronic hardening or to study the effect of the neutrons on various materials. Therefore CALIBAN irradiation characteristics and especially its central cavity neutron spectrum have to be very accurately evaluated. In order to strengthen our knowledge of this spectrum, several adjustment methods based on activation foils measurements are being studied for a few years in the laboratory. Firstly two codes included in the UMG package have been tested and compared: MAXED and GRAVEL. More recently, the CALIBAN cavity spectrum has been studied using CALMAR, a new adjustment tool currently under development at the CEA Center of Cadarache. The article will discuss and compare the results and the quality of spectrum rebuilding obtained with the UMG codes and with the CALMAR software, from a set of activation measurements carried out in the CALIBAN irradiation cavity.

Maternal Employment and Adolescent Adjustment and Perceptions of Child Rearing.

ERIC Educational Resources Information Center

Dusek, Jerome B.; Litovsky, Viviana G.

In this investigation of the effects of maternal employment on adolescents, 88 male and 128 female adolescents from grades 7 through 12 completed the Children's Report of Parental Behavior Inventory and the Inventory of Psychosocial Development. Several questions were addressed: (1) Does maternal employment status influence adolescents'…

Socio-emotional regulation in children with intellectual disability and typically developing children, and teachers' perceptions of their social adjustment.

PubMed

Baurain, Céline; Nader-Grosbois, Nathalie; Dionne, Carmen

2013-09-01

This study examined the extent to which socio-emotional regulation displayed in three dyadic interactive play contexts (neutral, competitive or cooperative) by 45 children with intellectual disability compared with 45 typically developing children (matched on developmental age, ranging from 3 to 6 years) is linked with the teachers' perceptions of their social adjustment. A Coding Grid of Socio-Emotional Regulation by Sequences (Baurain & Nader-Grosbois, 2011b, 2011c) focusing on Emotional Expression, Social Behavior and Behavior toward Social Rules in children was applied. The Social Adjustment for Children Scale (EASE, Hugues, Soares-Boucaud, Hochman, & Frith, 1997) and the Assessment, Evaluation and Intervention Program System (AEPS, Bricker, 2002) were completed by teachers. Regression analyses emphasized, in children with intellectual disability only, a positive significant link between their Behavior toward Social Rules in interactive contexts and the teachers' perceptions of their social adjustment. Children with intellectual disabilities who listen to and follow instructions, who are patient in waiting for their turn, and who moderate their externalized behavior are perceived by their teachers as socially adapted in their daily social relationships. The between-groups dissimilarity in the relational patterns between abilities in socio-emotional regulation and social adjustment supports the "structural difference hypothesis" with regard to the group with intellectual disability, compared with the typically developing group. Hierarchical cluster cases analyses identified distinct subgroups showing variable structural patterns between the three specific categories of abilities in socio-emotional regulation and their levels of social adjustment perceived by teachers. In both groups, several abilities in socio-emotional regulation and teachers' perceptions of social adjustment vary depending on children's developmental age. Chronological age in children with intellectual disability had no impact on their socio-emotional regulation and social adjustment. Copyright © 2013 Elsevier Ltd. All rights reserved.

Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis.

PubMed

Daru, Jahnavi; Zamora, Javier; Fernández-Félix, Borja M; Vogel, Joshua; Oladapo, Olufemi T; Morisaki, Naho; Tunçalp, Özge; Torloni, Maria Regina; Mittal, Suneeta; Jayaratne, Kapila; Lumbiganon, Pisake; Togoobaatar, Ganchimeg; Thangaratinam, Shakila; Khan, Khalid S

2018-05-01

Anaemia affects as many as half of all pregnant women in low-income and middle-income countries, but the burden of disease and associated maternal mortality are not robustly quantified. We aimed to assess the association between severe anaemia and maternal death with data from the WHO Multicountry Survey on maternal and newborn health. We used multilevel and propensity score regression analyses to establish the relation between severe anaemia and maternal death in 359 health facilities in 29 countries across Latin America, Africa, the Western Pacific, eastern Mediterranean, and southeast Asia. Severe anaemia was defined as antenatal or postnatal haemoglobin concentrations of less than 70 g/L in a blood sample obtained before death. Maternal death was defined as death any time after admission until the seventh day post partum or discharge. In regression analyses, we adjusted for post-partum haemorrhage, general anaesthesia, admission to intensive care, sepsis, pre-eclampsia or eclampsia, thrombocytopenia, shock, massive transfusion, severe oliguria, failure to form clots, and severe acidosis as confounding variables. These variables were used to develop the propensity score. 312 281 women admitted in labour or with ectopic pregnancies were included in the adjusted multilevel logistic analysis, and 12 470 were included in the propensity score regression analysis. The adjusted odds ratio for maternal death in women with severe anaemia compared with those without severe anaemia was 2·36 (95% CI 1·60-3·48). In the propensity score analysis, severe anaemia was also associated with maternal death (adjusted odds ratio 1·86 [95% CI 1·39-2·49]). Prevention and treatment of anaemia during pregnancy and post partum should remain a global public health and research priority. Barts and the London Charity. Copyright This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

Emotional and Meta-Emotional Intelligence as Predictors of Adjustment Problems in Students with Specific Learning Disorders

ERIC Educational Resources Information Center

D'Amico, Antonella; Guastaferro, Teresa

2017-01-01

The purpose of this study was to analyse adjustment problems in a group of adolescents with a Specific Learning Disorder (SLD), examining to what extent they depend on the severity level of the learning disorder and/or on the individual's level of emotional intelligence. Adjustment problems,, perceived severity levels of SLD, and emotional and…

A Review of Sex Differences in Peer Relationship Processes: Potential Trade-offs for the Emotional and Behavioral Development of Girls and Boys

PubMed Central

Rose, Amanda J.; Rudolph, Karen D.

2011-01-01

Theory and research on sex differences in adjustment focus largely on parental, societal, and biological influences. However, it also is important to consider how peers contribute to girls’ and boys’ development. This paper provides a critical review of sex differences in: several peer-relationship processes, including behavioral and social-cognitive styles, stress and coping, and relationship provisions. Based on this review, a speculative peer-socialization model is presented that considers the implications of these sex differences for girls’ and boys’ emotional and behavioral development. Central to this model is the idea that sex-linked relationship processes have costs and benefits for girls’ and boys’ adjustment. Finally, we present recent research testing certain model components and propose approaches for testing understudied aspects of the model. PMID:16435959

Can they recover? An assessment of adult adjustment problems among males in the abstainer, recovery, life-course persistent, and adolescence-limited pathways followed up to age 56 in the Cambridge Study in Delinquent Development.

PubMed

Jennings, Wesley G; Rocque, Michael; Fox, Bryanna Hahn; Piquero, Alex R; Farrington, David P

2016-05-01

Much research has examined Moffitt's developmental taxonomy, focusing almost exclusively on the distinction between life-course persistent and adolescence-limited offenders. Of interest, a handful of studies have identified a group of individuals whose early childhood years were marked by extensive antisocial behavior but who seemed to recover and desist (at least from severe offending) in adolescence and early adulthood. We use data from the Cambridge Study in Delinquent Development to examine the adult adjustment outcomes of different groups of offenders, including a recoveries group, in late middle adulthood, offering the most comprehensive investigation of this particular group to date. Findings indicate that abstainers comprise the largest group of males followed by adolescence-limited offenders, recoveries, and life-course persistent offenders. Furthermore, the results reveal that a host of adult adjustment problems measured at ages 32 and 48 in a number of life-course domains are differentially distributed across these four offender groups. In addition, the recoveries and life-course persistent offenders often show the greatest number of adult adjustment problems relative to the adolescence-limited offenders and abstainers.

Carotenoids as protection against disability in older persons.

PubMed

Lauretani, Fulvio; Semba, Richard D; Bandinelli, Stefania; Dayhoff-Brannigan, Margaret; Lauretani, Fabrizio; Corsi, Anna Maria; Guralnik, Jack M; Ferrucci, Luigi

2008-06-01

The purpose was to examine the relationship of total plasma carotenoids, an indicator of fruit and vegetable intake, with walking speed and severe walking disability in older adults. Nine hundred twenty-eight men and women aged 65 to 102 years from the Invecchiare in Chianti (Aging in the Chianti Area [InCHIANTI]) study, a population-based cohort in Tuscany, Italy, were studied. Plasma carotenoids were measured at enrollment (1998-2000), and walking speed over 4 meters and 400 meters distance were assessed at enrollment and 6 years later (2004-2006). At enrollment, 85 of 928 (9.2%) participants had severe walking disability (defined as being unable to walk or having a walking speed at the 4-meter walking test < 0.4 m/sec). After adjusting for potential confounders, participants with high total plasma carotenoids were significantly less likely to have prevalent severe walking disability (odds ration [OR] 0.59, 95% confidence interval [CI] 0.38-0.90, p = 0.01) and had higher walking speed over 4 meters (beta = 0.024, standard error [SE] = 0.011, p = 0.03) and over 400 meters (beta = 0.019, SE = 0.010, p = 0.04). Of 621 participants without severe walking disability at enrollment who were seen 6 years later, 68 (11.0%) developed severe walking disability. After adjusting for potential confounders, higher total plasma carotenoids were associated with a significantly lower risk of developing severe walking disability (OR 0.51, 95% CI 0.30-0.86, p = 0.01) and were associated with a less steep decline in 4-meter walking speed over a 6-year follow-up (n = 579; beta = 0.026, SE = 0.012, p = 0.03) and with lower incidence rates of being unable to successfully complete the 400-meter walking test at the 6-year follow-up visit (beta = -0.054, SE = 0.03, p = 0.04). High plasma carotenoids concentrations may be protective against the decline in walking speed and the development of severe walking disability in older adults.

Strategies for Improving Power in School-Randomized Studies of Professional Development.

PubMed

Kelcey, Ben; Phelps, Geoffrey

2013-12-01

Group-randomized designs are well suited for studies of professional development because they can accommodate programs that are delivered to intact groups (e.g., schools), the collaborative nature of professional development, and extant teacher/school assignments. Though group designs may be theoretically favorable, prior evidence has suggested that they may be challenging to conduct in professional development studies because well-powered designs will typically require large sample sizes or expect large effect sizes. Using teacher knowledge outcomes in mathematics, we investigated when and the extent to which there is evidence that covariance adjustment on a pretest, teacher certification, or demographic covariates can reduce the sample size necessary to achieve reasonable power. Our analyses drew on multilevel models and outcomes in five different content areas for over 4,000 teachers and 2,000 schools. Using these estimates, we assessed the minimum detectable effect sizes for several school-randomized designs with and without covariance adjustment. The analyses suggested that teachers' knowledge is substantially clustered within schools in each of the five content areas and that covariance adjustment for a pretest or, to a lesser extent, teacher certification, has the potential to transform designs that are unreasonably large for professional development studies into viable studies. © The Author(s) 2014.

End user evaluation of a Kneeling Wheelchair with "on the fly" adjustable seating functions.

PubMed

Mattie, Johanne; Wong, Angie; Leland, Danny; Borisoff, Jaimie

2018-04-18

A "kneeling" ultralight wheelchair prototype has been developed that allows users to adjust seat position "on the fly" for different activities throughout the day. The wheelchair includes independent adjustment functions for rear seat height, front seat height ("kneeling") and backrest angle.  Aim: This work aimed to gather feedback about the wheelchair's functionality and performance through end user evaluation trials.  Methods: Eight manual wheelchair users evaluated the prototype Kneeling Wheelchair for a range of activities. User perspectives on parameters such as usability, comfort, stability and effectiveness were obtained through both open-ended and Likert-scale rating questions.  Results: Results indicate several potential benefits of the adjustment functions of the Kneeling Wheelchair. Rear seat height adjustment may facilitate a number of activities of daily living, as well as provide benefits for comfort and social interactions. Back rest adjustment may increase comfort and stability on slopes. Front seat height adjustment may be beneficial for transfers and conducting sustained low-to-the-ground activities. While benefits of this adjustment function were described by many participants, some struggled with usability of the kneeling mechanism and rated this function less favourably than the other two.  Conclusion: The findings of this study will inform future iterations of the Kneeling Wheelchair design and may spur future developments in wheeled mobility. In the long-term, it is anticipated that novel wheelchair solutions, such as the one described in this paper, may support improved health, quality of life and community participation for people with mobility impairments. Implications for rehabilitation Wheelchairs that allow users to easily adjust seat and backrest position "on the fly" to better suit different tasks throughout the day may provide benefits such as facilitating activities of daily living. A front seat height adjustment feature on a new wheelchair prototype may be beneficial for transfers and conducting sustained low-to-the ground activities. End user evaluations can provide valuable insight to direct future design modifications and innovation.

Adjusted poor weight gain for birth weight and gestational age as a predictor of severe ROP in VLBW infants.

PubMed

Aydemir, O; Sarikabadayi, Y U; Aydemir, C; Tunay, Z O; Tok, L; Erdeve, O; Oguz, S S; Uras, N; Dilmen, U

2011-06-01

To analyze relative weight gain by 2-week intervals up to 6 weeks after birth in order to predict the development of retinopathy of prematurity (ROP) requiring treatment among very low birth weight (BW) infants. A prospective study including infants with BW ≤1500 g born in a single tertiary intensive care unit over 1-year period was conducted. Body weight measurements were recorded weekly and relative weight gains (g/kg/day) were calculated. The main outcome was development of ROP requiring treatment. Mean BW and gestational age (GA) of the whole cohort were 1165±223 g and 29.3±2.3 weeks, respectively. Relative weight gain at 2 weeks and 4 weeks postnatal age were significantly lower in infants with severe ROP (P=0.041 and P=0.017, respectively). Relative weight gain at 6 weeks was not different between groups. Infants with severe ROP gained 6.7±4 g/kg/day in the first 4 weeks of life, compared with 9.3±4.5 g/kg/day for those with mild or no ROP. After adjusted for BW and GA in logistic regression poor relative weight gain in the first 4 weeks was found to be related to severe ROP (P=0.015). When all the other risk factors significant for severe ROP were included in the logistic regression poor weight gain did not arise as an independent risk factor. Poor postnatal weight gain in the first 4 weeks of life is the end result of several comorbidities rather than being an independent risk factor. Poor weight gain can be an additional predictor of severe ROP in very low BW infants.

Attachment and Effortful Control: Relationships With Maladjustment in Early Adolescence

ERIC Educational Resources Information Center

Heylen, Joke; Vasey, Michael W.; Dujardin, Adinda; Vandevivere, Eva; Braet, Caroline; De Raedt, Rudi; Bosmans, Guy

2017-01-01

Based on former research, it can be assumed that attachment relationships provide a context in which children develop both the effortful control (EC) capacity and the repertoire of responses to regulate distress. Both are important to understand children's (mal)adjustment. While the latter assumption has been supported in several studies, less is…

Chi-Squared Test of Fit and Sample Size-A Comparison between a Random Sample Approach and a Chi-Square Value Adjustment Method.

PubMed

Bergh, Daniel

2015-01-01

Chi-square statistics are commonly used for tests of fit of measurement models. Chi-square is also sensitive to sample size, which is why several approaches to handle large samples in test of fit analysis have been developed. One strategy to handle the sample size problem may be to adjust the sample size in the analysis of fit. An alternative is to adopt a random sample approach. The purpose of this study was to analyze and to compare these two strategies using simulated data. Given an original sample size of 21,000, for reductions of sample sizes down to the order of 5,000 the adjusted sample size function works as good as the random sample approach. In contrast, when applying adjustments to sample sizes of lower order the adjustment function is less effective at approximating the chi-square value for an actual random sample of the relevant size. Hence, the fit is exaggerated and misfit under-estimated using the adjusted sample size function. Although there are big differences in chi-square values between the two approaches at lower sample sizes, the inferences based on the p-values may be the same.

External Validation of the Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) in the Scoli-RISK-1 Patient Database.

PubMed

Miller, Emily K; Lenke, Lawrence G; Neuman, Brian J; Sciubba, Daniel M; Kebaish, Khaled M; Smith, Justin S; Qiu, Yong; Dahl, Benny T; Pellisé, Ferran; Matsuyama, Yukihiro; Carreon, Leah Y; Fehlings, Michael G; Cheung, Kenneth M; Lewis, Stephen; Dekutoski, Mark B; Schwab, Frank J; Boachie-Adjei, Oheneba; Mehdian, Hossein; Bess, Shay; Shaffrey, Christopher I; Ames, Christopher P

2018-05-14

Analysis of a prospective multicenter database. To assess the ability of the recently created Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) to predict odds of major complications and length of hospital stay for patients who had more severe preoperative deformity and underwent more invasive ASD surgery compared with patients in the database used to create the index. Accurate preoperative estimates of risk are necessary given the high complication rates currently associated with ASD surgery. Patients were enrolled by participating institutions in Europe, Asia, and North America from 2009 to 2011. ASD-FI scores were used to classify 267 patients as not frail (NF) (<0.3), frail (0.3-0. 5), or severely frail (SF) (>0.5). Multivariable logistic regression, adjusted for preoperative and surgical covariates such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and incidence of major complications, overall incidence of complications, and length of hospital stay. The mean ASD-FI score was 0.3 (range, 0-0.7). We categorized 105 patients as NF, 103 as frail, and 59 as SF. The adjusted odds of developing a major complication were higher for SF patients (odds ratio = 4.4; 95% CI 2.0, 9.9) compared with NF patients. After adjusting for covariates, length of hospital stay for SF patients increased by 19% (95% CI 1.4%, 39%) compared with NF patients. The odds of developing a major complication or having increased length of stay were similar between frail and NF patients. Greater patient frailty, as measured by the ASD-FI, is associated with a longer hospital stay and greater risk of major complications among patients who have severe preoperative deformity and undergo invasive surgical procedures. 2.

Male Sex Associated With Increased Risk of Neonatal Abstinence Syndrome.

PubMed

Charles, M Katherine; Cooper, William O; Jansson, Lauren M; Dudley, Judith; Slaughter, James C; Patrick, Stephen W

2017-06-01

Neonatal abstinence syndrome (NAS) is a postnatal opioid withdrawal syndrome. Factors associated with development of the syndrome are poorly understood; however, infant sex may influence the risk of NAS. Our objective was to determine if infant sex was associated with the development or severity of the syndrome in a large population-based cohort. This retrospective cohort study used vital statistics and prescription, outpatient, and inpatient administrative data for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. Multivariable logistic regression models were used to evaluate the association between male sex and diagnosis of NAS, accounting for potential demographic and clinical confounders. NAS severity, as evidenced by hospital length of stay, was modeled by using negative binomial regression. Of 102 695 infants, 927 infants were diagnosed with NAS (484 male subjects and 443 female subjects). Adjustments were made for the following: maternal age, race, and education; maternal hepatitis C infection, anxiety, or depression; in utero exposure to selective serotonin reuptake inhibitors and cigarettes; infant birth weight, small for gestational age, and year; and the interaction between opioid type and opioid amount. Male infants were more likely than female infants to be diagnosed with NAS (adjusted odds ratio, 1.18 [95% confidence interval, 1.05-1.33]) and NAS requiring treatment (adjusted odds ratio, 1.24 [95% confidence interval, 1.04-1.47]). However, there was no sex-based difference in severity for those diagnosed with NAS. Treatment of NAS should be tailored to an infant's individual risk for the syndrome. Clinicians should be mindful that male sex is an important risk factor in the diagnosis of NAS. Copyright © 2017 by the American Academy of Pediatrics.

Factoring socioeconomic status into cardiac performance profiling for hospitals: does it matter?

PubMed

Alter, David A; Austin, Peter C; Naylor, C David; Tu, Jack V

2002-01-01

Critics of "scorecard medicine" often highlight the incompleteness of risk-adjustment methods used when accounting for baseline patient differences. Although socioeconomic status is a highly important determinant of adverse outcome for patients admitted to the hospital with acute myocardial infarction, it has not been used in most risk-adjustment models for cardiovascular report cards. To determine the incremental impact of socioeconomic status adjustments on age, sex, and illness severity for hospital-specific 30-day mortality rates after acute myocardial infarction. The authors compared the absolute and relative hospital-specific 30-day acute myocardial infarction mortality rates in 169 hospitals throughout Ontario between April 1, 1994 and March 31, 1997. Patient socioeconomic status was characterized by median neighborhood income using postal codes and 1996 Canadian census data. They examined two risk-adjustment models: the first adjusted for age, sex, and illness severity (standard), whereas the second adjusted for age, sex, illness severity, and median neighborhood income level (socioeconomic status). There was an extremely strong correlation between 'standard' and 'socioeconomic status' risk-adjusted mortality rates (r = 0.99). Absolute differences in 30-day risk-adjusted mortality rates between the socioeconomic status and standard risk-adjustment models were small (median, 0.1%; 25th-75th percentile, 0.1-0.2). The agreement in the quintile rankings of hospitals between the socioeconomic status and standard risk-adjustment models was high (weighted kappa = 0.93). Despite its importance as a determinant of patient outcomes, the effect of socioeconomic status on hospital-specific mortality rates over and above standard risk-adjustment methods for acute myocardial infarction hospital profiling in Ontario was negligible.

Outcomes of Patients With Severe Chronic Lung Disease Who Are Undergoing Transcatheter Aortic Valve Replacement.

PubMed

Suri, Rakesh M; Gulack, Brian C; Brennan, J Matthew; Thourani, Vinod H; Dai, Dadi; Zajarias, Alan; Greason, Kevin L; Vassileva, Christina M; Mathew, Verghese; Nkomo, Vuyisile T; Mack, Michael J; Rihal, Charanjit S; Svensson, Lars G; Nishimura, Rick A; O'Gara, Patrick T; Holmes, David R

2015-12-01

In this study, we sought to determine the clinical outcomes after transcatheter aortic valve replacement (TAVR) among patients with chronic lung disease (CLD) and to evaluate the safety of transaortic versus transapical alternate access approaches in patients with varying severities of CLD. Clinical records for patients undergoing TAVR from 2011 to 2014 in The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry were linked to Medicare hospital claims (n = 11,656). Clinical outcomes were evaluated across strata of CLD severity, and the risk-adjusted association between access route and post-TAVR mortality was determined among patients with severe CLD. In this cohort (median age, 84 years; 51.7% female), moderate to severe CLD was present in 27.7% (14.3%, moderate; 13.4%, severe). Compared with patients with no or mild CLD, patients with severe CLD had a higher rate of post-TAVR mortality to 1-year (32.3% versus 21.0%; adjusted hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.31 to 1.66), as did those with moderate CLD (25.5%; adjusted HR, 1.16; 95% CI, 1.03 to 1.30). The adjusted rate of mortality was similar for transapical versus transaortic approaches to 1 year (adjusted HR, 1.17; 95% CI, 0.83 to 1.65). Moderate or severe CLD is associated with an increased risk of death to 1-year after TAVR, and among patients with severe CLD, the risk of death appears to be similar with either transapical or transaortic alternate-access approaches. Further study is necessary to understand strategies to mitigate risk associated with CLD and the long-term implications of these findings. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Maternal vitamin D status and the risk of mild and severe preeclampsia

PubMed Central

Bodnar, Lisa M.; Simhan, Hyagriv N.; Catov, Janet M.; Roberts, James M.; Platt, Robert W.; Diesel, Jill C.; Klebanoff, Mark A.

2014-01-01

Background We sought to determine the association between maternal vitamin D status at ≤26 weeks gestation and the risk of preeclampsia separately by clinical subtype. Methods We conducted a case-cohort study among women enrolled at 12 U.S. sites from 1959 to 1966 in the Collaborative Perinatal Project. In 717 women who later developed preeclampsia (560 mild and 157 severe cases) and in 2986 mothers without preeclampsia, we measured serum 25-hydroxyvitamin D at ≤26 weeks gestation (median 20.9 weeks) over 40 years later using liquid-chromatography-tandem mass spectrometry. Results Half of women in the subcohort had 25(OH)D <50 nmol/L. Maternal 25(OH)D 50–<75 nmol/L was associated with a reduction in the absolute and relative risk of preeclampsia and mild preeclampsia compared with 25(OH)D <30 nmol/L, but the effects were no longer present after adjustment for confounders including race, prepregnancy body mass index, and parity. For severe preeclampsia, 25(OH)D ≥50 nmol/L was associated with a reduction of 3 cases per 1,000 pregnancies (adjusted RD −.003, 95% CI: −.005, .0002) and a 40% reduction in risk (adjusted RR .65, 95% CI .43, .98) compared with 25(OH)D <50 nmol/L. The conclusions were the same after restricting to women with 25(OH)D measured at <22 weeks gestation and after formal sensitivity analyses for unmeasured confounding. Conclusions Maternal vitamin D deficiency may be a risk factor for severe preeclampsia, but it is not associated with preeclampsia overall or its mild subtypes. Contemporary cohorts with large numbers of severe preeclampsia cases are needed to confirm or refute these findings. PMID:24457526

Laser Reliability Prediction

DTIC Science & Technology

1975-08-01

prism adjustment screw 12 - 45° prism adjustment lockscrew 13-45° prism 14 - Porro prism 15 - Collimating telescope X-axis adjustment lockscrew...4) 16 - Q-switch tilt adjustment screw 17 - Q-switch tilt adjustment lockscrew (4) 18 - Porro prism adjustment nut (3) 19 - Porro prism mounting...is increased by several orders of magnitude. "Q" switch technology has progressed from rotating prisms or mirrors to electro-optical (E/0

A risk prediction model for severe intraventricular hemorrhage in very low birth weight infants and the effect of prophylactic indomethacin.

PubMed

Luque, M J; Tapia, J L; Villarroel, L; Marshall, G; Musante, G; Carlo, W; Kattan, J

2014-01-01

Develop a risk prediction model for severe intraventricular hemorrhage (IVH) in very low birth weight infants (VLBWI). Prospectively collected data of infants with birth weight 500 to 1249 g born between 2001 and 2010 in centers from the Neocosur Network were used. Forward stepwise logistic regression model was employed. The model was tested in the 2011 cohort and then applied to the population of VLBWI that received prophylactic indomethacin to analyze its effect in the risk of severe IVH. Data from 6538 VLBWI were analyzed. The area under ROC curve for the model was 0.79 and 0.76 when tested in the 2011 cohort. The prophylactic indomethacin group had lower incidence of severe IVH, especially in the highest-risk groups. A model for early severe IVH prediction was developed and tested in our population. Prophylactic indomethacin was associated with a lower risk-adjusted incidence of severe IVH.

The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?

PubMed

Magee, Laura A; von Dadelszen, Peter; Singer, Joel; Lee, Terry; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E; Menzies, Jennifer; Sanchez, Johanna; Gafni, Amiram; Helewa, Michael; Hutton, Eileen; Koren, Gideon; Lee, Shoo K; Logan, Alexander G; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim G; Moutquin, Jean-Marie

2016-11-01

To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of "less tight" (target diastolic blood pressure [dBP] 100 mm Hg) versus "tight" control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight <10th percentile, preeclampsia, delivery at <34 or <37 weeks, platelets <100×10 9 /L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1%) women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight <10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all P<0.001), platelets <100×10 9 /L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome (P<0.001), birth weight <10th percentile (P=0.005), delivery at <37 (P<0.001) or <34 weeks (P<0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence. URL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01192412. © 2016 The Authors.

The Vermicelli Handling Test: A Simple Quantitative Measure of Dexterous Forepaw Function in Rats

PubMed Central

Allred, Rachel P.; Adkins, DeAnna L.; Woodlee, Martin T.; Husbands, Lincoln C.; Maldonado, Mónica A.; Kane, Jacqueline R.; Schallert, Timothy; Jones, Theresa A.

2008-01-01

Loss of function in the hands occurs with many brain disorders, but there are few measures of skillful forepaw use in rats available to model these impairments that are both sensitive and simple to administer. Whishaw and Coles (1996) previously described the dexterous manner in which rats manipulate food items with their paws, including thin pieces of pasta. We set out to develop a measure of this food handling behavior that would be quantitative, easy to administer, sensitive to the effects of damage to sensory and motor systems of the CNS and useful for identifying the side of lateralized impairments. When rats handle 7 cm lengths of vermicelli, they manipulate the pasta by repeatedly adjusting the forepaw hold on the pasta piece. As operationally defined, these adjustments can be easily identified and counted by an experimenter without specialized equipment. After unilateral sensorimotor cortex (SMC) lesions, transient middle cerebral artery occlusion (MCAO) and striatal dopamine depleting (6-hydroxydopamine, 6-OHDA) lesions in adult rats, there were enduring reductions in adjustments made with the contralateral forepaw. Additional pasta handling characteristics distinguished between the lesion types. MCAO and 6-OHDA lesions increased the frequency of several identified atypical handling patterns. Severe dopamine depletion increased eating time and adjustments made with the ipsilateral forepaw. However, contralateral forepaw adjustment number most sensitively detected enduring impairments across lesion types. Because of its ease of administration and sensitivity to lateralized impairments in skilled forepaw use, this measure may be useful in rat models of upper extremity impairment. PMID:18325597

The College Adjustment Questionnaire: A Measure of Students' Educational, Relational, and Psychological Adjustment to the College Environment

ERIC Educational Resources Information Center

O'Donnell, Maeve B.; Shirley, Lauren A.; Park, Stacey S.; Nolen, Julian P.; Gibbons, Alyssa M.; Rosén, Lee A.

2018-01-01

Several instruments exist to measure college adjustment: the Student Adaptation to College Questionnaire (SACQ; Baker & Siryk, 1989), the College Adjustment Rating Scale (Zitzow, 1984), and the College Adjustment Scales (Anton & Reed, 1991). Of these, the SACQ is the most widely used and takes a multifaceted approach to measuring college…

Clinical Seizures in Neonatal Hypoxic-Ischemic Encephalopathy Have No Independent Impact on Neurodevelopmental Outcome: Secondary Analyses of Data from the Neonatal Research Network Hypothermia Trial

PubMed Central

Kwon, Jennifer M.; Guillet, Ronnie; Shankaran, Seetha; Laptook, Abbot R.; McDonald, Scott A.; Ehrenkranz, Richard A.; Tyson, Jon E.; O'Shea, T. Michael; Goldberg, Ronald N.; Donovan, Edward F.; Fanaroff, Avroy A.; Poole, W. Kenneth; Higgins, Rosemary D.; Walsh, Michele C.

2012-01-01

It remains controversial as to whether neonatal seizures have additional direct effects on the developing brain separate from the severity of the underlying encephalopathy. Using data collected from infants diagnosed with hypoxic-ischemic encephalopathy, and who were enrolled in an National Institute of Child Health and Human Development trial of hypothermia, we analyzed associations between neonatal clinical seizures and outcomes at 18 months of age. Of the 208 infants enrolled, 102 received whole body hypothermia and 106 were controls. Clinical seizures were generally noted during the first 4 days of life and rarely afterward. When adjustment was made for study treatment and severity of encephalopathy, seizures were not associated with death, or moderate or severe disability, or lower Bayley Mental Development Index scores at 18 months of life. Among infants diagnosed with hypoxic-ischemic encephalopathy, the mortality and morbidity often attributed to neonatal seizures can be better explained by the underlying severity of encephalopathy. PMID:20921569

Education and severe maternal outcomes in developing countries: a multicountry cross-sectional survey.

PubMed

Tunçalp, Ö; Souza, J P; Hindin, M J; Santos, C A; Oliveira, T H; Vogel, J P; Togoobaatar, G; Ha, D Q; Say, L; Gülmezoglu, A M

2014-03-01

To assess the relationship between education and severe maternal outcomes among women delivering in healthcare facilities. Cross-sectional study. Twenty-nine countries in Africa, Asia, Latin America, and the Middle East. Pregnant women admitted to 359 facilities during a period of 2-4 months of data collection between 2010 and 2011. Data were obtained from hospital records. Stratification was based on the Human Development Index (HDI) values of the participating countries. Multivariable logistic regression analyses were conducted to assess the association between maternal morbidity and education, categorised in quartiles based on the years of formal education by country. Coverage of key interventions was assessed. Severe maternal outcomes (near misses and death). A significant association between low education and severe maternal outcomes (adjusted odds ratio, aOR, 2.07; 95% confidence interval, 95% CI, 1.46-2.95), maternal near miss (aOR 1.80; 95% CI 1.25-2.57), and maternal death (aOR 5.62; 95% CI 3.45-9.16) was observed. This relationship persisted in countries with medium HDIs (aOR 2.36; 95% CI 1.33-4.17) and low HDIs (aOR 2.65; 95% CI 1.54-2.57). Less educated women also had increased odds of presenting to the hospital in a severe condition (i.e. with organ dysfunction on arrival or within 24 hours: aOR 2.06; 95% CI 1.36-3.10). The probability that a woman received magnesium sulphate for eclampsia or had a caesarean section significantly increased as education level increased (P < 0.05). Women with lower levels of education are at greater risk for severe maternal outcomes, even after adjustment for key confounding factors. This is particularly true for women in countries that have poorer markers of social and economic development. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

The use of a high resolution model in a private environment.

NASA Astrophysics Data System (ADS)

van Dijke, D.; Malda, D.

2009-09-01

The commercial organisation MeteoGroup uses high resolution modelling for multiple purposes. MeteoGroup uses the Weather Research and Forecasting Model (WRF®1). WRF is used in the operational environment of several MeteoGroup companies across Europe. It is also used in hindcast studies, for example hurricane tracking, wind climate computation and deriving boundary conditions for air quality models. A special operational service was set up for our tornado chasing team that uses high resolution flexible WRF data to chase for super cells and tornados in the USA during spring. Much effort is put into the development and improvement of the pre- and post-processing of the model. At MeteoGroup the static land-use data has been extended and adjusted to improve temperature and wind forecasts. The system has been modified such that sigma level input data from the global ECMWF model can be used for initialisation. By default only pressure level data could be used. During the spin-up of the model synoptical observations are nudged. A program to adjust possible initialisation errors of several surface parameters in coastal areas has been implemented. We developed an algorithm that computes cloud fractions using multiple direct model output variables. Forecasters prefer to use weather codes for their daily forecasts to detect severe weather. For this usage we developed model weather codes using a variety of direct model output and our own derived variables. 1 WRF® is a registered trademark of the University Corporation for Atmospheric Research (UCAR)

Grandparents and learning.

PubMed

Strom, R; Strom, S

1989-01-01

The educational needs of grandparents have been overlooked. They deserve access to a curriculum that can help them adjust to their changing role and illustrate how to build satisfying family relationships. In order to identify appropriate topics and instructional procedures for grandparent education, weekly meetings were held for a semester with 400 grandmothers and grandfathers. The resulting program includes experiences in sharing feelings and ideas with peers; listening to the views of younger people; studying lifespan growth and adjustment; acquiring intergenerational communication skills; and focusing self-evaluation. A fieldtest involving several hundred participants, equally divided into experimental and control groups, is underway to determine the worthwhileness of this approach to family development.

Factors Influencing the Phenotypic Expression of Hypertrophic Cardiomyopathy in Genetic Carriers.

PubMed

Pérez-Sánchez, Inmaculada; Romero-Puche, Antonio José; García-Molina Sáez, Esperanza; Sabater-Molina, María; López-Ayala, José María; Muñoz-Esparza, Carmen; López-Cuenca, David; de la Morena, Gonzalo; Castro-García, Francisco José; Gimeno-Blanes, Juan Ramón

2018-03-01

Hypertrophic cardiomyopathy (HCM) is a disorder with variable expression. It is mainly caused by mutations in sarcomeric genes but the phenotype could be modulated by other factors. The aim of this study was to determine whether factors such as sex, systemic hypertension, or physical activity are modifiers of disease severity and to establish their role in age-related penetrance of HCM. We evaluated 272 individuals (mean age 49 ± 17 years, 57% males) from 72 families with causative mutations. The relationship between sex, hypertension, physical activity, and left ventricular hypertrophy was studied. The proportion of affected individuals increased with age. Men developed the disease 12.5 years earlier than women (adjusted median, 95%CI, -17.52 to -6.48; P < .001). Hypertensive patients were diagnosed with HCM later (10.8 years of delay) than normotensive patients (adjusted median, 95%CI, 6.28-17.09; P < .001). Individuals who performed physical activity were diagnosed with HCM significantly earlier (7.3 years, adjusted median, 95%CI, -14.49 to -1.51; P = .016). Sex, hypertension, and the degree of physical activity were not significantly associated with the severity of left ventricular hypertrophy. Adjusted survival both free from sudden death and from the combined event were not influenced by any of the exploratory variables. Men and athletes who are carriers of sarcomeric mutations are diagnosed earlier than women and sedentary individuals. Hypertensive carriers of sarcomeric mutations have a delayed diagnosis. Sex, hypertension, and physical activity are not associated with disease severity in carriers of HCM causative mutations. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

The relationship between target joints and direct resource use in severe haemophilia.

PubMed

O'Hara, Jamie; Walsh, Shaun; Camp, Charlotte; Mazza, Giuseppe; Carroll, Liz; Hoxer, Christina; Wilkinson, Lars

2018-01-16

Target joints are a common complication of severe haemophilia. While factor replacement therapy constitutes the majority of costs in haemophilia, the relationship between target joints and non drug-related direct costs (NDDCs) has not been studied. Data on haemophilia patients without inhibitors was drawn from the 'Cost of Haemophilia across Europe - a Socioeconomic Survey' (CHESS) study, a cost assessment in severe haemophilia A and B across five European countries (France, Germany, Italy, Spain, and the United Kingdom) in which 139 haemophilia specialists provided demographic and clinical information for 1285 adult patients. NDDCs were calculated using publicly available cost data, including 12-month ambulatory and secondary care activity: haematologist and other specialist consultant consultations, medical tests and examinations, bleed-related hospital admissions, and payments to professional care providers. A generalized linear model was developed to investigate the relationship between NDDCs and target joints (areas of chronic synovitis), adjusted for patient covariates. Five hundred and thirteen patients (42% of the sample) had no diagnosed target joints; a total of 1376 target joints (range 1-10) were recorded in the remaining 714 patients. Mean adjusted NDDCs for persons with no target joints were EUR 3134 (standard error (SE) EUR 158); for persons with one or more target joints, mean adjusted NDDCs were EUR 3913 (SE EUR 157; average mean effect EUR 779; p < 0.001). Our analysis suggests that the presence of one or more target joints has a significant impact on NDDCs for patients with severe haemophilia, ceteris paribus. Prevention and management of target joints should be an important consideration of managing haemophilia patients.

Inflammatory Bowel Disease and the Risk of Autoimmune Diseases.

PubMed

Wilson, J Claire; Furlano, Raoul I; Jick, Susan S; Meier, Christoph R

2016-02-01

An increased risk of autoimmune disease has been reported in patients with inflammatory bowel disease [IBD]. Using data from the Clinical Practice Research Datalink [CPRD], this study set out to further examine this relationship. Patients with a first-time IBD diagnosis were randomly matched to an equal-sized IBD-free comparison group. Incidence rates for new-onset autoimmune diseases were estimated. A nested case-control analysis comprising IBD patients was conducted, using conditional logistic regression to assess whether IBD severity, duration, or treatment influences the risk of developing autoimmune diseases. During follow-up, 1069 IBD and 585 IBD-free patients developed an incident autoimmune disease. An increased incidence of autoimmune disease was observed in IBD patients (incidence rate [IR] 9.65, 95% confidence interval [CI] 9.09-10.24) compared with the non-IBD comparison group [IR 5.22, 95% CI 4.82-5.66]. In IBD patients, increased disease severity was associated with an increased risk of autoimmune disease development (odds ratio [OR] 1.62, 95% CI 1.28-2.05). Current antibiotic use was also associated with an increased risk [adjusted OR 1.72, 95% CI 1.07-2.78]. A reduced risk of incident autoimmune diseases was observed for current long-term users of aminosalicylates [adjusted OR 0.72, 95% CI 0.57-0.91]. Individuals with IBD had an increased risk of developing an autoimmune disease. Increased disease severity and current antibiotic use were associated with an increased relative risk of developing additional autoimmune diseases in IBD patients. Long-term current aminosalicylate use was associated with a reduced risk. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Centrifugal pump’s impeller optimization using methods of calculation hydrodynamics

NASA Astrophysics Data System (ADS)

Grigoriev, S.; Mayorov, S.; Polyakov, R.

2017-08-01

The paper features the results of the fluid flow calculation in the channels of varying geometry of the centrifugal pump for the service water in the methanol production chain. Modeling of the flow in ANSYS CFX allowed developing recommendations on adjusting the impeller’s profile, significantly decrease the cavitation wear and increase the lifetime by several times.

Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy

PubMed Central

2012-01-01

Introduction Ventilator-associated pneumonia (VAP) may contribute to the mortality associated with acute respiratory distress syndrome (ARDS). We aimed to determine the incidence, outcome, and risk factors of bacterial VAP complicating severe ARDS in patients ventilated by using a strictly standardized lung-protective strategy. Methods This prospective epidemiologic study was done in all the 339 patients with severe ARDS included in a multicenter randomized, placebo-controlled double-blind trial of cisatracurium besylate in severe ARDS patients. Patients with suspected VAP underwent bronchoalveolar lavage to confirm the diagnosis. Results Ninety-eight (28.9%) patients had at least one episode of microbiologically documented bacterial VAP, including 41 (41.8%) who died in the ICU, compared with 74 (30.7%) of the 241 patients without VAP (P = 0.05). After adjustment, age and severity at baseline, but not VAP, were associated with ICU death. Cisatracurium besylate therapy within 2 days of ARDS onset decreased the risk of ICU death. Factors independently associated with an increased risk to develop a VAP were male sex and worse admission Glasgow Coma Scale score. Tracheostomy, enteral nutrition, and the use of a subglottic secretion-drainage device were protective. Conclusions In patients with severe ARDS receiving lung-protective ventilation, VAP was associated with an increased crude ICU mortality which did not remain significant after adjustment. PMID:22524447

Family Adjustment, Parental Attitudes, and Social Desirability.

ERIC Educational Resources Information Center

Robinson, Elizabeth A.; Anderson, Linda L.

The relationship between the degree of marital adjustment and the emotional adjustment of the children within the family is widely accepted as is the corollary belief that the marital relationship determines the child's adjustment. A sample of 69 married couples with children was used to examine the interrelationships among several measures of…

Update of the trauma risk adjustment model of the TraumaRegister DGU™: the Revised Injury Severity Classification, version II.

PubMed

Lefering, Rolf; Huber-Wagner, Stefan; Nienaber, Ulrike; Maegele, Marc; Bouillon, Bertil

2014-09-05

The TraumaRegister DGU™ (TR-DGU) has used the Revised Injury Severity Classification (RISC) score for outcome adjustment since 2003. In recent years, however, the observed mortality rate has fallen to about 2% below the prognosis, and it was felt that further prognostic factors, like pupil size and reaction, should be included as well. Finally, an increasing number of cases did not receive a RISC prognosis due to the missing values. Therefore, there was a need for an updated model for risk of death prediction in severely injured patients to be developed and validated using the most recent data. The TR-DGU has been collecting data from severely injured patients since 1993. All injuries are coded according to the Abbreviated Injury Scale (AIS, version 2008). Severely injured patients from Europe (ISS ≥ 4) documented between 2010 and 2011 were selected for developing the new score (n = 30,866), and 21,918 patients from 2012 were used for validation. Age and injury codes were required, and transferred patients were excluded. Logistic regression analysis was applied with hospital mortality as the dependent variable. Results were evaluated in terms of discrimination (area under the receiver operating characteristic curve, AUC), precision (observed versus predicted mortality), and calibration (Hosmer-Lemeshow goodness-of-fit statistic). The mean age of the development population was 47.3 years; 71.6% were males, and the average ISS was 19.3 points. Hospital mortality rate was 11.5% in this group. The new RISC II model consists of the following predictors: worst and second-worst injury (AIS severity level), head injury, age, sex, pupil reactivity and size, pre-injury health status, blood pressure, acidosis (base deficit), coagulation, haemoglobin, and cardiopulmonary resuscitation. Missing values are included as a separate category for every variable. In the development and the validation dataset, the new RISC II outperformed the original RISC score, for example AUC in the development dataset 0.953 versus 0.939. The updated RISC II prognostic score has several advantages over the previous RISC model. Discrimination, precision and calibration are improved, and patients with partial missing values could now be included. Results were confirmed in a validation dataset.

The Pennsylvania Trauma Outcomes Study Risk-Adjusted Mortality Model: Results of a Statewide Benchmarking Program

PubMed Central

WIEBE, DOUGLAS J.; HOLENA, DANIEL N.; DELGADO, M. KIT; McWILLIAMS, NATHAN; ALTENBURG, JULIET; CARR, BRENDAN G.

2018-01-01

Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system. We performed a retrospective cohort study of patients ≥16 years old at Pennsylvania trauma centers from 2011 to 2013 (n = 100,278). Our main outcome measure was observed-to-expected mortality ratios (overall and within blunt, penetrating, multisystem, isolated head, and geriatric subgroups). Patient demographic variables, physiology, mechanism of injury, transfer status, injury severity, and pre-existing conditions were included as predictor variables. The statistical model had excellent discrimination (area under the curve = 0.94). Funnel plots of observed-to-expected identified five centers with lower than expected mortality and two centers with higher than expected mortality. No centers were outliers for management of penetrating trauma, but five centers had lower and three had higher than expected mortality for blunt trauma. It is feasible to use Trauma Quality Improvement Program methodology to develop risk-adjusted models for statewide trauma systems. Even with smaller numbers of trauma centers that are available in national datasets, it is possible to identify high and low outliers in performance. PMID:28541852

The Pennsylvania Trauma Outcomes Study Risk-Adjusted Mortality Model: Results of a Statewide Benchmarking Program.

PubMed

Wiebe, Douglas J; Holena, Daniel N; Delgado, M Kit; McWilliams, Nathan; Altenburg, Juliet; Carr, Brendan G

2017-05-01

Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system. We performed a retrospective cohort study of patients ≥16 years old at Pennsylvania trauma centers from 2011 to 2013 (n = 100,278). Our main outcome measure was observed-to-expected mortality ratios (overall and within blunt, penetrating, multisystem, isolated head, and geriatric subgroups). Patient demographic variables, physiology, mechanism of injury, transfer status, injury severity, and pre-existing conditions were included as predictor variables. The statistical model had excellent discrimination (area under the curve = 0.94). Funnel plots of observed-to-expected identified five centers with lower than expected mortality and two centers with higher than expected mortality. No centers were outliers for management of penetrating trauma, but five centers had lower and three had higher than expected mortality for blunt trauma. It is feasible to use Trauma Quality Improvement Program methodology to develop risk-adjusted models for statewide trauma systems. Even with smaller numbers of trauma centers that are available in national datasets, it is possible to identify high and low outliers in performance.

A retrospective analysis of oral cholera vaccine use, disease severity and deaths during an outbreak in South Sudan.

PubMed

Bekolo, Cavin Epie; van Loenhout, Joris Adriaan Frank; Rodriguez-Llanes, Jose Manuel; Rumunu, John; Ramadan, Otim Patrick; Guha-Sapir, Debarati

2016-09-01

To determine whether pre-emptive oral cholera vaccination reduces disease severity and mortality in people who develop cholera disease during an outbreak. The study involved a retrospective analysis of demographic and clinical data from 41 cholera treatment facilities in South Sudan on patients who developed cholera disease between 23 April and 20 July 2014 during a large outbreak, a few months after a pre-emptive oral vaccination campaign. Patients who developed severe dehydration were regarded as having a severe cholera infection. Vaccinated and unvaccinated patients were compared and multivariate logistic regression analysis was used to identify factors associated with developing severe disease or death. In total, 4115 cholera patients were treated at the 41 facilities: 1946 (47.3%) had severe disease and 62 (1.5%) deaths occurred. Multivariate analysis showed that patients who received two doses of oral cholera vaccine were 4.5-fold less likely to develop severe disease than unvaccinated patients (adjusted odds ratio, aOR: 0.22; 95% confidence interval, CI: 0.11-0.44). Moreover, those with severe cholera were significantly more likely to die than those without (aOR: 4.76; 95% CI: 2.33-9.77). Pre-emptive vaccination with two doses of oral cholera vaccine was associated with a significant reduction in the likelihood of developing severe cholera disease during an outbreak in South Sudan. Moreover, severe disease was the strongest predictor of death. Two doses of oral cholera vaccine should be used in emergencies to reduce the disease burden.

Incidence of and risk factors for severe hypoglycaemia in treated type 2 diabetes mellitus patients in the UK--a nested case-control analysis.

PubMed

Bruderer, S G; Bodmer, M; Jick, S S; Bader, G; Schlienger, R G; Meier, C R

2014-09-01

To assess incidence rates (IRs) of and identify risk factors for incident severe hypoglycaemia in patients with type 2 diabetes newly treated with antidiabetic drugs. Using the UK-based General Practice Research Database, we performed a retrospective cohort study between 1994 and 2011 and a nested case-control analysis. Ten controls from the population at risk were matched to each case with a recorded severe hypoglycaemia during follow-up on general practice, years of history in the database and calendar time. Using multivariate conditional logistic regression analyses, we adjusted for potential confounders. Of 130,761 patients with newly treated type 2 diabetes (mean age 61.7 ± 13.0 years), 690 (0.5%) had an incident episode of severe hypoglycaemia recorded [estimated IR 11.97 (95% confidence interval, CI, 11.11-12.90) per 10,000 person-years (PYs)]. The IR was markedly higher in insulin users [49.64 (95% CI, 44.08-55.89) per 10,000 PYs] than in patients not using insulin [8.03 (95% CI, 7.30-8.84) per 10,000 PYs]. Based on results of the nested case-control analysis increasing age [≥ 75 vs. 20-59 years; adjusted odds ratio (OR), 2.27; 95% CI, 1.65-3.12], cognitive impairment/dementia (adjusted OR, 2.00; 95% CI, 1.37-2.91), renal failure (adjusted OR, 1.34; 95% CI, 1.04-1.71), current use of sulphonylureas (adjusted OR, 4.45; 95% CI, 3.53-5.60) and current insulin use (adjusted OR, 11.83; 95% CI, 9.00-15.54) were all associated with an increased risk of severe hypoglycaemia. Severe hypoglycaemia was recorded in 12 cases per 10,000 PYs. Risk factors for severe hypoglycaemia included increasing age, renal failure, cognitive impairment/dementia, and current use of insulin or sulphonylureas. © 2014 John Wiley & Sons Ltd.

Behavioral adjustment of siblings of children with autism engaged in applied behavior analysis early intervention programs: the moderating role of social support.

PubMed

Hastings, Richard P

2003-04-01

There have been few studies of the impact of intensive home-based early applied behavior analysis (ABA) intervention for children with autism on family functioning. In the present study, behavioral adjustment was explored in 78 siblings of children with autism on ABA programs. First, mothers' ratings of sibling adjustment were compared to a normative sample. There were no reported increases in behavioral adjustment problems in the present sample. Second, regression analyses revealed that social support functioned as a moderator of the impact of autism severity on sibling adjustment rather than a mediator or compensatory variable. In particular, siblings in families with a less severely autistic child had fewer adjustment problems when more formal social support was also available to the family. The implications of these data for future research and for practice are discussed.

Severe Hypertriglyceridemia During Therapy For Childhood Acute Lymphoblastic Leukemia

PubMed Central

Bhojwani, Deepa; Darbandi, Rashid; Pei, Deqing; Ramsey, Laura B.; Chemaitilly, Wassim; Sandlund, John T.; Cheng, Cheng; Pui, Ching-Hon; Relling, Mary V.; Jeha, Sima; Metzger, Monika L.

2014-01-01

Background Asparaginase and steroids can cause hypertriglyceridemia in children with acute lymphoblastic leukemia (ALL). There are no guidelines for screening or management of patients with severe hypertriglyceridemia (>1000 mg/dL) during ALL therapy. Patients and Methods Fasting lipid profiles were obtained prospectively at 4 time-points for 257 children consecutively enrolled on a frontline ALL study. Risk factors were evaluated by the exact chi-square test. Details of adverse events and management of hypertriglyceridemia were extracted retrospectively. Results Eighteen of 257 (7%) patients developed severe hypertriglyceridemia. Older age and treatment with higher doses of asparaginase and steroids on the standard/high-risk arm were significant risk factors. Severe hypertriglyceridemia was not associated with pancreatitis after adjustment for age and treatment arm or with osteonecrosis after adjustment for age. However, patients with severe hypertriglyceridemia had a 2.5 to 3 times higher risk of thrombosis compared to patients without, albeit the difference was not statistical significant. Of the 30 episodes of severe hypertriglyceridemia in 18 patients, 7 were managed conservatively while the others with pharmacotherapy. Seventeen of 18 patients continued to receive asparaginase and steroids. Triglyceride levels normalized after completion of ALL therapy in all 12 patients with available measurements. Conclusion Asparaginase- and steroid-induced transient hypertriglyceridemia can be adequately managed with dietary modifications and close monitoring without altering chemotherapy. Patients with severe hypertriglyceridemia were not at increased risk of adverse events, with a possible exception of thrombosis. The benefit of pharmacotherapy in decreasing symptoms and potential complications requires further investigation. PMID:25087182

Severe hypertriglyceridaemia during therapy for childhood acute lymphoblastic leukaemia.

PubMed

Bhojwani, Deepa; Darbandi, Rashid; Pei, Deqing; Ramsey, Laura B; Chemaitilly, Wassim; Sandlund, John T; Cheng, Cheng; Pui, Ching-Hon; Relling, Mary V; Jeha, Sima; Metzger, Monika L

2014-10-01

Asparaginase and steroids can cause hypertriglyceridaemia in children with acute lymphoblastic leukaemia (ALL). There are no guidelines for screening or management of patients with severe hypertriglyceridaemia (>1000mg/dL) during ALL therapy. Fasting lipid profiles were obtained prospectively at four time-points for 257 children consecutively enrolled on a frontline ALL study. Risk factors were evaluated by the exact chi-square test. Details of adverse events and management of hypertriglyceridaemia were extracted retrospectively. Eighteen of 257 (7%) patients developed severe hypertriglyceridaemia. Older age and treatment with higher doses of asparaginase and steroids on the standard/high-risk arm were significant risk factors. Severe hypertriglyceridaemia was not associated with pancreatitis after adjustment for age and treatment arm or with osteonecrosis after adjustment for age. However, patients with severe hypertriglyceridaemia had a 2.5-3 times higher risk of thrombosis compared to patients without, albeit the difference was not statistically significant. Of the 30 episodes of severe hypertriglyceridaemia in 18 patients, seven were managed conservatively while the others with pharmacotherapy. Seventeen of 18 patients continued to receive asparaginase and steroids. Triglyceride levels normalised after completion of ALL therapy in all 12 patients with available measurements. Asparaginase- and steroid-induced transient hypertriglyceridaemia can be adequately managed with dietary modifications and close monitoring without altering chemotherapy. Patients with severe hypertriglyceridaemia were not at increased risk of adverse events, with a possible exception of thrombosis. The benefit of pharmacotherapy in decreasing symptoms and potential complications requires further investigation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Human sense utilization method on real-time computer graphics

NASA Astrophysics Data System (ADS)

Maehara, Hideaki; Ohgashi, Hitoshi; Hirata, Takao

1997-06-01

We are developing an adjustment method of real-time computer graphics, to obtain effective ones which give audience various senses intended by producer, utilizing human sensibility technologically. Generally, production of real-time computer graphics needs much adjustment of various parameters, such as 3D object models/their motions/attributes/view angle/parallax etc., in order that the graphics gives audience superior effects as reality of materials, sense of experience and so on. And it is also known it costs much to adjust such various parameters by trial and error. A graphics producer often evaluates his graphics to improve it. For example, it may lack 'sense of speed' or be necessary to be given more 'sense of settle down,' to improve it. On the other hand, we can know how the parameters in computer graphics affect such senses by means of statistically analyzing several samples of computer graphics which provide different senses. We paid attention to these two facts, so that we designed an adjustment method of the parameters by inputting phases of sense into a computer. By the way of using this method, it becomes possible to adjust real-time computer graphics more effectively than by conventional way of trial and error.

Cognitive, behavioral and goal adjustment coping and depressive symptoms in young people with diabetes: a search for intervention targets for coping skills training.

PubMed

Kraaij, Vivian; Garnefski, Nadia

2015-03-01

The aim of the present study was to find relevant coping factors for the development of psychological intervention programs for young people with Type 1 (T1) diabetes. A wide range of coping techniques was studied, including cognitive coping, behavioral coping and goal adjustment coping. A total of 78 young people with T1 diabetes participated. They were contacted through a social networking website, several Internet sites, and flyers. A wide range of coping techniques appeared to be related to depressive symptoms. Especially the cognitive coping strategies self-blame, rumination, refocus positive, and other-blame, together with goal adjustment coping, were of importance. A large proportion of the variance of depressive symptoms could be explained (65 %). These findings suggest that these specific coping strategies should be part of coping skills trainings for young people with T1 diabetes.

Risk-adjusted outcome prediction with initial post-cardiac arrest illness severity: implications for cardiac arrest survivors being considered for early invasive strategy.

PubMed

Reynolds, Joshua C; Rittenberger, Jon C; Toma, Catalin; Callaway, Clifton W

2014-09-01

Early CATH is recommended for cardiac arrest survivors with STEMI or suspicion for coronary ischemia. Comatose patients are at risk of death from neurologic injury irrespective of CATH, but post-procedural mortality data do not distinguish between causes of death. Pittsburgh Post Cardiac Arrest Category (PCAC) is a validated, early post-cardiac arrest illness severity score based on initial cardiopulmonary dysfunction and neurologic examination. We evaluated the association between early coronary angiography (CATH) and patient outcome after adjusting for initial post-cardiac arrest illness severity. Retrospective study of a prospective cardiac arrest database at a single site. We included 1011 adult survivors of non-traumatic in-hospital or out-of-hospital cardiac arrest from 2005 to 2012, then stratified by PCAC and immediate CATH. Logistic regression tested the association between immediate CATH and patient outcomes, adjusting for PCAC. Overall, 273 (27%) received immediate CATH. Patients with immediate CATH had higher proportions of good outcome in all but the most severe stratum of illness severity (11% vs. 6%; p=0.11). The primary mode of death was neurologic for all but the least severe stratum. Adjusting for PCAC, immediate CATH was associated with favorable discharge disposition (OR 1.92; 95%CI 1.20, 3.07; p=0.006) and modified Rankin scale (OR 1.95; 95%CI 1.12, 3.38; p=0.02). The benefit of CATH is less clear in the most severe stratum of illness, in which the high risk of mortality is primarily from neurologic causes. PCAC is a risk-stratification tool that provides pre-procedural risk-adjusted outcome prediction for post-cardiac arrest patients being evaluated for immediate CATH. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Standard guide for developing a cost-effective risk mitigation plan for new and existing constructed facilities

Treesearch

Jeffrey Prestemon

2011-01-01

Protecting constructed facilities from damages from natural and man-made hazards in a costeffective manner is a challenging task. Several measures of economic performance are available for evaluating building-related investments. These measures include, but are not limited to, life-cycle cost, present value net savings, savings-to-investment ratio, and adjusted...

Constructing spherical panoramas of a bladder phantom from endoscopic video using bundle adjustment

NASA Astrophysics Data System (ADS)

Soper, Timothy D.; Chandler, John E.; Porter, Michael P.; Seibel, Eric J.

2011-03-01

The high recurrence rate of bladder cancer requires patients to undergo frequent surveillance screenings over their lifetime following initial diagnosis and resection. Our laboratory is developing panoramic stitching software that would compile several minutes of cystoscopic video into a single panoramic image, covering the entire bladder, for review by an urolgist at a later time or remote location. Global alignment of video frames is achieved by using a bundle adjuster that simultaneously recovers both the 3D structure of the bladder as well as the scope motion using only the video frames as input. The result of the algorithm is a complete 360° spherical panorama of the outer surface. The details of the software algorithms are presented here along with results from both a virtual cystoscopy as well from real endoscopic imaging of a bladder phantom. The software successfully stitched several hundred video frames into a single panoramic with subpixel accuracy and with no knowledge of the intrinsic camera properties, such as focal length and radial distortion. In the discussion, we outline future work in development of the software as well as identifying factors pertinent to clinical translation of this technology.

High morbidity and mortality of Clostridium difficile infection and its associations with ribotype 002 in Hong Kong.

PubMed

Wong, Sunny H; Ip, Margaret; Hawkey, Peter M; Lo, Norman; Hardy, Katie; Manzoor, Susan; Hui, Wyman W M; Choi, Kin-Wing; Wong, Rity Y K; Yung, Irene M H; Cheung, Catherine S K; Lam, Kelvin L Y; Kwong, Thomas; Wu, William K K; Ng, Siew C; Wu, Justin C Y; Sung, Joseph J Y; Lee, Nelson

2016-08-01

We aim to study the disease burden, risk factors and severity of Clostridium difficile infection (CDI) in Hong Kong. We conducted a prospective, case-control study in three acute-care hospitals in Hong Kong. Adult inpatients who developed CDI diarrhoea confirmed by PCR (n = 139) were compared with the non-CDI controls (n = 114). Ribotyping of isolates and antimicrobial susceptibility testing were performed. The estimated crude annual incidence of CDI was 23-33/100,000 population, and 133-207/100,000 population among those aged ≥65 years. The mean age of CDI patients was 71.5. Nursing home care, recent hospitalization, antibiotics exposure (adjusted OR 3.0, 95% CI 1.3-7.1) and proton-pump inhibitors use (adjusted OR 2.2, 95% CI 1.2-3.9) were risk factors. Severe CDI occurred in 41.7%. Overall mortality was 16.5% (among severe CDI, 26.5%). The commonest ribotypes were 002 (22.8%), 014 (14.1%), 012 and 046; ribotype 027 was absent. Ribotype 002 was associated with fluoroquinolone resistance and higher mortality (47.6% vs. 12.7%; adjusted HR 2.8, 95% CI 1.1-7.0). Our findings show high morbidity and mortality of CDI in the older adults, and identify ribotype 002 as a possible virulent strain causing serious infections in this cohort. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Association Between Severe Hypoglycemia and Cardiovascular Disease Risk in Japanese Patients With Type 2 Diabetes.

PubMed

Goto, Atsushi; Goto, Maki; Terauchi, Yasuo; Yamaguchi, Naohito; Noda, Mitsuhiko

2016-03-09

It remains unclear whether severe hypoglycemia is associated with cardiovascular disease (CVD) in Asian populations with type 2 diabetes (T2D). Furthermore, no study in Japan, where the prescription patterns differ from those in other countries, has examined this association. We retrospectively included 58 223 patients (18-74 years old) with T2D. First, we examined the potential predictors of severe hypoglycemia. Then, we investigated the association between severe hypoglycemia and CVD risk. Finally, we performed an updated systematic review and meta-analysis to incorporate our findings and recently published studies into the previous systematic review and meta-analysis. During 134 597 person-years from cumulative observation periods, 128 persons experienced severe hypoglycemia and 550 developed CVD events. In a multivariate Cox proportional hazard model, severe hypoglycemia was strongly and positively associated with the risk of CVD (multivariate-adjusted adjusted hazard ratio, 3.39; 95% CI, 1.25-9.18). In a propensity score-matched cohort that had similar baseline characteristics for patients with severe hypoglycemia and those without, severe hypoglycemia was more strongly associated with the risk of CVD. An updated systematic review and meta-analysis that included 10 studies found that severe hypoglycemia was associated with an ≈2-fold increased risk of CVD (pooled relative risk, 1.91; 95% CI, 1.69-2.15). Our results suggest that severe hypoglycemia is strongly associated with an increased risk of CVD in Japanese patients with T2D, further supporting the notion that avoiding severe hypoglycemia may be important in preventing CVD in this patient population. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Consciousness Level and Off‐Hour Admission Affect Discharge Outcome of Acute Stroke Patients: A J‐ASPECT Study

PubMed Central

Kamitani, Satoru; Nishimura, Kunihiro; Nakamura, Fumiaki; Kada, Akiko; Nakagawara, Jyoji; Toyoda, Kazunori; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Matsuda, Shinya; Miyamoto, Yoshihiro; Iwata, Michiaki; Suzuki, Akifumi; Ishikawa, Koichi B.; Kataoka, Hiroharu; Morita, Kenichi; Kobayashi, Yasuki; Iihara, Koji

2014-01-01

Background Poor outcomes have been reported for stroke patients admitted outside of regular working hours. However, few studies have adjusted for case severity. In this nationwide assessment, we examined relationships between hospital admission time and disabilities at discharge while considering case severity. Methods and Results We analyzed 35 685 acute stroke patients admitted to 262 hospitals between April 2010 and May 2011 for ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). The proportion of disabilities/death at discharge as measured by the modified Rankin Scale (mRS) was quantified. We constructed 2 hierarchical logistic regression models to estimate the effect of admission time, one adjusted for age, sex, comorbidities, and number of beds; and the second adjusted for the effect of consciousness levels and the above variables at admission. The percentage of severe disabilities/death at discharge increased for patients admitted outside of regular hours (22.8%, 27.2%, and 28.2% for working‐hour, off‐hour, and nighttime; P<0.001). These tendencies were significant in the bivariate and multivariable models without adjusting for consciousness level. However, the effects of off‐hour or nighttime admissions were negated when adjusted for consciousness levels at admission (adjusted OR, 1.00 and 0.99; 95% CI, 1.00 to 1.13 and 0.89 to 1.10; P=0.067 and 0.851 for off‐hour and nighttime, respectively, versus working‐hour). The same trend was observed when each stroke subtype was stratified. Conclusions The well‐known off‐hour effect might be attributed to the severely ill patient population. Thus, sustained stroke care that is sufficient to treat severely ill patients during off‐hours is important. PMID:25336463

Restless Legs Syndrome and Depression: Effect Mediation by Disturbed Sleep and Periodic Limb Movements.

PubMed

Koo, Brian B; Blackwell, Terri; Lee, Hochang B; Stone, Katie L; Louis, Elan D; Redline, Susan

2016-11-01

To investigate an association between restless legs syndrome (RLS) and depression and to what extent sleep disturbance, periodic limb movements during sleep (PLMS), and antidepressant medication mediate this relationship. A cross-sectional analysis was conducted of the Osteoporotic Fractures in Older Men Study data in 982 men assessed for RLS (International RLS Study Group scale [IRLSS]) and depression (Geriatric Depression Scale [GDS]), who underwent actigraphy (for sleep latency/efficiency) and polysomnography (for PLMS). Men were split into three groups: no RLS (N = 815), mild RLS (IRLSS ≤ 12, N = 85), moderate-to-severe RLS (IRLSS > 12, N = 82). Depression was defined as GDS score ≥ 6. Logistic and linear regression assessed associations of RLS and depression or number depressive symptoms, respectively. Models were adjusted for age, site, race, education, body mass index, personal habits, benzodiazepine/dopaminergic medication, physical activity, cardiovascular risk factors, and apnea-hypopnea index. Of 982 men, 167 (17.0%) had RLS. Depression was significantly associated with moderate-to-severe RLS after adjustment (versus no RLS: OR [95% CI] 2.85 [1.23, 6.64]). Further adjustment for potential mediators attenuated effect size modestly, most for sleep efficiency (OR: 2.85-2.55). Compared with no RLS, moderate-to-severe RLS was associated with the number of depressive symptoms after adjustment (adjusted means [95% CI]; no RLS: 1.14 [1.05, 1.24] versus IRLSS > 12: 1.69 [1.32, 2.11]). Further adjustment for potential mediators did not alter effect size. For men with PLMS index at least median, number of depressive symptoms significantly increased as RLS category became more severe. Depression is more common as RLS severity worsens. The RLS-depression relationship is modestly explained by sleep disturbance and PLMS. Published by Elsevier Inc.

Early aspirin use and the development of cardiac allograft vasculopathy.

PubMed

Kim, Miae; Bergmark, Brian A; Zelniker, Thomas A; Mehra, Mandeep R; Stewart, Garrick C; Page, Deborah S; Woodcome, Erica L; Smallwood, Jennifer A; Gabardi, Steven; Givertz, Michael M

2017-12-01

Cardiac allograft vasculopathy (CAV) remains a leading cause of morbidity and mortality after orthotopic heart transplantation (OHT). Little is known about the influence of aspirin on clinical expression of CAV. We followed 120 patients with OHT at a single center for a median of 7 years and categorized them by the presence or absence of early aspirin therapy post-transplant (aspirin treatment ≥6 months in the first year). The association between aspirin use and time to the primary end-point of angiographic moderate or severe CAV (International Society for Heart and Lung Transplantation grade ≥2) was investigated. Propensity scores for aspirin treatment were estimated using boosting models and applied by inverse probability of treatment weighting (IPTW). Despite a preponderance of risk factors for CAV among patients receiving aspirin (male sex, ischemic heart disease as the etiology of heart failure, and smoking), aspirin therapy was associated with a lower rate of moderate or severe CAV at 5 years. Event-free survival was 95.9% for patients exposed to aspirin compared with 79.6% for patients without aspirin exposure (log-rank p = 0.005). IPTW-weighted Cox regression revealed a powerful inverse association between aspirin use and moderate to severe CAV (adjusted hazard ratio 0.13; 95% confidence interval 0.03-0.59), which was directionally consistent for CAV of any severity (adjusted hazard ratio 0.50; 95% confidence interval 0.23-1.08). This propensity score-based comparative observational analysis suggests that early aspirin exposure may be associated with a reduced risk of development of moderate to severe CAV. These findings warrant prospective validation in controlled investigations. Copyright © 2017 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Children's Adjustment Problems in Families Characterized by Men's Severe Violence toward Women: Does Other Family Violence Matter?

ERIC Educational Resources Information Center

McDonald, Renee; Jouriles, Ernest N.; Tart, Candyce D.; Minze, Laura C.

2009-01-01

Objective: This research examined whether additional forms of family violence (partner-child aggression, mother-child aggression, and women's intimate partner violence [IPV]) contribute to children's adjustment problems in families characterized by men's severe violence toward women. Methods: Participants were 258 children and their mothers…

Psychosocial Adjustment and Life Satisfaction until 5 Years after Severe Brain Damage

ERIC Educational Resources Information Center

Sorbo, Ann K.; Blomqvist, Maritha; Emanuelsson, Ingrid M.; Rydenhag, Bertil

2009-01-01

The objectives of this study were to describe psychosocial adjustment and outcome over time for severely brain-injured patients and to find suitable outcome measures for clinical practice during the rehabilitation process and for individual rehabilitation planning after discharge from hospital. The methods include a descriptive, prospective,…

Course and Severity of Maternal Depression: Associations with Family Functioning and Child Adjustment

ERIC Educational Resources Information Center

Foster, Cynthia Ewell; Webster, Melissa C.; Weissman, Myrna M.; Pilowsky, Daniel J.; Wickramaratne, Priya J.; Rush, A. John; Hughes, Carroll W.; Garber, Judy; Malloy, Erin; Cerda, Gabrielle; Kornstein, Susan G.; Alpert, Jonathan E.; Wisniewski, Stephen R.; Trivedi, Madhukar H.; Fava, Maurizio; King, Cheryl A.

2008-01-01

Number of lifetime episodes, duration of current episode, and severity of maternal depression were investigated in relation to family functioning and child adjustment. Participants were the 151 mother-child pairs in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) child multi-site study. Mothers were diagnosed with Major…

Ego strengths, racial/ethnic identity, and well-being among North American Indian/First Nations adolescents.

PubMed

Gfellner, Barbara

2016-01-01

This study investigated associations between ego strengths (psychosocial development), racial/ethnic identity using Multi-Ethnic Identity Measure-Revised (exploration, commitment) and Multidimensional Measure of Racial Identity (centrality, private regard, public regard) dimensions, and personal adjustment/well-being among 178 North American Indian/First Nations adolescents who resided and attended school on reserves. As predicted, ego strengths related directly with centrality, private regard, and the adjustment measures; the moderation of ego strengths for exploration, commitment, and private regard reflected adverse functioning for those with less than advanced ego strengths. As well, ego strengths mediated associations between centrality and private regard with several measures of personal well-being. Practical and theoretical implications are considered.

Interpersonal Stressors and Resources as Predictors of Adolescent Adjustment Following Traumatic Brain Injury.

PubMed

Lantagne, Ann; Peterson, Robin L; Kirkwood, Michael W; Taylor, H Gerry; Stancin, Terry; Yeates, Keith Owen; Wade, Shari L

2018-03-29

The present study sought to examine adolescents' perceptions of their interpersonal stressors and resources across parent, sibling, friend, and school relationships, and the longitudinal associations with self-reported adjustment after traumatic brain injury (TBI) over a 12-month period. We examined the main effects of stressors and resources on internalizing and externalizing symptoms in 152 adolescents who had sustained complicated mild-to-severe TBI. We also investigated the conjoint effects of stressors and resources and the moderating effects of TBI severity with stressors and resources on outcomes. High stressors consistently predicted worse adjustment. High resources were generally only associated with fewer internalizing symptoms. Main effects were qualified by interactions between school stressors and resources in predicting externalizing symptoms and between friend stressors and resources in predicting internalizing and externalizing symptoms. For school stressors, the effects of resources on externalizing symptoms functioned as a buffer. In comparison, the buffering effects of friend resources on internalizing and externalizing symptoms disappeared at moderate-to-high levels of friend stress. Moderating effects of TBI severity were also observed, such that as family resources increased, only adolescents with complicated mild-to-moderate TBI, but not those with severe TBI, experienced decreases in internalizing and eternalizing symptoms. Interpersonal stressors and social support have important implications for adolescent adjustment after TBI. Adolescents with low levels of school resources, with high levels of friend stress, and who sustain severe TBI are at greatest risk for difficulties with adjustment.

Acute Kidney Injury in Pediatric Severe Sepsis, An Independent Risk Factor for Death and New Disability

PubMed Central

Fitzgerald, Julie C.; Basu, Rajit; Akcan-Arikan, Ayse; Izquierdo, Ledys M.; Piñeres Olave, Byron E.; Hassinger, Amanda B.; Szczepanska, Maria; Deep, Akash; Williams, Duane; Sapru, Anil; Roy, Jason A.; Nadkarni, Vinay M.; Thomas, Neal J.; Weiss, Scott L.; Furth, Susan

2017-01-01

Objective The prevalence of septic acute kidney injury (AKI) and impact on functional status of pediatric intensive care unit (PICU) survivors are unknown. We utilized data from an international prospective severe sepsis study to elucidate functional outcomes of children suffering septic AKI. Design Secondary analysis of patients in the Sepsis PRevalence, OUtcomes, and Therapies (SPROUT) point prevalence study. AKI was defined on the study day using Kidney Disease Improving Global Outcomes definitions. Patients with no AKI or stage 1 AKI (“No/mild AKI”) were compared to those with stage 2 or 3 AKI (“Severe AKI”). The primary outcome was a composite of death or new moderate disability at discharge defined as a Pediatric Overall Performance Category score of 3 or higher, and increased by 1 from baseline. Setting 128 PICUs in 26 countries. Patients Children with severe sepsis in the SPROUT study. Interventions None Measurements and Main Results One hundred two (21%) of 493 patients had Severe AKI. More than twice as many patients with Severe AKI died or developed new moderate disability compared to those with No/mild AKI (64% vs. 30%, p<0.001). Severe AKI was independently associated with death or new moderate disability (adjusted OR 2.5, 95% CI 1.5, 4.2; p=0.001) after adjustment for age, region, baseline disability, malignancy, invasive mechanical ventilation, albumin administration, and the pediatric logistic organ dysfunction score. Conclusions In a multi-national cohort of critically ill children with severe sepsis and high mortality rates, septic AKI is independently associated with further increased death or new disability. PMID:27513354

Relationship Between a Sepsis Intervention Bundle and In-Hospital Mortality Among Hospitalized Patients: A Retrospective Analysis of Real-World Data.

PubMed

Prasad, Priya A; Shea, Erica R; Shiboski, Stephen; Sullivan, Mary C; Gonzales, Ralph; Shimabukuro, David

2017-08-01

Sepsis is a systemic response to infection that can lead to tissue damage, organ failure, and death. Efforts have been made to develop evidence-based intervention bundles to identify and manage sepsis early in the course of the disease to decrease sepsis-related morbidity and mortality. We evaluated the relationship between a minimally invasive sepsis intervention bundle and in-hospital mortality using robust methods for observational data. We performed a retrospective cohort study at the University of California, San Francisco, Medical Center among adult patients discharged between January 1, 2012, and December 31, 2014, and who received a diagnosis of severe sepsis/septic shock (SS/SS). Sepsis intervention bundle elements included measurement of blood lactate; drawing of blood cultures before starting antibiotics; initiation of broad spectrum antibiotics within 3 hours of sepsis presentation in the emergency department or 1 hour of presentation on an inpatient unit; administration of intravenous fluid bolus if the patient was hypotensive or had a lactate level >4 mmol/L; and starting intravenous vasopressors if the patient remained hypotensive after fluid bolus administration. Poisson regression for a binary outcome variable was used to estimate an adjusted incidence-rate ratio (IRR) comparing mortality in groups defined by bundle compliance measured as a binary predictor, and to estimate an adjusted number needed to treat (NNT). Complete bundle compliance was associated with a 31% lower risk of mortality (adjusted IRR, 0.69, 95% confidence interval [CI], 0.53-0.91), adjusting for SS/SS presentation in the emergency department, SS/SS present on admission (POA), age, admission severity of illness and risk of mortality, Medicaid/Medicare payor status, immunocompromised host status, and congestive heart failure POA. The adjusted NNT to save one life was 15 (CI, 8-69). Other factors independently associated with mortality included SS/SS POA (adjusted IRR, 0.55; CI, 0.32-0.92) and increased age (adjusted IRR, 1.13 per 10-year increase in age; CI, 1.03-1.24). The University of California, San Francisco, sepsis bundle was associated with a decreased risk of in-hospital mortality across hospital units after robust control for confounders and risk adjustment. The adjusted NNT provides a reasonable and achievable goal to observe measureable improvements in outcomes for patients diagnosed with SS/SS.

The dynamics of plant plasma membrane proteins: PINs and beyond.

PubMed

Luschnig, Christian; Vert, Grégory

2014-08-01

Plants are permanently situated in a fixed location and thus are well adapted to sense and respond to environmental stimuli and developmental cues. At the cellular level, several of these responses require delicate adjustments that affect the activity and steady-state levels of plasma membrane proteins. These adjustments involve both vesicular transport to the plasma membrane and protein internalization via endocytic sorting. A substantial part of our current knowledge of plant plasma membrane protein sorting is based on studies of PIN-FORMED (PIN) auxin transport proteins, which are found at distinct plasma membrane domains and have been implicated in directional efflux of the plant hormone auxin. Here, we discuss the mechanisms involved in establishing such polar protein distributions, focusing on PINs and other key plant plasma membrane proteins, and we highlight the pathways that allow for dynamic adjustments in protein distribution and turnover, which together constitute a versatile framework that underlies the remarkable capabilities of plants to adjust growth and development in their ever-changing environment. © 2014. Published by The Company of Biologists Ltd.

Psychological adjustment in Spanish young adult domestic adoptees: Mental health and licit substance consumption.

PubMed

Sánchez-Sandoval, Yolanda; Melero, Sandra

2018-05-24

Although adoptive families have been shown to provide a protective context for human development, some adopted children and adolescents are at increased risk for psychological adjustment problems. On the other hand, little is known about psychological adjustment of young adult adoptees. The aim of this study is to analyze the mental health and legal substance consumption (tobacco and alcohol) of young adults (n = 134) who were domestically adopted by Spanish families. Young adults showed significantly worse scores on the Symptom Check-List-90-R (Derogatis, 1975) and also more substance use than did the Spanish general population, but fewer difficulties than did the clinical population. On the Global Severity Index (GSI), 65.7% of adoptees were within the normal range, 24.6% were at risk, and 9.7% were within the clinical range. Male adoptees scored higher than expected for the general population on all subscales, whereas female adoptees did not. Age at adoption was not found to have a significant impact on adjustment. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Children's longing for everydayness: life following traumatic brain injury in the USA

PubMed Central

Roscigno, Cecelia I.; Swanson, Kristen M.; Vavilala, Monica S.; Solchany, JoAnne

2012-01-01

Primary Objective Little is known about life after traumatic brain injury (TBI) from the child's perspective. Research Design This descriptive phenomenological investigation explored themes of children's experiences following moderate to severe TBI. Methods and Procedures Inclusion criteria: 1) 6 – 18 years of age at injury; 2) moderate to severe TBI; 3) ≤ 3 years since injury; and 4) English speaking and could participate in an interview. Children participated (N = 39) in two interviews at least one year apart. A preliminary model was developed and shared for participants' input. Main Outcomes and Results Six themes emerged: 1) it is like waking up in a bad dream; 2) I thought going home would get me back to my old life, but it did not; 3) everything is such hard work; 4) you feel like you will never be like the person you were before; 5) it is not all bad; and 6) some people get it, but many people do not. Conclusions Social support was important to how children adjusted to changes or losses. Most children did adjust to functional changes by second interviews. Children had a more difficult time adjusting to how others defined them and limited their possibilities for a meaningful life. PMID:21631183

Women's prepregnancy underweight as a risk factor for preterm birth: a retrospective study.

PubMed

Girsen, A I; Mayo, J A; Carmichael, S L; Phibbs, C S; Shachar, B Z; Stevenson, D K; Lyell, D J; Shaw, G M; Gould, J B

2016-11-01

To investigate the distribution of known factors for preterm birth (PTB) by severity of maternal underweight; to investigate the risk-adjusted relation between severity of underweight and PTB, and to assess whether the relation differed by gestational age. Retrospective cohort study. State of California, USA. Maternally linked hospital and birth certificate records of 950 356 California deliveries in 2007-2010 were analysed. Singleton live births of women whose prepregnancy body mass index (BMI) was underweight (<18.5 kg/m 2 ) or normal (18.50-24.99 kg/m 2 ) were analysed. Underweight BMI was further categorised as: severe (<16.00), moderate (16.00-16.99) or mild (17.00-18.49). PTB was grouped as 22-27, 28-31, 32-36 or <37 weeks (compared with 37-41 weeks). Adjusted multivariable Poisson regression modeling was used to estimate relative risk for PTB. Risk of PTB. About 72 686 (7.6%) women were underweight. Increasing severity of underweight was associated with increasing percent PTB: 7.8% (n = 4421) in mild, 9.0% (n = 1001) in moderate and 10.2% (475) in severe underweight. The adjusted relative risk of PTB also significantly increased: adjusted relative risk (aRR) = 1.22 (95% CI 1.19-1.26) in mild, aRR = 1.41 (95% CI 1.32-1.50) in moderate and aRR = 1.61 (95% CI 1.47-1.76) in severe underweight. These findings were similar in spontaneous PTB, medically indicated PTB, and the gestational age groupings. Increasing severity of maternal prepregnancy underweight BMI was associated with increasing risk-adjusted PTB at <37 weeks. This increasing risk was of similar magnitude in spontaneous and medically indicated births and in preterm delivery at 28-31 and at 32-36 weeks of gestation. Increasing severity of maternal underweight BMI was associated with increasing risk of preterm birth. © 2016 Royal College of Obstetricians and Gynaecologists.

SiC MOSFET Switching Power Amplifier Project Summary

NASA Astrophysics Data System (ADS)

Miller, Kenneth E.; Ziemba, Timothy; Prager, James; Slobodov, Ilia; Henson, Alex

2017-10-01

Eagle Harbor Technologies has completed a Phase I/II program to develop SiC MOSFET based Switching Power Amplifiers (SPA) for precision magnet control in fusion science applications. During this program, EHT developed several units have been delivered to the Helicity Injected Torus (HIT) experiment at the University of Washington to drive both the voltage and flux circuits of the helicity injectors. These units are capable of switching 700 V at 100 kHz with an adjustable duty cycle from 10 - 90% and a combined total output current of 96 kA for 4 ms (at max current). The SPAs switching is controlled by the microcontroller at HIT, which adjusts the duty cycle to maintain a specific waveform in the injector. The SPAs include overcurrent and shoot-through protection circuity. EHT will present an overview of the program including final results for the SPA waveforms. With support of DOE SBIR.

Precarious employment and new-onset severe depressive symptoms: a population-based prospective study in South Korea.

PubMed

Jang, Suk-Yong; Jang, Sung-In; Bae, Hong-Chul; Shin, Jaeyong; Park, Eun-Cheol

2015-07-01

Considering the effect of sex and head of household responsibilities, this study was designed to evaluate whether precarious employment is associated with the development of new-onset severe depressive symptoms. We followed 2214 male and 1276 female waged workers, ≤59 years of age and without moderate depressive symptom, from the Korean Welfare Panel Study 2007-2013. Their employment status was classified as full-time permanent, precarious, self-employed, or unemployed after baseline. Except for occupation and company size, all variables were treated as time-dependent. Severe depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D-11). A generalized estimating equation was used to evaluate the effect of employment status on the development of new-onset severe depressive symptoms. After adjusting for initial baseline CES-D-11 score, chronic disease, and other socioeconomic covariates, precarious employment was associated with the development of new-onset severe depressive symptoms among male heads of household [odds ratio (OR) 1.52, 95% confidence interval (95% CI) 1.02-2.25] and female heads of household (OR 4.19, 95% CI 1.70-10.32). In addition, the transition from full-time permanent employment to another employment status was associated with the development of new-onset severe depressive symptoms among both sexes, with an especially strong association among females. The present study suggests that, depending on head of household status and sex, precarious employment is associated with the development of new-onset severe depressive symptoms.

Teachers and Their International Relocation: The Effect of Self-Efficacy and Flexibility on Adjustment and Outcome Variables

ERIC Educational Resources Information Center

von Kirchenheim, Clement; Richardson, Warnie

2005-01-01

In this study the adjustment process in a designated group of expatriates, (teachers), who have severed ties with their home country and employer is investigated. Based on existing literature, the value of self-efficacy and flexibility on the adjustment process was explored. It was hypothesised that adjustment would result in reduced turnover…

Use of Prolonged Travel to Improve Pediatric Risk-Adjustment Models

PubMed Central

Lorch, Scott A; Silber, Jeffrey H; Even-Shoshan, Orit; Millman, Andrea

2009-01-01

Objective To determine whether travel variables could explain previously reported differences in lengths of stay (LOS), readmission, or death at children's hospitals versus other hospital types. Data Source Hospital discharge data from Pennsylvania between 1996 and 1998. Study Design A population cohort of children aged 1–17 years with one of 19 common pediatric conditions was created (N=51,855). Regression models were constructed to determine difference for LOS, readmission, or death between children's hospitals and other types of hospitals after including five types of additional illness severity variables to a traditional risk-adjustment model. Principal Findings With the traditional risk-adjustment model, children traveling longer to children's or rural hospitals had longer adjusted LOS and higher readmission rates. Inclusion of either a geocoded travel time variable or a nongeocoded travel distance variable provided the largest reduction in adjusted LOS, adjusted readmission rates, and adjusted mortality rates for children's hospitals and rural hospitals compared with other types of hospitals. Conclusions Adding a travel variable to traditional severity adjustment models may improve the assessment of an individual hospital's pediatric care by reducing systematic differences between different types of hospitals. PMID:19207591

76 FR 2762 - Proposed Information Collection (VAAR Clause 852.236.91, Special Notes) Activity: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-14

... support claims for price adjustment due to delay in construction caused by severe weather. DATES: Written... facilities available to perform the work. The clause also requires contractors submitting a claim for price adjustment due to severe weather delay to provide climatologically data covering the period of the claim and...

An Illustration to Assist in Comparing and Remembering Several Multiplicity Adjustment Methods

ERIC Educational Resources Information Center

Hasler, Mario

2017-01-01

There are many well-known or new methods to adjust statistical tests for multiplicity. This article provides an illustration helping lecturers or consultants to remember the differences of three important multiplicity adjustment methods and to explain them to non-statisticians.

Mesoscale aspects of jet streak coupling and implications for the short term forecasting of severe convective storms. [severe environmental storms and mesoscale experiment (SESAME)

NASA Technical Reports Server (NTRS)

Uccellini, L. W.; Kocin, P. J.

1981-01-01

An analysis of a tornado outbreak in Wichita Falls, Texas was analyzed. The coupling of upper and lower tropospheric jet streaks, leading to severe storm outbreaks is illustrated. The high resolution SESAME data sets indicate that mass and momentum adjustments which couple upper and lower tropospheric jets occur within a 3 to 6 hr time frame over a 100 to 500 km domain, and establish the role of isallobaric forcing in the storm development. It is suggested that the output rate of data from the existing 12 hr network be increased to provide better temporal resolution of wind, mass and moisture data.

Counselling Needs of Pupils with Special Educational Needs and Disabilities in the Greater Accra Region of Ghana: Implications for Inclusive Education in Ghana

ERIC Educational Resources Information Center

Ocansey, S. K.; Gyimah, E. K.

2016-01-01

In this fast changing world, pupils all over the world have developed severe social and psychological needs that affect their interactions with others and subsequently, the achievement of their life goals. Essentially, the social and psychological needs of school pupils have manifested in diverse mal-adjusted behaviours that hinder their academic…

Development of a high stability pointing mechanism for wide application

NASA Technical Reports Server (NTRS)

Brunnen, A. J. D.; Bentall, R. H.

1982-01-01

A recurrent requirement of spaceborne instruments and communications equipment is that of accurate pointing. This need is recognizable in such diverse applications as Star Sensor trimming, Momentum Wheel gimballing, in-orbit adjustment or alignment of equipment, inter-satellite communication and Antenna Pointing. A pointing mechanism of novel design having several advantages over the more conventional gimbal, centre-pivoted, or cross axis pointing concepts is described.

Non-alcoholic fatty liver disease and the development of reflux esophagitis: A cohort study.

PubMed

Min, Yang Won; Kim, Youngha; Gwak, Geum-Youn; Gu, Seonhye; Kang, Danbee; Cho, Soo Jin; Guallar, Eliseo; Cho, Juhee; Sinn, Dong Hyun

2018-05-01

Non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome, is associated with gastroesophageal reflux disease in cross-sectional studies, but a prospective association has not been evaluated. The current study aimed to determine whether NAFLD increases the risk of incident reflux esophagitis in a large cohort study. We conducted a cohort study of 34 063 men and women without reflux esophagitis or other upper gastrointestinal disease at baseline who underwent health checkup examinations between January 2003 and December 2013. Fatty liver was diagnosed by ultrasound based on standard criteria. Reflux esophagitis was defined by the presence of at least grade A mucosal break on esophagogastroduodenoscopy. The prevalence of NAFLD at baseline was 33.2%. During 153 520.2 person-years of follow-up, the cumulative incidences of reflux esophagitis for participants without and with NAFLD were 9.6% and 13.8%, respectively (P < 0.001). The age-adjusted and sex-adjusted hazard ratio for the risk of reflux esophagitis development in participants with NAFLD compared with those without NAFLD was 1.15 (95% confidence interval 1.07-1.23; P < 0.001). However, this association disappeared after adjusting for body mass index and other metabolic factors (hazard ratio 1.01, 95% confidence interval 0.94-1.09; P = 0.79). Similarly, in multivariable-adjusted models, there was no significant association between NAFLD severity and the risk of developing reflux esophagitis. Non-alcoholic fatty liver disease is not independently associated with the risk of the development of reflux esophagitis, but rather, reflux esophagitis is primarily the consequence of increased body mass index commonly associated with NAFLD. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Racial differences in abnormal ambulatory blood pressure monitoring measures: Results from the Coronary Artery Risk Development in Young Adults (CARDIA) study.

PubMed

Muntner, Paul; Lewis, Cora E; Diaz, Keith M; Carson, April P; Kim, Yongin; Calhoun, David; Yano, Yuichiro; Viera, Anthony J; Shimbo, Daichi

2015-05-01

Several ambulatory blood pressure monitoring (ABPM) measures have been associated with increased cardiovascular disease risk independent of clinic blood pressure (BP). African Americans have higher clinic BP compared with Whites but few data are available on racial differences in ABPM measures. We compared ABPM measures between African American (n = 178) and White (n = 103) participants at the Year 5 Coronary Artery Risk Development in Young Adults study visit. BP was measured during a study visit and the second and third measurements were averaged. ABPM was conducted over the following 24 hours. Mean ± SD age of participants was 29.8 ± 3.8 years and 30.8 ± 3.5 years for African Americans and Whites, respectively. Mean daytime systolic BP (SBP) was 3.90 (SD 1.18) mm Hg higher among African Americans compared with Whites (P < 0.001) after age-gender adjustment and 1.71 (SD 1.03) mm Hg higher after multivariable adjustment including mean clinic SBP (P = 0.10). After multivariable adjustment including mean clinic SBP, nighttime SBP was 4.83 (SD 1.11) mm Hg higher among African Americans compared with Whites (P < 0.001). After multivariable adjustment, the African Americans were more likely than Whites to have nocturnal hypertension (prevalence ratio: 2.44, 95% CI: 0.99-6.05) and nondipping (prevalence ratio: 2.50, 95% CI: 1.39-4.48). The prevalence of masked hypertension among African Americans and Whites was 4.4% and 2.1%, respectively, (P = 0.49) and white coat hypertension was 3.3% and 3.9%, respectively (P = 0.99). Twenty-four hour BP variability on ABPM was higher among African Americans compared with Whites. These data suggest racial differences in several ABPM measures exist. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Post-Transplant Hypophosphatemia and the Risk of Death-Censored Graft Failure and Mortality after Kidney Transplantation.

PubMed

van Londen, Marco; Aarts, Brigitte M; Deetman, Petronella E; van der Weijden, Jessica; Eisenga, Michele F; Navis, Gerjan; Bakker, Stephan J L; de Borst, Martin H

2017-08-07

Hypophosphatemia is common in the first year after kidney transplantation, but its clinical implications are unclear. We investigated the relationship between the severity of post-transplant hypophosphatemia and mortality or death-censored graft failure in a large cohort of renal transplant recipients with long-term follow-up. We performed a longitudinal cohort study in 957 renal transplant recipients who were transplanted between 1993 and 2008 at a single center. We used a large real-life dataset containing 28,178 phosphate measurements (median of 27; first to third quartiles, 23-34) serial measurements per patient) and selected the lowest intraindividual phosphate level during the first year after transplantation. The primary outcomes were all-cause mortality, cardiovascular mortality, and death-censored graft failure. The median (interquartile range) intraindividual lowest phosphate level was 1.58 (1.30-1.95) mg/dl, and it was reached at 33 (21-51) days post-transplant. eGFR was the main correlate of the lowest serum phosphate level (model R 2 =0.32). During 9 (5-12) years of follow-up, 181 (19%) patients developed graft failure, and 295 (35%) patients died, of which 94 (32%) deaths were due to cardiovascular disease. In multivariable Cox regression analysis, more severe hypophosphatemia was associated with a lower risk of death-censored graft failure (fully adjusted hazard ratio, 0.61; 95% confidence interval, 0.43 to 0.88 per 1 mg/dl lower serum phosphate) and cardiovascular mortality (fully adjusted hazard ratio, 0.37; 95% confidence interval, 0.22 to 0.62) but not noncardiovascular mortality (fully adjusted hazard ratio, 1.33; 95% confidence interval, 0.9 to 1.96) or all-cause mortality (fully adjusted hazard ratio, 1.15; 95% confidence interval, 0.81 to 1.61). Post-transplant hypophosphatemia develops early after transplantation. These data connect post-transplant hypophosphatemia with favorable long-term graft and patient outcomes. Copyright © 2017 by the American Society of Nephrology.

Automatic welding systems for large ship hulls

NASA Astrophysics Data System (ADS)

Arregi, B.; Granados, S.; Hascoet, JY.; Hamilton, K.; Alonso, M.; Ares, E.

2012-04-01

Welding processes represents about 40% of the total production time in shipbuilding. Although most of the indoor welding work is automated, outdoor operations still require the involvement of numerous operators. To automate hull welding operations is a priority in large shipyards. The objective of the present work is to develop a comprehensive welding system capable of working with several welding layers in an automated way. There are several difficulties for the seam tracking automation of the welding process. The proposed solution is the development of a welding machine capable of moving autonomously along the welding seam, controlling both the position of the torch and the welding parameters to adjust the thickness of the weld bead to the actual gap between the hull plates.

Does 3-Day Course of Oral Amoxycillin Benefit Children of Non-Severe Pneumonia with Wheeze: A Multicentric Randomised Controlled Trial

PubMed Central

Awasthi, Shally; Agarwal, Girdhar; Kabra, Sushil K.; Singhi, Sunit; Kulkarni, Madhuri; More, Vaishali; Niswade, Abhimanyu; Pillai, Raj Mohan; Luke, Ravi; Srivastava, Neeraj M.; Suresh, Saradha; Verghese, Valsan P.; Raghupathy, P.; Lodha, R.; Walter, Stephen D.

2008-01-01

Background WHO-defined pneumonias, treated with antibiotics, are responsible for a significant proportion of childhood morbidity and mortality in the developing countries. Since substantial proportion pneumonias have a viral etiology, where children are more likely to present with wheeze, there is a concern that currently antibiotics are being over-prescribed for it. Hence the current trial was conducted with the objective to show the therapeutic equivalence of two treatments (placebo and amoxycillin) for children presenting with non-severe pneumonia with wheeze, who have persistent fast breathing after nebulisation with salbutamol, and have normal chest radiograph. Methodology This multi-centric, randomised placebo controlled double blind clinical trial intended to investigate equivalent efficacy of placebo and amoxicillin and was conducted in ambulatory care settings in eight government hospitals in India. Participants were children aged 2–59 months of age, who received either oral amoxycillin (31–54 mg/Kg/day, in three divided doses for three days) or placebo, and standard bronchodilator therapy. Primary outcome was clinical failure on or before day- 4. Principal Findings We randomized 836 cases in placebo and 835 in amoxycillin group. Clinical failures occurred in 201 (24.0%) on placebo and 166 (19.9%) on amoxycillin (risk difference 4.2% in favour of antibiotic, 95% CI: 0.2 to 8.1). Adherence for both placebo and amoxycillin was >96% and 98.9% subjects were followed up on day- 4. Clinical failure was associated with (i) placebo treatment (adjusted OR = 1.28, 95% CI: 1.01 to1.62), (ii) excess respiratory rate of >10 breaths per minute (adjusted OR = 1.51, 95% CI: 1.19, 1.92), (iii) vomiting at enrolment (adjusted OR = 1.49, 95% CI: 1.13, 1.96), (iv) history of use of broncho-dilators (adjusted OR = 1.71, 95% CI: 1.30, 2.24) and (v) non-adherence (adjusted OR = 8.06, 95% CI: 4.36, 14.92). Conclusions Treating children with non-severe pneumonia and wheeze with a placebo is not equivalent to treatment with oral amoxycillin. Trial Registration ClinicalTrials.gov NCT00407394 PMID:18431478

Economic evaluation of decompressive craniectomy versus barbiturate coma for refractory intracranial hypertension following traumatic brain injury.

PubMed

Alali, Aziz S; Naimark, David M J; Wilson, Jefferson R; Fowler, Robert A; Scales, Damon C; Golan, Eyal; Mainprize, Todd G; Ray, Joel G; Nathens, Avery B

2014-10-01

Decompressive craniectomy and barbiturate coma are often used as second-tier strategies when intracranial hypertension following severe traumatic brain injury is refractory to first-line treatments. Uncertainty surrounds the decision to choose either treatment option. We investigated which strategy is more economically attractive in this context. We performed a cost-utility analysis. A Markov Monte Carlo microsimulation model with a life-long time horizon was created to compare quality-adjusted survival and cost of the two treatment strategies, from the perspective of healthcare payer. Model parameters were estimated from the literature. Two-dimensional simulation was used to incorporate parameter uncertainty into the model. Value of information analysis was conducted to identify major drivers of decision uncertainty and focus future research. Trauma centers in the United States. Base case was a population of patients (mean age = 25 yr) who developed refractory intracranial hypertension following traumatic brain injury. We compared two treatment strategies: decompressive craniectomy and barbiturate coma. Decompressive craniectomy was associated with an average gain of 1.5 quality-adjusted life years relative to barbiturate coma, with an incremental cost-effectiveness ratio of $9,565/quality-adjusted life year gained. Decompressive craniectomy resulted in a greater quality-adjusted life expectancy 86% of the time and was more cost-effective than barbiturate coma in 78% of cases if our willingness-to-pay threshold is $50,000/quality-adjusted life year and 82% of cases at a threshold of $100,000/quality-adjusted life year. At older age, decompressive craniectomy continued to increase survival but at higher cost (incremental cost-effectiveness ratio = $197,906/quality-adjusted life year at mean age = 85 yr). Based on available evidence, decompressive craniectomy for the treatment of refractory intracranial hypertension following traumatic brain injury provides better value in terms of costs and health gains than barbiturate coma. However, decompressive craniectomy might be less economically attractive for older patients. Further research, particularly on natural history of severe traumatic brain injury patients, is needed to make more informed treatment decisions.

Mapping osmotic adjustment in an advanced back-cross inbred population of rice.

PubMed

Robin, S; Pathan, M S; Courtois, B; Lafitte, R; Carandang, S; Lanceras, S; Amante, M; Nguyen, H T; Li, Z

2003-11-01

Osmotic adjustment is one of several characters putatively associated with drought tolerance in rice. Indica cultivars are known to have a greater capacity for osmotic adjustment than japonica cultivars. We developed an advanced back-cross population using an indica donor, IR62266-42-6-2, to introgress osmotic adjustment into an elite japonica cultivar, IR60080-46A. One hundred and fifty BC(3)F(3) families were genotyped using microsatellites and RFLP markers, and a few candidate genes. We evaluated osmotic adjustment in these lines under greenhouse conditions using the re-hydration technique. Using the composite interval mapping technique, we detected 14 QTLs located on chromosomes 1, 2, 3, 4, 5, 7, 8 and 10 that together explained 58% of the phenotypic variability. Most, but not all, of the alleles with positive effects came from the donor parent. On chromosome 8, two QTLs were associated in repulsion. The QTL locations were in good agreement with previous studies on this trait on rice and in other cereals. Some BC(3)F(3) lines carried the favorable alleles at the two markers flanking up to four QTLs. Intercrossing these lines followed by marker-aided selection in their progenies will be necessary to recover lines with levels of osmotic adjustment equal to the donor parent. The advanced back-cross strategy appeared to be an appropriate method to accelerate the process of introgressing interesting traits into elite material.

Algorithm and Application of Gcp-Independent Block Adjustment for Super Large-Scale Domestic High Resolution Optical Satellite Imagery

NASA Astrophysics Data System (ADS)

Sun, Y. S.; Zhang, L.; Xu, B.; Zhang, Y.

2018-04-01

The accurate positioning of optical satellite image without control is the precondition for remote sensing application and small/medium scale mapping in large abroad areas or with large-scale images. In this paper, aiming at the geometric features of optical satellite image, based on a widely used optimization method of constraint problem which is called Alternating Direction Method of Multipliers (ADMM) and RFM least-squares block adjustment, we propose a GCP independent block adjustment method for the large-scale domestic high resolution optical satellite image - GISIBA (GCP-Independent Satellite Imagery Block Adjustment), which is easy to parallelize and highly efficient. In this method, the virtual "average" control points are built to solve the rank defect problem and qualitative and quantitative analysis in block adjustment without control. The test results prove that the horizontal and vertical accuracy of multi-covered and multi-temporal satellite images are better than 10 m and 6 m. Meanwhile the mosaic problem of the adjacent areas in large area DOM production can be solved if the public geographic information data is introduced as horizontal and vertical constraints in the block adjustment process. Finally, through the experiments by using GF-1 and ZY-3 satellite images over several typical test areas, the reliability, accuracy and performance of our developed procedure will be presented and studied in this paper.

[Funding of the management of severe malaria in children by Kinshasa households (Democratic Republic of Congo)].

PubMed

Ilunga-Ilunga, Félicien; Levêque, Alain; Dramaix, Michèle

2015-01-01

The objective of this study was to determine the source of health care funding for heads of households related to the management of severe malaria in children admitted to a Kinshasa reference hospital. This cross-sectional study was conducted on 1,350 hospitalised children under the age of 15 years treated for severe malaria in Kinshasa reference hospitals from January to November 2011 and the heads of households of these children. Only 46% of heads of households reported having sufficient funds directly available in the household budget. The remaining 54% had to call upon external sources of funding (sale of assets, loans, pawning goods). The use of a loan tended to increase significantly mainly for households with a low (adjusted odds ratio = 6.2), and intermediate socioeconomic status (adjusted odds ratio = 3.8) and for households working in the informal sector (adjusted odds ratio = 2.5). Similarly, the sale of assets was more frequently reported for households working in the informal sector (adjusted odds ratio = 2.4) and for female heads of households (adjusted odds ratio = 3.9). The management of severe malaria is a burden on household income. The majority of heads of households concerned needs to use external funding sources. A State subsidy for this management would help to reduce the risk of debt and sale of assets, especially for the poorest households.

The interactive role of subsynoptic scale jet sreak and planetary boundary layer adjustments in organizing an apparently isolated convective complex

NASA Technical Reports Server (NTRS)

Kaplan, M. L.; Zack, J. W.; Wong, V. C.; Tuccillo, J. J.; Coats, G. D.

1982-01-01

A mesoscale atmospheric simulation system is described that is being developed in order to improve the simulation of subsynoptic and mesoscale adjustments associated with cyclogenesis, severe storm development, and significant atmospheric transport processes. Present emphasis in model development is in the parameterization of physical processes, time-dependent boundary conditions, sophisticated initialization and analysis procedures, nested grid solutions, and applications software development. Basic characteristics of the system as of March 1982 are listed. In a case study, the Grand Island tornado outbreak of 3 June 1980 is considered in substantial detail. Results of simulations with a mesoscale atmospheric simulation system indicate that over the high plains subtle interactions between existing jet streaks and deep well mixed boundary layers can lead to well organized patterns of mesoscale divergence and pressure falls. The amplitude and positioning of these mesoscale features is a function of the subtle nonlinear interaction between the pre-existing jet-streak and deep well mixed boundary layers. Model results for the case study indicate that the model has the potential for forecasting the precursor mesoscale convective environment.

Indochina Refugees: Families in Turmoil.

ERIC Educational Resources Information Center

Okura, K. Patrick

Many Indochinese refugees in the United States suffer from serious social adjustment problems. These adjustment problems appear to reflect the stress of adapting to American life rather than chronic dysfunction. Particular groups of Indochinese who appear to experience social adjustment problems that are more severe in terms of intensity,…

International students in speech-language pathology clinical education placements: Perceptions of experience and competency development.

PubMed

Attrill, Stacie; Lincoln, Michelle; McAllister, Sue

2015-06-01

This study aimed to describe perceptions of clinical placement experiences and competency development for international speech-language pathology students and to determine if these perceptions were different for domestic students. Domestic and international students at two Australian universities participated in nine focus group interviews. Thematic analysis led to the identification of two themes shared by international and domestic students and several separate themes. Shared themes identified the important influence of students' relationships with clinical educators, unique opportunities and learning that occurs on placement. International student themes included concerns about their communication skills and the impact of these skills on client progress. They also explored their adjustment to unfamiliar placement settings and relationships, preferring structured placements to assist this adjustment. Domestic student themes explored the critical nature of competency attainment and assessment on placement, valuing placements that enabled them to achieve their goals. The findings of this study suggest that international students experience additional communication, cultural and contextual demands on clinical placement, which may increase their learning requirements. Clinical education practices must be responsive to the learning needs of diverse student populations. Strategies are suggested to assist all students to adjust to the professional and learning expectations of clinical education placements.

A Boresight Adjustment Mechanism for use on Laser Altimeters

NASA Technical Reports Server (NTRS)

Hakun, Claef; Budinoff, Jason; Brown, Gary; Parong, Fil; Morell, Armando

2004-01-01

This paper describes the development of the Boresight Adjustment Mechanism (BAM) for the Geoscience Laser Altimeter System (GLAS) Instrument. The BAM was developed late in the integration and test phase of the GLAS instrument flight program. Thermal vacuum tests of the GLAS instrument indicated that the instrument boresight alignment stability over temperature may be marginal. To reduce the risk that GLAS may not be able to meet the boresight alignment requirements, an intensive effort was started to develop a BAM. Observatory-level testing and further evaluation of the boresight alignment data indicated that sufficient margin could be obtained utilizing existing instrument resources and therefore the BAM was never integrated onto the GLAS Instrument. However, the BAM was designed fabricated and fully qualified over a 4 month timeframe to be capable of precisely steering (< 1 arcsec over 300 arcsec) the output of three independent lasers to ensure the alignment between the transmit and receive paths of the GLAS instrument. The short timeline for the development of the mechanism resulted in several interesting design solutions. This paper discusses the requirement definition, design, and testing processes of the BAM development effort, how the design was affected by the extremely tight development schedule, and the lessons learned throughout the process.

Association between obstructive sleep apnea and optic neuropathy: a Taiwanese population-based cohort study.

PubMed

Sun, Ming-Hui; Liao, Yaping Joyce; Lin, Che-Chen; Chiang, Rayleigh Ping-Ying; Wei, James Cheng-Chung

2018-04-26

Obstructive sleep apnea (OSA) is associated with many systemic diseases including diabetes, hypertension, stroke, and cardiovascular disease. The aim of our study was to investigate the association between OSA and optic neuropathy (ON), and to evaluate the efficacy of treatment for OSA on the risk of ON. We used the data from the Longitudinal Health Insurance Database, which involved one million insurants from Taiwan National Health Insurance program (Taiwan NHI). OSA patients had a 1.95-fold higher risk of ON compared with non-OSA patients in all age group. The risk was significantly higher (adjusted hazard ratio: 4.21) in the group aged <45 years and male individuals (adjusted hazard ratio: 1.93). Meanwhile, sleep apnea was associated with ON regardless of the existence of comorbidity or not. OSA patients treated with continuous positive airway pressure (CPAP) had an adjusted 2.31-fold higher hazard of developing ON compared to controls, and those without any treatment had an adjusted 1.82-fold higher hazard of developing ON compared to controls. Moreover, ON patients had a 1.45-fold higher risk of OSA, and those aged between 45 and 64 years (hazard ratio: 1.76) and male individuals (hazard ratio: 1.55) had highest risk. Our study showed that OSA increased the risk of developing ON after controlling the comorbidities; however, treatment with CPAP did not reduce the risk of ON. Further large population study accessing to medical records about the severity of OSA and treatment for OSA is needed to clarify the efficacy of treatment for OSA in reducing the risk of ON.

The American College of Surgeons National Surgical Quality Improvement Program: achieving better and safer surgery.

PubMed

Ko, Clifford Y; Hall, Bruce L; Hart, Amy J; Cohen, Mark E; Hoyt, David B

2015-05-01

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), in operation since late 2004, evaluates surgical quality and safety by feeding back valid, timely, risk-adjusted outcomes, which providers use to improve care. A number of components have been developed and refined in the more than a decade since ACS NSQIP's initiation. These items can be grouped into areas of data collection, case sampling, risk adjustment, feedback reporting, the expansion into procedure-targeted sampling, development of improvement collaboratives, and the development of improvement tools. Although ACS NSQIP was originally designed as a hospital-based program, it now also allows for surgeon-specific reporting that can be used by individual surgeons as a feedback tool to improve their performance. There are more than 600 ACS NSQIP hospitals in 49 of the 50 states of the United States and in 13 other countries. Virtually all surgical (sub)specialties are touched by ACS NSQIP, which contains several million patient records and more than 100 statistically risk-adjusted models. In studies that have used ACS NSQIP clinical data, demonstrable improvement has been reported in local hospitals, in regional collaboratives, and across the program overall. Concomitantly, substantial cost savings for individual hospitals, as well as at regional and national levels, have been reported. ACS NSQIP has not only demonstrated how and why the use of accurate clinical data is crucial, but also how the program, through its risk-adjusted feedback, improvement tools, and hospital collaboratives, helps hospitals and providers to achieve safer surgery and better patient care.

Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea

PubMed Central

Lettieri, Christopher J.; Paolino, Nathalie; Eliasson, Arn H.; Shah, Anita A.; Holley, Aaron B.

2011-01-01

Study Objectives: To compare the efficacy of adjustable and fixed oral appliances for the treatment of OSA. Methods: Retrospective review of consecutive patients with OSA treated with either adjustable or fixed oral appliances. Polysomnography was conducted before and during therapy. Effective treatment was defined as an apnea-hypopnea index (AHI) < 5 events/h or < 10 events/h with resolution of sleepiness (Epworth < 10). We compared efficacy rates between fixed and adjustable appliances and sought to identify factors associated with greater success. Results: We included 805 patients, 602 (74.8%) treated with an adjustable and 203 (25.2%) a fixed oral appliances. Among the cohort, 86.4% were men; mean age was 41.3 ± 9.2 years. Mean AHI was 30.7 ± 25.6, with 34.1% having mild (AHI 5-14.9), 29.2% moderate (AHI 15-29.9), and 36.8% severe (AHI ≥ 30) OSA. Successful therapy was significantly more common with adjustable appliances. Obstructive events were reduced to < 5/h in 56.8% with adjustable compared to 47.0% with fixed appliances (p = 0.02). Similarly, a reduction of events to < 10 with resolution of sleepiness occurred in 66.4% with adjustable appliances versus 44.9% with fixed appliances (p < 0.001). For both devices, success was more common in younger patients, with lower BMI and less severe disease. Conclusions: Adjustable devices produced greater reductions in obstructive events and were more likely to provide successful therapy, especially in moderate-severe OSA. Fixed appliances were effective in mild disease, but were less successful in those with higher AHIs. Given these findings, the baseline AHI should be considered when selecting the type of oral appliance. Citation: Lettieri CJ; Paolino N; Eliasson AH; Shah AA; Holley AB. Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea. J Clin Sleep Med 2011;7(5):439-445. PMID:22003337

Differences in Obesity Prevalence by Demographic Characteristics and Urbanization Level Among Adults in the United States, 2013-2016.

PubMed

Hales, Craig M; Fryar, Cheryl D; Carroll, Margaret D; Freedman, David S; Aoki, Yutaka; Ogden, Cynthia L

2018-06-19

Differences in obesity by sex, age group, race and Hispanic origin among US adults have been reported, but differences by urbanization level have been less studied. To provide estimates of obesity by demographic characteristics and urbanization level and to examine trends in obesity prevalence by urbanization level. Serial cross-sectional analysis of measured height and weight among adults aged 20 years or older in the 2001-2016 National Health and Nutrition Examination Survey, a nationally representative survey of the civilian, noninstitutionalized US population. Sex, age group, race and Hispanic origin, education level, smoking status, and urbanization level as assessed by metropolitan statistical areas (MSAs; large: ≥1 million population). Prevalence of obesity (body mass index [BMI] ≥30) and severe obesity (BMI ≥40) by subgroups in 2013-2016 and trends by urbanization level between 2001-2004 and 2013-2016. Complete data on weight, height, and urbanization level were available for 10 792 adults (mean age, 48 years; 51% female [weighted]). During 2013-2016, 38.9% (95% CI, 37.0% to 40.7%) of US adults had obesity and 7.6% (95% CI, 6.8% to 8.6%) had severe obesity. Men living in medium or small MSAs had a higher age-adjusted prevalence of obesity compared with men living in large MSAs (42.4% vs 31.8%, respectively; adjusted difference, 9.8 percentage points [95% CI, 5.1 to 14.5 percentage points]); however, the age-adjusted prevalence among men living in non-MSAs was not significantly different compared with men living in large MSAs (38.9% vs 31.8%, respectively; adjusted difference, 4.8 percentage points [95% CI, -2.9 to 12.6 percentage points]). The age-adjusted prevalence of obesity was higher among women living in medium or small MSAs compared with women living in large MSAs (42.5% vs 38.1%, respectively; adjusted difference, 4.3 percentage points [95% CI, 0.2 to 8.5 percentage points]) and among women living in non-MSAs compared with women living in large MSAs (47.2% vs 38.1%, respectively; adjusted difference, 4.7 percentage points [95% CI, 0.2 to 9.3 percentage points]). Similar patterns were seen for severe obesity except that the difference between men living in large MSAs compared with non-MSAs was significant. The age-adjusted prevalence of obesity and severe obesity also varied significantly by age group, race and Hispanic origin, and education level, and these patterns of variation were often different by sex. Between 2001-2004 and 2013-2016, the age-adjusted prevalence of obesity and severe obesity significantly increased among all adults at all urbanization levels. In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity and severe obesity in 2013-2016 varied by level of urbanization, with significantly greater prevalence of obesity and severe obesity among adults living in nonmetropolitan statistical areas compared with adults living in large metropolitan statistical areas.

Impact of Aortic Valve Calcification, as Measured by MDCT, on Survival in Patients With Aortic Stenosis

PubMed Central

Clavel, Marie-Annick; Pibarot, Philippe; Messika-Zeitoun, David; Capoulade, Romain; Malouf, Joseph; Aggarval, Shivani; Araoz, Phillip A.; Michelena, Hector I.; Cueff, Caroline; Larose, Eric; Miller, Jordan D.; Vahanian, Alec; Enriquez-Sarano, Maurice

2014-01-01

BACKGROUND Aortic valve calcification (AVC) load measures lesion severity in aortic stenosis (AS) and is useful for diagnostic purposes. Whether AVC predicts survival after diagnosis, independent of clinical and Doppler echocardiographic AS characteristics, has not been studied. OBJECTIVES This study evaluated the impact of AVC load, absolute and relative to aortic annulus size (AVCdensity), on overall mortality in patients with AS under conservative treatment and without regard to treatment. METHODS In 3 academic centers, we enrolled 794 patients (mean age, 73 ± 12 years; 274 women) diagnosed with AS by Doppler echocardiography who underwent multidetector computed tomography (MDCT) within the same episode of care. Absolute AVC load and AVCdensity (ratio of absolute AVC to cross-sectional area of aortic annulus) were measured, and severe AVC was separately defined in men and women. RESULTS During follow-up, there were 440 aortic valve implantations (AVIs) and 194 deaths (115 under medical treatment). Univariate analysis showed strong association of absolute AVC and AVCdensity with survival (both, p < 0.0001) with a spline curve analysis pattern of threshold and plateau of risk. After adjustment for age, sex, coronary artery disease, diabetes, symptoms, AS severity on hemodynamic assessment, and LV ejection fraction, severe absolute AVC (adjusted hazard ratio [HR]: 1.75; 95% confidence interval [CI]: 1.04 to 2.92; p = 0.03) or severe AVCdensity (adjusted HR: 2.44; 95% CI: 1.37 to 4.37; p = 0.002) independently predicted mortality under medical treatment, with additive model predictive value (all, p ≤ 0.04) and a net reclassification index of 12.5% (p = 0.04). Severe absolute AVC (adjusted HR: 1.71; 95% CI: 1.12 to 2.62; p = 0.01) and severe AVCdensity (adjusted HR: 2.22; 95% CI: 1.40 to 3.52; p = 0.001) also independently predicted overall mortality, even with adjustment for time-dependent AVI. CONCLUSIONS This large-scale, multicenter outcomes study of quantitative Doppler echocardiographic and MDCT assessment of AS shows that measuring AVC load provides incremental prognostic value for survival beyond clinical and Doppler echocardiographic assessment. Severe AVC independently predicts excess mortality after AS diagnosis, which is greatly alleviated by AVI. Thus, measurement of AVC by MDCT should be considered for not only diagnostic but also risk-stratification purposes in patients with AS. PMID:25236511

Maternal hypertension and risk for hypospadias in offspring.

PubMed

Agopian, A J; Hoang, Thanh T; Mitchell, Laura E; Morrison, Alanna C; Tu, Duong; Nassar, Natasha; Canfield, Mark A

2016-12-01

Hypospadias is one of the most common birth defects in male infants. Maternal hypertension is a suspected risk factor; however, few previous studies have addressed the possibility of reporting bias, and several previous studies have not accounted for hypospadias severity. We analyzed data from the Texas Birth Defects Registry for 10,924 nonsyndromic cases and statewide vital records for deliveries during 1999-2009, using Poisson regression. After adjustment for potential confounders, hypospadias was associated with maternal hypertension (adjusted prevalence ratio: 1.5, 95% confidence interval: 1.4-1.7). Similar associations were observed with gestational and pregestational hypertension, including separate analyses restricted to the subset of cases with severe (second- or third-degree) hypospadias. All of these associations were also similar among the subset of cases with isolated hypospadias (without additional birth defects). To evaluate the potential for bias due to potential hypertension misclassification, we repeated our analyses using logistic regression, comparing the cases to controls with other birth defects. In these analyses, the associations with gestational hypertension were similar, but adjusted associations with pregestational hypertension were no longer observed. Our findings support an association between gestational hypertension and hypospadias in offspring, but also suggest that previously observed associations with pregestational hypertension may have been inflated due to differential misclassification of hypertension (e.g., reporting bias). As gestational hypertension is recognized after hypospadias development, more research is needed to determine if this association reflects an increase in gestational hypertension risk secondary to hypospadias or if both conditions have shared risk factors (e.g., precursors of gestational hypertension). © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Maternal Health Literacy Is Associated with Early Childhood Nutritional Status in India.

PubMed

Johri, Mira; Subramanian, S V; Koné, Georges K; Dudeja, Sakshi; Chandra, Dinesh; Minoyan, Nanor; Sylvestre, Marie-Pierre; Pahwa, Smriti

2016-07-01

The global burden of child undernutrition is concentrated in South Asia, where gender inequality and female educational disadvantage are important factors. Maternal health literacy is linked to women's education and empowerment, can influence multiple malnutrition determinants, and is rapidly modifiable. This study investigated whether maternal health literacy is associated with child undernutrition in 2 resource-poor Indian populations. We conducted cross-sectional surveys in an urban and a rural site, interviewing 1 woman with a child aged 12-23 mo/household. Multivariate logistic regression analyses were conducted independently for each site. The main exposure was maternal health literacy. We assessed respondents' ability to understand, appraise, and apply health-related information with the use of Indian health promotion materials. The main outcomes were severe stunting, severe underweight, and severe wasting. We classified children as having a severe nutritional deficiency if their z score was <-3 SDs from the WHO reference population for children of the same age and sex. Analyses controlled for potential confounding factors including parental education and household wealth. Rural and urban analyses included 1116 and 657 mother-child pairs, respectively. In each site, fully adjusted models showed that children of mothers with high health literacy had approximately half the likelihood of being severely stunted (rural adjusted OR: 0.50; 95% CI: 0.33, 0.74; P = 0.001; urban adjusted OR: 0.58; 95% CI: 0.35, 0.94; P = 0.028) or severely underweight (rural adjusted OR: 0.57; 95% CI: 0.38, 0.87; P = 0.009; urban adjusted OR: 0.48; 95% CI: 0.25, 0.91; P = 0.025) than children of mothers with low health literacy. Health literacy was not associated with severe wasting. In resource-poor rural and urban settings in India, maternal health literacy is associated with child nutritional status. Programs targeting health literacy may offer effective entry points for intervention. © 2016 American Society for Nutrition.

Hispanic Americans and African Americans with multiple sclerosis have more severe disease course than Caucasian Americans.

PubMed

Ventura, Rachel E; Antezana, Ariel O; Bacon, Tamar; Kister, Ilya

2017-10-01

Whether disease course in Hispanic Americans (HA) with multiple sclerosis (MS) is different from Caucasian Americans (CA) or African Americans (AA) is unknown. We compared MS severity in the three main ethnic populations in our tertiary MS clinics using disease duration-adjusted rank score of disability: Patient-Derived Multiple Sclerosis Severity Score (P-MSSS). The age- and gender-adjusted P-MSSS was significantly higher in HA (3.9 ± 2.6) and AA (4.5 ± 3.0) compared to CA (3.4 ± 2.6; p < 0.0001 for both). Adjusting for insurance did not change these results. These findings suggest that HA, as AA, have more rapid disability accumulation than CA.

Factors discriminating among profiles of resilience and psychopathology in children exposed to intimate partner violence (IPV).

PubMed

Graham-Bermann, Sandra A; Gruber, Gabrielle; Howell, Kathryn H; Girz, Laura

2009-09-01

To evaluate the social and emotional adjustment of 219 children in families with varying levels of intimate partner violence (IPV) using a model of risk and protection. To explore factors that differentiate children with poor adjustment from those with resilience. Mothers who experienced IPV in the past year and their children ages 6-12 were interviewed. Standardized measures assessed family violence, parenting, family functioning, maternal mental health, and children's adjustment and beliefs. Using cluster analysis, all cases with valid data on the Child Behavior Checklist, Child Depression Inventory, General Self-Worth and Social Self-Competence measures were described by four profiles of children's adjustment: Severe Adjustment Problems (24%); children who were Struggling (45%); those with Depression Only (11%); and Resilient (20%) with high competence and low adjustment problems. Multinomial logistic regression analyses showed children in the Severe Problems cluster witnessed more family violence and had mothers higher in depression and trauma symptoms than other children. Resilient and Struggling children had mothers with better parenting, more family strengths and no past violent partner. Parents of children with Severe Problems were lacking these attributes. The Depressed profile children witnessed less violence but had greater fears and worries about mother's safety. Factors related to the child, to the mother and to the family distinguish different profiles of adjustment for children exposed to IPV who are living in the community. Resilient children have less violence exposure, fewer fears and worries, and mothers with better mental health and parenting skills, suggesting avenues for intervention with this population. Findings suggest that child adjustment is largely influenced by parent functioning. Thus, services should be targeted at both the child and the parent. Clinical interventions shaped to the unique needs of the child might also be tested with this population.

Early life adversity and/or posttraumatic stress disorder severity are associated with poor diet quality, including consumption of trans fatty acids, and fewer hours of resting or sleeping in a US middle-aged population: A cross-sectional and prospective study

PubMed Central

Gavrieli, Anna; Farr, Olivia M; Davis, Cynthia R; Crowell, Judith A; Mantzoros, Christos S.

2015-01-01

Background Early life adversity (ELA) and post-traumatic stress disorder (PTSD) are associated with poorer psychological and physical health. Potential underlying mechanisms and mediators remain to be elucidated, and the lifestyle habits and characteristics of individuals with ELA and/or PTSD have not been fully explored. We investigated whether the presence of ELA and/or PTSD are associated with nutrition, physical activity, resting and sleeping and smoking. Methods A cross-sectional sample of 151 males and females (age: 45.6±3.5 y, BMI: 30.0±7.1kg/m2) underwent anthropometric measurements, as well as detailed questionnaires for dietary assessment, physical activity, resting and sleeping, smoking habits and psychosocial assessments. A prospective follow-up visit of 49 individuals was performed 2.5 years later and the same outcomes were assessed. ELA and PTSD were evaluated as predictors, in addition to a variable assessing the combined presence/severity of ELA–PTSD. Data were analyzed using analysis of covariance after adjusting for several socioeconomic, psychosocial and anthropometric characteristics. Results Individuals with higher ELA or PTSD severity were found to have a poorer diet quality (DASH score: p=0.006 and p=0.003, respectively; aHEI-2010 score: ELA p=0.009), including further consumption of trans fatty acids (ELA p=0.003); the differences were significantly attenuated null after adjusting mainly for education or income and/or race. Further, individuals with higher ELA severity reported less hours of resting and sleeping (p=0.043) compared to those with zero/lower ELA severity, and the difference remained significant in the fully adjusted model indicating independence from potential confounders. When ELA and PTSD were combined, an additive effect was observed on resting and sleeping (p=0.001); results remained significant in the fully adjusted model. They also consumed more energy from trans fatty acids (p=0.017) tended to smoke more (p=0.008), and have less physical activity (PTSD p=0.024) compared to those with no or lower ELA and PTSD severity. Adjustments for sociodemographic factors and/or BMI rendered results of the above life style parameters non-significant. The analysis of the prospective data showed similar trends to the cross-sectional analysis, further supporting the conclusions, although statistical significance of results was lower due to the lower number of participants. Conclusion Fewer hours of resting and sleeping and poorer diet quality are linked to ELA and/or PTSD, indicating that these pathways might underlie the development of several metabolic abnormalities in individuals with ELA and/or PTSD. Differences in terms of diet quality are significantly attenuated by race and/or education and/or income, whereas differences in other lifestyle habits of individuals with and without ELA and/or PTSD, such as physical activity, are mostly explained by confounding sociodemographic variables and/or body mass index. PMID:26404481

Early life adversity and/or posttraumatic stress disorder severity are associated with poor diet quality, including consumption of trans fatty acids, and fewer hours of resting or sleeping in a US middle-aged population: A cross-sectional and prospective study.

PubMed

Gavrieli, Anna; Farr, Olivia M; Davis, Cynthia R; Crowell, Judith A; Mantzoros, Christos S

2015-11-01

Early life adversity (ELA) and post-traumatic stress disorder (PTSD) are associated with poorer psychological and physical health. Potential underlying mechanisms and mediators remain to be elucidated, and the lifestyle habits and characteristics of individuals with ELA and/or PTSD have not been fully explored. We investigated whether the presence of ELA and/or PTSD are associated with nutrition, physical activity, resting and sleeping and smoking. A cross-sectional sample of 151 males and females (age: 45.6±3.5 years, BMI: 30.0±7.1 kg/m(2)) underwent anthropometric measurements, as well as detailed questionnaires for dietary assessment, physical activity, resting and sleeping, smoking habits and psychosocial assessments. A prospective follow-up visit of 49 individuals was performed 2.5 years later and the same outcomes were assessed. ELA and PTSD were evaluated as predictors, in addition to a variable assessing the combined presence/severity of ELA-PTSD. Data were analyzed using analysis of covariance after adjusting for several socioeconomic, psychosocial and anthropometric characteristics. Individuals with higher ELA or PTSD severity were found to have a poorer diet quality (DASH score: p=0.006 and p=0.003, respectively; aHEI-2010 score: ELA p=0.009), including further consumption of trans fatty acids (ELA p=0.003); the differences were significantly attenuated null after adjusting mainly for education or income and/or race. Further, individuals with higher ELA severity reported less hours of resting and sleeping (p=0.043) compared to those with zero/lower ELA severity, and the difference remained significant in the fully adjusted model indicating independence from potential confounders. When ELA and PTSD were combined, an additive effect was observed on resting and sleeping (p=0.001); results remained significant in the fully adjusted model. They also consumed more energy from trans fatty acids (p=0.017) tended to smoke more (p=0.008), and have less physical activity (PTSD p=0.024) compared to those with no or lower ELA and PTSD severity. Adjustments for sociodemographic factors and/or BMI rendered results of the above lifestyle parameters non-significant. The analysis of the prospective data showed similar trends to the cross-sectional analysis, further supporting the conclusions, although statistical significance of results was lower due to the lower number of participants. Fewer hours of resting and sleeping and poorer diet quality are linked to ELA and/or PTSD, indicating that these pathways might underlie the development of several metabolic abnormalities in individuals with ELA and/or PTSD. Differences in terms of diet quality are significantly attenuated by race and/or education and/or income, whereas differences in other lifestyle habits of individuals with and without ELA and/or PTSD, such as physical activity, are mostly explained by confounding sociodemographic variables and/or body mass index. Copyright © 2015 Elsevier Inc. All rights reserved.

Acute Kidney Injury in Pediatric Severe Sepsis: An Independent Risk Factor for Death and New Disability.

PubMed

Fitzgerald, Julie C; Basu, Rajit K; Akcan-Arikan, Ayse; Izquierdo, Ledys M; Piñeres Olave, Byron E; Hassinger, Amanda B; Szczepanska, Maria; Deep, Akash; Williams, Duane; Sapru, Anil; Roy, Jason A; Nadkarni, Vinay M; Thomas, Neal J; Weiss, Scott L; Furth, Susan

2016-12-01

The prevalence of septic acute kidney injury and impact on functional status of PICU survivors are unknown. We used data from an international prospective severe sepsis study to elucidate functional outcomes of children suffering septic acute kidney injury. Secondary analysis of patients in the Sepsis PRevalence, OUtcomes, and Therapies point prevalence study: acute kidney injury was defined on the study day using Kidney Disease Improving Global Outcomes definitions. Patients with no acute kidney injury or stage 1 acute kidney injury ("no/mild acute kidney injury") were compared with those with stage 2 or 3 acute kidney injury ("severe acute kidney injury"). The primary outcome was a composite of death or new moderate disability at discharge defined as a Pediatric Overall Performance Category score of 3 or higher and increased by 1 from baseline. One hundred twenty-eight PICUs in 26 countries. Children with severe sepsis in the Sepsis PRevalence, OUtcomes, and Therapies study. None. One hundred two (21%) of 493 patients had severe acute kidney injury. More than twice as many patients with severe acute kidney injury died or developed new moderate disability compared with those with no/mild acute kidney injury (64% vs 30%; p < 0.001). Severe acute kidney injury was independently associated with death or new moderate disability (adjusted odds ratio, 2.5; 95% CI, 1.5-4.2; p = 0.001) after adjustment for age, region, baseline disability, malignancy, invasive mechanical ventilation, albumin administration, and the pediatric logistic organ dysfunction score. In a multinational cohort of critically ill children with severe sepsis and high mortality rates, septic acute kidney injury is independently associated with further increased death or new disability.

Pain as a risk factor for disability or death.

PubMed

Andrews, James S; Cenzer, Irena Stijacic; Yelin, Edward; Covinsky, Kenneth E

2013-04-01

To determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older. Prospective cohort study. The 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals. Twelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL. Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10 yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility). At baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all P < .001) to be female (65% vs 54%), have ADL difficulty (e.g., transferring 12% vs 2%, toileting 11% vs 2%), have difficulty walking several blocks (60% vs 21%), and have difficulty climbing one flight of stairs (40% vs 12%). Over 10 years, participants with pain were more likely to develop ADL disability or death (58% vs 43%, unadjusted hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.57-1.79), although after adjustment for confounders, participants with pain were not at greater risk for ADL disability or death (HR = 0.98, 95% CI = 0.91-1.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results. Although there are strong cross-sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Pain as a Risk Factor for Disability or Death

PubMed Central

Andrews, James S.; Cenzer, Irena Stijacic; Yelin, Edward; Covinsky, Kenneth E.

2013-01-01

OBJECTIVES To determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 years and above. DESIGN Prospective cohort study SETTING The 1998 to 2008 Health and Retirement Study (HRS), a nationally-representative study of older community-living individuals. PARTICIPANTS Twelve thousand six hundred and thirty-one participants in the 1998 HRS aged 60 years and older who did not need help in any activity of daily living (ADL). MEASUREMENTS Participants reporting that they were troubled by moderate or severe pain most of the time were defined as having significant pain. Our primary outcome was time to development of ADL disability or death over 10 years, assessed in 5 successive 2 year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. We used a discrete hazards survival model to examine the relationship between pain and incident disability over each two year interval using only participants who started the interval with no ADL disability. We adjusted for several potential confounders at the start of each interval: demographic factors, 7 chronic health conditions, and functional limitations (ADL difficulty, and difficulty with 5 measures of mobility). RESULTS At baseline, 2,283 (18%) subjects had significant pain. Subjects with pain were more likely (all p<0.001) to be female (65% vs. 54%), have ADL difficulty (eg. transferring 12% vs. 2%, toileting 11% vs. 2%), have difficulty walking several blocks (60% vs. 21%), and have difficulty climbing one flight of stairs (40% vs. 12%). Over 10 years, subjects with pain were more likely to develop ADL disability or death (58% vs43%, unadjusted HR 1.67, 95% confidence interval (1.57 to 1.79)). However, after adjustment for confounders, participants with pain were not at increased risk for ADL disability or death (HR 0.98 (0.91 to 1.07)). The difference between the unadjusted and adjusted results was almost entirely explained by adjustment for functional status. CONCLUSION While there are strong cross-sectional relationships between pain and functional limitations, individuals with pain are not at higher risk for subsequent disability or death, after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms. PMID:23521614

Retinopathy of prematurity and brain damage in the very preterm newborn.

PubMed

Allred, Elizabeth N; Capone, Antonio; Fraioli, Anthony; Dammann, Olaf; Droste, Patrick; Duker, Jay; Gise, Robert; Kuban, Karl; Leviton, Alan; O'Shea, T Michael; Paneth, Nigel; Petersen, Robert; Trese, Michael; Stoessel, Kathleen; Vanderveen, Deborah; Wallace, David K; Weaver, Grey

2014-06-01

To explain why very preterm newborns who develop retinopathy of prematurity (ROP) appear to be at increased risk of abnormalities of both brain structure and function. A total of 1,085 children born at <28 weeks' gestation had clinically indicated retinal examinations and had a developmental assessment at 2 years corrected age. Relationships between ROP categories and brain abnormalities were explored using logistic regression models with adjustment for potential confounders. The 173 children who had severe ROP, defined as prethreshold ROP (n = 146) or worse (n = 27) were somewhat more likely than their peers without ROP to have brain ultrasound lesions or cerebral palsy. They were approximately twice as likely to have very low Bayley Scales scores. After adjusting for risk factors common to both ROP and brain disorders, infants who developed severe ROP were at increased risk of low Bayley Scales only. Among children with prethreshold ROP, exposure to anesthesia was not associated with low Bayley Scales. Some but not all of the association of ROP with brain disorders can be explained by common risk factors. Most of the increased risks of very low Bayley Scales associated with ROP are probably not a consequence of exposure to anesthetic agents. Copyright © 2014 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

Factors associated with recovery from acute optic neuritis in patients with multiple sclerosis.

PubMed

Malik, Muhammad Taimur; Healy, Brian C; Benson, Leslie A; Kivisakk, Pia; Musallam, Alexander; Weiner, Howard L; Chitnis, Tanuja

2014-06-17

To identify clinical and demographic features associated with the severity and recovery from acute optic neuritis (AON) episodes in patients with multiple sclerosis (MS). Adult (n = 253) and pediatric (n = 38) patients whose first symptom was AON were identified from our MS database. Severity measured by loss of visual acuity (mild attack ≤20/40, moderate attack 20/50-20/190, and severe attack ≥20/200) and recovery in visual acuity at 1 year after the attack (complete recovery ≤20/20, fair recovery 20/40, and poor recovery ≥20/50) were recorded. Demographic and clinical features associated with attack severity and recovery were identified using proportional odds logistic regression. For another group of patients, blood samples were available within 6 months of an AON attack. In this group, the impact of vitamin D level on the severity/recovery was also assessed. Men (adjusted odds ratio [OR] = 2.28, p = 0.03) and subjects with severe attacks (adjusted OR = 5.24, p < 0.001) had worse recovery. AON severity was similar between the pediatric and adult subjects, but recovery was significantly better in pediatric subjects in the unadjusted analysis (p = 0.041) and the analysis adjusted for sex (p = 0.029). Season-adjusted vitamin D level was significantly associated with attack severity (OR for 10-U increase in vitamin D level = 0.47; 95% confidence interval: 0.32, 0.68; p < 0.001). Vitamin D level was not associated with recovery from the attack (p = 0.98) in univariate analysis or after accounting for attack severity (p = 0.10). Vitamin D levels affect AON severity, whereas younger age, attack severity, and male sex affect AON recovery. Underlying mechanisms and potential therapeutic targets may identify new measures to mitigate disability accrual in MS. © 2014 American Academy of Neurology.

Are Asian American women at higher risk of severe perineal lacerations?

PubMed

Quist-Nelson, Johanna; Hua Parker, Meiling; Berghella, Vincenzo; Biba Nijjar, J

2017-03-01

To evaluate whether Asian race is an independent risk factor for severe perineal lacerations. We performed a nationwide population-based retrospective cohort study examining the relationship between Asian race and severe perineal lacerations (third and fourth degree). The data were collected from the 2012 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS). Characteristics of Asian American women were compared with those of non-Asian women. The primary outcome of interest was severe perineal lacerations. Multivariable logistic regression was used to refine the associations between Asian race and severe perineal lacerations while adjusting for confounding effects. Results were compared with previously published data using a pooled odds ratio. 2,270,044 Women with singleton vaginal deliveries were identified, and 120,452 (5.3%) were Asian. After adjusting for confounders, Asian women were more likely to experience severe perineal lacerations than any other racial group (3.5% versus 6.3%, adjusted odds ratio [aOR] 1.50, 99% CI 1.29-1.74, p < 0.0001). Analysis of literature indicated that Asian American women are 74% more likely to experience severe perineal lacerations (aOR 1.74, 99% CI 1.72-1.76, p < 0.0001) than non-Asians. Asian race is an independent risk factor for severe perineal lacerations in the United States.

National cohort study comparing severe medium-term urinary complications after robot-assisted vs laparoscopic vs retropubic open radical prostatectomy.

PubMed

Sujenthiran, Arunan; Nossiter, Julie; Parry, Matthew; Charman, Susan C; Aggarwal, Ajay; Payne, Heather; Dasgupta, Prokar; Clarke, Noel W; van der Meulen, Jan; Cathcart, Paul

2018-03-01

To evaluate the occurrence of severe urinary complications within 2 years of surgery in men undergoing either robot-assisted radical prostatectomy (RARP), laparoscopic radical prostatectomy (LRP) or retropubic open radical prostatectomy (ORP). We conducted a population-based cohort study in men who underwent RARP (n = 4 947), LRP (n = 5 479) or ORP (n = 6 873) between 2008 and 2012 in the English National Health Service (NHS) using national cancer registry records linked to Hospital Episodes Statistics, an administrative database of admissions to NHS hospitals. We identified the occurrence of any severe urinary or severe stricture-related complication within 2 years of surgery using a validated tool. Multi-level regression modelling was used to determine the association between the type of surgery and occurrence of complications, with adjustment for patient and surgical factors. Men undergoing RARP were least likely to experience any urinary complication (10.5%) or a stricture-related complication (3.3%) compared with those who had LRP (15.8% any or 5.7% stricture-related) or ORP (19.1% any or 6.9% stricture-related). The impact of the type of surgery on the occurrence of any urinary or stricture-related complications remained statistically significant after adjustment for patient and surgical factors (P < 0.01). Men who underwent RARP had the lowest risk of developing severe urinary complications within 2 years of surgery. © 2017 The Authors BJU International published by John Wiley & Sons Ltd on behalf of BJU International.

Maternal hypertension, medication use, and hypospadias in the National Birth Defects Prevention Study.

PubMed

Van Zutphen, Alissa R; Werler, Martha M; Browne, Marilyn M; Romitti, Paul A; Bell, Erin M; McNutt, Louise-Anne; Druschel, Charlotte M; Mitchell, Allen A

2014-02-01

To investigate whether antihypertensive classes and specific medications in early pregnancy increase the risk of severe hypospadias and to assess prior associations detected for late-treated and untreated hypertension in the National Birth Defects Prevention Study. Using telephone interviews from mothers of 2,131 children with severe hypospadias and 5,129 nonmalformed male control children for 1997-2009 births in a population-based case-control study, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) with multivariable logistic regression. We adjusted P values to account for multiple testing. Forty-eight (2.3%) case and 70 (1.4%) control mothers reported early pregnancy antihypertensive treatment, 45 (2.1%) case and 31 (0.6%) control mothers reported late treatment, and 315 (14.8%) case and 394 (7.7%) control mothers reported untreated hypertension. Selective β-blockers, centrally acting agents, renin-angiotensin system-acting agents, diuretics, and specific medications, methyldopa and atenolol, were not associated with hypospadias. Nonselective β-blockers (adjusted OR 3.22, 95% CI 1.47-7.05) were associated with hypospadias; however, P values adjusted for multiple testing were not statistically significant. We confirmed prior findings for associations between hypospadias and untreated hypertension (adjusted OR 2.09, 95% CI 1.76-2.48) and late initiation of treatment (adjusted OR 3.98, 95% CI 2.41-6.55). The increased risks would translate to severe hypospadias prevalences of 11.5, 17.7, and 21.9 per 10,000 births for women with untreated hypertension, nonselective β-blocker use, and late initiation of treatment, respectively. Our study suggests a relationship between hypospadias and the severity of hypertension. II.

Predictors of sense of coherence in typically developing adolescent siblings of individuals with autism spectrum disorder.

PubMed

Smith, L O; Elder, J H; Storch, E A; Rowe, M A

2015-01-01

Children with autism spectrum disorder (ASD) may be a stressor for family members yet there is little published research on the impact of having a child with ASD on their typically developing (TD) adolescent siblings. According to Antonovsky's salutogenic model, a strong sense of coherence leads to the view that the stressor is a manageable challenge rather than a burden and promotes healthier adaptation. This study examines the relationship between stress, TD sibling resources and the sense of coherence in TD siblings. This quantitative mail-based study uses a survey methodology, analysing the responses of TD adolescent siblings (n = 96) of individuals with autism, Asperger's syndrome, or pervasive developmental disorder - not otherwise specified to several rating scales. Adolescent siblings, ages 11 to 18 years, completed the Adolescent Coping Orientation for Problem Experience (ACOPE), Network of Relationship Inventory - Social Provision Version (NRI-SPV), Youth Self Report (YSR), and Sense of Coherence (SOC) instruments; parents completed the Child Autism Rating Scale - 2nd Edition (CARS-2). The salutogenesis model was used to guide and inform this research. Findings suggested the following: (a) the stress of ASD severity and resource of adjustment are related in TD adolescent siblings; (b) TD sibling adjustment has a strong relationship with sense of coherence levels; and (c) a greater number of positive coping strategies buffer TD sibling coherence levels when ASD severity scores are high. ASD severity and TD adolescent sibling resources influence sense of coherence in adolescent TD siblings of individuals with ASD. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Exploratory Calibration of Adjustable-Protrusion Surface-Obstacle (APSO) Skin Friction Vector Gage

NASA Technical Reports Server (NTRS)

Hakkinen, Raimo J.; Neubauer, Jeremy S.; Hamory, Philip J.; Bui, Trong T.; Noffz, Gregory K.; Young, Ron (Technical Monitor)

2003-01-01

The design of an adjustable-protrusion surface-obstacle (APSO) skin friction vector gage is presented. Results from exploratory calibrations conducted in laminar and turbulent boundary layers at the Washington University Low-Speed Wind Tunnel and for turbulent boundary layers at speeds up to Mach 2 on the ceiling of the NASA Glenn Research Center 8- X 6-ft Supersonic Wind Tunnel are also discussed. The adjustable-height gage was designed to yield both the magnitude and direction of the surface shear stress vector and to measure the local static pressure distribution. Results from the NASA test show good correlation for subsonic and low supersonic conditions covering several orders of magnitude in terms of the adopted similarity variables. Recommendations for future work in this area consist of identifying the physical parameters responsible for the disagreement between the university and NASA data sets, developing a compressibility correction specific to the APSO geometry, and examining the effect that static pressure distribution and skewed boundary layers have on the results from the APSO.

[Adjustment disorder and DSM-5: A review].

PubMed

Appart, A; Lange, A-K; Sievert, I; Bihain, F; Tordeurs, D

2017-02-01

This paper exposes the complexity and discrete characteristic of the adjustment disorder with reference to its clinical and scientific diagnosis. Even though the disorder occurs in frequent clinical circumstances after important life events, such as mobbing, burn-out, unemployment, divorce or separation, pregnancy denial, surgical operation or cancer, the adjustment disorder is often not considered in the diagnosis since better known disorders with similar symptoms prevail, such as major depression and anxiety disorder. Ten years ago, Bottéro had already noticed that the adjustment disorder diagnosis remained rather uncommon with reference to patients he was working with while Langlois assimilated this disorder with an invisible diagnosis. In order to maximize the data collection, we used the article review below and challenged their surveys and results: National Center for Biotechnology Information (NBCI - Pubmed) for international articles and Cairn.info for French literature. Moreover, we targeted the following keywords on the search engine and used articles, which had been published from 1 February 1975 to 31 January 2015: "adjustment", "adjustment disorder" and the French translation "trouble de l'adaptation". One hundred and ninety-one articles matched our search criteria. However, after a closer analysis, solely 105 articles were selected as being of interest. Many articles were excluded since they were related to non-psychiatric fields induced by the term "adaptation". Indeed, the number of corresponding articles found for the adjustment disorder literally pointed-out the lack of existing literature on that topic in comparison to more known disorders such as anxiety disorder (2661 articles) or major depression (5481 articles). This represents up to 50 times more articles in comparison to the number of articles we found on adjustment disorder and up to 20 times more articles for the eating disorder (1994), although the prevalence is not significantly higher than for the adjustment disorder. According to their relevance and their content, we have split the articles into seven subcategories: 1. General description: most scientific articles generally describe the adjustment disorder as being a transition diagnosis, which is ambiguous, marginal and difficult to detect. The findings claim that only a few studies have been conducted on the adjustment disorder despite a high prevalence in the general population and in the clinical field. 2. the DSM-5 defined the adjustment disorder as a set of different outcomes and syndromes induced by stress after a difficult life event. While the link to other disorders has not been mentioned, the diagnosis of this disorder is no longer excluded or perceived as a secondary diagnosis. The DSM-5 faced criticism from three points of view: the operationalization of the concept of stress, the differential diagnosis and the description. 3. Prevalence: different samples have shown a significantly high prevalence of the adjustment disorder within the population. In addition to the psychiatric pain induced by difficult life events we need to emphasize the fact that 12.5 to 19.4 percent of the patients faced heavy and severe pathologies and depended on clinical care and treatment. 4. Etiology, comorbidity or associated symptomatology: the literature identified the tendency to commit suicide and stressful life events as being two fundamental characteristics of adjustment disorder. The third one is the personality profile. 5. that motivates researchers to focus on the adjustment disorder: the differentiation approach as to the major depression. Indeed, the aetiology, the symptomatology and the treatment differ from the adjustment disorder. 6. very recently, Dutch researchers have developed and validated the Diagnostic Interview Adjustment Disorder (DIAD). 7. in 2014, no data or meta-analysis recommended drug treatment in addition to therapy. In fact, several authors have demonstrated the ineffectiveness of drug therapy. The literature suggests a psychotherapeutic approach to treat adjustment disorder. Emotional reactions triggered by life events are responsible for full therapy agendas and for the rush in emergency rooms and hospitals. The reflex when faced with crying, insomnia or suicidal thoughts to give a diagnostic of major depressive disorder s is generally accepted by everyone. The elevated risk to commit suicide and the approved success of remission or healing through treatment (psychotherapy) are two major reasons why several studies promote the importance and the need to identify the adjustment disorder of our patients. Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Predictive value of European Scleroderma Group Activity Index in an early scleroderma cohort.

PubMed

Nevskaya, Tatiana; Baron, Murray; Pope, Janet E

2017-07-01

To estimate the effect of disease activity, as measured by the European Scleroderma Research Group Activity Index (EScSG-AI), on the risk of subsequent organ damage in a large systemic sclerosis (SSc) cohort. Of 421 SSc patients from the Canadian Scleroderma Research Group database with disease duration of ⩽ 3 years, 197 who had no evidence of end-stage organ damage initially and available 3 year follow-up were included. Disease activity was assessed by the EScSG-AI with two variability measures: the adjusted mean EScSG-AI (the area under the curve of the EScSG-AI over the observation period) and persistently active disease/flare. Outcomes were based on the Medsger severity scale and included accrual of a new severity score (Δ ⩾ 1) overall and within organ systems or reaching a significant level of deterioration in health status. After adjustment for covariates, the adjusted mean EScSG-AI was the most consistent predictor of risk across the study outcomes over 3 years in dcSSc: disease progression defined as Δ ⩾ 1 in any major internal organ, significant decline in forced vital capacity and diffusing capacity of carbon monoxide, severity of visceral disease and HAQ Disability Index worsening. In multivariate analysis, progression of lung disease was predicted solely by adjusted mean EScSG-AI, while the severity of lung disease was predicted the adjusted mean EScSG-AI, older age, modified Rodnan skin score (mRSS) and initial severity. The EScSG-AI was associated with patient- and physician-assessed measures of health status and overpowered the mRSS in predicting disease outcomes. Disease activity burden quantified with the adjusted mean EScSG-AI predicted the risk of deterioration in health status and severe organ involvement in dcSSc. The EScSG-AI is more responsive when done repeatedly and averaged. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Temperament, School Adjustment, and Academic Achievement: Existing Research and Future Directions

ERIC Educational Resources Information Center

Al-Hendawi, Maha

2013-01-01

Since the 1980s, research has been examining the role of temperament in education. In particular, academic achievement and school adjustment were among the first variables to be examined. Subsequently, several studies have documented associations between temperament and either academic achievement or school adjustment. However, no review of this…

Risk adjustment alternatives in paying for behavioral health care under Medicaid.

PubMed Central

Ettner, S L; Frank, R G; McGuire, T G; Hermann, R C

2001-01-01

OBJECTIVE: To compare the performance of various risk adjustment models in behavioral health applications such as setting mental health and substance abuse (MH/SA) capitation payments or overall capitation payments for populations including MH/SA users. DATA SOURCES/STUDY DESIGN: The 1991-93 administrative data from the Michigan Medicaid program were used. We compared mean absolute prediction error for several risk adjustment models and simulated the profits and losses that behavioral health care carve outs and integrated health plans would experience under risk adjustment if they enrolled beneficiaries with a history of MH/SA problems. Models included basic demographic adjustment, Adjusted Diagnostic Groups, Hierarchical Condition Categories, and specifications designed for behavioral health. PRINCIPAL FINDINGS: Differences in predictive ability among risk adjustment models were small and generally insignificant. Specifications based on relatively few MH/SA diagnostic categories did as well as or better than models controlling for additional variables such as medical diagnoses at predicting MH/SA expenditures among adults. Simulation analyses revealed that among both adults and minors considerable scope remained for behavioral health care carve outs to make profits or losses after risk adjustment based on differential enrollment of severely ill patients. Similarly, integrated health plans have strong financial incentives to avoid MH/SA users even after adjustment. CONCLUSIONS: Current risk adjustment methodologies do not eliminate the financial incentives for integrated health plans and behavioral health care carve-out plans to avoid high-utilizing patients with psychiatric disorders. PMID:11508640

Subjective Sleep Related to Post Traumatic Stress Disorder Symptoms among Trauma-Exposed Men and Women.

PubMed

Gibson, Carolyn J; Richards, Anne; Villanueva, Cynthia; Barrientos, Maureen; Neylan, Thomas C; Inslicht, Sabra S

2017-11-27

Sleep difficulty is both a common symptom of posttraumatic stress disorder (PTSD) and a risk factor for the development and maintenance of PTSD symptomatology. Gender differences in sleep following trauma exposure have been posited to contribute to the increased risk for the development of PTSD among women, but the persistence and long-term contributions of these potential differences to the maintenance and severity of PTSD symptoms is unclear. Men and women reporting a history of trauma exposure (n = 112, 63% female) participated in this study. Subjective sleep complaints and PTSD symptom severity were assessed using well-validated measures (Pittsburgh Sleep Quality Index, PTSD Symptom Checklist). Multivariable regression models (full sample and gender-stratified) were used to predict PTSD symptom severity from global, subscale, and individual item sleep parameters, adjusted for gender, age, race/ethnicity, education, and body mass index. In the full sample, traditional measures of sleep quality and sleep disturbance were associated with PTSD symptom severity. Difficulty falling asleep, poor sleep quality, and sleep disturbance from a variety of sources were related to higher PTSD symptom severity in men, while self-reported sleep disturbance related to nightmares and emotional regulation were associated with PTSD symptom severity among women. These findings add to the limited literature on gender-specific risk factors related to sleep and PTSD, and may inform intervention development and implementation related to PTSD severity among vulnerable adults.

Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study.

PubMed

Gajic, Ognjen; Dabbagh, Ousama; Park, Pauline K; Adesanya, Adebola; Chang, Steven Y; Hou, Peter; Anderson, Harry; Hoth, J Jason; Mikkelsen, Mark E; Gentile, Nina T; Gong, Michelle N; Talmor, Daniel; Bajwa, Ednan; Watkins, Timothy R; Festic, Emir; Yilmaz, Murat; Iscimen, Remzi; Kaufman, David A; Esper, Annette M; Sadikot, Ruxana; Douglas, Ivor; Sevransky, Jonathan; Malinchoc, Michael

2011-02-15

Accurate, early identification of patients at risk for developing acute lung injury (ALI) provides the opportunity to test and implement secondary prevention strategies. To determine the frequency and outcome of ALI development in patients at risk and validate a lung injury prediction score (LIPS). In this prospective multicenter observational cohort study, predisposing conditions and risk modifiers predictive of ALI development were identified from routine clinical data available during initial evaluation. The discrimination of the model was assessed with area under receiver operating curve (AUC). The risk of death from ALI was determined after adjustment for severity of illness and predisposing conditions. Twenty-two hospitals enrolled 5,584 patients at risk. ALI developed a median of 2 (interquartile range 1-4) days after initial evaluation in 377 (6.8%; 148 ALI-only, 229 adult respiratory distress syndrome) patients. The frequency of ALI varied according to predisposing conditions (from 3% in pancreatitis to 26% after smoke inhalation). LIPS discriminated patients who developed ALI from those who did not with an AUC of 0.80 (95% confidence interval, 0.78-0.82). When adjusted for severity of illness and predisposing conditions, development of ALI increased the risk of in-hospital death (odds ratio, 4.1; 95% confidence interval, 2.9-5.7). ALI occurrence varies according to predisposing conditions and carries an independently poor prognosis. Using routinely available clinical data, LIPS identifies patients at high risk for ALI early in the course of their illness. This model will alert clinicians about the risk of ALI and facilitate testing and implementation of ALI prevention strategies. Clinical trial registered with www.clinicaltrials.gov (NCT00889772).

Early Identification of Patients at Risk of Acute Lung Injury

PubMed Central

Gajic, Ognjen; Dabbagh, Ousama; Park, Pauline K.; Adesanya, Adebola; Chang, Steven Y.; Hou, Peter; Anderson, Harry; Hoth, J. Jason; Mikkelsen, Mark E.; Gentile, Nina T.; Gong, Michelle N.; Talmor, Daniel; Bajwa, Ednan; Watkins, Timothy R.; Festic, Emir; Yilmaz, Murat; Iscimen, Remzi; Kaufman, David A.; Esper, Annette M.; Sadikot, Ruxana; Douglas, Ivor; Sevransky, Jonathan

2011-01-01

Rationale: Accurate, early identification of patients at risk for developing acute lung injury (ALI) provides the opportunity to test and implement secondary prevention strategies. Objectives: To determine the frequency and outcome of ALI development in patients at risk and validate a lung injury prediction score (LIPS). Methods: In this prospective multicenter observational cohort study, predisposing conditions and risk modifiers predictive of ALI development were identified from routine clinical data available during initial evaluation. The discrimination of the model was assessed with area under receiver operating curve (AUC). The risk of death from ALI was determined after adjustment for severity of illness and predisposing conditions. Measurements and Main Results: Twenty-two hospitals enrolled 5,584 patients at risk. ALI developed a median of 2 (interquartile range 1–4) days after initial evaluation in 377 (6.8%; 148 ALI-only, 229 adult respiratory distress syndrome) patients. The frequency of ALI varied according to predisposing conditions (from 3% in pancreatitis to 26% after smoke inhalation). LIPS discriminated patients who developed ALI from those who did not with an AUC of 0.80 (95% confidence interval, 0.78–0.82). When adjusted for severity of illness and predisposing conditions, development of ALI increased the risk of in-hospital death (odds ratio, 4.1; 95% confidence interval, 2.9–5.7). Conclusions: ALI occurrence varies according to predisposing conditions and carries an independently poor prognosis. Using routinely available clinical data, LIPS identifies patients at high risk for ALI early in the course of their illness. This model will alert clinicians about the risk of ALI and facilitate testing and implementation of ALI prevention strategies. Clinical trial registered with www.clinicaltrials.gov (NCT00889772). PMID:20802164

Ileostomy creation in colorectal cancer surgery: risk of acute kidney injury and chronic kidney disease.

PubMed

Li, Linda; Lau, Kelsey S; Ramanathan, Venkat; Orcutt, Sonia T; Sansgiry, Shubhada; Albo, Daniel; Berger, David H; Anaya, Daniel A

2017-04-01

Ileostomy creation is associated with postoperative dehydration and readmission; however, the effect on renal function is unknown. Our goal was to characterize the impact of ileostomy creation on acute and chronic renal function. A retrospective cohort study with patients undergoing colorectal cancer surgery at a tertiary referral institution (2005-2011). The relationship between ileostomy creation and acute kidney injury (AKI)-related readmission, severe chronic kidney disease (CKD) at 12 mo (glomerular filtration rate <30 mL/min/1.73 m 2 ), and onset of severe CKD over time was evaluated using multivariable logistic and Cox regression and adjusted using propensity score stratification. Among 619 patients, 84 (13%) had ileostomy. AKI-related readmission and severe CKD at 12 mo were more common among ileostomy patients (17% versus 2%, P < 0.01 and 13.3% versus 5%, P = 0.02, respectively). After propensity score adjustment, ileostomy was a significant predictor of AKI-related readmissions (odds ratio: 10.3; 95% confidence interval [CI], 3.9-27.2), severe CKD at 12 mo (odds ratio: 4.1; 95% CI, 1.4-11.9), and onset of severe CKD over time (hazard ratio: 4.2; 95% CI, 2.3-6.6). Ileostomy creation is associated with increased risk of AKI-related readmissions and development of severe CKD. Future studies must focus on strategies to minimize kidney injury when ileostomy is a necessary component of colorectal cancer surgery and revisiting current indications for ileostomy creation. Copyright © 2016 Elsevier Inc. All rights reserved.

Using Trauma and Injury Severity Score (TRISS)-based analysis in the development of regional risk adjustment tools to trend quality in a voluntary trauma system: the experience of the Trauma Foundation of Northeast Ohio.

PubMed

Mancuso, C; Barnoski, A; Tinnell, C; Fallon, W

2000-04-01

Presently, no trauma system exists in Ohio. Since 1993, all hospitals in Cuyahoga County (CUY), northeast Ohio (n = 22) provide data to a trauma registry. In return, each received hospital-specific data, comparison data by trauma care level and a county-wide aggregate summary. This report describes the results of this approach in our region. All cases were entered by paper abstract or electronic download. Interrater reliability audits and z score analysis was performed by using the Major Trauma Outcome Study and the CUY 1994 baseline groups. Risk adjustment of mortality data was performed using statistical modeling and logistic regression (Trauma and Injury Severity Score, Major Trauma Outcome Study, CUY). Trauma severity measures were defined. In 1995, 3,375 patients were entered. Two hundred ninety-one died (8.6%). Severity measures differed by level of trauma care, indicating differences in case mix. Probability of survival was lowest in the Level I centers, highest in the acute care hospitals. Outcomes z scores demonstrated survival differences for all levels. In a functioning trauma system, the most severely injured patients should be cared for at the trauma centers. A low volume at acute care hospitals is desirable. By using Trauma and Injury Severity Score with community-specific constants, NE Ohio is accomplishing these goals. The Level I performance data are an interesting finding compared with the data from the Level II centers in the region

Religiousness Among At-Risk Drinkers: Is It Prospectively Associated With the Development or Maintenance of an Alcohol-Use Disorder?*

PubMed Central

Borders, Tyrone F.; Curran, Geoffrey M.; Mattox, Rhonda; Booth, Brenda M.

2010-01-01

Objective: This study examined whether particular dimensions of religiousness are prospectively associated with the development or maintenance of an alcohol-use disorder (AUD) among at-risk drinkers or persons with a history of problem drinking. Method: A prospective cohort study was conducted among at-risk drinkers identified through a population-based telephone survey of adults residing in the southeastern United States. The cohort was stratified by baseline AUD status to determine how several dimensions of religiousness (organized religious attendance, religious self-ranking, religious influence on one's life, coping through prayer, and talking with a religious leader) were associated with the development and, separately, the maintenance or remission of an AUD over 6 months. Multiple logistic regression analyses were conducted to estimate the odds of developing versus not developing an AUD and maintaining versus remitting from an AUD while adjusting for measures of social support and other covariates. Results: Among persons without an AUD at baseline, more frequent organized religious attendance, adjusted odds ratio (ORadj) = 0.73, 95% CI [0.55, 0.96], and coping through prayer, ORadj = 0.63, 95% CI [0.45, 0.87], were associated with lower adjusted odds of developing an AUD. In contrast, among persons with an AUD at baseline, no dimension of religiousness was associated with the maintenance or remission of an AUD. Conclusions: The findings of this study suggest that religious attendance and coping through prayer may protect against the development of an AUD among at-risk drinkers. Further research is warranted to ascertain whether these or other religious activities and practices should be promoted among at-risk drinkers. PMID:20105423

ATLAS: Finding the Nearest Asteroids

NASA Astrophysics Data System (ADS)

Heinze, Aren; Tonry, John L.; Denneau, Larry; Stalder, Brian

2017-10-01

The Asteroid Terrestrial-impact Last Alert System (ATLAS) became fully operational in June 2017. Our two robotic, 0.5 meter telescopes survey the whole accessible sky every two nights from the Hawaiian mountains of Haleakala and Mauna Loa. With sensitivity to magnitude 19.5 over a field of 30 square degrees, we discover several bright near-Earth objects every month - particularly fast moving asteroids, which can slip by other surveys that scan the sky more slowly. Several important developments in 2017 have enhanced our sensitivity to small, nearby asteroids and potential impactors. We report on these developments - including optical adjustments, automated screening of detections, closer temporal spacing of images, and tolerance for large deviations from Great Circle motion on the sky - and we describe their effect in terms of measuring and discovering real objects.

Impact of disasters on child stunting in Nepal

PubMed Central

Gaire, Surya; Delbiso, Tefera Darge; Pandey, Srijana; Guha-Sapir, Debarati

2016-01-01

Background Stunting is a major public health problem that results from inadequate nutritional intake over a long period of time. Disasters have major implications in poor and vulnerable children. The aim of this study was, therefore, to assess the impact of disasters on child stunting in Nepal. Method A sample consisting of 2,111 children aged 6–59 months was obtained from the 2011 Nepal Demographic and Health Survey. We used bivariate and multivariate analyses to examine moderate and severe stunting against disaster, controlling for all possible confounders. Result Out of the total study sample, 43% were stunted (17.1% severely and 25.9% moderately). The final model, after adjusting for confounders, showed that epidemics have no impact on child stunting (adjusted odds ratio [OR] =1.14, 95% confidence interval [CI]: 0.66, 1.97 and adjusted OR =1.04, 95% CI: 0.66, 1.65 for severe and moderate stunting, respectively). Floods have impact on child stunting (adjusted OR =0.57, 95% CI: 0.31, 0.96 and adjusted OR =0.66, 95% CI: 0.41, 0.94 for severe and moderate stunting, respectively). However, children aged 6–11 months, nonvaccinated children, children of working women, children who live in mountainous areas, and children from the poorest households were more likely to be moderately stunted. Similarly, children aged 36–47 months, Dalit and other ethnic groups, children from rural settings, and children from the poorest households were more likely to be severely stunted. Conclusion This article illustrates the need to rethink about child stunting in Nepal. This study suggests need for further research, integration of disaster data in the Nepal Demography Health Survey, educational interventions, public awareness, promotion of vaccination, and equity in health service delivery. PMID:27354834

Severity-Adjusted Mortality in Trauma Patients Transported by Police

PubMed Central

Band, Roger A.; Salhi, Rama A.; Holena, Daniel N.; Powell, Elizabeth; Branas, Charles C.; Carr, Brendan G.

2018-01-01

Study objective Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. We conduct a large, multiyear, citywide analysis of this policy. We examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia. Methods This is a retrospective cohort study of trauma registry data. Patients who sustained any proximal penetrating trauma and presented to any Level I or II trauma center in Philadelphia between January 1, 2003, and December 31, 2007, were included. Analyses were conducted with logistic regression models and were adjusted for injury severity with the Trauma and Injury Severity Score and for case mix with a modified Charlson index. Results Four thousand one hundred twenty-two subjects were identified. Overall mortality was 27.4%. In unadjusted analyses, patients transported by police were more likely to die than patients transported by ambulance (29.8% versus 26.5%; OR 1.18; 95% confidence interval [CI] 1.00 to 1.39). In adjusted models, no significant difference was observed in overall mortality between the police department and EMS groups (odds ratio [OR] 0.78; 95% CI 0.61 to 1.01). In subgroup analysis, patients with severe injury (Injury Severity Score >15) (OR 0.73; 95% CI 0.59 to 0.90), patients with gunshot wounds (OR 0.70; 95% CI 0.53 to 0.94), and patients with stab wounds (OR 0.19; 95% CI 0.08 to 0.45) were more likely to survive if transported by police. Conclusion We found no significant overall difference in adjusted mortality between patients transported by the police department compared with EMS but found increased adjusted survival among 3 key subgroups of patients transported by police. This practice may augment traditional care. PMID:24387925

Dietary intake habits and the prevalence of nocturia in Japanese patients with type 2 diabetes mellitus.

PubMed

Furukawa, Shinya; Sakai, Takenori; Niiya, Tetsuji; Miyaoka, Hiroaki; Miyake, Teruki; Yamamoto, Shin; Maruyama, Koutatsu; Tanaka, Keiko; Ueda, Teruhisa; Senba, Hidenori; Torisu, Masamoto; Minami, Hisaka; Tanigawa, Takeshi; Matsuura, Bunzo; Hiasa, Yoichi; Miyake, Yoshihiro

2018-03-01

No reports have been published on the association between dietary intake habits and nocturia in the diabetes population. We therefore evaluated this issue among Japanese patients with diabetes mellitus. Study participants in the present study were 785 Japanese patients with type 2 diabetes mellitus. Self-administered questionnaires were used to assess each type of dietary intake habit. Vegetable intake habit was assessed by the following question: "Do you have vegetables or seaweed every day?" We used the following two outcomes: (i) nocturia: ≥2 voids per night; and (ii) severe nocturia: ≥3 voids per night. Adjustment was made for age, sex, body mass index, glycated hemoglobin, hypertension, dyslipidemia, smoking, drinking, exercise habit, stroke, ischemic artery disease, diabetic nephropathy, diabetic neuropathy and diabetic retinopathy. The prevalence of nocturia, severe nocturia, and vegetable intake habit was 39.9%, 14.4% and 67.3%, respectively. After adjusting for confounding factors, vegetable intake habit was independently inversely associated with nocturia and severe nocturia: the adjusted odds ratios were 0.67 (95% confidence interval [CI] 0.48-0.94) and 0.46 (95% CI 0.30-0.71), respectively. Among male patients, vegetable intake habit was independently inversely associated with severe nocturia, but not nocturia: the adjusted OR was 0.51 (95% CI 0.29-0.88). Among female patients, vegetable intake habit was independently inversely associated with nocturia and severe nocturia: the adjusted ORs were 0.44 (95% CI 0.24-0.79) and 0.34 (95% CI 0.15-0.78), respectively. We found an inverse association between vegetable intake habit and nocturia in Japanese patients with type 2 diabetes mellitus. © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Robust Covariate-Adjusted Log-Rank Statistics and Corresponding Sample Size Formula for Recurrent Events Data

PubMed Central

Song, Rui; Kosorok, Michael R.; Cai, Jianwen

2009-01-01

Summary Recurrent events data are frequently encountered in clinical trials. This article develops robust covariate-adjusted log-rank statistics applied to recurrent events data with arbitrary numbers of events under independent censoring and the corresponding sample size formula. The proposed log-rank tests are robust with respect to different data-generating processes and are adjusted for predictive covariates. It reduces to the Kong and Slud (1997, Biometrika 84, 847–862) setting in the case of a single event. The sample size formula is derived based on the asymptotic normality of the covariate-adjusted log-rank statistics under certain local alternatives and a working model for baseline covariates in the recurrent event data context. When the effect size is small and the baseline covariates do not contain significant information about event times, it reduces to the same form as that of Schoenfeld (1983, Biometrics 39, 499–503) for cases of a single event or independent event times within a subject. We carry out simulations to study the control of type I error and the comparison of powers between several methods in finite samples. The proposed sample size formula is illustrated using data from an rhDNase study. PMID:18162107

Dynamic probability control limits for risk-adjusted CUSUM charts based on multiresponses.

PubMed

Zhang, Xiang; Loda, Justin B; Woodall, William H

2017-07-20

For a patient who has survived a surgery, there could be several levels of recovery. Thus, it is reasonable to consider more than two outcomes when monitoring surgical outcome quality. The risk-adjusted cumulative sum (CUSUM) chart based on multiresponses has been developed for monitoring a surgical process with three or more outcomes. However, there is a significant effect of varying risk distributions on the in-control performance of the chart when constant control limits are applied. To overcome this disadvantage, we apply the dynamic probability control limits to the risk-adjusted CUSUM charts for multiresponses. The simulation results demonstrate that the in-control performance of the charts with dynamic probability control limits can be controlled for different patient populations because these limits are determined for each specific sequence of patients. Thus, the use of dynamic probability control limits for risk-adjusted CUSUM charts based on multiresponses allows each chart to be designed for the corresponding patient sequence of a surgeon or a hospital and therefore does not require estimating or monitoring the patients' risk distribution. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Risk of Disabling Response Fluctuations and Dyskinesias for Dopamine Agonists Versus Levodopa in Parkinson's Disease.

PubMed

Haaxma, Charlotte A; Horstink, Martin W I M; Zijlmans, Jan C; Lemmens, Wim A J G; Bloem, Bastiaan R; Borm, George F

2015-01-01

Response fluctuations and dyskinesias develop during the use of both levodopa (LD) and dopamine agonists (DA), but may not be equally disabling. To compare the risk and time of onset of disabling response fluctuations and dyskinesias (DRFD) among patients with Parkinson's disease (PD) who were initially treated with either LD or DA. Open cohort study of all consecutive de-novo PD patients in routine clinical practice, included over a period of 15 years (median follow-up: 8.1 years, range 1.1-17.7), since embarking on LD or DA. Older patients and patients with more severe PD were started on LD (n = 77), younger patients on a DA (n = 50). Therapy was adjusted according to generally accepted guidelines. The primary endpoints were: the onset of response fluctuations, dyskinesias, and the moment when these complications became disabling (DRFD). LD-starters developed response fluctuations 0.8 years earlier than DA-starters (p = 0.07), while dyskinesias appeared around 2.5 years earlier (p = 0.003). However, the risk and time of onset of DRFD did not differ statistically between the groups (LD-starters: 60% , median interval 7.3 years, DA-starters: 52% , 6.1 years, p = 0.63). DA-starters displayed a 0.19 points lower adjusted mean improvement in motor scores than LD-starters (p = 0.002). Adjustments for age and severity of PD at start of dopaminergic therapy did not change these results. In routine clinical practice, the risk and time of onset of DRFD is comparable for LD-starters versus DA-starters, but motor functioning is worse in DA-starters. These results support the use of LD as initial therapy for PD.

A Latent Class Analysis of Maternal Depressive Symptoms over 12 Years and Offspring Adjustment in Adolescence

PubMed Central

Campbell, Susan B.; Morgan-Lopez, Antonio A.; Cox, Martha J.; McLoyd, Vonnie C.

2009-01-01

We used data from the NICHD Study of Early Child Care and Youth Development and latent class analysis to model patterns of maternal depressive symptoms from infant age 1 month to the transition to adolescence (age 12), and then examined adolescent adjustment at age 15 as a function of the course and severity of maternal symptoms. We identified five latent classes of symptoms in these 1357 women while also taking into account sociodemographic measures: never depressed; stable subclinical; early-decreasing; moderately elevated; chronic. Women with few symptoms were more likely to be married, better educated, and in better physical health than women with more elevated symptoms. Family size and whether the pregnancy was planned also differentiated among classes. At age 15, adolescents whose mothers were in the chronic, elevated, and stable subclinical latent classes reported more internalizing and externalizing problems and acknowledged engaging in more risky behavior than did children of never-depressed mothers. Latent class differences in self-reported loneliness and dysphoria were also found. Finally, several significant interactions between sex and latent class suggested that girls whose mothers reported elevated symptoms of depression over time experienced more internalizing distress and dysphoric mood relative to their male counterparts. Discussion focuses on adolescent adjustment, especially among offspring whose mothers report stable symptoms of depression across their childhoods. PMID:19685946

75 FR 36360 - New England Fishery Management Council; Public Hearings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-25

... access general category fishery, adjusting the overfishing definition, modifying the essential fish habitat closed areas in the Scallop FMP, changing the scallop fishing year and several adjustments to the...

Stroke outcomes measures must be appropriately risk adjusted to ensure quality care of patients: a presidential advisory from the American Heart Association/American Stroke Association.

PubMed

Fonarow, Gregg C; Alberts, Mark J; Broderick, Joseph P; Jauch, Edward C; Kleindorfer, Dawn O; Saver, Jeffrey L; Solis, Penelope; Suter, Robert; Schwamm, Lee H

2014-05-01

Because stroke is among the leading causes of death, disability, hospitalizations, and healthcare expenditures in the United States, there is interest in reporting outcomes for patients hospitalized with acute ischemic stroke. The American Heart Association/American Stroke Association, as part of its commitment to promote high-quality, evidence-based care for cardiovascular and stroke patients, fully supports the development of properly risk-adjusted outcome measures for stroke. To accurately assess and report hospital-level outcomes, adequate risk adjustment for case mix is essential. During the development of the Centers for Medicare & Medicaid Services 30-day stroke mortality and 30-day stroke readmission measures, concerns were expressed that these measures were not adequately designed because they do not include a valid initial stroke severity measure, such as the National Institutes of Health Stroke Scale. These outcome measures, as currently constructed, may be prone to mischaracterizing the quality of stroke care being delivered by hospitals and may ultimately harm acute ischemic stroke patients. This article details (1) why the Centers for Medicare & Medicaid Services acute ischemic stroke outcome measures in their present form may not provide adequate risk adjustment, (2) why the measures as currently designed may lead to inaccurate representation of hospital performance and have the potential for serious unintended consequences, (3) what activities the American Heart Association/American Stroke Association has engaged in to highlight these concerns to the Centers for Medicare & Medicaid Services and other interested parties, and (4) alternative approaches and opportunities that should be considered for more accurately risk-adjusting 30-day outcomes measures in patients with ischemic stroke.

The impact of coping and emotional intelligence on the relationship between posttraumatic stress disorder from past trauma, adjustment difficulty, and psychological distress following divorce.

PubMed

Slanbekova, Gulnara; Chung, Man Cheung; Abildina, Saltanat; Sabirova, Raikhan; Kapbasova, Gulzada; Karipbaev, Baizhol

2017-08-01

Focusing on a group of Kazakh divorcees, this study examined the inter-relationship between posttraumatic stress disorder (PTSD) from past trauma, coping strategies, emotional intelligence, adjustment difficulties, and psychiatric symptom severity following divorce. One hundred and twenty divorcees participated in the research and completed the Emotional Intelligence Questionnaire, Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28, Brief COPE, and Fisher's Divorce Adjustment Scale Results: About 29% reported no trauma; 53%, 21%, and 26% met the criteria for no-PTSD, partial-PTSD, and full-PTSD respectively. Emotion-focused coping and managing emotions predicted adjustment difficulties. Controlling for gender, PTSD, problem-focused coping, and managing emotions predicted psychiatric symptom severity. Problem-focused coping mediated the direct effect of the path between PTSD and psychiatric symptom severity with its mediational effect being moderated by the effect of managing emotions. Following divorce, people can experience psychological distress which is influenced by the effects of PTSD from past trauma, and whether they used problem-focused coping and were able to manage their emotions.

Influence of the National Trauma Data Bank on the study of trauma outcomes: is it time to set research best practices to further enhance its impact?

PubMed

Haider, Adil H; Saleem, Taimur; Leow, Jeffrey J; Villegas, Cassandra V; Kisat, Mehreen; Schneider, Eric B; Haut, Elliott R; Stevens, Kent A; Cornwell, Edward E; MacKenzie, Ellen J; Efron, David T

2012-05-01

Risk-adjusted analyses are critical in evaluating trauma outcomes. The National Trauma Data Bank (NTDB) is a statistically robust registry that allows such analyses; however, analytical techniques are not yet standardized. In this study, we examined peer-reviewed manuscripts published using NTDB data, with particular attention to characteristics strongly associated with trauma outcomes. Our objective was to determine if there are substantial variations in the methodology and quality of risk-adjusted analyses and therefore, whether development of best practices for risk-adjusted analyses is warranted. A database of all studies using NTDB data published through December 2010 was created by searching PubMed and Embase. Studies with multivariate risk-adjusted analyses were examined for their central question, main outcomes measures, analytical techniques, covariates in adjusted analyses, and handling of missing data. Of 286 NTDB publications, 122 performed a multivariable adjusted analysis. These studies focused on clinical outcomes (51 studies), public health policy or injury prevention (30), quality (16), disparities (15), trauma center designation (6), or scoring systems (4). Mortality was the main outcome in 98 of these studies. There were considerable differences in the covariates used for case adjustment. The 3 covariates most frequently controlled for were age (95%), Injury Severity Score (85%), and sex (78%). Up to 43% of studies did not control for the 5 basic covariates necessary to conduct a risk-adjusted analysis of trauma mortality. Less than 10% of studies used clustering to adjust for facility differences or imputation to handle missing data. There is significant variability in how risk-adjusted analyses using data from the NTDB are performed. Best practices are needed to further improve the quality of research from the NTDB. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Hypertension after preeclampsia and relation to the C1114G polymorphism (rs4606) in RGS2: data from the Norwegian HUNT2 study.

PubMed

Kvehaugen, Anne Stine; Melien, Øyvind; Holmen, Oddgeir L; Laivuori, Hannele; Dechend, Ralf; Staff, Anne Cathrine

2014-03-05

Preeclampsia is associated with an increased risk of hypertension later in life. The regulator of G protein signaling 2 negatively regulates several vasoconstrictors. We recently demonstrated an association between preeclampsia and the CG or GG genotype of the C1114G polymorphism (rs4606) of the regulator of G protein signaling 2 gene. Here, we examined the polymorphism with respect to the development of hypertension after pregnancy. We genotyped 934 women on average 15.1 years after preeclampsia and 2011 age matched women with previous normotensive pregnancy. All women in this study were retrospectively recruited from the Nord-Trøndelag Health Study (HUNT2). Information from HUNT2 was linked to the Medical Birth Registry of Norway to identify women with a history of preeclampsia and women without a history of preeclampsia. No significant association was found between hypertension (blood pressure ≥140/90 mmHg and/or taking antihypertensive drugs) and the polymorphism in crude analysis (OR (95% CI): CG genotype: 1.07 (0.90-1.27); GG genotype: 1.23 (0.90-1.67)). However, in a minimally adjusted model (age and BMI adjusted), a significant association between the GG genotype and hypertension was found (OR (95% CI): 1.49 (1.05-2.11)). This association remained significant also after adjustment for a history of preeclampsia (OR (95% CI): 1.46 (1.02-2.09)), but not in a model adjusted for multiple other variables (OR (95% CI): 1.26 (0.82-1.94)). In multivariate, but not in crude, analysis, the GG genotype of rs4606 (OR (95% CI): 1.93 (1.05-3.53)) was significantly and independently associated with severe hypertension later in life, defined as systolic blood pressure ≥160 mmHg (stage 2 hypertension) and/or taking antihypertensive drugs. A significant association was also found for the merged CG and GG genotypes (OR (95% CI): 1.43 (1.02-2.00)). Moreover, an interaction with physical activity was found. A history of preeclampsia was a significant and independent predictor of either definition of hypertension, both in crude and adjusted analyses. Women carrying the rs4606 CG or GG genotype are at elevated risk for developing hypertension after delivery. Physical activity may interact with the association. Preeclampsia remains an independent risk factor for subsequent hypertension after adjusting for this polymorphism and classical CVD risk factors.

Hypertension after preeclampsia and relation to the C1114G polymorphism (rs4606) in RGS2: data from the Norwegian HUNT2 study

PubMed Central

2014-01-01

Background Preeclampsia is associated with an increased risk of hypertension later in life. The regulator of G protein signaling 2 negatively regulates several vasoconstrictors. We recently demonstrated an association between preeclampsia and the CG or GG genotype of the C1114G polymorphism (rs4606) of the regulator of G protein signaling 2 gene. Here, we examined the polymorphism with respect to the development of hypertension after pregnancy. Methods We genotyped 934 women on average 15.1 years after preeclampsia and 2011 age matched women with previous normotensive pregnancy. All women in this study were retrospectively recruited from the Nord-Trøndelag Health Study (HUNT2). Information from HUNT2 was linked to the Medical Birth Registry of Norway to identify women with a history of preeclampsia and women without a history of preeclampsia. Results No significant association was found between hypertension (blood pressure ≥140/90 mmHg and/or taking antihypertensive drugs) and the polymorphism in crude analysis (OR (95% CI): CG genotype: 1.07 (0.90-1.27); GG genotype: 1.23 (0.90-1.67)). However, in a minimally adjusted model (age and BMI adjusted), a significant association between the GG genotype and hypertension was found (OR (95% CI): 1.49 (1.05-2.11)). This association remained significant also after adjustment for a history of preeclampsia (OR (95% CI): 1.46 (1.02-2.09)), but not in a model adjusted for multiple other variables (OR (95% CI): 1.26 (0.82-1.94)). In multivariate, but not in crude, analysis, the GG genotype of rs4606 (OR (95% CI): 1.93 (1.05-3.53)) was significantly and independently associated with severe hypertension later in life, defined as systolic blood pressure ≥160 mmHg (stage 2 hypertension) and/or taking antihypertensive drugs. A significant association was also found for the merged CG and GG genotypes (OR (95% CI): 1.43 (1.02-2.00)). Moreover, an interaction with physical activity was found. A history of preeclampsia was a significant and independent predictor of either definition of hypertension, both in crude and adjusted analyses. Conclusion Women carrying the rs4606 CG or GG genotype are at elevated risk for developing hypertension after delivery. Physical activity may interact with the association. Preeclampsia remains an independent risk factor for subsequent hypertension after adjusting for this polymorphism and classical CVD risk factors. PMID:24593135

Cohort Study of Severe Bronchiolitis during Infancy and Risk of Asthma by Age 5 Years.

PubMed

Balekian, Diana S; Linnemann, Rachel W; Hasegawa, Kohei; Thadhani, Ravi; Camargo, Carlos A

Severe bronchiolitis (ie, bronchiolitis requiring hospital admission) is thought to markedly increase asthma risk, with 30%-50% developing asthma by age 5 years. To date, studies of this association are small, and most are from outside the United States. The objective of this study was to investigate the association between severe bronchiolitis and risk of asthma in a US birth cohort. We studied a cohort nested within the Massachusetts General Hospital Obstetric Maternal Study (MOMS), a prospective cohort of pregnant women enrolled during 1998-2006. Children of mothers enrolled in MOMS were included in the analysis if they received care within our health system (n = 3653). Diagnoses and medications were extracted from the children's electronic health records; we also examined pregnancy and perinatal risk factors collected for the underlying pregnancy study. The birth cohort was 52% male, 49% white, and 105 infants (2.9%) had severe bronchiolitis. Overall, 421 children (11.5%) developed asthma by age 5 years. Among the children with severe bronchiolitis, 27.6% developed asthma by age 5 years. In multivariable logistic regression adjusting for 12 risk factors, severe bronchiolitis remained a strong risk factor for developing asthma by age 5 years (odds ratio 2.57; 95% confidence interval 1.61-4.09). In a large Boston birth cohort, the frequency of severe bronchiolitis and childhood asthma was similar to published data. Among children with severe bronchiolitis, the risk of developing asthma was lower than prior studies but still high (27.6%). This difference may be due to different study designs, populations, and outcome definitions studied. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Potential risk factors for onset of severe neck and shoulder discomfort (Katakori) in urban Japanese workers.

PubMed

Sawada, Takayuki; Matsudaira, Ko; Muto, Yumiko; Koga, Tadashi; Takahashi, Masaya

2016-06-10

Katakori is a Japanese word, and there is no clear English translation. Katakori consists of two terms, Kata means neck and shoulder, kori means stiffness. Consequently, Katakori is defined as neck and shoulder discomfort or dull pain. Katakori is a major somatic complaint and has a large impact on workers. To examine the association between onset of severe Katakori and potential risk factors in Japanese workers, a prospective cohort study, entitled "Cultural and Psychosocial Influence on Disability (CUPID)", was conducted. Self-administered questionnaires were distributed twice: at baseline and 1 year after baseline. Logistic regression was used to explore the risk factors of onset of severe Katakori. Of those 1,398, the incidence of severe Katakori onset after 1 year was 3.0% (42 workers). Being female (adjusted odds ratio: 2.39, 95% confidence interval: 1.18-4.86), short sleep duration (adjusted odds ratio: 2.86, 95% confidence interval: 1.20-6.82) and depressed mood with some issues at work (adjusted odds ratio: 3.11, 95% confidence interval: 1.38-7.03) were significantly associated with onset of severe Katakori. Psychosocial factors as well as gender difference were associated with onset of severe Katakori. We suggest that mental health support at the workplace is important to prevent severe Katakori.

Stress and Personal Resource as Predictors of the Adjustment of Parents to Autistic Children: A Multivariate Model

ERIC Educational Resources Information Center

Siman-Tov, Ayelet; Kaniel, Shlomo

2011-01-01

The research validates a multivariate model that predicts parental adjustment to coping successfully with an autistic child. The model comprises four elements: parental stress, parental resources, parental adjustment and the child's autism symptoms. 176 parents of children aged between 6 to 16 diagnosed with PDD answered several questionnaires…

Understanding New Jersey's School Funding Formula: The Role of Adjustment Aid

ERIC Educational Resources Information Center

Farrie, Danielle; Luhm, Theresa; Johnson, Monete

2015-01-01

The objective of this policy brief is to explain the purpose of adjustment aid in New Jersey's school funding formula and to correct several misconceptions about the level of aid and how it is distributed. The main conclusions include: (1) The amount of adjustment aid in the funding formula is currently overstated in the "informational"…

Neurocognitive Outcome of Children Exposed to Perinatal Mother-to-Child Chikungunya Virus Infection: The CHIMERE Cohort Study on Reunion Island

PubMed Central

Ramful, Duksha; Boumahni, Brahim; Bintner, Marc; Alessandri, Jean-Luc; Carbonnier, Magali; Tiran-Rajaoefera, Isabelle; Beullier, Gilles; Boya, Irénée; Noormahomed, Tahir; Okoï, Jocelyn; Rollot, Olivier; Cotte, Liliane; Jaffar-Bandjee, Marie-Christine; Michault, Alain; Favier, François; Kaminski, Monique; Fourmaintraux, Alain; Fritel, Xavier

2014-01-01

Background Little is known about the neurocognitive outcome in children exposed to perinatal mother-to-child Chikungunya virus (p-CHIKV) infection. Methods The CHIMERE ambispective cohort study compared the neurocognitive function of 33 p-CHIKV-infected children (all but one enrolled retrospectively) at around two years of age with 135 uninfected peers (all enrolled prospectively). Psychomotor development was assessed using the revised Brunet-Lezine scale, examiners blinded to infectious status. Development quotients (DQ) with subscores covering movement/posture, coordination, language, sociability skills were calculated. Predictors of global neurodevelopmental delay (GND, DQ≤85), were investigated using multivariate Poisson regression modeling. Neuroradiologic follow-up using magnetic resonance imaging (MRI) scans was proposed for most of the children with severe forms. Results The mean DQ score was 86.3 (95%CI: 81.0–91.5) in infected children compared to 100.2 (95%CI: 98.0–102.5) in uninfected peers (P<0.001). Fifty-one percent (n = 17) of infected children had a GND compared to 15% (n = 21) of uninfected children (P<0.001). Specific neurocognitive delays in p-CHIKV-infected children were as follows: coordination and language (57%), sociability (36%), movement/posture (27%). After adjustment for maternal social situation, small for gestational age, and head circumference, p-CHIKV infection was found associated with GND (incidence rate ratio: 2.79, 95%CI: 1.45–5.34). Further adjustments on gestational age or breastfeeding did not change the independent effect of CHIKV infection on neurocognitive outcome. The mean DQ of p-CHIKV-infected children was lower in severe encephalopathic children than in non-severe children (77.6 versus 91.2, P<0.001). Of the 12 cases of CHIKV neonatal encephalopathy, five developed a microcephaly (head circumference <−2 standard deviations) and four matched the definition of cerebral palsy. MRI scans showed severe restrictions of white matter areas, predominant in the frontal lobes in these children. Conclusions The neurocognitive outcome of children exposed to perinatal mother-to-child CHIKV infection is poor. Severe CHIKV neonatal encephalopathy is associated with an even poorer outcome. PMID:25033077

Combined Use of Integral Experiments and Covariance Data

NASA Astrophysics Data System (ADS)

Palmiotti, G.; Salvatores, M.; Aliberti, G.; Herman, M.; Hoblit, S. D.; McKnight, R. D.; Obložinský, P.; Talou, P.; Hale, G. M.; Hiruta, H.; Kawano, T.; Mattoon, C. M.; Nobre, G. P. A.; Palumbo, A.; Pigni, M.; Rising, M. E.; Yang, W.-S.; Kahler, A. C.

2014-04-01

In the frame of a US-DOE sponsored project, ANL, BNL, INL and LANL have performed a joint multidisciplinary research activity in order to explore the combined use of integral experiments and covariance data with the objective to both give quantitative indications on possible improvements of the ENDF evaluated data files and to reduce at the same time crucial reactor design parameter uncertainties. Methods that have been developed in the last four decades for the purposes indicated above have been improved by some new developments that benefited also by continuous exchanges with international groups working in similar areas. The major new developments that allowed significant progress are to be found in several specific domains: a) new science-based covariance data; b) integral experiment covariance data assessment and improved experiment analysis, e.g., of sample irradiation experiments; c) sensitivity analysis, where several improvements were necessary despite the generally good understanding of these techniques, e.g., to account for fission spectrum sensitivity; d) a critical approach to the analysis of statistical adjustments performance, both a priori and a posteriori; e) generalization of the assimilation method, now applied for the first time not only to multigroup cross sections data but also to nuclear model parameters (the "consistent" method). This article describes the major results obtained in each of these areas; a large scale nuclear data adjustment, based on the use of approximately one hundred high-accuracy integral experiments, will be reported along with a significant example of the application of the new "consistent" method of data assimilation.

Stress across the life course and depression in a rapidly developing population: The Guangzhou Biobank Cohort Study

PubMed Central

Ni, Michael Y.; Jiang, Chaoqiang; Cheng, Kar Keung; Zhang, Weisen; Gilman, Stephen E.; Lam, Tai Hing; Leung, Gabriel M.; Schooling, C. Mary

2017-01-01

Objective To examine the role of stress across the life course in the development of depression among older adults in a non-Western developing setting. Methods Multivariable linear and multinomial logistic regression were used in cross-sectional analyses of 9729 Chinese participants (mean age 60.2 years) from phase 3 of the Guangzhou Biobank Cohort Study (2006-8) to investigate the association of childhood adversities and adulthood stressors with depression. Results Childhood adversities were associated with mild depression (odds ratio (OR) 1.78, 95% CI 1.58–2.02) and moderate-to-severe depression (OR 2.30, 95% CI 1.68–3.15), adjusted for age, sex, education and childhood socio-economic status. Past-year adulthood stressors were also associated with mild depression (OR 1.96, 95% CI 1.54–2.02) and moderate-to-severe depression (OR 3.55, 95% CI 2.21–5.68), adjusting additionally for occupation and income. Adulthood stressors were more strongly associated with depressive symptoms among individuals with a history of childhood adversities. Conclusions Childhood adversities and adulthood stressors were independently associated with an increased risk of depression among older ambulatory adults, though adulthood stressors were more strongly associated with depression following exposure to childhood adversities. This is consistent with evidence from Western settings in which the social context of risk and protective factors for depression may differ, and implies that the role of stress in the aetiology of depression is not context-specific. PMID:26452069

Determinants of Anemia and Hemoglobin Concentration in Haitian School-Aged Children

PubMed Central

Iannotti, Lora L.; Delnatus, Jacques R.; Odom, Audrey R.; Eaton, Jacob C.; Griggs, Jennifer J.; Brown, Sarah; Wolff, Patricia B.

2015-01-01

Anemia diminishes oxygen transport in the body, resulting in potentially irreversible growth and developmental consequences for children. Limited evidence for determinants of anemia exists for school-aged children. We conducted a cluster randomized controlled trial in Haiti from 2012 to 2013 to test the efficacy of a fortified school snack. Children (N = 1,047) aged 3–13 years were followed longitudinally at three time points for hemoglobin (Hb) concentrations, anthropometry, and bioelectrical impedance measures. Dietary intakes, infectious disease morbidities, and socioeconomic and demographic factors were collected at baseline and endline. Longitudinal regression modeling with generalized least squares and logit models with random effects identified anemia risk factors beyond the intervention effect. At baseline, 70.6% of children were anemic and 2.6% were severely anemic. Stunting increased the odds of developing anemia (adjusted odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.05–2.08) and severe anemia (adjusted OR: 2.47, 95% CI: 1.30–4.71). Parent-reported vitamin A supplementation and deworming were positively associated with Hb concentrations, whereas fever and poultry ownership showed a negative relationship with Hb concentration and increased odds of severe anemia, respectively. Further research should explore the full spectrum of anemia etiologies in school children, including genetic causes. PMID:26350448

Methods for estimating comparable prevalence rates of food insecurity experienced by adults in 147 countries and areas

NASA Astrophysics Data System (ADS)

Nord, Mark; Cafiero, Carlo; Viviani, Sara

2016-11-01

Statistical methods based on item response theory are applied to experiential food insecurity survey data from 147 countries, areas, and territories to assess data quality and develop methods to estimate national prevalence rates of moderate and severe food insecurity at equal levels of severity across countries. Data were collected from nationally representative samples of 1,000 adults in each country. A Rasch-model-based scale was estimated for each country, and data were assessed for consistency with model assumptions. A global reference scale was calculated based on item parameters from all countries. Each country's scale was adjusted to the global standard, allowing for up to 3 of the 8 scale items to be considered unique in that country if their deviance from the global standard exceeded a set tolerance. With very few exceptions, data from all countries were sufficiently consistent with model assumptions to constitute reasonably reliable measures of food insecurity and were adjustable to the global standard with fair confidence. National prevalence rates of moderate-or-severe food insecurity assessed over a 12-month recall period ranged from 3 percent to 92 percent. The correlations of national prevalence rates with national income, health, and well-being indicators provide external validation of the food security measure.

Retinopathy and chronic kidney disease in the Chronic Renal Insufficiency Cohort (CRIC) study.

PubMed

Grunwald, Juan E; Alexander, Judith; Ying, Gui-Shuang; Maguire, Maureen; Daniel, Ebenezer; Whittock-Martin, Revell; Parker, Candace; McWilliams, Kathleen; Lo, Joan C; Go, Alan; Townsend, Raymond; Gadegbeku, Crystal A; Lash, James P; Fink, Jeffrey C; Rahman, Mahboob; Feldman, Harold; Kusek, John W; Xie, Dawei; Jaar, Bernard G

2012-09-01

To investigate the association between retinopathy and chronic kidney disease. In this observational, cross-sectional study, 2605 patients of the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter study of chronic kidney disease, were offered participation. Nonmydriatic fundus photographs of the disc and macula in both eyes were obtained in 1936 of these subjects. The photographs were reviewed in a masked fashion at a central photograph reading center using standard protocols. Presence and severity of retinopathy (diabetic, hypertensive, or other) and vessel diameter caliber were assessed by trained graders and a retinal specialist using protocols developed for large epidemiologic studies. Kidney function measurements and information on traditional and nontraditional risk factors for decreased kidney function were obtained from the CRIC study. Greater severity of retinopathy was associated with lower estimated glomerular filtration rate after adjustment for traditional and nontraditional risk factors. The presence of vascular abnormalities usually associated with hypertension was also associated with lower estimated glomerular filtration rate. We found no strong direct relationship between estimated glomerular filtration rate and average arteriolar or venular calibers. Our findings show a strong association between severity of retinopathy and its features and level of kidney function after adjustment for traditional and nontraditional risk factors for chronic kidney disease, suggesting that retinovascular pathology reflects renal disease.

Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study.

PubMed

Clavel, Marie-Annick; Pibarot, Philippe; Messika-Zeitoun, David; Capoulade, Romain; Malouf, Joseph; Aggarval, Shivani; Araoz, Phillip A; Michelena, Hector I; Cueff, Caroline; Larose, Eric; Miller, Jordan D; Vahanian, Alec; Enriquez-Sarano, Maurice

2014-09-23

Aortic valve calcification (AVC) load measures lesion severity in aortic stenosis (AS) and is useful for diagnostic purposes. Whether AVC predicts survival after diagnosis, independent of clinical and Doppler echocardiographic AS characteristics, has not been studied. This study evaluated the impact of AVC load, absolute and relative to aortic annulus size (AVCdensity), on overall mortality in patients with AS under conservative treatment and without regard to treatment. In 3 academic centers, we enrolled 794 patients (mean age, 73 ± 12 years; 274 women) diagnosed with AS by Doppler echocardiography who underwent multidetector computed tomography (MDCT) within the same episode of care. Absolute AVC load and AVCdensity (ratio of absolute AVC to cross-sectional area of aortic annulus) were measured, and severe AVC was separately defined in men and women. During follow-up, there were 440 aortic valve implantations (AVIs) and 194 deaths (115 under medical treatment). Univariate analysis showed strong association of absolute AVC and AVCdensity with survival (both, p < 0.0001) with a spline curve analysis pattern of threshold and plateau of risk. After adjustment for age, sex, coronary artery disease, diabetes, symptoms, AS severity on hemodynamic assessment, and LV ejection fraction, severe absolute AVC (adjusted hazard ratio [HR]: 1.75; 95% confidence interval [CI]: 1.04 to 2.92; p = 0.03) or severe AVCdensity (adjusted HR: 2.44; 95% CI: 1.37 to 4.37; p = 0.002) independently predicted mortality under medical treatment, with additive model predictive value (all, p ≤ 0.04) and a net reclassification index of 12.5% (p = 0.04). Severe absolute AVC (adjusted HR: 1.71; 95% CI: 1.12 to 2.62; p = 0.01) and severe AVCdensity (adjusted HR: 2.22; 95% CI: 1.40 to 3.52; p = 0.001) also independently predicted overall mortality, even with adjustment for time-dependent AVI. This large-scale, multicenter outcomes study of quantitative Doppler echocardiographic and MDCT assessment of AS shows that measuring AVC load provides incremental prognostic value for survival beyond clinical and Doppler echocardiographic assessment. Severe AVC independently predicts excess mortality after AS diagnosis, which is greatly alleviated by AVI. Thus, measurement of AVC by MDCT should be considered for not only diagnostic but also risk-stratification purposes in patients with AS. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

DIY Weights and Measures: Developing Your Own Calibration Methods Using Available Materials

NASA Astrophysics Data System (ADS)

Marchetto, P.

2017-12-01

In most cases, when a custom device is built, when an instrument arrives from the manufacturer, or when a piece of equipment is picked up from the store, it is assumed that it will just work, and that data from it will be completely reliable. This fundamental expectation by many scientists is completely unfounded. Between shipping, variable environmental conditions, and many other factors, sensing systems and instruments will be out of tolerance when used. In order to get them back in tolerance, or to at least find out what their uncertainties are, characterization is necessary. If adjustment to the device is possible, this is carried out and called a calibration. In this work, several ways of generating characterization and adjustment methods are discussed, with acoustic, hydraulic, and meteorological devices as examples.

Intakes and adequacy of potentially important nutrients for cognitive development among 5-year-old children in the Seychelles Child Development and Nutrition Study.

PubMed

McAfee, Alison J; Mulhern, Maria S; McSorley, Emeir M; Wallace, Julie M W; Bonham, Maxine P; Faure, Jude; Romain, Sarah; Esther, Christina; Shamlaye, Conrad F; Watson, Gene E; Myers, Gary J; Clarkson, Thomas W; Davidson, Philip W; Strain, J J

2012-09-01

To assess the nutritional adequacy of Seychellois children in relation to nutrients reported to be important for cognitive development. Dietary intakes were assessed by 4 d weighed food diaries and analysed using dietary analysis software (WISP version 3·0; Tinuviel Software, UK). Individual nutrient intakes were adjusted to usual intakes and, in order to investigate adequacy, were compared with the UK Estimated Average Requirements for children aged 4-6 years. Children 5 years old were followed up as part of the Seychelles Child Development Nutrition Study (SCDNS), located in the high-fish-consuming population of Mahé, Republic of Seychelles. Analysis was carried out on a sample of 229 children (118 boys, 111 girls). Children consumed a diet of which fortified cereal and milk products contributed the most to nutrient intakes. The majority (≥80 %) of children met requirements for several nutrients important for child development including Fe, folate and Se. Adjusted dietary intakes of Cu, Zn, iodine, niacin and vitamin A were below the Estimated Average Requirement or Recommended Nutrient Intake. Mean adjusted energy intakes (boys 4769 kJ/d (1139·84 kcal/d), girls 4759 kJ/d (1137·43 kcal/d)) were lower than the estimated energy requirement (boys 5104 kJ/d (1220 kcal/d), girls 5042 kJ/d (1205 kcal/d)) for 88 % of boys and 86 % of girls. Nutrition was adequate for most children within the SCDNS cohort. Low intakes of some nutrients (including Zn, niacin and vitamin A) could reflect nutritional database inaccuracies, but may require further investigation. The study provides valuable information on the adequacy of intakes of nutrients which could affect the growth and development of Seychellois children.

Land use regression modeling of ultrafine particles, ozone, nitrogen oxides and markers of particulate matter pollution in Augsburg, Germany.

PubMed

Wolf, Kathrin; Cyrys, Josef; Harciníková, Tatiana; Gu, Jianwei; Kusch, Thomas; Hampel, Regina; Schneider, Alexandra; Peters, Annette

2017-02-01

Important health relevance has been suggested for ultrafine particles (UFP) and ozone, but studies on long-term effects are scarce, mainly due to the lack of appropriate spatial exposure models. We designed a measurement campaign to develop land use regression (LUR) models to predict the spatial variability focusing on particle number concentration (PNC) as indicator for UFP, ozone and several other air pollutants in the Augsburg region, Southern Germany. Three bi-weekly measurements of PNC, ozone, particulate matter (PM 10 , PM 2.5 ), soot (PM 2.5 abs) and nitrogen oxides (NO x , NO 2 ) were performed at 20 sites in 2014/15. Annual average concentration were calculated and temporally adjusted by measurements from a continuous background station. As geographic predictors we offered several traffic and land use variables, altitude, population and building density. Models were validated using leave-one-out cross-validation. Adjusted model explained variance (R 2 ) was high for PNC and ozone (0.89 and 0.88). Cross-validation adjusted R 2 was slightly lower (0.82 and 0.81) but still indicated a very good fit. LUR models for other pollutants performed well with adjusted R 2 between 0.68 (PM coarse ) and 0.94 (NO 2 ). Contrary to previous studies, ozone showed a moderate correlation with NO 2 (Pearson's r=-0.26). PNC was moderately correlated with ozone and PM 2.5 , but highly correlated with NO x (r=0.91). For PNC and NO x , LUR models comprised similar predictors and future epidemiological analyses evaluating health effects need to consider these similarities. Copyright © 2016 Elsevier B.V. All rights reserved.

New Radiosonde Temperature Bias Adjustments for Potential NWP Applications Based on GPS RO Data

NASA Astrophysics Data System (ADS)

Sun, B.; Reale, A.; Ballish, B.; Seidel, D. J.

2014-12-01

Conventional radiosonde observations (RAOBs), along with satellite and other in situ data, are assimilated in numerical weather prediction (NWP) models to generate a forecast. Radiosonde temperature observations, however, have solar and thermal radiation induced biases (typically a warm daytime bias from sunlight heating the sensor and a cold bias at night as the sensor emits longwave radiation). Radiation corrections made at stations based on algorithms provided by radiosonde manufacturers or national meteorological agencies may not be adequate, so biases remain. To adjust these biases, NWP centers may make additional adjustments to radiosonde data. However, the radiation correction (RADCOR) schemes used in the NOAA NCEP data assimilation and forecasting system is outdated and does not cover several widely-used contemporary radiosonde types. This study focuses on work whose objective is to improve these corrections and test their impacts on the NWP forecasting and analysis. GPS Radio Occultation (RO) dry temperature (Tdry) is considered to be highly accurate in the upper troposphere and low stratosphere where atmospheric water vapor is negligible. This study uses GPS RO Tdry from the Constellation Observing System for Meteorology, Ionosphere, and Climate (COSMIC) as the reference to quantify the radiation induced RAOB temperature errors by analyzing ~ 3-yr collocated RAOB and COSMIC GPS RO data compile by the NOAA Products Validation System (NPROVS). The new radiation adjustments are developed for different solar angle categories and for all common sonde types flown in the WMO global operational upper air network. Results for global and several commonly used sondes are presented in the context of NCEP Global Forecast System observation-minus-background analysis, indicating projected impacts in reducing forecast error. Dedicated NWP impact studies to quantify the impact of the new RADCOR schemes on the NCEP analyses and forecast are under consideration.

Liquid-crystal microlens array with swing and adjusting focus and constructed by dual patterned ITO-electrodes

NASA Astrophysics Data System (ADS)

Dai, Wanwan; Xie, Xingwang; Li, Dapeng; Han, Xinjie; Liu, Zhonglun; Wei, Dong; Xin, Zhaowei; Zhang, Xinyu; Wang, Haiwei; Xie, Changsheng

2018-02-01

Under the condition of existing intense turbulence, the object's wavefront may be severely distorted. So, the wavefront sensors based on the traditional microlens array (MLA) with a fixed focal length can not be used to measure the wavefront effectively. In order to obtain a larger measurement range and higher measurement accuracy, we propose a liquid-crystal microlens array (LCMLA) with needed ability of swing focus over the focal plane and further adjusting focal length, which is constructed by a dual patterned ITO electrodes. The main structure of the LCMLA is divided into two layers, which are made of glass substrate with ITO transparent electrodes. The top layer of each liquid-crystal microlens consists of four rectangular electrodes, and the bottom layer is a circular electrode. In common optical measurements performed, the operations are carried out such as adding the same signal voltage over four electrodes of each microlens to adjust the focal length of the lens cell and adding a signal voltage with different RMS amplitude to adjust the focus position on the focal plane. Experiments show that the LCMLA developed by us demonstrate a desired focal length adjustable function and dynamic swing ability, so as to indicate that the method can be used not only to measure wavefront but also correct the wavefront with strong distortion.

Radar-raingauge data combination techniques: a revision and analysis of their suitability for urban hydrology.

PubMed

Wang, Li-Pen; Ochoa-Rodríguez, Susana; Simões, Nuno Eduardo; Onof, Christian; Maksimović, Cedo

2013-01-01

The applicability of the operational radar and raingauge networks for urban hydrology is insufficient. Radar rainfall estimates provide a good description of the spatiotemporal variability of rainfall; however, their accuracy is in general insufficient. It is therefore necessary to adjust radar measurements using raingauge data, which provide accurate point rainfall information. Several gauge-based radar rainfall adjustment techniques have been developed and mainly applied at coarser spatial and temporal scales; however, their suitability for small-scale urban hydrology is seldom explored. In this paper a review of gauge-based adjustment techniques is first provided. After that, two techniques, respectively based upon the ideas of mean bias reduction and error variance minimisation, were selected and tested using as case study an urban catchment (∼8.65 km(2)) in North-East London. The radar rainfall estimates of four historical events (2010-2012) were adjusted using in situ raingauge estimates and the adjusted rainfall fields were applied to the hydraulic model of the study area. The results show that both techniques can effectively reduce mean bias; however, the technique based upon error variance minimisation can in general better reproduce the spatial and temporal variability of rainfall, which proved to have a significant impact on the subsequent hydraulic outputs. This suggests that error variance minimisation based methods may be more appropriate for urban-scale hydrological applications.

Periodontitis is associated with the risk of subclinical atherosclerosis and peripheral arterial disease in Korean adults.

PubMed

Ahn, Yoo-Been; Shin, Myung-Seop; Han, Dong-Hun; Sukhbaatar, Munkhzaya; Kim, Mi-Sun; Shin, Hye-Sun; Kim, Hyun-Duck

2016-08-01

We aimed to evaluate the association of periodontitis with the development of early atherosclerotic vascular disease in Korean adults. In this cross-sectional study, a total of 1343 adults aged over 40 years were recruited from a community-based cohort of Yangpyeong county, Korea, during the period 2010-2014. Only dentate individuals were included in the study. Subclinical atherosclerosis (SA) was defined as carotid intima-media thickness (cIMT)≥0.754 mm, as assessed bilaterally by B-mode ultrasound. Peripheral arterial disease (PAD) was defined as ankle-brachial index (ABI)≤1.0, as measured by Doppler. History of periodontitis was assessed by measuring the radiographic alveolar bone loss (RABL) on a digital dental panorama and was classified into three groups: normal, moderate and severe periodontitis (≥2 non-adjacent interproximal sites with RABL≥4 mm and 6 mm, respectively). The associations of periodontitis with SA and PAD were evaluated by multivariable logistic regression analysis and analysis of covariance, adjusted for age, sex, education level, tooth loss, smoking, drinking, exercise, obesity, triglycerides, HDL, LDL, hs-CRP, diabetes and hypertension. Stratified analyses were performed to identify specific risk groups. After controlling for confounders, severe periodontitis was associated with SA [adjusted odds ratio (aOR) = 1.55; 95% confidence interval (CI): 1.07-2.24] and PAD (aOR = 2.03; 95% CI: 1.05-3.93). These associations were highlighted in never-smokers. For increasing severity of periodontitis, the adjusted mean cIMT increased (p = 0.011) while that of ABI decreased (p = 0.033). Our data showed that periodontitis is a substantially important risk factor for atherosclerotic vascular disease among Korean adults. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Parathyroid hormone response to severe vitamin D deficiency is associated with femoral neck bone mineral density: an observational study of 405 women with hip-fracture.

PubMed

Di Monaco, Marco; Castiglioni, Carlotta; Tappero, Rosa

2016-10-01

Hip-fracture patients with vitamin D deficiency can have either secondary hyperparathyroidism or normal levels of parathyroid hormone (PTH). We hypothesized that bone mineral density (BMD) could be lower in patients with high PTH levels than in those with normal levels of PTH, irrespectively of the severity of vitamin D depletion. In this cross-sectional study, we examined 405 women who had serum 25-hydroxyvitamin D below 12ng/ml 20.0 ± 5.9 (mean ± SD) days after a hip-fracture. PTH was assessed by a chemiluminescent immunometric assay and BMD by dual-energy x-ray absorptiometry at the unfractured femoral neck. BMD was significantly lower in the 148 women with secondary hyperparathyroidism than in the 257 with normal PTH levels: the mean T-score (SD) was -2.88 (0.93) and -2.65 (0.83), respectively, in the two groups (mean difference 0.23; 95% CI 0.05 - 0.41; P = 0.010). The association between PTH status and BMD persisted after adjustment for age, body mass index, phosphate, albumin-adjusted total calcium, 25-hydroxyvitamin D, estimated glomerular filtration rate, and magnesium (P=0.01). The presence of secondary hyperparathyroidism was significantly associated with a femoral neck T-score lower than -2.5. The adjusted odds ratio was 1.81 (95% CI 1.11 - 2.95; P=0.017). Our results show that PTH levels in the presence of severe vitamin D deficiency were significantly associated with femoral BMD in women with hip-fracture. Prevention and treatment of vitamin D deficiency may be particularly relevant in women who develop secondary hyperparathyroidism.

Severely Elevated Blood Pressure and Early Mortality in Children with Traumatic Brain Injuries: The Neglected End of the Spectrum

PubMed Central

Borgman, Matthew A.; Cannon, Jeremy W.; Kuppermann, Nathan; Neff, Lucas P.

2018-01-01

Introduction In adults with traumatic brain injuries (TBI), hypotension and hypertension at presentation are associated with mortality. The effect of age-adjusted blood pressure in children with TBI has been insufficiently studied. We sought to determine if age-adjusted hypertension in children with severe TBI is associated with mortality. Methods This was a retrospective analysis of the Department of Defense Trauma Registry (DoDTR) between 2001 and 2013. We included for analysis patients <18 years with severe TBI defined as Abbreviated Injury Severity (AIS) scores of the head ≥3. We defined hypertension as moderate for systolic blood pressures (SBP) between the 95th and 99th percentile for age and gender and severe if greater than the 99th percentile. Hypotension was defined as SBP <90 mmHg for children >10 years or < 70mmHg + (2 × age) for children ≤10 years. We performed multivariable logistic regression and Cox regression to determine if BP categories were associated with mortality. Results Of 4,990 children included in the DoDTR, 740 met criteria for analysis. Fifty patients (6.8%) were hypotensive upon arrival to the ED, 385 (52.0%) were normotensive, 115 (15.5%) had moderate hypertension, and 190 (25.7%) had severe hypertension. When compared to normotensive patients, moderate and severe hypertension patients had similar Injury Severity Scores, similar AIS head scores, and similar frequencies of neurosurgical procedures. Multivariable logistic regression demonstrated that hypotension (odd ratio [OR] 2.85, 95 confidence interval [CI] 1.26–6.47) and severe hypertension (OR 2.58, 95 CI 1.32–5.03) were associated with increased 24-hour mortality. Neither hypotension (Hazard ratio (HR) 1.52, 95 CI 0.74–3.11) nor severe hypertension (HR 1.65, 95 CI 0.65–2.30) was associated with time to mortality. Conclusion Pediatric age-adjusted hypertension is frequent after severe TBI. Severe hypertension is strongly associated with 24-hour mortality. Pediatric age-adjusted blood pressure needs to be further evaluated as a critical marker of early mortality. PMID:29760839

Severely Elevated Blood Pressure and Early Mortality in Children with Traumatic Brain Injuries: The Neglected End of the Spectrum.

PubMed

Johnson, M Austin; Borgman, Matthew A; Cannon, Jeremy W; Kuppermann, Nathan; Neff, Lucas P

2018-05-01

In adults with traumatic brain injuries (TBI), hypotension and hypertension at presentation are associated with mortality. The effect of age-adjusted blood pressure in children with TBI has been insufficiently studied. We sought to determine if age-adjusted hypertension in children with severe TBI is associated with mortality. This was a retrospective analysis of the Department of Defense Trauma Registry (DoDTR) between 2001 and 2013. We included for analysis patients <18 years with severe TBI defined as Abbreviated Injury Severity (AIS) scores of the head ≥3. We defined hypertension as moderate for systolic blood pressures (SBP) between the 95 th and 99 th percentile for age and gender and severe if greater than the 99th percentile. Hypotension was defined as SBP <90 mmHg for children >10 years or < 70mmHg + (2 × age) for children ≤10 years. We performed multivariable logistic regression and Cox regression to determine if BP categories were associated with mortality. Of 4,990 children included in the DoDTR, 740 met criteria for analysis. Fifty patients (6.8%) were hypotensive upon arrival to the ED, 385 (52.0%) were normotensive, 115 (15.5%) had moderate hypertension, and 190 (25.7%) had severe hypertension. When compared to normotensive patients, moderate and severe hypertension patients had similar Injury Severity Scores, similar AIS head scores, and similar frequencies of neurosurgical procedures. Multivariable logistic regression demonstrated that hypotension (odd ratio [OR] 2.85, 95 confidence interval [CI] 1.26-6.47) and severe hypertension (OR 2.58, 95 CI 1.32-5.03) were associated with increased 24-hour mortality. Neither hypotension (Hazard ratio (HR) 1.52, 95 CI 0.74-3.11) nor severe hypertension (HR 1.65, 95 CI 0.65-2.30) was associated with time to mortality. Pediatric age-adjusted hypertension is frequent after severe TBI. Severe hypertension is strongly associated with 24-hour mortality. Pediatric age-adjusted blood pressure needs to be further evaluated as a critical marker of early mortality.

Inhibitor development and mortality in non-severe hemophilia A.

PubMed

Eckhardt, C L; Loomans, J I; van Velzen, A S; Peters, M; Mauser-Bunschoten, E P; Schwaab, R; Mazzucconi, M G; Tagliaferri, A; Siegmund, B; Reitter-Pfoertner, S E; van der Bom, J G; Fijnvandraat, K

2015-07-01

The life expectancy of non-severe hemophilia A (HA) patients equals the life expectancy of the non-hemophilic population. However, data on the effect of inhibitor development on mortality and on hemophilia-related causes of death are scarce. The development of neutralizing factor VIII antibodies in non-severe HA patients may dramatically change their clinical outcome due to severe bleeding complications. We assessed the association between the occurrence of inhibitors and mortality in patients with non-severe HA. In this retrospective cohort study, clinical data and vital status were collected for 2709 non-severe HA patients (107 with inhibitors) who were treated between 1980 and 2011 in 34 European and Australian centers. Mortality rates for patients with and without inhibitors were compared. During 64,200 patient-years of follow-up, 148 patients died (mortality rate, 2.30 per 1000 person-years; 95% confidence interval (CI), 1.96-2.70) at a median age of 64 years (interquartile range [IQR], 49-76). In 62 patients (42%) the cause of death was hemophilia related. Sixteen inhibitor patients died at a median age of 71 years (IQR, 60-81). In ten patients the inhibitor was present at time of death; seven of them died of severe bleeding complications. The all-cause mortality rate in inhibitor patients was > 5 times increased compared with that for those without inhibitors (age-adjusted mortality rate ratio, 5.6). Inhibitor development in non-severe hemophilia is associated with increased mortality. High rates of hemophilia-related mortality in this study indicate that non-severe hemophilia is not mild at all and stress the importance of close follow-up for these patients. © 2015 International Society on Thrombosis and Haemostasis.

MicroRNAs play critical roles during plant development and in response to abiotic stresses.

PubMed

de Lima, Júlio César; Loss-Morais, Guilherme; Margis, Rogerio

2012-12-01

MicroRNAs (miRNAs) have been identified as key molecules in regulatory networks. The fine-tuning role of miRNAs in addition to the regulatory role of transcription factors has shown that molecular events during development are tightly regulated. In addition, several miRNAs play crucial roles in the response to abiotic stress induced by drought, salinity, low temperatures, and metals such as aluminium. Interestingly, several miRNAs have overlapping roles with regard to development, stress responses, and nutrient homeostasis. Moreover, in response to the same abiotic stresses, different expression patterns for some conserved miRNA families among different plant species revealed different metabolic adjustments. The use of deep sequencing technologies for the characterisation of miRNA frequency and the identification of new miRNAs adds complexity to regulatory networks in plants. In this review, we consider the regulatory role of miRNAs in plant development and abiotic stresses, as well as the impact of deep sequencing technologies on the generation of miRNA data.

The Role of Parental and Extrafamilial Social Support in the Psychosocial Adjustment of Children with a Chronically Ill Father.

ERIC Educational Resources Information Center

Kotchick, Beth A.; Summers, Peter; Forehand, Rex; Steele, Ric G.

1997-01-01

Examines the relation between social support and psychosocial adjustment in children of men with hemophilia. Results, based on 53 families, indicate that the impact of illness, not the severity of illness itself, related to children's psychosocial adjustment. Main effects were observed for parental support on child- and parent-reported…

Ethnic-Racial Socialization and Adjustment among Latino College Students: The Mediating Roles of Ethnic Centrality, Public Regard, and Perceived Barriers to Opportunity

ERIC Educational Resources Information Center

Rivas-Drake, Deborah

2011-01-01

Parents' efforts to socialize their children around issues of ethnicity and race have implications for well-being in several life domains, including academic and psychological adjustment. The present study tested a multiple mediator model in which parental ethnic-racial socialization was linked to psychological adjustment through two dimensions of…

Factors Influencing Adjustment in Siblings of Children with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Meyer, Katherine A.; Ingersoll, Brooke; Hambrick, David Z.

2011-01-01

Siblings of children with autism spectrum disorders (ASD) may be at an increased risk of adjustment problems. To examine possible predictors of adjustment difficulties in siblings, 70 mothers with at least one child with ASD and one typical child completed surveys of symptom severity in the child with ASD, impact of the child with ASD on the…

Factors associated with positive adjustment in siblings of children with severe emotional disturbance: the role of family resources and community life.

PubMed

Kilmer, Ryan P; Cook, James R; Munsell, Eylin Palamaro; Salvador, Samantha Kane

2010-10-01

This study builds on the scant research involving siblings of children with severe emotional disturbances (SED) and examines: associations between adversity experiences and adjustment among 5- to 10-year-old siblings, and relations among family resources, community life, and sibling adjustment. Caregivers from 100 families completed standardized indicators of sibling adjustment and scales reflecting multiple contextual variables. Results document negative associations between stress exposure and sibling adjustment. Regression models also indicate positive associations between the caregiver-child relationship and broader family resources on sibling behavioral and emotional strengths, even after accounting for adversity experiences; adversity exposure was the prime correlate in regression models involving sibling oppositional behavior. Analyses also suggest that strain related to parenting a child with SED is associated with sibling adjustment. This work documents the needs of these siblings and their family systems and highlights the relevance of not only core proximal influences (e.g., child-caregiver relationship) but also elements of their broader contexts. Implications and recommendations are described, including the need to support plans of care that involve services, supports, or preventive strategies for these siblings. © 2010 American Orthopsychiatric Association.

The SLUScore: A Novel Method for Detecting Hazardous Hypotension in Adult Patients Undergoing Noncardiac Surgical Procedures

PubMed Central

Yuan, Hui; Dryden, Jefferson K.; Strehl, Kristen E.; Cywinski, Jacek B.; Ehrenfeld, Jesse M.; Bromley, Pamela

2017-01-01

BACKGROUND: It has been suggested that longer-term postsurgical outcome may be adversely affected by less than severe hypotension under anesthesia. However, evidence-based guidelines are unavailable. The present study was designed to develop a method for identifying patients at increased risk of death within 30 days in association with the severity and duration of intraoperative hypotension. METHODS: Intraoperative mean arterial blood pressure recordings of 152,445 adult patients undergoing noncardiac surgery were analyzed for periods of time accumulated below each one of the 31 thresholds between 75 and 45 mm Hg (hypotensive exposure times). In a development cohort of 35,904 patients, the associations were sought between each of these 31 cumulative hypotensive exposure times and 30-day postsurgical mortality. On the basis of covariable-adjusted percentage increases in the odds of mortality per minute elapsed of hypotensive exposure time, certain sets of exposure time limits were calculated that portended certain percentage increases in the odds of mortality. A novel risk-scoring method was conceived by counting the number of exposure time limits that had been exceeded within each respective set, one of them being called the SLUScore. The validity of this new method in identifying patients at increased risk was tested in a multicenter validation cohort consisting of 116,541 patients from Cleveland Clinic, Vanderbilt and Saint Louis Universities. Data were expressed as 95% confidence interval, P < .05 considered significant. RESULTS: Progressively greater hypotensive exposures were associated with greater 30-day mortality. In the development cohort, covariable-adjusted (age, Charlson score, case duration, history of hypertension) exposure limits were identified for time accumulated below each of the thresholds that portended certain identical (5%–50%) percentage expected increases in the odds of mortality. These exposure time limit sets were shorter in patients with a history of hypertension. A novel risk score, the SLUScore (range 0–31), was conceived as the number of exposure limits exceeded for one of these sets (20% set). A SLUScore > 0 (average 13.8) was found in 40% of patients who had twice the mortality, adjusted odds increasing by 5% per limit exceeded. When tested in the validation cohort, a SLUScore > 0 (average 14.1) identified 35% of patients who had twice the mortality, each incremental limit exceeded portending a 5% compounding increase in adjusted odds of mortality, independent of age and Charlson score (C = 0.73, 0.72–0.74, P < .05). CONCLUSIONS: The SLUScore represents a novel method for identifying nearly 1 in every 3 patients experiencing greater 30-day mortality portended by more severe intraoperative hypotensive exposures. PMID:28107274

Association of maternal chronic disease with risk of congenital heart disease in offspring

PubMed Central

Chou, Hsin-Hsu; Chiou, Meng-Jiun; Liang, Fu-Wen; Chen, Lea-Hua; Lu, Tsung-Hsueh; Li, Chung-Yi

2016-01-01

Background: Information about known risk factors for congenital heart disease is scarce. In this population-based study, we aimed to investigate the relation between maternal chronic disease and congenital heart disease in offspring. Methods: The study cohort consisted of 1 387 650 live births from 2004 to 2010. We identified chronic disease in mothers and mild and severe forms of congenital heart disease in their offspring from Taiwan’s National Health Insurance medical claims. We used multivariable logistic regression analysis to assess the associations of all cases and specific types of congenital heart disease with various maternal chronic diseases. Results: For mothers with the following chronic diseases, the overall prevalence of congenital heart disease in their children was significantly higher than for mothers without these diseases: diabetes mellitus type 1 (adjusted odds ratio [OR] 2.32, 95% confidence interval [CI] 1.66–3.25), diabetes mellitus type 2 (adjusted OR 2.85, 95% CI 2.60–3.12), hypertension (adjusted OR 1.87, 95% CI 1.69–2.07), congenital heart defects (adjusted OR 3.05, 95% CI 2.45–3.80), anemia (adjusted OR 1.31, 95% CI 1.25–1.38), connective tissue disorders (adjusted OR 1.39, 95% CI 1.19–1.62), epilepsy (adjusted OR 1.37, 95% CI 1.08–1.74) and mood disorders (adjusted OR 1.25, 95% CI 1.11–1.41). The same pattern held for mild forms of congenital heart disease. A higher prevalence of severe congenital heart disease was seen only among offspring of mothers with congenital heart defects or type 2 diabetes. Interpretation: The children of women with several kinds of chronic disease appear to be at risk for congenital heart disease. Preconception counselling and optimum treatment of pregnant women with chronic disease would seem prudent. PMID:27729382

Association of maternal chronic disease with risk of congenital heart disease in offspring.

PubMed

Chou, Hsin-Hsu; Chiou, Meng-Jiun; Liang, Fu-Wen; Chen, Lea-Hua; Lu, Tsung-Hsueh; Li, Chung-Yi

2016-12-06

Information about known risk factors for congenital heart disease is scarce. In this population-based study, we aimed to investigate the relation between maternal chronic disease and congenital heart disease in offspring. The study cohort consisted of 1 387 650 live births from 2004 to 2010. We identified chronic disease in mothers and mild and severe forms of congenital heart disease in their offspring from Taiwan's National Health Insurance medical claims. We used multivariable logistic regression analysis to assess the associations of all cases and specific types of congenital heart disease with various maternal chronic diseases. For mothers with the following chronic diseases, the overall prevalence of congenital heart disease in their children was significantly higher than for mothers without these diseases: diabetes mellitus type 1 (adjusted odds ratio [OR] 2.32, 95% confidence interval [CI] 1.66-3.25), diabetes mellitus type 2 (adjusted OR 2.85, 95% CI 2.60-3.12), hypertension (adjusted OR 1.87, 95% CI 1.69-2.07), congenital heart defects (adjusted OR 3.05, 95% CI 2.45-3.80), anemia (adjusted OR 1.31, 95% CI 1.25-1.38), connective tissue disorders (adjusted OR 1.39, 95% CI 1.19-1.62), epilepsy (adjusted OR 1.37, 95% CI 1.08-1.74) and mood disorders (adjusted OR 1.25, 95% CI 1.11-1.41). The same pattern held for mild forms of congenital heart disease. A higher prevalence of severe congenital heart disease was seen only among offspring of mothers with congenital heart defects or type 2 diabetes. The children of women with several kinds of chronic disease appear to be at risk for congenital heart disease. Preconception counselling and optimum treatment of pregnant women with chronic disease would seem prudent. © 2016 Canadian Medical Association or its licensors.

[Remuneration distribution - should morbidity-dependent overall remuneration also be distributed after adjustments for morbidity?].

PubMed

Walendzik, A; Trottmann, M; Leonhardt, R; Wasem, J

2013-04-01

In the 2009 reform of the German collective remuneration system for outpatient medical care, on the level of overall remuneration, the morbidity risk was transferred to the health funds fulfilling a long-term demand of physicians. Nevertheless not transferring morbidity adjustment to the levels of physician groups and singular practices can lead to budgets not related to patient needs and to incentives for risk selection for individual doctors. The systematics of the distribution of overall remuneration in the German remuneration system for outpatient care are analysed focusing on the aspect of morbidity adjustment. Using diagnostic and pharmaceutical information of about half a million insured subjects, a risk adjustment model able to predict individual expenditures for outpatient care for different provider groups is presented. This model enables to additively split the individual care burden into several parts attributed to different physician groups. Conditions for the use of the model in the distribution of overall remuneration between physician groups are developed. A simulation of the use of diagnoses-based risk adjustment in standard service volumes then highlights the conditions for a successfull installation of standard service volumes representing a higher degree of risk adjustment. The presented estimation model is generally applicable for the distribution of overall remuneration to different physician groups. The simulation of standard service volumes using diagnosis-based risk adjustment does not provide a more accurate prediction of the expenditures on the level of physician practices than the age-related calculation currently used in the German remuneration system for outpatient medical care. Using elements of morbidity-based risk adjustment the current German collective system for outpatient medical care could be transformed towards a higher degree of distributional justice concerning medical care for patients and more appropriate incentives avoiding risk selection. Limitations of the applicability of risk-adjustment can be especially pointed out when a high share of lump-sum-payments is used for the remuneration of some physician groups. © Georg Thieme Verlag KG Stuttgart · New York.

Embedding measurement within existing computerized data systems: scaling clinical laboratory and medical records heart failure data to predict ICU admission.

PubMed

Fisher, William P; Burton, Elizabeth C

2010-01-01

This study employs existing data sources to develop a new measure of intensive care unit (ICU) admission risk for heart failure patients. Outcome measures were constructed from laboratory, accounting, and medical record data for 973 adult inpatients with primary or secondary heart failure. Several scoring interpretations of the laboratory indicators were evaluated relative to their measurement and predictive properties. Cases were restricted to tests within first lab draw that included at least 15 indicators. After optimizing the original clinical observations, a satisfactory heart failure severity scale was calibrated on a 0-1000 continuum. Patients with unadjusted CHF severity measures of 550 or less were 2.7 times more likely to be admitted to the ICU than those with higher measures. Patients with low HF severity measures (550 or less) adjusted for demographic and diagnostic risk factors are about six times more likely to be admitted to the ICU than those with higher adjusted measures. A nomogram facilitates routine clinical application. Existing computerized data systems could be programmed to automatically structure clinical laboratory reports using the results of studies like this one to reduce data volume with no loss of information, make laboratory results more meaningful to clinical end users, improve the quality of care, reduce errors and unneeded tests, prevent unnecessary ICU admissions, lower costs, and improve patient satisfaction. Existing data typically examined piecemeal form a coherent scale measuring heart failure severity sensitive to increased likelihood of ICU admission. Marked improvements in ROC curves were found for the aggregate measures relative to individual clinical indicators.

INFECTION HOSPITALIZATION INCREASES RISK OF DEMENTIA IN THE ELDERLY

PubMed Central

Tate, Judith A; Snitz, Beth E; Alvarez, Karina A; Nahin, Richard L; Weissfeld, Lisa A; Lopez, Oscar; Angus, Derek C; Shah, Faraaz; Ives, Diane G; Fitzpatrick, Annette L; Williamson, Jeffrey D; Arnold, Alice M; DeKosky, Steven T; Yende, Sachin

2014-01-01

Objectives Severe infections, often requiring intensive care unit (ICU) admission, have been associated with persistent cognitive dysfunction. Less severe infections are more common and whether they are associated with an increased risk of dementia is unclear. We determined the association of pneumonia hospitalization with risk of dementia in well-functioning older adults. Design Secondary analysis of a randomized multicenter trial to determine the effect of Gingko biloba on incident dementia. Setting and Subjects Community volunteers (n=3069) with a median follow-up of 6.1 years. Measurement and Main Results We identified pneumonia hospitalizations using ICD-9CM codes and validated them in a subset. Less than 3% of pneumonia cases necessitated ICU admission, mechanical ventilation or vasopressor support. Dementia was adjudicated based on neuropsychological evaluation, neurological exam, and magnetic resonance imaging. Two hundred twenty one participants (7.2%) incurred at least one hospitalization with pneumonia (mean time to pneumonia=3.5 years). Of these, 38 (17%) developed dementia after pneumonia with half of these cases occurring 2 years after the pneumonia hospitalization. Hospitalization with pneumonia was associated with increased risk of time to dementia diagnosis (unadjusted hazard ratio [HR] = 2.3, CI: 1.6–3.2, p<0.0001). The association remained significant when adjusted for age, sex, race, study site, education, and baseline Mini-Mental Status Exam (HR=1.9, CI 1.4–2.8, p<.0001). Results were unchanged when additionally adjusted for smoking, hypertension, diabetes, heart disease, and pre-infection functional status. Results were similar using propensity analysis where participants with pneumonia were matched to those without pneumonia based on age, probability of developing pneumonia, and similar trajectories of cognitive and physical function prior to pneumonia (adjusted incidence rates: 91.7 vs. 65 cases per 1,000 person-years, adjusted incidence rate ratio=1.6, CI:1.06–2.7, p=0.03). Sensitivity analyses showed that the higher risk also occurred among those hospitalized with other infections. Conclusion Hospitalization with pneumonia is associated with increased risk of dementia. PMID:24368344

Possible Common Aetiology behind Maternal Preeclampsia and Congenital Heart Defects in the Child: a Cardiovascular Diseases in Norway Project Study.

PubMed

Brodwall, Kristoffer; Leirgul, Elisabeth; Greve, Gottfried; Vollset, Stein Emil; Holmstrøm, Henrik; Tell, Grethe S; Øyen, Nina

2016-01-01

The aetiology of congenital heart defects (CHD) is mostly unknown, but maternal factors may modify the infant risk of CHD. We investigated the association between maternal preeclampsia and offspring risk of severe CHD in a nation-wide cohort study. Information on all births registered in the Medical Birth Registry of Norway, 1994-2009, was completed with information on CHD diagnoses from national health registries and the Cardiovascular Diseases in Norway Project (CVDNOR). Among 914 703 singleton births without chromosomal abnormalities, 32 864 (3.6%) were born after a pregnancy with preeclampsia. The preeclampsia was diagnosed before the 34th week of pregnancy (early-onset preeclampsia) in 2618 (8.0% of preeclamptic pregnancies). CHDs were diagnosed in 10 691 infants; of these, 2473 had severe CHD. The risk of severe CHD was compared between births with and without maternal preeclampsia and estimated with binomial log-linear regression. When adjusting for year of birth, maternal age, parity, and pregestational diabetes, the risk ratio (RR) for severe CHD in offspring of mothers with any preeclampsia was 1.3 [95% confidence interval (CI) 1.1, 1.5], and in pregnancies with early-onset preeclampsia, the RR was 2.8 (95% CI 1.8, 4.4). The association between early-onset preeclampsia and specific types of severe CHD was stronger for atrioventricular septal defects (AVSD), with adjusted RR 13.5 (95% CI 6.8, 26.8). Early-onset preeclampsia was strongly associated with infant risk of severe CHD, specifically; the risk of AVSD was 15-fold higher if the mother was diagnosed with early-onset preeclampsia, suggesting common aetiological factors for early-onset preeclampsia and erroneous fetal heart development. © 2015 John Wiley & Sons Ltd.

Patient Satisfaction with Treatments for Moderate-to-Severe Plaque Psoriasis in Clinical Practice

PubMed Central

Takeshita, J.; Krueger, G.G.; Robertson, A.D.; Troxel, A.B.; Shin, D.B.; Van Voorhees, A.S.; Gelfand, J.M.

2014-01-01

Background Treatment satisfaction among moderate-to-severe psoriasis patients has not been studied and compared across treatments using a validated instrument. Objectives To assess patient-reported satisfaction with systemic and phototherapy treatments for moderate-to-severe psoriasis in clinical practice and to correlate satisfaction with disease severity and quality of life measures. Methods Cross-sectional study of 1182 patients with moderate-to-severe psoriasis in the Dermatology Clinical Effectiveness Research Network in the United States. Patients receiving either topical therapies only; monotherapy with oral systemic therapies, biologics, or narrowband ultraviolet B phototherapy; or combination therapy with biologics and methotrexate completed the Treatment Satisfaction Questionnaire for Medication version II. Results Median unadjusted Overall Satisfaction scores were highest for patients receiving biologic monotherapies, biologic-methotrexate combinations, or phototherapy (83.3); scores were lowest for those receiving topical therapies only or acitretin (66.7). In fully adjusted models, compared to patients receiving methotrexate monotherapy, those receiving adalimumab, etanercept, ustekinumab, phototherapy, or adalimumab with methotrexate had significantly higher median Overall Satisfaction scores by 7.2 to 8.3 points, while those receiving topical therapies only had significantly lower Overall Satisfaction by 8.9 points. Adjusted Convenience scores were the lowest for patients receiving topical therapies only or infliximab. Modest but significant correlations were found between Overall Satisfaction and Psoriasis Area and Severity Index (ρ = −0.36, p < 0.001) and Dermatology Life Quality Index (−0.47, p < 0.001). Conclusions Discernable differences were found in treatment satisfaction among therapies, particularly regarding treatment effectiveness and convenience. Further application of treatment satisfaction measures may inform treatment decisions and guideline development. PMID:24266717

Harmonizing the Classification of Age-related Macular Degeneration in the Three Continent AMD Consortium

PubMed Central

Klein, Ronald; Meuer, Stacy M.; Myers, Chelsea E.; Buitendijk, Gabriëlle H. S.; Rochtchina, Elena; Choudhury, Farzana; de Jong, Paulus T. V. M.; McKean-Cowdin, Roberta; Iyengar, Sudha K.; Gao, Xiaoyi; Lee, Kristine E.; Vingerling, Johannes R.; Mitchell, Paul; Klaver, Caroline C. W.; Wang, Jie Jin; Klein, Barbara E. K.

2014-01-01

Purpose To describe methods to harmonize the classification of age-related macular degeneration (AMD) phenotypes across four population-based cohort studies: the Beaver Dam Eye Study (BDES), Blue Mountains Eye Study (BMES), Los Angeles Latino Eye Study (LALES), and Rotterdam Study (RS). Methods AMD grading protocols, definitions of categories, and grading forms from each study were compared to determine whether there were systematic differences in AMD severity definitions and lesion categorization among the three grading centers. Each center graded the same set of 60 images using their respective systems to determine presence and severity of AMD lesions. A common five-step AMD severity scale and definitions of lesion measurement cutpoints and early and late AMD were developed from this exercise. Results Applying this severity scale changed the age-sex adjusted prevalence of early AMD from 18.7% to 20.3% in BDES, from 4.7% to 14.4% in BMES, from 14.1% to 15.8% in LALES, and from 7.5% to 17.1% in RS. Age-sex adjusted prevalences of late AMD remained unchanged. Comparison of each center’s grades of the 60 images converted to the consortium scale showed that exact agreement of AMD severity among centers varied from 61.0% to 81.4%, and one-step agreement varied from 84.7% to 98.3%. Conclusion Harmonization of AMD classification reduced categorical differences in phenotypic definitions across the studies, resulted in a new 5-step AMD severity scale, and enhanced similarity of AMD prevalence among four cohorts. Despite harmonization it may still be difficult to remove systematic differences in grading, if present. PMID:24467558

Role of Osmotic Adjustment in Plant Productivity

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

Gebre, G.M.

2001-01-11

Successful implementation of short rotation woody crops requires that the selected species and clones be productive, drought tolerant, and pest resistant. Since water is one of the major limiting factors in poplar (Populus sp.) growth, there is little debate for the need of drought tolerant clones, except on the wettest of sites (e.g., lower Columbia River delta). Whether drought tolerance is compatible with productivity remains a debatable issue. Among the many mechanisms of drought tolerance, dehydration postponement involves the maintenance of high leaf water potential due to, for example, an adequate root system. This trait is compatible with productivity, butmore » requires available soil moisture. When the plant leaf water potential and soil water content decline, the plant must be able to survive drought through dehydration tolerance mechanisms, such as low osmotic potential or osmotic adjustment. Osmotic adjustment and low osmotic potential are considered compatible with growth and yield because they aid in the maintenance of leaf turgor. However, it has been shown that turgor alone does not regulate cell expansion or stomatal conductance and, therefore, the role of osmotic adjustment is debated. Despite this finding, osmotic adjustment has been correlated with grain yield in agronomic crop species, and gene markers responsible for osmotic adjustment are being investigated to improve drought tolerance in productive progenies. Although osmotic adjustment and low osmotic potentials have been investigated in several forest tree species, few studies have investigated the relationship between osmotic adjustment and growth. Most of these studies have been limited to greenhouse or container-grown plants. Osmotic adjustment and rapid growth have been specifically associated in Populus and black spruce (Picea mariuna (Mill.) B.S.P.) progenies. We tested whether these relationships held under field conditions using several poplar clones. In a study of two hybrid poplar clones (P. trichocurpa Torr. & Gray x P: deltoides Bartr., TD and P. deltoides x P. nigra L., DN), we determined the TD clone, which was more productive during the first three years, had slightly lower osmotic potential than the DN clone, and also indicated a small osmotic adjustment compared with the DN hybrid. However, the productivity differences were negligible by the fifth growing season. In a separate study with several P. deltoides clones, we did not observe a consistent relationship between growth and osmotic adjustment. Some clones that had low osmotic potential and osmotic adjustment were as productive as another clone that had high osmotic potential. The least productive clone also had low osmotic potential and osmotic adjustment. The absence of a correlation may have been partly due to the fact that all clones were capable of osmotic adjustment and had low osmotic potential. In a study involving an inbred three-generation TD F{sub 2} pedigree (family 331), we did not observe a correlation between relative growth rate and osmotic potential or osmotic adjustment. However, when clones that exhibited osmotic adjustment were analyzed, there was a negative correlation between growth and osmotic potential, indicating clones with lower osmotic potential were more productive. This was observed only in clones that were exposed to drought. Although the absolute osmotic potential varied by growing environment, the relative ranking among progenies remains generally the same, suggesting that osmotic potential is genetically controlled. We have identified a quantitative trait locus for osmotic potential in another three-generation TD F{sub 2} pedigree (family 822). Unlike the many studies in agricultural crops, most of the forest tree studies were not based on plants exposed to severe stress to determine the role of osmotic adjustment. Future studies should consider using clones that are known to be productive but have contrasting osmotic adjustment capability as well as clones with contrasting growth and osmotic adjustment.« less

On the Importance of Age-Adjustment Methods in Ecological Studies of Social Determinants of Mortality

PubMed Central

Milyo, Jeffrey; Mellor, Jennifer M

2003-01-01

Objective To illustrate the potential sensitivity of ecological associations between mortality and certain socioeconomic factors to different methods of age-adjustment. Data Sources Secondary analysis employing state-level data from several publicly available sources. Crude and age-adjusted mortality rates for 1990 are obtained from the U.S. Centers for Disease Control. The Gini coefficient for family income and percent of persons below the federal poverty line are from the U.S. Bureau of Labor Statistics. Putnam's (2000) Social Capital Index was downloaded from ; the Social Mistrust Index was calculated from responses to the General Social Survey, following the method described in Kawachi et al. (1997). All other covariates are obtained from the U.S. Census Bureau. Study Design We use least squares regression to estimate the effect of several state-level socioeconomic factors on mortality rates. We examine whether these statistical associations are sensitive to the use of alternative methods of accounting for the different age composition of state populations. Following several previous studies, we present results for the case when only mortality rates are age-adjusted. We contrast these results with those obtained from regressions of crude mortality on age variables. Principal Findings Different age-adjustment methods can cause a change in the sign or statistical significance of the association between mortality and various socioeconomic factors. When age variables are included as regressors, we find no significant association between mortality and either income inequality, minority racial concentration, or social capital. Conclusions Ecological associations between certain socioeconomic factors and mortality may be extremely sensitive to different age-adjustment methods. PMID:14727797

Prognostic Significance of Bleeding Location and Severity Among Patients With Acute Coronary Syndromes

PubMed Central

Vavalle, John P.; Clare, Robert; Chiswell, Karen; Rao, Sunil V.; Petersen, John L.; Kleiman, Neal S.; Mahaffey, Kenneth W.; Wang, Tracy Y.

2013-01-01

Objectives This study sought to determine if there is an association between bleed location and clinical outcomes in acute coronary syndromes (ACS) patients. Background The prognostic significance of bleeding location among ACS patients undergoing cardiac catheterization is not well known. Methods We analyzed in-hospital bleeding events among 9,978 patients randomized in the SYNERGY (Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors) study. Bleeding events were categorized by location as access site, systemic, surgical, or superficial, and severity was graded using the GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definition. We assessed the association of each bleeding location and severity with 6-month risk of death or myocardial infarction using a multicovariate-adjusted Cox proportional hazard model. Results A total of 4,900 bleeding events were identified among 3,694 ACS patients with in-hospital bleeding. Among 4,679 GUSTO mild/moderate bleeding events, only surgical and systemic bleeds were associated with an increased risk of 6-month death or myocardial infarction (adjusted hazard ratio [HR]: 2.52 [95% confidence interval (CI): 2.16 to 2.94, and 1.40 [95% CI: 1.16 to 1.69], respectively). Mild/moderate superficial and access-site bleeds were not associated with downstream risk (adjusted HR: 1.17 [95% CI: 0.97 to 1.40], and 0.96 [95% CI: 0.82 to 1.12], respectively). Among 221 GUSTO severe bleeds, surgical bleeds were associated with the highest risk (HR: 5.27 [95% CI: 3.80 to 7.29]), followed by systemic (HR: 4.48 [95% CI: 2.98 to 6.72]), and finally access-site bleeds (HR: 3.57 [95% CI: 2.35 to 5.40]). Conclusions Among ACS patients who develop in-hospital bleeding, systemic and surgical bleeding are associated with the highest risks of adverse outcomes regardless of bleeding severity. Although the most frequent among bleeds, GUSTO mild/moderate access-site bleeding is not associated with increased risk. These data underscore the importance of strategies to minimize overall bleeding risk beyond vascular access site management. PMID:23866183

Development of an Open Building Automation System Specification Based on ANSI/ASHRAE 135-2004 (BACnet(R) Communications Protocol: A Technical Assessment

DTIC Science & Technology

2007-02-01

on/off control), trending and trend reports, load shedding/load manage- ment, remote setpoint adjustment, initial diagnosis of a service call and...building-specific operational data such as on/off scheduling com- mands, setpoints , and outside air temperature. With help from several other agencies and...interface for monitoring 3. Provide one interface for device/system management/configuration 4. ( Optimally ) provide one interface for device

Development of an Open Building Automation System Specification Based on ANSI/ASHRAE 135-2004 (BACnet(Registered) Communications Protocol): A Technical Assessment

DTIC Science & Technology

2007-02-01

on/off control), trending and trend reports, load shedding/load manage- ment, remote setpoint adjustment, initial diagnosis of a service call and...building-specific operational data such as on/off scheduling com- mands, setpoints , and outside air temperature. With help from several other agencies and...interface for monitoring 3. Provide one interface for device/system management/configuration 4. ( Optimally ) provide one interface for device

Effect of Depth and Duration of Cooling on Death or Disability at Age 18 Months Among Neonates With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial.

PubMed

Shankaran, Seetha; Laptook, Abbot R; Pappas, Athina; McDonald, Scott A; Das, Abhik; Tyson, Jon E; Poindexter, Brenda B; Schibler, Kurt; Bell, Edward F; Heyne, Roy J; Pedroza, Claudia; Bara, Rebecca; Van Meurs, Krisa P; Huitema, Carolyn M Petrie; Grisby, Cathy; Devaskar, Uday; Ehrenkranz, Richard A; Harmon, Heidi M; Chalak, Lina F; DeMauro, Sara B; Garg, Meena; Hartley-McAndrew, Michelle E; Khan, Amir M; Walsh, Michele C; Ambalavanan, Namasivayam; Brumbaugh, Jane E; Watterberg, Kristi L; Shepherd, Edward G; Hamrick, Shannon E G; Barks, John; Cotten, C Michael; Kilbride, Howard W; Higgins, Rosemary D

2017-07-04

Hypothermia for 72 hours at 33.5°C for neonatal hypoxic-ischemic encephalopathy reduces death or disability, but rates continue to be high. To determine if cooling for 120 hours or to a temperature of 32.0°C reduces death or disability at age 18 months in infants with hypoxic-ischemic encephalopathy. Randomized 2 × 2 factorial clinical trial in neonates (≥36 weeks' gestation) with hypoxic-ischemic encephalopathy at 18 US centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network between October 2010 and January 2016. A total of 364 neonates were randomly assigned to 4 hypothermia groups: 33.5°C for 72 hours (n = 95), 32.0°C for 72 hours (n = 90), 33.5°C for 120 hours (n = 96), or 32.0°C for 120 hours (n = 83). The primary outcome was death or moderate or severe disability at 18 to 22 months of age adjusted for center and level of encephalopathy. Severe disability included any of Bayley Scales of Infant Development III cognitive score less than 70, Gross Motor Function Classification System (GMFCS) level of 3 to 5, or blindness or hearing loss despite amplification. Moderate disability was defined as a cognitive score of 70 to 84 and either GMFCS level 2, active seizures, or hearing with amplification. The trial was stopped for safety and futility in November 2013 after 364 of the planned 726 infants were enrolled. Among 347 infants (95%) with primary outcome data (mean age at follow-up, 20.7 [SD, 3.5] months; 42% female), death or disability occurred in 56 of 176 (31.8%) cooled for 72 hours and 54 of 171 (31.6%) cooled for 120 hours (adjusted risk ratio, 0.92 [95% CI, 0.68-1.25]; adjusted absolute risk difference, -1.0% [95% CI, -10.2% to 8.1%]) and in 59 of 185 (31.9%) cooled to 33.5°C and 51 of 162 (31.5%) cooled to 32.0°C (adjusted risk ratio, 0.92 [95% CI, 0.68-1.26]; adjusted absolute risk difference, -3.1% [95% CI, -12.3% to 6.1%]). A significant interaction between longer and deeper cooling was observed (P = .048), with primary outcome rates of 29.3% at 33.5°C for 72 hours, 34.5% at 32.0°C for 72 hours, 34.4% at 33.5°C for 120 hours, and 28.2% at 32.0°C for 120 hours. Among term neonates with moderate or severe hypoxic-ischemic encephalopathy, cooling for longer than 72 hours, cooling to lower than 33.5°C, or both did not reduce death or moderate or severe disability at 18 months of age. However, the trial may be underpowered, and an interaction was found between longer and deeper cooling. These results support the current regimen of cooling for 72 hours at 33.5°C. clinicaltrials.gov Identifier: NCT01192776.

Hurricane Katrina experience and the risk of post-traumatic stress disorder and depression among pregnant women.

PubMed

Xiong, Xu; Harville, Emily W; Mattison, Donald R; Elkind-Hirsch, Karen; Pridjian, Gabriella; Buekens, Pierre

2010-01-01

Little is known about the effects of disaster exposure and intensity on the development of mental disorders among pregnant women. The aim of this study was to examine the effect of exposure to Hurricane Katrina on mental health in pregnant women. Prospective cohort epidemiological study. Tertiary hospitals in New Orleans and Baton Rouge, U.S.A. Women who were pregnant during Hurricane Katrina or became pregnant immediately after the hurricane. Post-traumatic stress disorder (PTSD) and depression. The frequency of PTSD was higher in women with high hurricane exposure (13.8 percent) than women without high hurricane exposure (1.3 percent), with an adjusted odds ratio (aOR) of 16.8 (95% confidence interval: 2.6-106.6) after adjustment for maternal race, age, education, smoking and alcohol use, family income, parity, and other confounders. The frequency of depression was higher in women with high hurricane exposure (32.3 percent) than women without high hurricane exposure (12.3 percent), with an aOR of 3.3 (1.6-7.1). Moreover, the risk of PTSD and depression increased with an increasing number of severe experiences of the hurricane. Pregnant women who had severe hurricane experiences were at a significantly increased risk for PTSD and depression. This information should be useful for screening pregnant women who are at higher risk of developing mental disorders after a disaster.

Monitoring water quality in a hypereutrophic reservoir using Landsat ETM+ and OLI sensors: how transferable are the water quality algorithms?

PubMed

Deutsch, Eliza S; Alameddine, Ibrahim; El-Fadel, Mutasem

2018-02-15

The launch of the Landsat 8 in February 2013 extended the life of the Landsat program to over 40 years, increasing the value of using Landsat to monitor long-term changes in the water quality of small lakes and reservoirs, particularly in poorly monitored freshwater systems. Landsat-based water quality hindcasting often incorporate several Landsat sensors in an effort to increase the temporal range of observations; yet the transferability of water quality algorithms across sensors remains poorly examined. In this study, several empirical algorithms were developed to quantify chlorophyll-a, total suspended matter (TSM), and Secchi disk depth (SDD) from surface reflectance measured by Landsat 7 ETM+ and Landsat 8 OLI sensors. Sensor-specific multiple linear regression models were developed by correlating in situ water quality measurements collected from a semi-arid eutrophic reservoir with band ratios from Landsat ETM+ and OLI sensors, along with ancillary data (water temperature and seasonality) representing ecological patterns in algae growth. Overall, ETM+-based models outperformed (adjusted R 2 chlorophyll-a = 0.70, TSM = 0.81, SDD = 0.81) their OLI counterparts (adjusted R 2 chlorophyll-a = 0.50, TSM = 0.58, SDD = 0.63). Inter-sensor differences were most apparent for algorithms utilizing the Blue spectral band. The inclusion of water temperature and seasonality improved the power of TSM and SDD models.

Severity of Illness Scores May Misclassify Critically Ill Obese Patients.

PubMed

Deliberato, Rodrigo Octávio; Ko, Stephanie; Komorowski, Matthieu; Armengol de La Hoz, M A; Frushicheva, Maria P; Raffa, Jesse D; Johnson, Alistair E W; Celi, Leo Anthony; Stone, David J

2018-03-01

Severity of illness scores rest on the assumption that patients have normal physiologic values at baseline and that patients with similar severity of illness scores have the same degree of deviation from their usual state. Prior studies have reported differences in baseline physiology, including laboratory markers, between obese and normal weight individuals, but these differences have not been analyzed in the ICU. We compared deviation from baseline of pertinent ICU laboratory test results between obese and normal weight patients, adjusted for the severity of illness. Retrospective cohort study in a large ICU database. Tertiary teaching hospital. Obese and normal weight patients who had laboratory results documented between 3 days and 1 year prior to hospital admission. None. Seven hundred sixty-nine normal weight patients were compared with 1,258 obese patients. After adjusting for the severity of illness score, age, comorbidity index, baseline laboratory result, and ICU type, the following deviations were found to be statistically significant: WBC 0.80 (95% CI, 0.27-1.33) × 10/L; p = 0.003; log (blood urea nitrogen) 0.01 (95% CI, 0.00-0.02); p = 0.014; log (creatinine) 0.03 (95% CI, 0.02-0.05), p < 0.001; with all deviations higher in obese patients. A logistic regression analysis suggested that after adjusting for age and severity of illness at least one of these deviations had a statistically significant effect on hospital mortality (p = 0.009). Among patients with the same severity of illness score, we detected clinically small but significant deviations in WBC, creatinine, and blood urea nitrogen from baseline in obese compared with normal weight patients. These small deviations are likely to be increasingly important as bigger data are analyzed in increasingly precise ways. Recognition of the extent to which all critically ill patients may deviate from their own baseline may improve the objectivity, precision, and generalizability of ICU mortality prediction and severity adjustment models.

Longitudinal diffusion changes following postoperative delirium in older people without dementia.

PubMed

Cavallari, Michele; Dai, Weiying; Guttmann, Charles R G; Meier, Dominik S; Ngo, Long H; Hshieh, Tammy T; Fong, Tamara G; Schmitt, Eva; Press, Daniel Z; Travison, Thomas G; Marcantonio, Edward R; Jones, Richard N; Inouye, Sharon K; Alsop, David C

2017-09-05

To investigate the effect of postoperative delirium on longitudinal brain microstructural changes, as measured by diffusion tensor imaging. We studied a subset of the larger Successful Aging after Elective Surgery (SAGES) study cohort of older adults (≥70 years) without dementia undergoing elective surgery: 113 participants who had diffusion tensor imaging before and 1 year after surgery. Postoperative delirium severity and occurrence were assessed during the hospital stay using the Confusion Assessment Method and a validated chart review method. We investigated the association of delirium severity and occurrence with longitudinal diffusion changes across 1 year, adjusting for age, sex, vascular comorbidity, and baseline cognitive performance. We also assessed the association between changes in diffusion and cognitive performance across the 1-year follow-up period, adjusting for age, sex, education, and baseline cognitive performance. Postoperative delirium occurred in 25 participants (22%). Delirium severity and occurrence were associated with longitudinal diffusion changes in the periventricular, frontal, and temporal white matter. Diffusion changes were also associated with changes in cognitive performance across 1 year, although the cognitive changes did not show significant association with delirium severity or occurrence. Our study raises the possibility that delirium has an effect on the development of brain microstructural abnormalities, which may reflect brain changes underlying cognitive trajectories. Future studies are warranted to clarify whether delirium is the driving factor of the observed changes or rather a correlate of a vulnerable brain that is at high risk for neurodegenerative processes. © 2017 American Academy of Neurology.

Levosimendan in Critical Illness: A Literature Review

PubMed Central

Pierrakos, Charalampos; Velissaris, Dimitrios; Franchi, Federico; Muzzi, Luigi; Karanikolas, Menelaos; Scolletta, Sabino

2014-01-01

Levosimendan, the active enantiomer of simendan, is a calcium sensitizer developed for treatment of decompensated heart failure, exerts its effects independently of the beta adrenergic receptor and seems beneficial in cases of severe, intractable heart failure. Levosimendan is usually administered as 24-h infusion, with or without a loading dose, but dosing needs adjustment in patients with severe liver or renal dysfunction. Despite several promising reports, the role of levosimendan in critical illness has not been thoroughly evaluated. Available evidence suggests that levosimendan is a safe treatment option in critically ill patients and may reduce mortality from cardiac failure. However, data from well-designed randomized controlled trials in critically ill patients are needed to validate or refute these preliminary conclusions. This literature review is an attempt to synthesize available evidence on the role and possible benefits of levosimendan in critically ill patients with severe heart failure. PMID:24578748

The association between compliance with recommended follow-up and glaucomatous disease severity in a county hospital population.

PubMed

Ung, Cindy; Murakami, Yohko; Zhang, Elisa; Alfaro, Tatyana; Zhang, Monica; Seider, Michael I; Singh, Kuldev; Lin, Shan C

2013-08-01

To assess the association between insufficient follow-up and clinical parameters such as disease severity and medication use among glaucoma patients at a metropolitan county hospital. Cross-sectional study. Two-hundred and six patients with established glaucoma were recruited from San Francisco General Hospital. Subjects were classified based on compliance with recommended follow-up examination intervals over the year preceding commencement of the study, as determined by patient medical records. Glaucoma severity was determined based on the American Academy of Ophthalmology Preferred Practice Patterns guidelines. Multivariate logistic regression analysis was used to assess the relationship between adherence with follow-up visits and disease severity. After adjustment for the impact of potential confounding variables, subjects with severe glaucomatous disease were found to have been less adherent to their recommended follow-up than those patients with mild or moderate glaucomatous disease (adjusted OR 1.89, 95% CI 1.21-2.94; P = .01). Subjects who were on glaucoma medications were found to be less adherent to follow-up recommendations (adjusted OR 3.29, 95% CI 1.41-7.65, P = .01). Subjects with poor follow-up adherence were significantly more likely to have severe glaucomatous disease, suggesting that poor follow-up may contribute to disease worsening or, alternatively, those with more severe disease are less inclined to follow up at appropriate intervals. Published by Elsevier Inc.

Association of Endothelial Glycocalyx and Tight and Adherens Junctions With Severity of Plasma Leakage in Dengue Infection

PubMed Central

Sasmono, R. Tedjo; Sinto, Robert; Ibrahim, Eppy; Suryamin, Maulana

2017-01-01

Abstract Background. The role of vascular endothelial (VE) components in dengue infection with plasma leakage is unknown. Therefore, we conducted a study to determine the adjusted association of the endothelial glycocalyx layer (EGL) and tight and adherens junction markers with plasma leakage. Methods. A prospective observational study was conducted at Cipto Mangunkusumo Hospital and Persahabatan Hospital, Jakarta, Indonesia. Adult dengue patients admitted to the hospital on the third day of fever from November 2013 through August 2015 were included in the study. Multiple regression analysis was used to determine the adjusted association of the VE biomarkers with the severity of the plasma leakage. Results. A total of 103 dengue-infected patients participated in the study. In the critical phase, levels of syndecan-1 (odds ratio [OR] = 1.004; 95% confidence interval [CI] = 1.001–1.007) and chondroitin sulfate (OR = 1.157; 95% CI = 1.025–1.307) had an adjusted association with plasma leakage, whereas levels of syndecan-1 (OR = 1.004; 95% CI = 1.000–1.008) and claudin-5 (OR = 1.038; 95% CI = 1.004–1.074) had an adjusted association with severe plasma leakage. Conclusions. In dengue-infected patients, elevated levels of syndecan-1 and chondroitin sulfate are strongly associated with plasma leakage, and elevated levels of syndecan-1 and claudin-5 are strongly associated with severe plasma leakage. PMID:28453844

Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study

PubMed Central

2013-01-01

Introduction Long-lasting relapsing or lingering rheumatic musculoskeletal pain (RMSP) is the hallmark of Chikungunya virus (CHIKV) rheumatism (CHIK-R). Little is known on their prognostic factors. The aim of this prognostic study was to search the determinants of lingering or relapsing RMSP indicative of CHIK-R. Methods Three hundred and forty-six infected adults (age ≥ 15 years) having declared RMSP at disease onset were extracted from the TELECHIK cohort study, Reunion island, and analyzed using a multinomial logistic regression model. We also searched for the predictors of CHIKV-specific IgG titres, assessed at the time of a serosurvey, using multiple linear regression analysis. Results Of these, 111 (32.1%) reported relapsing RMSP, 150 (43.3%) lingering RMSP, and 85 (24.6%) had fully recovered (reference group) on average two years after acute infection. In the final model controlling for gender, the determinants of relapsing RMSP were the age 45-59 years (adjusted OR: 2.9, 95% CI: 1.0, 8.6) or greater or equal than 60 years (adjusted OR: 10.4, 95% CI: 3.5, 31.1), severe rheumatic involvement (fever, at least six joints plus four other symptoms) at presentation (adjusted OR: 3.6, 95% CI: 1.5, 8.2), and CHIKV-specific IgG titres (adjusted OR: 3.2, 95% CI: 1.8, 5.5, per one unit increase). Prognostic factors for lingering RMSP were age 45-59 years (adjusted OR: 6.4, 95% CI: 1.8, 22.1) or greater or equal than 60 years (adjusted OR: 22.3, 95% CI: 6.3, 78.1), severe initial rheumatic involvement (adjusted OR: 5.5, 95% CI: 2.2, 13.8) and CHIKV-specific IgG titres (adjusted OR: 6.2, 95% CI: 2.8, 13.2, per one unit increase). CHIKV specific IgG titres were positively correlated with age, female gender and the severity of initial rheumatic symptoms. Conclusions Our data support the roles of age, severity at presentation and CHIKV specific IgG titres for predicting CHIK-R. By identifying the prognostic value of the humoral immune response of the host, this work also suggest a significant contribution of the adaptive immune response to the physiopathology of CHIK-R and should help to reconsider the paradigm of this chronic infection primarily shifted towards the involvement of the innate immune response. PMID:23302155

Probing the big five in adolescence: personality and adjustment during a developmental transition.

PubMed

Graziano, W G; Ward, D

1992-06-01

The present study probed the links among Big Five personality differences, self-reported personality differences, and adjustment to school among young adolescents. We used a multimethod converging analysis, with three sources of data: (a) adolescent self-report on standardized personality inventories; (b) classroom teacher trait ratings and evaluations of adjustment; and (c) school guidance counselor evaluations of adjustment. Evaluations of adolescent adjustment were systematically related to Big Five personality differences, as assessed by both classroom teachers' and school counselors' ratings. For classroom teachers, adjustment was closely related to evaluations on the Big Five dimension of Conscientiousness. Adolescent self-report on several standardized measures was not related to adult evaluation of school adjustment. We suggest that the five-factor model may be a useful tool for probing adjustment during the transition to adolescence.

Teachers and Their International Relocation: The Effect of Self-Esteem and Pay Satisfaction on Adjustment and Outcome Variables

ERIC Educational Resources Information Center

Richardson, Warnie; von Kirchenheim, Clement; Richardson, Carole

2006-01-01

This is the second of two papers investigating the adjustment process in a designated group of expatriates, (teachers), who have severed ties with their home country and employer. In the first paper we examined the effect of self-efficacy and flexibility within this adjustment process, revealing the significance of self-efficacy but failing to…

A balanced perspective: using nonfinancial measures to assess financial performance.

PubMed

Watkins, Ann L

2003-11-01

Assessments of hospitals' financial performance have traditionally been based exclusively on analysis of a concise set of key financial ratios. One study, however, demonstrates that analysis of a hospital's financial condition can be significantly enhanced with the addition of several nonfinancial measures, including case-mix adjusted admissions, case-mix adjusted admissions per full-time equivalent, and case-mix adjusted admissions per beds in service.

Decreased risk adjusted 30-day mortality for hospital admitted injuries: a multi-centre longitudinal study.

PubMed

Larsen, Robert; Bäckström, Denise; Fredrikson, Mats; Steinvall, Ingrid; Gedeborg, Rolf; Sjoberg, Folke

2018-04-03

The interpretation of changes in injury-related mortality over time requires an understanding of changes in the incidence of the various types of injury, and adjustment for their severity. Our aim was to investigate changes over time in incidence of hospital admission for injuries caused by falls, traffic incidents, or assaults, and to assess the risk-adjusted short-term mortality for these patients. All patients admitted to hospital with injuries caused by falls, traffic incidents, or assaults during the years 2001-11 in Sweden were identified from the nationwide population-based Patient Registry. The trend in mortality over time for each cause of injury was adjusted for age, sex, comorbidity and severity of injury as classified from the International Classification of diseases, version 10 Injury Severity Score (ICISS). Both the incidence of fall (689 to 636/100000 inhabitants: p = 0.047, coefficient - 4.71) and traffic related injuries (169 to 123/100000 inhabitants: p < 0.0001, coefficient - 5.37) decreased over time while incidence of assault related injuries remained essentially unchanged during the study period. There was an overall decrease in risk-adjusted 30-day mortality in all three groups (OR 1.00; CI95% 0.99-1.00). Decreases in traffic (OR 0.95; 95% CI 0.93 to 0.97) and assault (OR 0.93; 95% CI 0.87 to 0.99) related injuries was significant whereas falls were not during this 11-year period. Risk-adjustment is a good way to use big materials to find epidemiological changes. However after adjusting for age, year, sex and risk we find that a possible factor is left in the pre- and/or in-hospital care. The decrease in risk-adjusted mortality may suggest changes over time in pre- and/or in-hospital care. A non-significantdecrease in risk-adjusted mortality was registered for falls, which may indicate that low-energy trauma has not benefited for the increased survivability as much as high-energy trauma, ie traffic- and assault related injuries.

Use of Epidural Analgesia as an Adjunct in Elective Abdominal Wall Reconstruction: A Review of 4983 Cases.

PubMed

Karamanos, Efstathios; Dream, Sophie; Falvo, Anthony; Schmoekel, Nathan; Siddiqui, Aamir

2017-01-01

Use of epidural analgesia in patients undergoing elective abdominal wall reconstruction is common. To assess the impact of epidural analgesia in patients undergoing abdominal wall reconstruction. All patients who underwent elective ventral hernia repair from 2005 to 2014 were retrospectively identified. Patients were divided into two groups by the postoperative use of epidural analgesics as an adjunct analgesic method. Preoperative comorbidities, American Society of Anesthesiologists status, operative findings, postoperative pain management, and venothromboembolic prophylaxis were extracted from the database. Logistic regressions were performed to assess the impact of epidural use. Severity of pain on postoperative days 1 and 2. During the study period, 4983 patients were identified. Of those, 237 patients (4.8%) had an epidural analgesic placed. After adjustment for differences between groups, use of epidural analgesia was associated with significantly lower rates of 30-day presentation to the Emergency Department (adjusted odds ratio [AOR] = 0.53, 95% confidence interval [CI] = 0.32-0.87, adjusted p = 0.01). Use of epidural analgesia resulted in higher odds of abscess development (AOR = 5.89, CI = 2.00-17.34, adjusted p < 0.01) and transfusion requirement (AOR = 2.92, CI = 1.34-6.40, adjusted p < 0.01). Use of epidural analgesia resulted in a significantly lower pain score on postoperative day 1 (3 vs 4, adjusted p < 0.01). Use of epidural analgesia in patients undergoing abdominal wall reconstruction may result in longer hospital stay and higher incidence of complications while having no measurable positive clinical impact on pain control.

The impact of hospital-onset Clostridium difficile infection on outcomes of hospitalized patients with sepsis.

PubMed

Lagu, Tara; Stefan, Mihaela S; Haessler, Sarah; Higgins, Thomas L; Rothberg, Michael B; Nathanson, Brian H; Hannon, Nicholas S; Steingrub, Jay S; Lindenauer, Peter K

2014-07-01

To examine the impact of hospital-onset Clostridium difficile infection (HOCDI) on the outcomes of patients with sepsis. Most prior studies that have addressed this issue lacked adequate matching to controls, suffered from small sample size, or failed to consider time to infection. Retrospective cohort study. We identified adults with a principal or secondary diagnosis of sepsis who received care at 1 of the institutions that participated in a large multihospital database between July 1, 2004 and December 31, 2010. Among eligible patients with sepsis, we identified patients who developed HOCDI during their hospital stay. We used propensity matching and date of diagnosis to match cases to patients without Clostridium difficile infections and compared outcomes between the 2 groups. Of 218,915 sepsis patients, 2368 (1.08%) developed HOCDI. Unadjusted in-hospital mortality was significantly higher in HOCDI patients than controls (25% vs 10%, P < 0.001). After multivariate adjustment, in-hospital mortality rate was 24% in cases vs. 15% in controls. In an analysis limited to survivors, adjusted length of stay (LOS) among cases with Clostridium difficile infections was 5.1 days longer than controls (95% confidence interval: 4.4-5.8) and the median-adjusted cost increase was $4916 (P < 0.001). After rigorous adjustment for time to diagnosis and presenting severity, hospital-acquired Clostridium difficile infection was associated with increased mortality, LOS, and cost. Our results can be used to assess the cost-effectiveness of prevention programs and suggest that efforts directed toward high-risk patient populations are needed. © 2014 Society of Hospital Medicine.

Percolation

NASA Astrophysics Data System (ADS)

Dã¡Vila, Alã¡N.; Escudero, Christian; López, Jorge, , Dr.

2004-10-01

Several methods have been developed in order to study phase transitions in nuclear fragmentation. The one used in this research is Percolation. This method allows us to adjust resulting data to heavy ion collisions experiments. In systems, such as atomic nuclei or molecules, energy is put into the system. The system's particles move away from each other until their links are broken. Some particles will still be linked. The fragments' distribution is found to be a power law. We are witnessing then a critical phenomenon. In our model the particles are represented as occupied spaces in a cubical array. Each particle has a bound to each one of its 6 neighbors. Each bound can be active if the two particles are linked or inactive if they are not. When two or more particles are linked, a fragment is formed. The probability for a specific link to be broken cannot be calculated, so the probability for a bound to be active is going to be used as parameter when trying to adjust the data. For a given probability p several arrays are generated. The fragments are counted. The fragments' distribution is then adjusted to a power law. The probability that generates the better fit is going to be the critical probability that indicates a phase transition. The better fit is found by seeking the fragments' distribution that gives the minimal chi squared when compared to a power law. As additional evidence of criticality the entropy and normalized variance of the mass are also calculated for each probability.

Ultrasonography guidance reduces complications and costs associated with thoracentesis procedures.

PubMed

Patel, Pankaj A; Ernst, Frank R; Gunnarsson, Candace L

2012-01-01

PURPOSE.: We performed an analysis of hospitalizations involving thoracentesis procedures to determine whether the use of ultrasonographic (US) guidance is associated with differences in complications or hospital costs as compared with not using US guidance. METHODS.: We used the Premier hospital database to identify patients with ICD-9 coded thoracentesis in 2008. Use of US guidance was identified using CPT-4 codes. We performed univariate and multivariable analyses of cost data and adjusted for patient demographics, hospital characteristics, patient morbidity severity, and mortality. Logistic regression models were developed for pneumothorax and hemorrhage adverse events, controlling for patient demographics, morbidity severity, mortality, and hospital size. RESULTS.: Of 19,339 thoracentesis procedures, 46% were performed with US guidance. Mean total hospitalization costs were $11,786 (±$10,535) and $12,408 (±$13,157) for patients with and without US guidance, respectively (p < 0.001). Unadjusted risk of pneumothorax or hemorrhage was lower with US guidance (p = 0.019 and 0.078, respectively). Logistic regression analyses demonstrate that US is associated with a 16.3% reduction likelihood of pneumothorax (adjusted odds ratio 0.837, 95% CI: 0.73-0.96; p= 0.014), and 38.7% reduction in likelihood of hemorrhage (adjusted odds ratio 0.613, 95% CI: 0.36-1.04; p = 0.071). CONCLUSIONS.: US-guided thoracentesis is associated with lower total hospital stay costs and lower incidence of pneumothorax and hemorrhage. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound, 2011. Copyright © 2011 Wiley Periodicals, Inc.

Peri-operative heart-type fatty acid binding protein is associated with acute kidney injury after cardiac surgery

PubMed Central

Schaub, Jennifer A.; Garg, Amit X.; Coca, Steven G.; Testani, Jeffrey M.; Shlipak, Michael G.; Eikelboom, John; Kavsak, Peter; McArthur, Eric; Shortt, Colleen; Whitlock, Richard; Parikh, Chirag R.

2015-01-01

Acute Kidney Injury (AKI) is a common complication after cardiac surgery and is associated with worse outcomes. Since heart fatty acid binding protein (H-FABP) is a myocardial protein that detects cardiac injury, we sought to determine if plasma H-FABP was associated with AKI in the TRIBE-AKI cohort; a multi-center cohort of 1219 patients at high risk for AKI who underwent cardiac surgery. The primary outcomes of interest were any AKI (Acute Kidney Injury Network (AKIN) stage 1 or higher) and severe AKI (AKIN stage 2 or higher). The secondary outcome was long-term mortality after discharge. Patients who developed AKI had higher levels of H-FABP pre- and post-operatively than patients who did not have AKI. In analyses adjusted for known AKI risk factors, first post-operative log(H-FABP) was associated with severe AKI (adjusted OR 5.39 [95% CI, 2.87-10.11] per unit increase), while pre-operative log(H-FABP) was associated with any AKI (2.07 [1.48-2.89]) and mortality (1.67 [1.17-2.37]). These relationships persisted after adjustment for change in serum creatinine (for first postoperative log(H-FABP)) and biomarkers of cardiac and kidney injury, including brain natriuretic peptide, cardiac troponin-I, interleukin-18, liver fatty acid binding protein, kidney injury molecule-1, and neutrophil gelatinase associated lipocalin. Thus, peri-operative plasma H-FABP levels may be used for risk-stratification of AKI and mortality following cardiac surgery. PMID:25830762

Severe preeclampsia and maternal self-report of oral health, hygiene, and dental care.

PubMed

Boggess, Kim A; Berggren, Erica K; Koskenoja, Viktoria; Urlaub, Diana; Lorenz, Carol

2013-02-01

Maternal periodontal disease diagnosed by a detailed oral health examination is associated with preeclampsia. Our objective was to measure the association between maternal self-report of oral symptoms/problems, oral hygiene practices, and/or dental service use before or during pregnancy and severe preeclampsia. A written questionnaire was administered to pregnant females at the time of prenatal ultrasound and outcomes were ascertained by chart abstraction. The χ(2) test compared maternal oral symptoms/problems, hygiene practices, and dental service use between females with severe preeclampsia versus normotensive females. Multivariable logistic regression was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for severe preeclampsia. A total of 48 (10%) of 470 females reported ≥2 oral symptoms/problems in the 6 months before pregnancy and 77 (16%) since pregnancy. Fifty-one (11%) reported previous periodontal treatment. Twenty-eight (6%) of 470 developed severe preeclampsia. Females with a history of periodontal treatment were more likely to develop severe preeclampsia (aOR = 3.71; 95% CI = 1.40 to 9.83) than females without a history of periodontal treatment. Self-reported oral health symptoms/problems, oral hygiene practices, or dental service use before or during pregnancy were not associated with severe preeclampsia when considered in the context of other maternal risk factors. Maternal self-report of previous periodontal treatment before pregnancy is associated with severe preeclampsia.

Diagnostic specificity of poor premorbid adjustment: Comparison of schizophrenia, schizoaffective disorder, and mood disorder with psychotic features

PubMed Central

Tarbox, Sarah I.; Brown, Leslie H.; Haas, Gretchen L.

2012-01-01

Individuals with schizophrenia have significant deficits in premorbid social and academic adjustment compared to individuals with non-psychotic diagnoses. However, it is unclear how severity and developmental trajectory of premorbid maladjustment compare across psychotic disorders. This study examined the association between premorbid functioning (in childhood, early adolescence, and late adolescence) and psychotic disorder diagnosis in a first-episode sample of 105 individuals: schizophrenia (n=68), schizoaffective disorder (n=22), and mood disorder with psychotic features (n=15). Social and academic maladjustment was assessed using the Cannon-Spoor Premorbid Adjustment Scale. Worse social functioning in late adolescence was associated with higher odds of schizophrenia compared to odds of either schizoaffective disorder or mood disorder with psychotic features, independently of child and early adolescent maladjustment. Greater social dysfunction in childhood was associated with higher odds of schizoaffective disorder compared to odds of schizophrenia. Premorbid decline in academic adjustment was observed for all groups, but did not predict diagnosis at any stage of development. Results suggest that social functioning is disrupted in the premorbid phase of both schizophrenia and schizoaffective disorder, but remains fairly stable in mood disorders with psychotic features. Disparities in the onset and time course of social dysfunction suggest important developmental differences between schizophrenia and schizoaffective disorder. PMID:22858353

[Characteristics of cases hospitalized for severe pandemic (H1N1) 2009 in Catalonia].

PubMed

Godoy, Pere; Rodés, Anna; Alvarez, Josep; Camps, Neus; Barrabeig, Irene; Sala, María Rosa; Minguell, Sofía; Lafuente, Sarah; Pumarola, Tomás; Domínguez, Angela; Plasència, Antoni

2011-01-01

Influenza pandemics may cause more severe cases. The objective was to determine the characteristics of hospitalized severe cases of pandemic influenza in Catalonia and to study risk factors for admission to intensive care unit (ICU). A prospective epidemiologic study of new cases of pandemic influenza hospitalized by their severity between June 2009 and May 2010. Hospitals were asked to declare laboratory confirmed pandemic influenza cases that met the case specific case definition for severe case. A standardized epidemiological survey was conducted to collect information on demographics, clinical characteristics, risk factors, treatment and outcome. Differences between the cases in ICU compared to other severe cases were studied with the odds ratio (OR), which were adjusted using a logistic regression model. We detected total of 773 pandemic influenza (H1N1) 2009 severe cases; 465 (60.2%) of them had at least one risk factor and the most prevalent were: pregnancy 19 (13%), asthma 87 (12%), chronic obstructive pulmonary disease 87 (11.4%) and heart disease 80 (10.5%). Required admission to ICU 293 patients (37.9%). Factors associated with ICU admission were obesity BMI>40 (adjusted OR = 2.5, 95% CI 1.4-4.5) and chronic liver disease (adjusted OR = 2.3, 95% CI 1.1-4.8). This study confirms the high prevalence of pregnancy, chronic respiratory diseases, diabetes and obesity among pandemic influenza severe cases. Obesity acts as a risk factor for ICU admission and should therefore be considered as an indicator for influenza vaccination.

Divorce and Severity of Coronary Artery Disease: A Multicenter Study

PubMed Central

Al-Murayeh, Mushabab; Al-kaabi, Salem; Lotfi, Amir; Al-Faifi, Salem M.; Alqahtani, Saleh; Stewart, James; Heavey, Jon; Hurley, William T.; Alama, Mohamed N.; Faden, Mazen; Al-Shehri, Mohamed; Youssef, Ali; Alsheikh-Ali, Alawi A.

2017-01-01

The association between marital status and coronary artery disease (CAD) is supported by numerous epidemiological studies. While divorce may have an adverse effect on cardiac outcomes, the relationship between divorce and severe CAD is unclear. We conducted a multicenter, observational study of consecutive patients undergoing coronary angiography during the period between April 1, 2013, and March 30, 2014. Of 1,068 patients, 124 (12%) were divorced. Divorce was more frequent among women (27%) compared to men (6%). Most divorced patients had been divorced only once (49%), but a subset had been divorced 2 (38%) or ≥3 (12%) times. After adjusting for baseline differences, there was no significant association between divorce and severe CAD in men. In women, there was a significant adjusted association between divorce and severe MVD (OR 2.31 [1.16, 4.59]) or LMD (OR 5.91 [2.19, 15.99]). The modification of the association between divorce and severe CAD by gender was statistically significant for severe LMD (Pinteraction 0.0008) and marginally significant for CAD (Pinteraction 0.05). Among women, there was a significant adjusted association between number of divorces and severe CAD (OR 2.4 [95% CI 1.2, 4.5]), MVD (OR 2.0 [95% CI 1.4, 3.0]), and LMD (OR 3.4 [95% CI 1.9, 5.9]). In conclusion, divorce, particularly multiple divorces, is associated with severe CAD, MVD, and LMD in women but not in men. PMID:28811952

Factors influencing psychosocial adjustment and quality of life in Parkinson patients and informal caregivers.

PubMed

Navarta-Sánchez, María Victoria; Senosiain García, Juana M; Riverol, Mario; Ursúa Sesma, María Eugenia; Díaz de Cerio Ayesa, Sara; Anaut Bravo, Sagrario; Caparrós Civera, Neus; Portillo, Mari Carmen

2016-08-01

The influence that social conditions and personal attitudes may have on the quality of life (QoL) of Parkinson's disease (PD) patients and informal caregivers does not receive enough attention in health care, as a result of it not being clearly identified, especially in informal caregivers. The aim of this study was to provide a comprehensive analysis of psychosocial adjustment and QoL determinants in PD patients and informal caregivers. Ninety-one PD patients and 83 caregivers participated in the study. Multiple regression analyses were performed including benefit finding, coping, disease severity and socio-demographic factors, in order to determine how these aspects influence the psychosocial adjustment and QoL in PD patients and caregivers. Regression models showed that severity of PD was the main predictor of psychosocial adjustment and QoL in patients. Nevertheless, multiple regression analyses also revealed that coping was a significant predictor of psychosocial adjustment in patients and caregivers. Furthermore, psychosocial adjustment was significantly related to QoL in patients and caregivers. Also, coping and benefit finding were predictors of QoL in caregivers but not in patients. Multidisciplinary interventions aimed at improving PD patients' QoL may have more effective outcomes if education about coping skills, and how these can help towards a positive psychosocial adjustment to illness, were included, and targeted not only at patients, but also at informal caregivers.

Quality of life after TIA and stroke: ten-year results of the Oxford Vascular Study.

PubMed

Luengo-Fernandez, Ramon; Gray, Alastair M; Bull, Linda; Welch, Sarah; Cuthbertson, Fiona; Rothwell, Peter M

2013-10-29

To evaluate the 5-year impact of stroke and TIA on utility and quality-adjusted survival. TIA and stroke patients from a UK population-based study (Oxford Vascular Study) were recruited from 2002 to 2007, and followed up until 2012. Quality of life was assessed over 5 years using the EQ-5D (EuroQol-5 Dimensions), with responses converted into utilities ranging from -0.59 (worse than death) to 1 (perfect health), using UK population valuations. Utilities for stroke and TIA patients were compared with those in matched controls obtained from the 2006 Health Survey for England. Five-year quality-adjusted life years were estimated by combining utility and survival information. Four hundred forty TIA and 748 stroke patients were ascertained and included. Utility remained constant at approximately 0.78 over the 5 years after TIA. Utility improved from 0.64 one month after stroke to 0.70 at 6 months (p = 0.006), remaining at approximately 0.70 thereafter. Matched controls had considerably higher utility levels than stroke/TIA patients (0.85, p < 0.001). Event severity and recurrent stroke were significant predictors of decreased long-term utility. Five-year quality-adjusted life expectancy was 3.32 (95% confidence interval: 3.22-3.48) quality-adjusted life years after TIA and 2.21 (2.15-2.37) after stroke, varying considerably by severity (minor: 2.94; moderate: 1.65; and severe: 0.70). Quality-adjusted survival is low over the 5 years after stroke and TIA, with severity and recurrent stroke being major predictors. There remains considerable scope for improvements in acute treatment and secondary prevention to improve the quality of life after TIA and stroke.

Maternal Obesity: Risks for Developmental Delays in Early Childhood.

PubMed

Duffany, Kathleen O'Connor; McVeigh, Katharine H; Kershaw, Trace S; Lipkind, Heather S; Ickovics, Jeannette R

2016-02-01

To assess the risk for neurodevelopmental delays for children of mothers who were obese (≥200 pounds) prior to pregnancy, and to characterize delays associated with maternal obesity among children referred to and found eligible to receive Early Intervention Program services. We conducted a retrospective cohort study (N = 541,816) using a population-based New York City data warehouse with linked birth and Early Intervention data. Risks for children suspected of a delay and 'significantly delayed', with two moderate or one severe delay, were calculated. Among the group of children eligible by delay for Early Intervention, analyses assessed risk for being identified with a moderate-to-severe delay across each of five functional domains as well as risks for multiple delays. Children of mothers who were obese were more likely to be suspected of a delay (adjusted RR 1.19 [CI 1.15-1.22]) and borderline association for 'significantly delayed' (adjusted RR 1.01 [CI 1.00-1.02). Among children eligible by delay, children of mothers who were obese evidenced an increased risk for moderate-to-severe cognitive (adjusted RR 1.04 [CI 1.02-1.07]) and physical (adjusted RR 1.04 [CI 1.01-1.08]) delays and for global developmental delay (adjusted RR 1.05 [CI 1.01-1.08]). Maternal obesity is associated with increased risk of developmental delay in offspring. Among children with moderate or severe delays, maternal obesity is associated with increased risk of cognitive and physical delays as well as with increased risk for global developmental delay. While causation remains uncertain, this adds to the growing body of research reporting an association between maternal obesity and neurodevelopmental delays in offspring.

The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis

PubMed Central

Park, Marcelo; Mendes, Pedro Vitale; Zampieri, Fernando Godinho; Azevedo, Luciano Cesar Pontes; Costa, Eduardo Leite Vieira; Antoniali, Fernando; Ribeiro, Gustavo Calado de Aguiar; Caneo, Luiz Fernando; da Cruz Neto, Luiz Monteiro; Carvalho, Carlos Roberto Ribeiro; Trindade, Evelinda Marramon

2014-01-01

Objective To analyze the cost-utility of using extracorporeal oxygenation for patients with severe acute respiratory distress syndrome in Brazil. Methods A decision tree was constructed using databases from previously published studies. Costs were taken from the average price paid by the Brazilian Unified Health System (Sistema Único de Saúde; SUS) over three months in 2011. Using the data of 10,000,000 simulated patients with predetermined outcomes and costs, an analysis was performed of the ratio between cost increase and years of life gained, adjusted for quality (cost-utility), with survival rates of 40 and 60% for patients using extracorporeal membrane oxygenation. Results The decision tree resulted in 16 outcomes with different life support techniques. With survival rates of 40 and 60%, respectively, the increased costs were R$=-301.00/-14.00, with a cost of R$=-30,913.00/-1,752.00 paid per six-month quality-adjusted life-year gained and R$=-2,386.00/-90.00 per quality-adjusted life-year gained until the end of life, when all patients with severe ARDS were analyzed. Analyzing only patients with severe hypoxemia (i.e., a ratio of partial oxygen pressure in the blood to the fraction of inspired oxygen <100mmHg), the increased cost was R$=-5,714.00/272.00, with a cost per six-month quality-adjusted life-year gained of R$=-9,521.00/293.00 and a cost of R$=-280.00/7.00 per quality-adjusted life-year gained. Conclusion The cost-utility ratio associated with the use of extracorporeal membrane oxygenation in Brazil is potentially acceptable according to this hypothetical study. PMID:25295819

Delta XTE Spacecraft Solar Panel Deployment, Hangar AO at Cape Canaveral Air Station

NASA Technical Reports Server (NTRS)

1995-01-01

The footage shows technicians in the clean room checking and adjusting the deployment mechanism of the solar panel for XTE spacecraft. Other scenes show several technicians making adjustments to software for deployment of the solar panels.

A Matter of Classes: Stratifying Health Care Populations to Produce Better Estimates of Inpatient Costs

PubMed Central

Rein, David B

2005-01-01

Objective To stratify traditional risk-adjustment models by health severity classes in a way that is empirically based, is accessible to policy makers, and improves predictions of inpatient costs. Data Sources Secondary data created from the administrative claims from all 829,356 children aged 21 years and under enrolled in Georgia Medicaid in 1999. Study Design A finite mixture model was used to assign child Medicaid patients to health severity classes. These class assignments were then used to stratify both portions of a traditional two-part risk-adjustment model predicting inpatient Medicaid expenditures. Traditional model results were compared with the stratified model using actuarial statistics. Principal Findings The finite mixture model identified four classes of children: a majority healthy class and three illness classes with increasing levels of severity. Stratifying the traditional two-part risk-adjustment model by health severity classes improved its R2 from 0.17 to 0.25. The majority of additional predictive power resulted from stratifying the second part of the two-part model. Further, the preference for the stratified model was unaffected by months of patient enrollment time. Conclusions Stratifying health care populations based on measures of health severity is a powerful method to achieve more accurate cost predictions. Insurers who ignore the predictive advances of sample stratification in setting risk-adjusted premiums may create strong financial incentives for adverse selection. Finite mixture models provide an empirically based, replicable methodology for stratification that should be accessible to most health care financial managers. PMID:16033501

Nitric-glycolic flowsheet testing for maximum hydrogen generation rate

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

Martino, C. J.; Newell, J. D.; Williams, M. S.

The Defense Waste Processing Facility (DWPF) at the Savannah River Site is developing for implementation a flowsheet with a new reductant to replace formic acid. Glycolic acid has been tested over the past several years and found to effectively replace the function of formic acid in the DWPF chemical process. The nitric-glycolic flowsheet reduces mercury, significantly lowers the chemical generation of hydrogen and ammonia, allows purge reduction in the Sludge Receipt and Adjustment Tank (SRAT), stabilizes the pH and chemistry in the SRAT and the Slurry Mix Evaporator (SME), allows for effective adjustment of the SRAT/SME rheology, and is favorablemore » with respect to melter flammability. The objective of this work was to perform DWPF Chemical Process Cell (CPC) testing at conditions that would bound the catalytic hydrogen production for the nitric-glycolic flowsheet.« less

24 CFR 902.24 - Database adjustment.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Database adjustment. 902.24 Section 902.24 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED... PUBLIC HOUSING ASSESSMENT SYSTEM Physical Condition Indicator § 902.24 Database adjustment. (a...

24 CFR 902.24 - Database adjustment.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Database adjustment. 902.24 Section 902.24 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED... PUBLIC HOUSING ASSESSMENT SYSTEM Physical Condition Indicator § 902.24 Database adjustment. (a...

24 CFR 902.24 - Database adjustment.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Database adjustment. 902.24 Section 902.24 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED... PUBLIC HOUSING ASSESSMENT SYSTEM Physical Condition Indicator § 902.24 Database adjustment. (a...

24 CFR 902.24 - Database adjustment.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Database adjustment. 902.24 Section 902.24 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED... PUBLIC HOUSING ASSESSMENT SYSTEM Physical Condition Indicator § 902.24 Database adjustment. (a...

Association between alcohol, cannabis, and other illicit substance abuse and risk of developing schizophrenia: a nationwide population based register study.

PubMed

Nielsen, S M; Toftdahl, N G; Nordentoft, M; Hjorthøj, C

2017-07-01

Several studies have examined whether use of substances can cause schizophrenia. However, due to methodological limitations in the existing literature (e.g. selection bias and lack of adjustment of co-abuse) uncertainties still remain. We aimed to investigate whether substance abuse increases the risk of developing schizophrenia, addressing some of these limitations. The longitudinal, nationwide Danish registers were linked to establish a cohort of 3 133 968 individuals (105 178 673 person-years at risk), identifying 204 505 individuals diagnosed with substance abuse and 21 305 diagnosed with schizophrenia. Information regarding substance abuse was extracted from several registers and did not include psychotic symptoms caused by substance abuse in the definition. This resulted in a large, generalizable sample of exposed individuals. The data was analysed using Cox regression analyses, and adjusted for calendar year, gender, urbanicity, co-abuse, other psychiatric diagnosis, parental substance abuse, psychiatric history, immigration and socioeconomic status. A diagnosis of substance abuse increased the overall risk of developing schizophrenia [hazard ratio (HR) 6.04, 95% confidence interval (CI) 5.84-6.26]. Cannabis (HR 5.20, 95% CI 4.86-5.57) and alcohol (HR 3.38, 95% CI 3.24-3.53) presented the strongest associations. Abuse of hallucinogens (HR 1.86, 95% CI 1.43-2.41), sedatives (HR 1.68, 95% CI 1.49-1.90), and other substances (HR 2.85, 95% CI 2.58-3.15) also increased the risk significantly. The risk was found to be significant even 10-15 years subsequent to a diagnosis of substance abuse. Our results illustrate robust associations between almost any type of substance abuse and an increased risk of developing schizophrenia later in life.

A model of the impact of reimbursement schemes on health plan choice.

PubMed

Keeler, E B; Carter, G; Newhouse, J P

1998-06-01

Flat capitation (uniform prospective payments) makes enrolling healthy enrollees profitable to health plans. Plans with relatively generous benefits may attract the sick and fail through a premium spiral. We simulate a model of idealized managed competition to explore the effect on market performance of alternatives to flat capitation such as severity-adjusted capitation and reduced supply-side cost-sharing. In our model flat capitation causes severe market problems. Severity adjustment and to a lesser extent reduced supply-side cost-sharing improve market performance, but outcomes are efficient only in cases in which people bear the marginal costs of their choices.

Stunting and severe stunting among children under-5 years in Nigeria: A multilevel analysis.

PubMed

Akombi, Blessing Jaka; Agho, Kingsley Emwinyore; Hall, John Joseph; Merom, Dafna; Astell-Burt, Thomas; Renzaho, Andre M N

2017-01-13

Stunting has been identified as one of the major proximal risk factors for poor physical and mental development of children under-5 years. Stunting predominantly occurs in the first 1000 days of life (0-23 months) and continues to the age of five. This study examines factors associated with stunting and severe stunting among children under-5 years in Nigeria. The sample included 24,529 children aged 0-59 months from the 2013 Nigeria Demographic and Health Survey (NDHS). Height-for-age z-scores (HFAz), generated using the 2006 World Health Organisation (WHO) growth reference, were used to define stunting (HFAz < -2SD) and severe stunting (HFAz < -3SD). Multilevel logistic regression analyses that adjusted for cluster and survey weights were used to determine potential risk factors associated with stunting and severe stunting among children under-5 years in Nigeria. The prevalence of stunting and severe stunting were 29% [95% Confidence interval (Cl): 27.4, 30.8] and 16.4% [95%Cl: 15.1, 17.8], respectively for children aged 0-23 months, and 36.7% [95%Cl: 35.1, 38.3] and 21% [95%Cl: 19.7, 22.4], respectively for children aged 0-59 months. Multivariate analysis revealed that the most consistent significant risk factors for stunting and severe stunting among children aged 0-23 months and 0-59 months are: sex of child (male), mother's perceived birth size (small and average), household wealth index (poor and poorest households), duration of breastfeeding (more than 12 months), geopolitical zone (North East, North West, North Central) and children who were reported to having had diarrhoea in the 2 weeks prior to the survey [Adjusted odds ratio (AOR) for stunted children 0-23 months = 1.22 (95%Cl: 0.99, 1.49)];[AOR for stunted children 0-59 months = 1.31 (95%Cl: 1.16, 1.49)], [AOR for severely stunted children 0-23 months = 1.31 (95%Cl: 1.03, 1.67)]; [AOR for severely stunted children 0-59 months = 1.58 (95%Cl: 1.38, 1.82)]. In order to meet the post-2015 sustainable development goals, policy interventions to reduce stunting in Nigeria should focus on poverty alleviation as well as improving women's nutrition, child feeding practices and household sanitation.

Association of anemia with the risk of cardiovascular adverse events in overweight/obese patients.

PubMed

Winther, S A; Finer, N; Sharma, A M; Torp-Pedersen, C; Andersson, C

2014-03-01

Anemia is associated with increased cardiovascular risks. Obesity may cause anemia in several ways, for example, by low-grade inflammation and relative iron deficit. The outcomes associated with anemia in overweight/obese patients at high cardiovascular risk are however not known. Therefore, we investigated the cardiovascular prognosis in overweight/obese subjects with anemia. A total of 9,687 overweight/obese cardiovascular high-risk patients from the Sibutramine Cardiovascular OUTcomes trial were studied. Patients were stratified after baseline hemoglobin level and followed for the risks of primary event (comprising nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality. Risk estimates (hazard ratios (HR) with 95% confidence intervals (CI)) were calculated using Cox regression models. Anemia was unadjusted associated with increased risk for the primary event, HR 1.73 (CI 1.37-2.18) and HR 2.02 (CI 1.34-3.06) for patients with mild or moderate-to-severe anemia, respectively, compared with patients without anemia. Adjusted for several confounders, anemia remained of prognostic importance. Increased risk of the primary events appeared to be driven by risk of cardiovascular death, adjusted HR 1.82 (CI 1.33-2.51) for mild anemia and adjusted HR 1.65 (CI 0.90-3.04) for moderate-to-severe anemia, and all-cause mortality, adjusted HR 1.50 (CI 1.17-1.93) for mild and adjusted HR 1.61 (CI 1.04-2.51) for moderate-to-severe anemia. While adding serum creatinine to the models, the increased risk of mild anemia was still a significant predictor for mortality (cardiovascular and all-cause), whereas moderate-to-severe anemia was not. For the primary events, anemia was no longer of independent prognostic importance when including serum creatinine. Anemia is associated with an increased risk of long-term adverse cardiovascular events and deaths among overweight/obese cardiovascular high-risk patients. The increased risk appeared to be driven by the risk of cardiovascular death and all-cause mortality, and renal impairments seemed to have a role in the increased risk.

Association of Red Blood Cell Transfusion, Anemia, and Necrotizing Enterocolitis in Very Low-Birth-Weight Infants.

PubMed

Patel, Ravi M; Knezevic, Andrea; Shenvi, Neeta; Hinkes, Michael; Keene, Sarah; Roback, John D; Easley, Kirk A; Josephson, Cassandra D

2016-03-01

Data regarding the contribution of red blood cell (RBC) transfusion and anemia to necrotizing enterocolitis (NEC) are conflicting. These associations have not been prospectively evaluated, accounting for repeated, time-varying exposures. To determine the relationship between RBC transfusion, severe anemia, and NEC. In a secondary, prospective, multicenter observational cohort study from January 2010 to February 2014, very low-birth-weight (VLBW, ≤1500 g) infants, within 5 days of birth, were enrolled at 3 level III neonatal intensive care units in Atlanta, Georgia. Two hospitals were academically affiliated and 1 was a community hospital. Infants received follow-up until 90 days, hospital discharge, transfer to a non-study-affiliated hospital, or death (whichever came first). Multivariable competing-risks Cox regression was used, including adjustment for birth weight, center, breastfeeding, illness severity, and duration of initial antibiotic treatment, to evaluate the association between RBC transfusion, severe anemia, and NEC. The primary exposure was RBC transfusion. The secondary exposure was severe anemia, defined a priori as a hemoglobin level of 8 g/dL or less. Both exposures were evaluated as time-varying covariates at weekly intervals. Necrotizing enterocolitis, defined as Bell stage 2 or greater by preplanned adjudication. Mortality was evaluated as a competing risk. Of 600 VLBW infants enrolled, 598 were evaluated. Forty-four (7.4%) infants developed NEC. Thirty-two (5.4%) infants died (all cause). Fifty-three percent of infants (319) received a total of 1430 RBC transfusion exposures. The unadjusted cumulative incidence of NEC at week 8 among RBC transfusion-exposed infants was 9.9% (95% CI, 6.9%-14.2%) vs 4.6% (95% CI, 2.6%-8.0%) among those who were unexposed. In multivariable analysis, RBC transfusion in a given week was not significantly related to the rate of NEC (adjusted cause-specific hazard ratio, 0.44 [95% CI, 0.17-1.12]; P = .09). Based on evaluation of 4565 longitudinal measurements of hemoglobin (median, 7 per infant), the rate of NEC was significantly increased among VLBW infants with severe anemia in a given week compared with those who did not have severe anemia (adjusted cause-specific hazard ratio, 5.99 [95% CI, 2.00-18.0]; P = .001). Among VLBW infants, severe anemia, but not RBC transfusion, was associated with an increased risk of NEC. Further studies are needed to evaluate whether preventing severe anemia is more important than minimizing RBC transfusion.

Hospitalizations for severe lower respiratory tract infections.

PubMed

Greenbaum, Adena H; Chen, Jufu; Reed, Carrie; Beavers, Suzanne; Callahan, David; Christensen, Deborah; Finelli, Lyn; Fry, Alicia M

2014-09-01

Hospitalization for lower respiratory tract infections (LRTIs) among children have been well characterized. We characterized hospitalizations for severe LRTI among children. We analyzed claims data from commercial and Medicaid insurance enrollees (MarketScan) ages 0 to 18 years from 2007 to 2011. LRTI hospitalizations were identified by the first 2 listed International Classification of Diseases, Ninth Revision discharge codes; those with ICU admission and/or receiving mechanical ventilation were defined as severe LRTI. Underlying conditions were determined from out- and inpatient discharge codes in the preceding year. We report insurance specific and combined rates that used both commercial and Medicaid rates and adjusted for age and insurance status. During 2007-2011, we identified 16797 and 12053 severe LRTI hospitalizations among commercial and Medicaid enrollees, respectively. The rates of severe LRTI hospitalizations per 100000 person-years were highest in children aged <1 year (commercial: 244; Medicaid: 372, respectively), and decreased with age. Among commercial enrollees, ≥ 1 condition increased the risk for severe LRTI (1 condition: adjusted relative risk, 2.68; 95% confidence interval, 2.58-2.78; 3 conditions: adjusted relative risk, 4.85; 95% confidence interval, 4.65-5.07) compared with children with no medical conditions. Using commercial/Medicaid combined rates, an estimated 31289 hospitalizations for severe LRTI occurred each year in children in the United States. Among children, the burden of hospitalization for severe LRTI is greatest among children aged <1 year. Children with underlying medical conditions are at greatest risk for severe LRTI hospitalization. Copyright © 2014 by the American Academy of Pediatrics.

24 CFR 888.202 - Manner of publication.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Manner of publication. 888.202 Section 888.202 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT... ADJUSTMENT FACTORS Contract Rent Annual Adjustment Factors § 888.202 Manner of publication. Adjustment...

Ethnic and socio-economic differences in the prevalence of wheeze, severe wheeze, asthma, eczema and medication usage at 4 years of age: Findings from the Born in Bradford birth cohort.

PubMed

Petherick, Emily S; Pearce, Neil; Sunyer, Jordi; Wright, John

2016-10-01

Asthma, wheeze and eczema are common in early childhood and cause considerable morbidity. Generally rates of these conditions are higher in high income compared to low income countries. Rates in developed nations are generally higher than in less developed countries. After migration to Western countries, differences in risks of developing these conditions may between migrant and non-migrant may diminish. A convenience sample of 1648 children of White British, Pakistani or Other ethnicity aged between 4 and 5 years were recruited from the main Born in Bradford cohort. Children's parents or guardians were asked to report on a range of potential risk factors and their associations with wheeze, asthma and eczema. Relationships between ethnicity and disease outcomes were examined using logistic regression after adjustment for other relevant risk factors and confounders. Ethnic differences in doctor diagnosed asthma were evident, with children of other ethnic Origin being less likely and children of Pakistani origin more likely to have a diagnosis than White British or other origin children, although after adjustment for other risk factors this difference only remained significant for the Other Ethnic group. Ethnic differences were not observed in other outcomes including wheeze in the past 12 months, severe wheeze and taking medications for breathing problems. In UK born children, traditional risk factors such as gender, family history, socio-economic status and child's medical history may be stronger risk factors than ethnicity or familial migration patterns. Copyright © 2016 Elsevier Ltd. All rights reserved.

Factor VIII brand and the incidence of factor VIII inhibitors in previously untreated UK children with severe hemophilia A, 2000-2011

PubMed Central

Palmer, Benedict P.; Chalmers, Elizabeth A.; Hart, Daniel P.; Liesner, Ri; Rangarajan, Savita; Talks, Katherine; Williams, Michael; Hay, Charles R. M.

2014-01-01

The effect of recombinant factor VIII (rFVIII) brand on inhibitor development was investigated in all 407 severe hemophilia A previously untreated patients born in the United Kingdom (UK) between 1 January 2000 and 31 December 2011. Eighty-eight (22%) had been in the RODIN study. Information was extracted from the National Haemophilia Database. Because exposure days (EDs) were not known for some patients, time from first treatment was used as a surrogate for rFVIII exposure. An inhibitor developed in 118 (29%) patients, 60 high and 58 low titer, after a median (interquartile range) of 7.8 (3.3-13.5) months from first exposure and 16 (9-30) EDs. Of 128 patients treated with Kogenate Bayer/Helixate NexGen, 45 (35.2%, 95% confidence interval [CI] 27.4-43.8) developed an inhibitor compared with 42/172 (24.4%, 95% CI 18.6% to 31.4%) with Advate (P = .04). The adjusted hazard ratio (HR) (95% CI) for Kogenate Bayer/Helixate NexGen compared with Advate was 2.14 (1.12-4.10) (P = .02) for high titer and 1.75 (1.11-2.76) (P = .02) for all inhibitors. When excluding UK-RODIN patients, the adjusted HR (95% CI) for high-titer inhibitors was 2.00 (0.93-4.34) (P = .08). ReFacto AF was associated with a higher incidence of all, but not high-titer, inhibitors than Advate. These results will help inform debate around the relative immunogenicity and use of rFVIII brands. PMID:25339360

Indirect pathways between depressive symptoms and marital distress: the role of conflict communication, attributions, and attachment style.

PubMed

Heene, Els L D; Buysse, Ann; Van Oost, Paulette

2005-12-01

Previous studies have focused on concomitants of depression and marital distress in order to help explain the relationship between the two, suggesting that several variables, such as conflict communication, attributions, and attachment style, are associated with depression, marital distress, or both. Our contention is that the selected variables may be important mediators (hypothesis 1) or moderators (hypothesis 2) of the concomitance between depression and marital adjustment, exploring the direct and indirect ways in which depressive symptoms and marital adjustment are related. In total, 415 heterosexual couples were recruited, and a series of regression analyses was conducted to test our hypotheses separately for men and women. Results indicated that demand-withdrawal, avoidance, causal attributions, and secure, ambivalent, and avoidant attachment mediated the relation between depressive symptoms and marital adjustment in the female sample, whereas constructive communication and causal and responsible attributions were significant mediators of men's levels of depressive symptoms and marital adjustment. In addition, avoidance and secure attachment moderated the association between depressive symptoms and marital adjustment in the female sample, and causal attributions were significant moderators of the association between depressive symptoms and marital adjustment for men. Several conclusions and implications for theory and future research are discussed.

When does female multiple mating evolve to adjust inbreeding? Effects of inbreeding depression, direct costs, mating constraints, and polyandry as a threshold trait

PubMed Central

Duthie, A. Bradley; Bocedi, Greta; Reid, Jane M.

2016-01-01

Polyandry is often hypothesized to evolve to allow females to adjust the degree to which they inbreed. Multiple factors might affect such evolution, including inbreeding depression, direct costs, constraints on male availability, and the nature of polyandry as a threshold trait. Complex models are required to evaluate when evolution of polyandry to adjust inbreeding is predicted to arise. We used a genetically explicit individual‐based model to track the joint evolution of inbreeding strategy and polyandry defined as a polygenic threshold trait. Evolution of polyandry to avoid inbreeding only occurred given strong inbreeding depression, low direct costs, and severe restrictions on initial versus additional male availability. Evolution of polyandry to prefer inbreeding only occurred given zero inbreeding depression and direct costs, and given similarly severe restrictions on male availability. However, due to its threshold nature, phenotypic polyandry was frequently expressed even when strongly selected against and hence maladaptive. Further, the degree to which females adjusted inbreeding through polyandry was typically very small, and often reflected constraints on male availability rather than adaptive reproductive strategy. Evolution of polyandry solely to adjust inbreeding might consequently be highly restricted in nature, and such evolution cannot necessarily be directly inferred from observed magnitudes of inbreeding adjustment. PMID:27464756

Perceived burdensomeness, thwarted belongingness and suicidal ideation in patients with fibromyalgia and healthy subjects: a cross-sectional study.

PubMed

Lafuente-Castro, Cristina P; Ordoñez-Carrasco, Jorge L; Garcia-Leiva, Juan M; Salgueiro-Macho, Monika; Calandre, Elena P

2018-06-01

Perceived burdensomeness and thwarted belongingness are key factors in the development of suicidal behaviors that have been frequently observed among patients with fibromyalgia. The aim of the present study was to compare these two factors in patients with fibromyalgia with and without suicidal ideation and healthy subjects. Secondary objectives were to evaluate the relationship between these two factors and the secondary variables included in the study, such as depression, sleep quality or the degree of marital adjustment. Perceived burdensomeness and thwarted belongingness were assessed with the Interpersonal Needs Questionnaire, depression and suicidal ideation with the Patients Health Questionnaire-9, suicidal risk with the Plutchik Suicide Risk scale, sleep with the Insomnia Severity Index, and marital adjustment with the Locke-Wallace Marital Adjustment scale. Questionnaire scores were compared with the Kruskal-Wallis test. 49 healthy subjects, 38 patients with fibromyalgia without suicidal ideation and 15 patients with fibromyalgia and suicidal ideations were included. Perceived burdensomeness scores were significantly higher in patients with suicidal ideation than in patients without suicidal ideation and controls; thwarted belongingness scores were significantly higher in patients with suicidal ideation than in controls. Marital adjustment was also significantly poor in patients with suicidal ideation than in patients without suicidal ideation and controls. Among patients with fibromyalgia, perceived burdensomeness seems to be strongly related with suicidal ideation, whereas thwarted belongingness seems to play a less relevant role at this respect. Poor marital adjustment could be related with depression.

Explaining resource consumption among non-normal neonates

PubMed Central

Schwartz, Rachel M.; Michelman, Thomas; Pezzullo, John; Phibbs, Ciaran S.

1991-01-01

The adoption by Medicare in 1983 of prospective payment using diagnosis-related groups (DRGs) has stimulated research to develop case-mix grouping schemes that more accurately predict resource consumption by patients. In this article, the authors explore a new method designed to improve case-mix classification for newborns through the use of birth weight in combination with DRGs to adjust the unexplained case-mix severity. Although the findings are developmental in nature, they reveal that the model significantly improves our ability to explain resource use. PMID:10122360

Acute Parotitis as a Complication of Noninvasive Ventilation.

PubMed

Alaya, S; Mofredj, Ali; Tassaioust, K; Bahloul, H; Mrabet, A

2016-09-01

Several conditions, including oropharyngeal dryness, pressure sores, ocular irritation, epistaxis, or gastric distension, have been described during noninvasive ventilation (NIV). Although this technique has been widely used in intensive care units and emergency wards, acute swelling of the parotid gland remains a scarcely reported complication. We describe herein the case of an 82-year-old man who developed unilateral parotitis during prolonged NIV for acute heart failure. Intravenous antibiotics, corticosteroids, and adjusting the mask laces' position allowed rapid resolution of clinical symptoms. © The Author(s) 2016.

Controlled nanostructures formation on stainless steel by short laser pulses for products protection against falsification.

PubMed

Ageev, E I; Veiko, V P; Vlasova, E A; Karlagina, Y Y; Krivonosov, A; Moskvin, M K; Odintsova, G V; Pshenichnov, V E; Romanov, V V; Yatsuk, R M

2018-01-22

The coloration of stainless steel surface due to the formation of spatially periodic structures induced by laser pulses of nanosecond duration is demonstrated. The period of microstructures corresponds to the laser wavelength, and their orientation angle depends on the adjustment of laser polarization. The marking algorithm for the development of authentication patterns is presented. Such patterns provide several levels of protection against falsification (visual, colorimetric and structural) along with high recording speed and capability of automated reading.

The use of adjustable gastric bands for management of severe and complex obesity

PubMed Central

Hopkins, James C. A.; Blazeby, Jane M.; Rogers, Chris A.; Welbourn, Richard

2016-01-01

Background Obesity levels in the UK have reached a sustained high and ∼4% of the population would be candidates for bariatric surgery based upon current UK NICE guidelines, which has important implications for Clinical Commissioning Groups. Sources of data Summary data from Cochrane systematic reviews, randomized controlled trials (RCTs) and cohort studies. Areas of agreement Currently, the only treatment that offers significant and durable weight loss for those with severe and complex obesity is surgery. Three operations account for 95% of all bariatric surgery in the UK, but the NHS offers surgery to only a small fraction of those who could benefit. Laparoscopic adjustable gastric banding (gastric banding) has potentially the lowest risk and up-front costs of the three procedures. Areas of controversy Reliable Level 1 evidence of the relative effectiveness of the operations is lacking. Growing points As a point intervention, weight loss surgery together with the chronic disease management strategy for obesity can prevent significant future disease and mortality, and the NHS should embrace both. Areas timely for developing research Better RCT evidence is needed including clinical effectiveness and economic analysis to answer the important question ‘which is the best of the three operations most frequently performed?’ This review considers the current evidence for gastric banding for the treatment of severe and complex obesity. PMID:27034443

Hypocalcaemia as a prognostic factor of early mortality in moderate and severe traumatic brain injury.

PubMed

Vinas-Rios, Juan Manuel; Sanchez-Aguilar, Martin; Sanchez-Rodriguez, Jose Juan; Gonzalez-Aguirre, Daniel; Heinen, Christian; Meyer, Frerk; Kretschmer, Thomas

2014-02-01

Our main objective was to evaluate whether serum hypocalcaemia on the third day [defined as < 2.1 mmol/l (8.5 mg/dl)] is a prognostic factor for early mortality after moderate and severe traumatic brain injury (TBI). We developed an ambispective comparative case control study. We evaluated clinical profiles from included patients from January 2005 to July 2009 and we prospectively recruited additional patients from August 2009 to July 2011. Patients were between 1 and 89 years old and had a Glasgow Coma Scale of 3-12 points following TBI. We calculated an Odds Ratio of 5.2 (Confidence Intervals 95%: 4.48 to 6.032) for hypocalcaemia on day three, which was associated with death. Retrospectively (January 2005 to July 2009) we compiled data from 81 patients. Prospectively (August 2009 to July 2011) we recruited 41 patients. The adjusted variables in the logistic regression final model were: serum calcium on day three (Odds Ratio 3.5, Confidence Intervals 95%: 1·12 to 13·61, P < 0·028) and anisocoria (Odds Ratio 8·24, Confidence Intervals 95%: 1·3 to 67·35, P < 0·019) obtaining an adjusted R2 of 0·22 (P < 0·005). The serum levels of calcium on day three could be useful for the prediction of mortality in patients with moderate and severe TBI.

Severe hypoglycaemia and late-life cognitive ability in older people with Type 2 diabetes: the Edinburgh Type 2 Diabetes Study.

PubMed

Aung, P P; Strachan, M W J; Frier, B M; Butcher, I; Deary, I J; Price, J F

2012-03-01

To determine the association between lifetime severe hypoglycaemia and late-life cognitive ability in older people with Type 2 diabetes. Cross-sectional, population-based study of 1066 men and women aged 60-75 years, with Type 2 diabetes. Frequency of severe hypoglycaemia over a person's lifetime and in the year prior to cognitive testing was assessed using a previously validated self-completion questionnaire. Results of age-sensitive neuropsychological tests were combined to derive a late-life general cognitive ability factor, 'g'. Vocabulary test scores, which are stable during ageing, were used to estimate early life (prior) cognitive ability. After age- and sex- adjustment, 'g' was lower in subjects reporting at least one prior severe hypoglycaemia episode (n = 113), compared with those who did not report severe hypoglycaemia (mean 'g'-0.34 vs. 0.05, P < 0.001). Mean vocabulary test scores did not differ significantly between the two groups (30.2 vs. 31.0, P = 0.13). After adjustment for vocabulary, difference in 'g' between the groups persisted (means -0.25 vs. 0.04, P < 0.001), with the group with severe hypoglycaemia demonstrating poorer performance on tests of Verbal Fluency (34.5 vs. 37.3, P = 0.02), Digit Symbol Testing (45.9 vs. 49.9, P = 0.002), Letter-Number Sequencing (9.1 vs. 9.8, P = 0.005) and Trail Making (P < 0.001). These associations persisted after adjustment for duration of diabetes, vascular disease and other potential confounders. Self-reported history of severe hypoglycaemia was associated with poorer late-life cognitive ability in people with Type 2 diabetes. Persistence of this association after adjustment for estimated prior cognitive ability suggests that the association may be attributable, at least in part, to an effect of hypoglycaemia on age-related cognitive decline. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Association of pain catastrophizing with the incidence and severity of acute and persistent perineal pain after natural childbirth: longitudinal cohort study.

PubMed

Soares, Anne Danielle Santos; Couceiro, Tânia Cursino de Menezes; Lima, Luciana Cavalcanti; Flores, Fernanda Lobo Lago; Alcoforado, Eusa Maria Belarmino; Filho, Roberto de Oliveira Couceiro

2013-01-01

Vaginal birth delivery may result in acute and persistent perineal pain postpartum. This study evaluated the association between catastrophizing, a phenomenon of poor psychological adjustment to pain leading the individual to magnify the painful experience making it more intense, and the incidence and severity of perineal pain and its relationship to perineal trauma. Cohort study conducted with pregnant women in labor. We used the pain catastrophizing scale during hospitalization and assessed the degree of perineal lesion and pain severity in the first 24 hours and after 8 weeks of delivery using a numerical pain scale. We evaluated 55 women, with acute pain reported by 69.1%, moderate/severe pain by 36.3%, and persistent pain by 14.5%. Catastrophizing mean score was 2.15 ± 1.24. Catastrophizing patients showed a 2.90 relative risk (RR) for perineal pain (95% CI: 1.08-7.75) and RR: 1.31 for developing persistent perineal pain (95% CI: 1.05-1.64). They also showed a RR: 2.2 for developing acute and severe perineal pain (95% CI: 1.11-4.33). The incidence of acute and persistent perineal pain after vaginal delivery is high. Catastrophizing pregnant women are at increased risk for developing acute and persistent perineal pain, as well as severe pain. Perineal trauma increased the risk of persistent perineal pain. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

The influence of sex and obesity on gait biomechanics in people with severe knee osteoarthritis scheduled for arthroplasty.

PubMed

Paterson, K L; Sosdian, L; Hinman, R S; Wrigley, T V; Kasza, J; Dowsey, M; Choong, P; Bennell, K L

2017-11-01

Sex and body mass may influence knee biomechanics associated with poor total knee arthroplasty (TKA) outcomes for knee osteoarthritis (OA). This study aimed to determine if gait differed between men and women, and overweight and class I obese patients with severe knee OA awaiting TKA. 34 patients with severe knee OA (average age 70.0 (SD 7.2) years, body mass index 30.3 (4.1kg/m 2 )) were recruited from a TKA waiting list. Three-dimensional gait analysis was performed at self-selected walking speed. Comparisons were made between men and women, and overweight (body mass index (BMI) 25.0-29.9kg/m 2 ) and class I obese (BMI 30.0-34.9kg/m 2 ) participants. Biomechanical outcomes included absolute and body size-adjusted peak knee adduction moment (KAM), KAM impulse, peak knee flexion moment, as well as peak knee flexion and varus-valgus angles, peak varus-valgus thrust, and peak vertical ground reaction force (GRF). Men had a higher absolute peak KAM, KAM impulse and peak GRF compared to women, and this sex-difference in frontal plane moments remained after adjusting for body size. However, when additionally adjusting for static knee alignment, differences disappeared. Knee biomechanics were similar between obesity groups after adjusting for the greater body weight of those with class I obesity. Men had greater KAM and KAM impulse even after adjustment for body size; however adjustment for their more varus knees removed this difference. Obesity group did not influence knee joint kinematics or moments. This suggests sex- and obesity-differences in these variables may not be associated with TKA outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Aberrant error processing in relation to symptom severity in obsessive–compulsive disorder: A multimodal neuroimaging study

PubMed Central

Agam, Yigal; Greenberg, Jennifer L.; Isom, Marlisa; Falkenstein, Martha J.; Jenike, Eric; Wilhelm, Sabine; Manoach, Dara S.

2014-01-01

Background Obsessive–compulsive disorder (OCD) is characterized by maladaptive repetitive behaviors that persist despite feedback. Using multimodal neuroimaging, we tested the hypothesis that this behavioral rigidity reflects impaired use of behavioral outcomes (here, errors) to adaptively adjust responses. We measured both neural responses to errors and adjustments in the subsequent trial to determine whether abnormalities correlate with symptom severity. Since error processing depends on communication between the anterior and the posterior cingulate cortex, we also examined the integrity of the cingulum bundle with diffusion tensor imaging. Methods Participants performed the same antisaccade task during functional MRI and electroencephalography sessions. We measured error-related activation of the anterior cingulate cortex (ACC) and the error-related negativity (ERN). We also examined post-error adjustments, indexed by changes in activation of the default network in trials surrounding errors. Results OCD patients showed intact error-related ACC activation and ERN, but abnormal adjustments in the post- vs. pre-error trial. Relative to controls, who responded to errors by deactivating the default network, OCD patients showed increased default network activation including in the rostral ACC (rACC). Greater rACC activation in the post-error trial correlated with more severe compulsions. Patients also showed increased fractional anisotropy (FA) in the white matter underlying rACC. Conclusions Impaired use of behavioral outcomes to adaptively adjust neural responses may contribute to symptoms in OCD. The rACC locus of abnormal adjustment and relations with symptoms suggests difficulty suppressing emotional responses to aversive, unexpected events (e.g., errors). Increased structural connectivity of this paralimbic default network region may contribute to this impairment. PMID:25057466

24 CFR 882.510 - Adjustment of utility allowance.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Adjustment of utility allowance. 882.510 Section 882.510 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN... Moderate Rehabilitation-Program Development and Operation § 882.510 Adjustment of utility allowance. The...

Epoxy Resins in Electron Microscopy

PubMed Central

Finck, Henry

1960-01-01

A method of embedding biological specimens in araldite 502 (Ciba) has been developed for materials available in the United States. Araldite-embedded tissues are suitable for electron microscopy, but the cutting qualities of the resin necessitates more than routine attention during microtomy. The rather high viscosity of araldite 502 also seems to be an unnecessary handicap. The less viscous epoxy epon 812 (Shell) produces specimens with improved cutting qualities, and has several features—low shrinkage and absence of specimen damage during cure, minimal compression of sections, relative absence of electron beam-induced section damage, etc.—which recommends it as a routine embedding material. The hardness of the cured resin can be easily adjusted by several methods to suit the materials embedded in it. Several problems and advantages of working with sections of epoxy resins are also discussed. PMID:13822825

Impact of prestroke selective serotonin reuptake inhibitor treatment on stroke severity and mortality.

PubMed

Mortensen, Janne Kaergaard; Larsson, Heidi; Johnsen, Søren Paaske; Andersen, Grethe

2014-07-01

Selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased risk of bleeding but also a possible neuroprotective effect in stroke. We aimed to examine the implications of prestroke SSRI use in hemorrhagic and ischemic stroke. We conducted a registry-based propensity score-matched follow-up study among first-ever patients with hemorrhage and ischemic stroke in Denmark (2003-2012). Multiple conditional logistic regression was used to compute adjusted odds ratios of severe stroke and death within 30 days. Among 1252 hemorrhagic strokes (626 prestroke SSRI users and 626 propensity score-matched nonusers), prestroke SSRI use was associated with an increased risk of the strokes being severe (adjusted propensity score-matched odds ratios, 1.41; confidence interval, 1.08-1.84) and an increased risk of death within 30 days (adjusted propensity score-matched odds ratios, 1.60; confidence interval, 1.17-2.18). Among 8956 patients with ischemic stroke (4478 prestroke SSRI users and 4478 propensity score-matched nonusers), prestroke SSRI use was not associated with the risk of severe stroke or death within 30 days. Prestroke SSRI use is associated with increased stroke severity and mortality in patients with hemorrhagic stroke. Although prestroke depression in itself may increase stroke severity and mortality, this was not found in SSRI users with ischemic stroke. © 2014 American Heart Association, Inc.

A Multi-Faceted Approach to Inquiry-Based Learning

NASA Astrophysics Data System (ADS)

Brudzinski, M. R.; Sikorski, J.

2009-12-01

In order to fully attain the benefits of inquiry-based learning, instructors who typically employ the traditional lecture format need to make several adjustments to their approach. This change in styles can be intimidating and logistically difficult to overcome. A stepwise approach to this transformation is likely to be more manageable for individual faculty or departments. In this session, we will describe several features that we are implementing in our introductory geology course with the ultimate goal of converting to an entirely inquiry-based approach. Our project is part of the Miami University initiative in the top 25 enrolled courses to move towards the “student as scholar” model for engaged learning. Some of the features we developed for our course include: student learning outcomes, student development outcomes, out-of-class content quizzes, in-class conceptests, pre-/post-course assessment, reflective knowledge surveys, and daily group activities.

Preparing for Themis Controlled Global Mars Mosaics

NASA Technical Reports Server (NTRS)

Archinal, B. A.; Weller, L.; Sides, S.; Cushing, G.; Kirk, R. L.; Soderblom, L. A.; Duxbury, T. C.

2004-01-01

We have begun work to prepare for producing controlled 2001 Mars Odyssey THEMIS infrared (IR) and visible (VIS) global mosaics of Mars. This effort is being coordinated with colleagues from Arizona State University and on the THEMIS team who plan to address radiometric issues in making such mosaics. We are concentrating on geometric issues. Several areas of investigation are now in progress, including: a) characterizing the absolute pointing accuracy of THEMIS images; b) investigating whether automatic tie point matching algorithms could be used to provide connections between overlapping THEMIS images; c) developing algorithms to allow for the photogrammetric (bundle) adjustment of the THEMIS IR (line scanner) camera images. Our primary goal in this pilot study effort will be to make several test control THEMIS mosaics and better determine which methods could be used, which require development, and what level of effort is required, in order to make large regional or global controlled THEMIS mosaics.

Design and characterization of a hybrid-integrated MEMS scanning grating spectrometer

NASA Astrophysics Data System (ADS)

Grüger, Heinrich; Knobbe, Jens; Pügner, Tino; Schenk, Harald

2013-03-01

Grating spectrometer, like the well-established Czerny-Turner, are based on an optical design consisting of several components. Typically at least two slits, two mirrors, the grating stage and a detector are required. There has been much work to reduce this effort, setups using only one mirror (Ebert - Fastie) or the replacement of the entrance slit through the use of thin optical fibers as well as integrated electronic detector arrays instead of a moving grating and an exit slit and single detector device have been applied. Reduced effort comes along with performance limitations: Either the optical resolution or throughput is affected or the use of the system is limited to the availability of detectors arrays with reasonable price. Components in micro opto electro mechanical systems (MOEMS-) technology and spectroscopic systems based thereon have been developed to improve this situation. Miniaturized scanning gratings fabricated on bonded silicon on insulator (BSOI-) wafers were used to design grating spectrometer for the near infrared requiring single detectors only. Discrete components offer flexibility but also need for adjustment of two mirrors, grating stage, fiber mount and the detector with its slit and optionally a second slit in the entrance area. Further development leads towards the integration of the slits into the MOEMS chip, thus less effort for adjustment. Flexibility might be reduced as adjustments of the optical design or grating spacing would require a new chip with own set of masks. Nevertheless if extreme miniaturization is desired this approach seems to be promising. Besides this, high volume production might be able for a comparable low price. A new chip was developed offering grating, two slits and a cavity for the detector chip. The optical design was adjusted to a planar arrangement of grating and slits. A detector buried in a chip cavity required a new mounting strategy. Other optical components were optimized and fabricated then the systems was assembled with electronics and software adjusted to the new design including some new features like integrated position sensors. A first test of systems to grant function of all components is presented. Further work will be aimed at improved performance like higher resolution and lower SNR.

One-dimensional Lagrangian implicit hydrodynamic algorithm for Inertial Confinement Fusion applications

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

Ramis, Rafael, E-mail: rafael.ramis@upm.es

A new one-dimensional hydrodynamic algorithm, specifically developed for Inertial Confinement Fusion (ICF) applications, is presented. The scheme uses a fully conservative Lagrangian formulation in planar, cylindrical, and spherically symmetric geometries, and supports arbitrary equations of state with separate ion and electron components. Fluid equations are discretized on a staggered grid and stabilized by means of an artificial viscosity formulation. The space discretized equations are advanced in time using an implicit algorithm. The method includes several numerical parameters that can be adjusted locally. In regions with low Courant–Friedrichs–Lewy (CFL) number, where stability is not an issue, they can be adjusted tomore » optimize the accuracy. In typical problems, the truncation error can be reduced by a factor between 2 to 10 in comparison with conventional explicit algorithms. On the other hand, in regions with high CFL numbers, the parameters can be set to guarantee unconditional stability. The method can be integrated into complex ICF codes. This is demonstrated through several examples covering a wide range of situations: from thermonuclear ignition physics, where alpha particles are managed as an additional species, to low intensity laser–matter interaction, where liquid–vapor phase transitions occur.« less

Psychological adjustment one year after the diagnosis of breast cancer: a prototype study of delayed post-traumatic stress disorder.

PubMed

Elklit, Ask; Blum, Alon

2011-11-01

OBJECTIVE. The utilization of a post-traumatic stress disorder (PTSD) diagnostic framework for categorizing the psychological adjustment of breast cancer (BC) patients has been debated. We wanted to study the prevalence of PTSD and predictors for PTSD. DESIGN. The current study is a one-year follow-up of 64 early BC patients. METHODS. PTSD, subclinical PTSD, delayed onset PTSD and several theory-driven predictive variables were examined. RESULTS. Thirteen per cent of the patients showed full symptoms of disease-related PTSD compared with 7% at the initial study (6 weeks after diagnosis). Considerable changes were observed in all PTSD clusters (intrusion, avoidance, and arousal), in most cases representing a decrease in symptom level. Immature defence style, emotional coping, avoidant behaviour, and negative affectivity were all implicated as predicting variables in a hierarchical multiple regression analysis which explained 65% of the variability of PTSD severity one year after diagnosis. CONCLUSIONS. This study highlights the PTSD diagnosis as being highly relevant in oncology settings. Early screening for the above-mentioned four variables may help early identification of the patients most at risk of developing PTSD. ©2010 The British Psychological Society.

Hypoglycaemia, Abnormal Lipids, and Cardiovascular Disease among Chinese with Type 2 Diabetes

PubMed Central

Li, Yijun; Mu, Yiming; Ji, Qiuhe; Huang, Qin; Kuang, Hongyu; Ji, Linong; Yang, Xilin

2015-01-01

We recruited a group of 6713 consecutive Chinese patients with T2D but normal renal and liver function who were admitted to one of 81 top tertiary care hospitals in China. Mild hypoglycaemia was defined as having symptomatic hypoglycaemia in one month before hospitalization. Severe hypoglycaemia was defined as having hypoglycaemia that needed assistance from other people in three months before hospitalization. Prior cardiovascular disease (CVD) was defined as having coronary heart disease, stroke, or peripheral arterial disease. Of 6713 patients, 80 and 304 had severe and mild hypoglycaemia episodes, respectively, and 561 had CVD. Patients with severe and mild hypoglycaemia episodes were more likely to have prior CVD (32.5% versus 16.5% versus 7.7%, P < 0.0001). Both mild and severe hypoglycaemia were associated with increased risk of CVD (adjusted odds ratios (ORs): 2.64, 95% CI: 1.85–3.76 for mild hypoglycaemia; 6.59, 95% CI: 3.79–11.45 for sever hypoglycaemia) than those patients free of hypoglycaemia. Further adjustment for lipid profile did not change these two ORs. In the same way, the ORs of lipid profile for CVD were similar before and after adjustment for hypoglycaemia. We concluded that hypoglycaemia and lipid profile were independently associated with increased risk of CVD. PMID:26504840

Hypoglycaemia, Abnormal Lipids, and Cardiovascular Disease among Chinese with Type 2 Diabetes.

PubMed

Li, Yijun; Mu, Yiming; Ji, Qiuhe; Huang, Qin; Kuang, Hongyu; Ji, Linong; Yang, Xilin

2015-01-01

We recruited a group of 6713 consecutive Chinese patients with T2D but normal renal and liver function who were admitted to one of 81 top tertiary care hospitals in China. Mild hypoglycaemia was defined as having symptomatic hypoglycaemia in one month before hospitalization. Severe hypoglycaemia was defined as having hypoglycaemia that needed assistance from other people in three months before hospitalization. Prior cardiovascular disease (CVD) was defined as having coronary heart disease, stroke, or peripheral arterial disease. Of 6713 patients, 80 and 304 had severe and mild hypoglycaemia episodes, respectively, and 561 had CVD. Patients with severe and mild hypoglycaemia episodes were more likely to have prior CVD (32.5% versus 16.5% versus 7.7%, P < 0.0001). Both mild and severe hypoglycaemia were associated with increased risk of CVD (adjusted odds ratios (ORs): 2.64, 95% CI: 1.85-3.76 for mild hypoglycaemia; 6.59, 95% CI: 3.79-11.45 for sever hypoglycaemia) than those patients free of hypoglycaemia. Further adjustment for lipid profile did not change these two ORs. In the same way, the ORs of lipid profile for CVD were similar before and after adjustment for hypoglycaemia. We concluded that hypoglycaemia and lipid profile were independently associated with increased risk of CVD.

Treating Type 1 Diabetes Mellitus with a Rapid-Acting Analog Insulin Regimen vs. Regular Human Insulin in Germany: A Long-Term Cost-Effectiveness Evaluation.

PubMed

Valentine, William J; Van Brunt, Kate; Boye, Kristina S; Pollock, Richard F

2018-06-01

The aim of the present study was to evaluate the cost effectiveness of rapid-acting analog insulin relative to regular human insulin in adults with type 1 diabetes mellitus in Germany. The PRIME Diabetes Model, a patient-level, discrete event simulation model, was used to project long-term clinical and cost outcomes for patients with type 1 diabetes from the perspective of a German healthcare payer. Simulated patients had a mean age of 21.5 years, duration of diabetes of 8.6 years, and baseline glycosylated hemoglobin of 7.39%. Regular human insulin and rapid-acting analog insulin regimens reduced glycosylated hemoglobin by 0.312 and 0.402%, respectively. Compared with human insulin, hypoglycemia rate ratios with rapid-acting analog insulin were 0.51 (non-severe nocturnal) and 0.80 (severe). No differences in non-severe diurnal hypoglycemia were modeled. Discount rates of 3% were applied to future costs and clinical benefits accrued over the 50-year time horizon. In the base-case analysis, rapid-acting analog insulin was associated with an improvement in quality-adjusted life expectancy of 1.01 quality-adjusted life-years per patient (12.54 vs. 11.53 quality-adjusted life-years). Rapid-acting analog insulin was also associated with an increase in direct costs of €4490, resulting in an incremental cost-effectiveness ratio of €4427 per quality-adjusted life-year gained vs. human insulin. Sensitivity analyses showed that the base case was driven predominantly by differences in hypoglycemia; abolishing these differences reduced incremental quality-adjusted life expectancy to 0.07 quality-adjusted life-years, yielding an incremental cost-effectiveness ratio of €74,622 per quality-adjusted life-year gained. Rapid-acting analog insulin is associated with beneficial outcomes in patients with type 1 diabetes and is likely to be considered cost effective in the German setting vs. regular human insulin.

Inclusion of Highest Glasgow Coma Scale Motor Component Score in Mortality Risk Adjustment for Benchmarking of Trauma Center Performance.

PubMed

Gomez, David; Byrne, James P; Alali, Aziz S; Xiong, Wei; Hoeft, Chris; Neal, Melanie; Subacius, Harris; Nathens, Avery B

2017-12-01

The Glasgow Coma Scale (GCS) is the most widely used measure of traumatic brain injury (TBI) severity. Currently, the arrival GCS motor component (mGCS) score is used in risk-adjustment models for external benchmarking of mortality. However, there is evidence that the highest mGCS score in the first 24 hours after injury might be a better predictor of death. Our objective was to evaluate the impact of including the highest mGCS score on the performance of risk-adjustment models and subsequent external benchmarking results. Data were derived from the Trauma Quality Improvement Program analytic dataset (January 2014 through March 2015) and were limited to the severe TBI cohort (16 years or older, isolated head injury, GCS ≤8). Risk-adjustment models were created that varied in the mGCS covariates only (initial score, highest score, or both initial and highest mGCS scores). Model performance and fit, as well as external benchmarking results, were compared. There were 6,553 patients with severe TBI across 231 trauma centers included. Initial and highest mGCS scores were different in 47% of patients (n = 3,097). Model performance and fit improved when both initial and highest mGCS scores were included, as evidenced by improved C-statistic, Akaike Information Criterion, and adjusted R-squared values. Three-quarters of centers changed their adjusted odds ratio decile, 2.6% of centers changed outlier status, and 45% of centers exhibited a ≥0.5-SD change in the odds ratio of death after including highest mGCS score in the model. This study supports the concept that additional clinical information has the potential to not only improve the performance of current risk-adjustment models, but can also have a meaningful impact on external benchmarking strategies. Highest mGCS score is a good potential candidate for inclusion in additional models. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

A brief indicator of household energy security: associations with food security, child health, and child development in US infants and toddlers.

PubMed

Cook, John T; Frank, Deborah A; Casey, Patrick H; Rose-Jacobs, Ruth; Black, Maureen M; Chilton, Mariana; Ettinger de Cuba, Stephanie; Appugliese, Danielle; Coleman, Sharon; Heeren, Timothy; Berkowitz, Carol; Cutts, Diana B

2008-10-01

Household energy security has not been measured empirically or related to child health and development but is an emerging concern for clinicians and researchers as energy costs increase. The objectives of this study were to develop a clinical indicator of household energy security and assess associations with food security, health, and developmental risk in children <36 months of age. A cross-sectional study that used household survey and surveillance data was conducted. Caregivers were interviewed in emergency departments and primary care clinics form January 2001 through December 2006 on demographics, public assistance, food security, experience with heating/cooling and utilities, Parents Evaluation of Developmental Status, and child health. The household energy security indicator includes energy-secure, no energy problems; moderate energy insecurity, utility shutoff threatened in past year; and severe energy insecurity, heated with cooking stove, utility shutoff, or >or=1 day without heat/cooling in past year. The main outcome measures were household and child food security, child reported health status, Parents Evaluation of Developmental Status concerns, and hospitalizations. Of 9721 children, 11% (n = 1043) and 23% (n = 2293) experienced moderate and severe energy insecurity, respectively. Versus children with energy security, children with moderate energy insecurity had greater odds of household food insecurity, child food insecurity, hospitalization since birth, and caregiver report of child fair/poor health, adjusted for research site and mother, child, and household characteristics. Children with severe energy insecurity had greater adjusted odds of household food insecurity, child food insecurity, caregivers reporting significant developmental concerns on the Parents Evaluation of Developmental Status scale, and report of child fair/poor health. No significant association was found between energy security and child weight for age or weight for length. As household energy insecurity increases, infants and toddlers experienced increased odds of household and child food insecurity and of reported poor health, hospitalizations, and developmental risks.

Household food insecurity, nutritional status and morbidity in Brazilian children.

PubMed

Gubert, Muriel Bauermann; Spaniol, Ana Maria; Bortolini, Gisele Ane; Pérez-Escamilla, Rafael

2016-08-01

To identify the association of household food insecurity (HFI) with anthropometric status, the risk of vitamin A deficiency and anaemia, morbidities such as cough and fever, and hospitalizations for diarrhoea and pneumonia in children under 5 years old. Cross-sectional study using data from the 2006 Brazilian Demographic and Health Survey. HFI was measured with the Brazilian Food Insecurity Measurement Scale (EBIA). Vitamin A deficiency and anaemia were assessed in blood samples. Child morbidities were reported by the child's mother and included cough, fever, and hospitalizations for diarrhoea and pneumonia. Regression results were expressed as unadjusted and adjusted OR and corresponding 95 % CI for severe food insecurity, with statistical significance set at P<0·05. Nationally representative survey. Children (n 4064) under 5 years old. There was no association between HFI and vitamin A deficiency, pneumonia, wasting or overweight. The prevalence of cough, fever, hospitalization for diarrhoea and stunting were associated with degree of HFI severity. There was a significant association of morbidities and stunting with severe food insecurity (v. food secure). After controlling for confounders, the association between severe food insecurity (v. food secure/rest of food insecurity categories) and the prevalence of common morbidities remained strong, showing that severely food-insecure children had a greater likelihood of experiencing cough (adjusted OR=1·79) and of being hospitalized for diarrhoea (adjusted OR=2·55). Severe HFI was associated with cough and severe diarrhoea among Brazilian children.

Diabetes Prevalence Among Racial-Ethnic Minority Group Members With Severe Mental Illness Taking Antipsychotics: Double Jeopardy?

PubMed

Mangurian, Christina; Keenan, Walker; Newcomer, John W; Vittinghoff, Eric; Creasman, Jennifer M; Schillinger, Dean

2017-08-01

This study assessed differences in diabetes prevalence based on race-ethnicity among people with severe mental illnesses. This retrospective cohort study examined diabetes prevalence in 2009 among California Medicaid enrollees with severe mental illness who were screened for diabetes (N=19,364). Poisson regression assessed differences in diabetes prevalence by race-ethnicity. The sample was standardized to the U.S. The overall prevalence of diabetes was 32.0%. The adjusted prevalence for all minority groups with severe mental illness, except for Asians, was significantly higher than for whites (1.21-1.28 adjusted prevalence ratios). With inverse probability weighting to reduce selection bias captured by measured factors, estimated prevalence of diabetes among screened participants was 27.3%. The prevalence of diabetes in minority groups with severe mental illness was significantly higher than among whites with severe mental illness. Mental health administrators should implement universal diabetes screening with specific outreach efforts targeting minority populations with severe mental illness.

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

PubMed

Antioch, Kathryn M; Walsh, Michael K

2004-06-01

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

26 CFR 26.2600-1 - Table of contents.

Code of Federal Regulations, 2010 CFR

2010-04-01

... lead annuity trusts. (a) In general. (b) Adjusted GST exemption defined. (c) Example. § 26.2642.... (b) Other GSTs. § 26.2642-6 Qualified severance. (a) In general. (b) Qualified severance defined. (c) Effective date of qualified severance. (d) Requirements for a qualified severance. (e) Reporting a qualified...

26 CFR 26.2600-1 - Table of contents.

Code of Federal Regulations, 2011 CFR

2011-04-01

... lead annuity trusts. (a) In general. (b) Adjusted GST exemption defined. (c) Example. § 26.2642.... (b) Other GSTs. § 26.2642-6 Qualified severance. (a) In general. (b) Qualified severance defined. (c) Effective date of qualified severance. (d) Requirements for a qualified severance. (e) Reporting a qualified...

Academic Performance in Children of Mothers With Schizophrenia and Other Severe Mental Illness, and Risk for Subsequent Development of Psychosis: A Population-Based Study.

PubMed

Lin, Ashleigh; Di Prinzio, Patsy; Young, Deidra; Jacoby, Peter; Whitehouse, Andrew; Waters, Flavie; Jablensky, Assen; Morgan, Vera A

2017-01-01

We examined the academic performance at age 12 years of children of mothers diagnosed with schizophrenia or other severe mental illness using a large whole-population birth cohort born in Western Australia. We investigated the association between academic performance and the subsequent development of psychotic illness. The sample comprised 3169 children of mothers with severe mental illness (schizophrenia, bipolar disorder, unipolar major depression, delusional disorder or other psychoses; ICD-9 codes 295-298), and 88 353 children of comparison mothers without known psychiatric morbidity. Academic performance of children was indexed on a mandatory state-wide test of reading, spelling, writing and numeracy. A larger proportion of children (43.1%) of mothers with severe mental illness performed below the acceptable standard than the reference group (30.3%; children of mothers with no known severe mental illness). After adjusting for covariates, children of mothers with any severe mental illness were more likely than the reference group to perform below-benchmark on all domains except reading. For all children, poor spelling was associated with the later development of psychosis, but particularly for those at familial risk for severe mental illness (hazard ratio [HR] = 1.81; 95% CI for HR = 1.21, 2.72). Children of mothers with a severe mental illness are at increased risk for sub-standard academic achievement at age 12 years, placing these children at disadvantage for the transition to secondary school. For children with familial risk for severe mental illness, very poor spelling skills at age 12 years may be an indicator of risk for later psychotic disorder. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Academic Performance in Children of Mothers With Schizophrenia and Other Severe Mental Illness, and Risk for Subsequent Development of Psychosis: A Population-Based Study

PubMed Central

Lin, Ashleigh; Di Prinzio, Patsy; Young, Deidra; Jacoby, Peter; Whitehouse, Andrew; Waters, Flavie; Jablensky, Assen; Morgan, Vera A.

2017-01-01

Objective: We examined the academic performance at age 12 years of children of mothers diagnosed with schizophrenia or other severe mental illness using a large whole-population birth cohort born in Western Australia. We investigated the association between academic performance and the subsequent development of psychotic illness. Method: The sample comprised 3169 children of mothers with severe mental illness (schizophrenia, bipolar disorder, unipolar major depression, delusional disorder or other psychoses; ICD-9 codes 295–298), and 88 353 children of comparison mothers without known psychiatric morbidity. Academic performance of children was indexed on a mandatory state-wide test of reading, spelling, writing and numeracy. Results: A larger proportion of children (43.1%) of mothers with severe mental illness performed below the acceptable standard than the reference group (30.3%; children of mothers with no known severe mental illness). After adjusting for covariates, children of mothers with any severe mental illness were more likely than the reference group to perform below-benchmark on all domains except reading. For all children, poor spelling was associated with the later development of psychosis, but particularly for those at familial risk for severe mental illness (hazard ratio [HR] = 1.81; 95% CI for HR = 1.21, 2.72). Conclusions: Children of mothers with a severe mental illness are at increased risk for sub-standard academic achievement at age 12 years, placing these children at disadvantage for the transition to secondary school. For children with familial risk for severe mental illness, very poor spelling skills at age 12 years may be an indicator of risk for later psychotic disorder. PMID:27131155

Development of a Fiber Laser with Independently Adjustable Properties for Optical Resolution Photoacoustic Microscopy.

PubMed

Aytac-Kipergil, Esra; Demirkiran, Aytac; Uluc, Nasire; Yavas, Seydi; Kayikcioglu, Tunc; Salman, Sarper; Karamuk, Sohret Gorkem; Ilday, Fatih Omer; Unlu, Mehmet Burcin

2016-12-08

Photoacoustic imaging is based on the detection of generated acoustic waves through thermal expansion of tissue illuminated by short laser pulses. Fiber lasers as an excitation source for photoacoustic imaging have recently been preferred for their high repetition frequencies. Here, we report a unique fiber laser developed specifically for multiwavelength photoacoustic microscopy system. The laser is custom-made for maximum flexibility in adjustment of its parameters; pulse duration (5-10 ns), pulse energy (up to 10 μJ) and repetition frequency (up to 1 MHz) independently from each other and covers a broad spectral region from 450 to 1100 nm and also can emit wavelengths of 532, 355, and 266 nm. The laser system consists of a master oscillator power amplifier, seeding two stages; supercontinuum and harmonic generation units. The laser is outstanding since the oscillator, amplifier and supercontinuum generation parts are all-fiber integrated with custom-developed electronics and software. To demonstrate the feasibility of the system, the images of several elements of standardized resolution test chart are acquired at multiple wavelengths. The lateral resolution of optical resolution photoacoustic microscopy system is determined as 2.68 μm. The developed system may pave the way for spectroscopic photoacoustic microscopy applications via widely tunable fiber laser technologies.

Life test results of OLED-XL long-life devices for use in active matrix organic light emitting diode (AMOLED) displays for head mounted applications

NASA Astrophysics Data System (ADS)

Fellowes, David A.; Wood, Michael V.; Hastings, Arthur R., Jr.; Ghosh, Amalkumar P.; Prache, Olivier

2007-04-01

eMagin Corporation has recently developed long-life OLED-XL devices for use in their AMOLED microdisplays for head-worn applications. AMOLED displays have been known to exhibit high levels of performance with regards to contrast, response time, uniformity, and viewing angle, but a lifetime improvement has been perceived to be essential for broadening the applications of OLED's in the military and in the commercial market. The new OLED-XL devices gave the promise of improvements in usable lifetime over 6X what the standard full color, white, and green devices could provide. The US Army's RDECOM CERDEC NVESD performed life tests on several standard and OLED-XL panels from eMagin under a Cooperative Research and Development Agreement (CRADA). Displays were tested at room temperature, utilizing eMagin's Design Reference Kit driver, allowing computer controlled optimization, brightness adjustment, and manual temperature compensation. The OLED Usable Lifetime Model, developed under a previous NVESD/eMagin SPIE paper presented at DSS 2005, has been adjusted based on the findings of these tests. The result is a better understanding of the applicability of AMOLEDs in military and commercial head mounted systems: where good fits are made, and where further development might be needed.

Development of a Fiber Laser with Independently Adjustable Properties for Optical Resolution Photoacoustic Microscopy

PubMed Central

Aytac-Kipergil, Esra; Demirkiran, Aytac; Uluc, Nasire; Yavas, Seydi; Kayikcioglu, Tunc; Salman, Sarper; Karamuk, Sohret Gorkem; Ilday, Fatih Omer; Unlu, Mehmet Burcin

2016-01-01

Photoacoustic imaging is based on the detection of generated acoustic waves through thermal expansion of tissue illuminated by short laser pulses. Fiber lasers as an excitation source for photoacoustic imaging have recently been preferred for their high repetition frequencies. Here, we report a unique fiber laser developed specifically for multiwavelength photoacoustic microscopy system. The laser is custom-made for maximum flexibility in adjustment of its parameters; pulse duration (5–10 ns), pulse energy (up to 10 μJ) and repetition frequency (up to 1 MHz) independently from each other and covers a broad spectral region from 450 to 1100 nm and also can emit wavelengths of 532, 355, and 266 nm. The laser system consists of a master oscillator power amplifier, seeding two stages; supercontinuum and harmonic generation units. The laser is outstanding since the oscillator, amplifier and supercontinuum generation parts are all-fiber integrated with custom-developed electronics and software. To demonstrate the feasibility of the system, the images of several elements of standardized resolution test chart are acquired at multiple wavelengths. The lateral resolution of optical resolution photoacoustic microscopy system is determined as 2.68 μm. The developed system may pave the way for spectroscopic photoacoustic microscopy applications via widely tunable fiber laser technologies. PMID:27929049

Adaptive wall research with two- and three-dimensional models in low speed and transonic tunnels

NASA Technical Reports Server (NTRS)

Lewis, M. C.; Neal, G.; Goodyer, M. J.

1988-01-01

This paper summarises recent research at the University of Southampton into adaptive wall technology and outlines the direction of current efforts. The work is aimed at developing techniques for use in test sections where the top and bottom walls may be adjusted in single curvature. Wall streamlining eliminates, as far as experimentally possible, the top and bottom wall interference in low speed and transonic aerofoil testing. A streamlining technique has been developed for low speeds which allows the testing of swept wing panels in low interference environments. At higher speeds, a comparison of several two-dimensional transonic streamlining algorithms has been made and a technique for streamlining with a choked test section has also been developed. Three-dimensional work has mainly concentrated on tests of sidewall mounted half-wings and the development of the software packages required to assess interference and to adjust the flexible walls. It has been demonstrated that two-dimensional wall adaptation can significantly modify the level of wall interference around relatively large three-dimensional models. The residual interferences are small and are probably amenable to standard post-test correction methods. Tests on a calibrated wing-body model are planned in the near future to further validate the proposed streamlining technique.

The impact of socioeconomic position on severe maternal morbidity outcomes among women in Australia: a national case-control study.

PubMed

Lindquist, A; Noor, N; Sullivan, E; Knight, M

2015-11-01

Studies in other developed countries have suggested that socioeconomic position may be a risk factor for poorer pregnancy outcomes. This analysis aimed to explore the independent impact of socioeconomic position on selected severe maternal morbidities among women in Australia. A case-control study using data on severe maternal morbidities associated with direct maternal death collected through the Australasian Maternity Outcomes Surveillance System. Australia. 623 cases, 820 controls. Logistic regression analysis to investigate differences in outcomes among different socioeconomic groups, classified by Socio-Economic Indexes for Areas (SEIFA) quintile. Severe maternal morbidity (amniotic fluid embolism, placenta accreta, peripartum hysterectomy, eclampsia or pulmonary embolism). SEIFA quintile was statistically significantly associated with maternal morbidity, with cases being twice as likely as controls to reside in the most disadvantaged areas (adjusted OR 2.00, 95%CI 1.29-3.10). Maternal age [adjusted odds ratio (aOR) 2.20 for women aged 35 or over compared with women aged 25-29, 95%CI 1.64-3.15] and previous pregnancy complications (aOR 1.30, 95%CI 1.21-1.87) were significantly associated with morbidity. A parity of 1 or 2 was protective (aOR 0.58, 95%CI 0.43-0.79), whereas previous caesarean delivery was associated with maternal morbidity (aOR 2.20 for women with one caesarean delivery, 95%CI 1.44-2.85, compared with women with no caesareans). The risk of severe maternal morbidity among women in Australia is significantly increased by social disadvantage. This study suggests that future efforts in improving maternity care provision and maternal outcomes in Australia should include socioeconomic position as an independent risk factor for adverse outcome. © 2014 Royal College of Obstetricians and Gynaecologists.

Estimating the Hospital Delivery Costs Associated With Severe Maternal Morbidity in New York City, 2008-2012.

PubMed

Howland, Renata E; Angley, Meghan; Won, Sang Hee; Wilcox, Wendy; Searing, Hannah; Tsao, Tsu-Yu

2018-02-01

To quantify the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries over a 5-year period in New York City adjusting for other sociodemographic and clinical factors. We conducted a population-based cross-sectional study using linked birth certificates and hospital discharge data for New York City deliveries from 2008 to 2012. Severe maternal morbidity was defined using a published algorithm of International Classification of Diseases, 9 Revision, Clinical Modification disease and procedure codes. Hospital costs were estimated by converting hospital charges using factors specific to each year and hospital and to each diagnosis. These estimates approximate what it costs the hospital to provide services (excluding professional fees) and were used in all subsequent analyses. To estimate adjusted mean costs associated with severe maternal morbidity, we used multivariable regression models with a log link, gamma distribution, robust standard errors, and hospital fixed effects, controlling for age, race and ethnicity, neighborhood poverty, primary payer, number of deliveries, method of delivery, comorbidities, and year. We used the adjusted mean cost to determine the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries from 2008 to 2012. Approximately 2.3% (n=13,502) of all New York City delivery hospitalizations were complicated by severe maternal morbidity. Compared with nonsevere maternal morbidity deliveries, these hospitalizations were clinically complicated, required more and intensive clinical services, and had a longer stay in the hospital. The average cost of delivery with severe maternal morbidity was $14,442 (95% CI $14,128-14,756), compared with $7,289 (95% CI $7,276-7,302) among deliveries without severe maternal morbidity. After adjusting for other factors, the difference between deliveries with and without severe maternal morbidity remained high ($6,126). Over 5 years, this difference resulted in approximately $83 million in total excess costs (13,502×$6,126). Severe maternal morbidity nearly doubled the cost of delivery above and beyond other drivers of cost, resulting in tens of millions of excess dollars spent in the health care system in New York City. These findings can be used to demonstrate the burden of severe maternal morbidity and evaluate the cost-effectiveness of interventions to improve maternal health.

Severe intimate partner physical violence as a risk factor for inadequate cervical cancer screening.

PubMed

Rafael, Ricardo de Mattos Russo; Moura, Anna Tereza Miranda Soares de

2017-12-18

With the aim of assessing the occurrence of severe intimate partner physical violence as a risk factor for inadequate screening of uterine cervical cancer, a case-control study was performed with a multidimensional questionnaire in a sample of 640 users of the Family Health Strategy in the Municipality of Nova Iguaçu, Rio de Janeiro State, Brazil. Cases were defined as women who had not had a cervical cytology test in the previous three years. The results showed that severe physical violence against the woman (adjustedOR = 2.2; 95%CI: 1.1-4.4) and co-occurrence of the event in the couple (adjustedOR = 3.8; 95%CI: 1.4-9.8) were risk factors for inadequate screening. Alcohol abuse by the woman was an effect modifier for not having the test among victims of violence (adjustedOR = 10.2; 95%CI: 1.8-56.4) and in cases of co-occurrence of violence (adjustedOR = 8.5; 95%CI: 1.4-50.7). In addition to known causal factors for intimate partner violence, the results point to a risk association between women's exposure to abuse and inadequate screening. The findings call for an expanded view of women's absenteeism from screening, since this indicator can represent unmet demands not readily detected by health teams.

Modeling the Prospective Relationships of Impairment, Injury Severity, and Participation to Quality of Life Following Traumatic Brain Injury

PubMed Central

Kalpinski, Ryan J.; Williamson, Meredith L. C.; Elliott, Timothy R.; Berry, Jack W.; Underhill, Andrea T.; Fine, Philip R.

2013-01-01

Identifying reliable predictors of positive adjustment following traumatic brain injury (TBI) remains an important area of inquiry. Unfortunately, much of available research examines direct relationships between predictor variables and outcomes without attending to the contextual relationships that can exist between predictor variables. Relying on theoretical models of well-being, we examined a theoretical model of adjustment in which the capacity to engage in intentional activities would be prospectively associated with greater participation, which in turn would predict subsequent life satisfaction and perceived health assessed at a later time. Structural equation modeling of data collected from 312 individuals (226 men, 86 women) with TBI revealed that two elements of participation—mobility and occupational activities—mediated the prospective influence of functional independence and injury severity to optimal adjustment 60 months following medical discharge for TBI. The model accounted for 21% of the variance in life satisfaction and 23% of the variance in self-rated health. Results indicate that the effects of functional independence and injury severity to optimal adjustment over time may be best understood in the context of participation in meaningful, productive activities. Implications for theoretical models of well-being and for clinical interventions that promote adjustmentafter TBI are discussed. PMID:24199186

Higher rate of severe toxicities in obese patients receiving dose-dense (dd) chemotherapy according to unadjusted body surface area: results of the prospectively randomized GAIN study.

PubMed

Furlanetto, J; Eiermann, W; Marmé, F; Reimer, T; Reinisch, M; Schmatloch, S; Stickeler, E; Thomssen, C; Untch, M; Denkert, C; von Minckwitz, G; Lederer, B; Nekljudova, V; Weber, K; Loibl, S; Möbus, V

2016-11-01

In routine clinical practice, chemotherapy doses are frequently capped at a body surface area (BSA) of 2.0 m 2 or adjusted to an ideal weight for obese patients due to safety reasons. Between August 2004 and July 2008, a total of 3023 patients were enrolled in the GAIN study, a randomized phase III adjuvant trial, comparing two types of dose-dense (dd) regimen [epirubicin, docetaxel and cyclophosphamide (iddETC) versus epirubicin and cyclophosphamide (EC) followed by docetaxel (T) plus capecitabine (X)]. We retrospectively evaluated a total of 555 patients with a BMI of ≥30 for safety and outcome. Eighteen percent of all patients were obese: 31% of those received chemotherapy according to an unadjusted BSA. For the remaining patients, BSA was adjusted to ideal weight or was capped at 2.0 m 2 . A total of 15% of obese patients receiving full (unadjusted) dose of chemotherapy versus 6% of obese patients with an adjusted BSA experienced febrile neutropenia (P = 0.003) and 9% versus 3% high-grade thrombopenia (P = 0.002). Overall, 17% versus 10% had a thromboembolic event (P = 0.017), which was high grade in 13% versus 6%, respectively (P = 0.019), and 3% versus 0.3% high-grade hot flushes (P = 0.013). Dizziness (5% versus 11%; P = 0.016), diarrhea (19% versus 27%; P = 0.033) and an increase in serum creatinine (7% versus 14%; P = 0.019) were higher in the adjusted group. However, no differences in disease-free survival (DFS) and overall survival (OS) were observed between non-obese patients, obese patients receiving full-dose chemotherapy or according to an adjusted BSA [5-year DFS 81% (confidence interval 79% to 83%) versus 82% (75% to 87%) versus 81% (76% to 84%); P = 0.761; 5-year OS 90% (88% to 91%) versus 86% (80% to 91%) versus 88% (84% to 91%); P = 0.143]. Obese patients receiving dd chemotherapy according to their real BSA have a higher risk of developing severe toxicities without influencing survival. Therefore, a dose adjustment of intense dd chemotherapy should be carried out to avoid life-threatening complications. © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Development of Hospitalization Resource Intensity Scores for Kids (H-RISK) and Comparison across Pediatric Populations.

PubMed

Richardson, Troy; Rodean, Jonathan; Harris, Mitch; Berry, Jay; Gay, James C; Hall, Matt

2018-04-25

In the Medicare population, measures of relative severity of illness (SOI) for hospitalized patents have been used in prospective payment models. Similar measures for pediatric populations have not been fully developed. To develop hospitalization resource intensity scores for kids (H-RISK) using pediatric relative weights (RWs) for SOI and to compare hospital types on case-mix index (CMI). Using the 2012 Kids' Inpatient Database (KID), we developed RWs for each All Patient Refined Diagnosis Related Group (APR-DRG) and SOI level. RW corresponded to the ratio of the adjusted mean cost for discharges in an APR-DRG SOI combination over adjusted mean cost of all discharges in the dataset. RWs were applied to every discharge from 3,117 hospitals in the database with at least 20 discharges. RWs were then averaged at the hospital level to provide each hospital's CMI. CMIs were compared by hospital type using Kruskal- Wallis tests. The overall adjusted mean cost of weighted discharges in Healthcare Cost and Utilization Project KID 2012 was $6,135 per discharge. Solid organ and bone marrow transplantations represented 4 of the 10 highest procedural RWs (range: 35.5 to 91.7). Neonatal APRDRG SOIs accounted for 8 of the 10 highest medical RWs (range: 19.0 to 32.5). Free-standing children's hospitals yielded the highest median (interquartile range [IQR]) CMI (2.7 [2.2-3.1]), followed by urban teaching hospitals (1.8 [1.3-2.6]), urban nonteaching hospitals (1.1 [0.9-1.5]), and rural hospitals (0.8 [0.7-0.9]; P < .001). H-RISK for populations of pediatric admissions are sensitive to detection of substantial differences in SOI by hospital type. © 2018 Society of Hospital Medicine.

Risk of Colorectal Neoplasia According to Fatty Liver Severity and Presence of Gall Bladder Polyps.

PubMed

Lee, Taeyoung; Yun, Kyung Eun; Chang, Yoosoo; Ryu, Seungho; Park, Dong Il; Choi, Kyuyong; Jung, Yoon Suk

2016-01-01

Fatty liver is the hepatic manifestation of metabolic syndrome (MetS) and is a known risk factor for colorectal neoplasia (CRN). Gallbladder (GB) polyps share many common risk factors with CRN. However, studies evaluating CRN risk according to fatty liver severity and the presence of GB polyps are rare. To investigate CRN risk according to the fatty liver severity and the presence of GB polyps. A retrospective cross-sectional study was performed on 44,220 participants undergoing colonoscopy and abdominal ultrasonography (US) as part of a health-screening program. Of the participants, fatty liver was diagnosed as mild in 27.7 %, moderate in 5.1 %, and severe in 0.4 % and 13.4 % were diagnosed with GB polyps. Mean age of participants was 42.7 years. In adjusted models, risk of overall CRN and non-advanced CRN increased with worsening fatty liver severity (P for trend = 0.007 and 0.020, respectively). Adjusted odd ratios for overall CRN and non-advanced CRN comparing participants with mild, moderate, and severe fatty liver to participants without fatty liver were 1.13 and 1.12 for mild, 1.12 and 1.10 for moderate, and 1.56 and 1.65 for severe. The presence of GB polyps did not correlate with CRN risk after adjusting for confounders. CRN risk increased with worsening fatty liver severity. However the association between GB polyp and CRN was not significant in the presence of other variables. Considering that many people undergo noninvasive abdominal US as a health screen, our study will contribute to colonoscopy screening strategies in people undergoing abdominal US.

Operational and environmental performance in China's thermal power industry: Taking an effectiveness measure as complement to an efficiency measure.

PubMed

Wang, Ke; Zhang, Jieming; Wei, Yi-Ming

2017-05-01

The trend toward a more fiercely competitive and strictly environmentally regulated electricity market in several countries, including China has led to efforts by both industry and government to develop advanced performance evaluation models that adapt to new evaluation requirements. Traditional operational and environmental efficiency measures do not fully consider the influence of market competition and environmental regulations and, thus, are not sufficient for the thermal power industry to evaluate its operational performance with respect to specific marketing goals (operational effectiveness) and its environmental performance with respect to specific emissions reduction targets (environmental effectiveness). As a complement to an operational efficiency measure, an operational effectiveness measure not only reflects the capacity of an electricity production system to increase its electricity generation through the improvement of operational efficiency, but it also reflects the system's capability to adjust its electricity generation activities to match electricity demand. In addition, as a complement to an environmental efficiency measure, an environmental effectiveness measure not only reflects the capacity of an electricity production system to decrease its pollutant emissions through the improvement of environmental efficiency, but it also reflects the system's capability to adjust its emissions abatement activities to fulfill environmental regulations. Furthermore, an environmental effectiveness measure helps the government regulator to verify the rationality of its emissions reduction targets assigned to the thermal power industry. Several newly developed effectiveness measurements based on data envelopment analysis (DEA) were utilized in this study to evaluate the operational and environmental performance of the thermal power industry in China during 2006-2013. Both efficiency and effectiveness were evaluated from the three perspectives of operational, environmental, and joint adjustments to each electricity production system. The operational and environmental performance changes over time were also captured through an effectiveness measure based on the global Malmquist productivity index. Our empirical results indicated that the performance of China's thermal power industry experienced significant progress during the study period and that policies regarding the development and regulation of the thermal power industry yielded the expected effects. However, the emissions reduction targets assigned to China's thermal power industry are loose and conservative. Copyright © 2017 Elsevier Ltd. All rights reserved.

A scale on beliefs about children's adjustment in same-sex families: reliability and validity.

PubMed

Frias-Navarro, Dolores; Monterde-I-Bort, Hector

2012-01-01

In this study, we developed a new instrument named Scale Beliefs about Children's Adjustment on Same-Sex Families (SBCASSF). The scale was developed to assess of the adults' beliefs about negative impacts on children who are raised by same-sex parents. An initial pool of 95 items was generated by the authors based on a review of the literature on homophobia and feedback from several focus groups. Research findings, based on a sample of 212 university students (mean age 22 years, SD = 8.28), supported the reliability and validity of the scale. The final versions of the SBCASSF included items reflecting the following two factors: individual opposition (α = .87) and normative opposition (α = .88). Convergent validity of the scale is demonstrated by predictable correlations with beliefs about the cause of same-sex sexual orientation and the support for gay and lesbian rights. Our study reveals a strong positive association between high scores on SBCASSF and beliefs that the origin of same-sex sexual orientation is learned and opposition to gay and lesbian rights.

Perceptual Contrast Enhancement with Dynamic Range Adjustment

PubMed Central

Zhang, Hong; Li, Yuecheng; Chen, Hao; Yuan, Ding; Sun, Mingui

2013-01-01

Recent years, although great efforts have been made to improve its performance, few Histogram equalization (HE) methods take human visual perception (HVP) into account explicitly. The human visual system (HVS) is more sensitive to edges than brightness. This paper proposes to take use of this nature intuitively and develops a perceptual contrast enhancement approach with dynamic range adjustment through histogram modification. The use of perceptual contrast connects the image enhancement problem with the HVS. To pre-condition the input image before the HE procedure is implemented, a perceptual contrast map (PCM) is constructed based on the modified Difference of Gaussian (DOG) algorithm. As a result, the contrast of the image is sharpened and high frequency noise is suppressed. A modified Clipped Histogram Equalization (CHE) is also developed which improves visual quality by automatically detecting the dynamic range of the image with improved perceptual contrast. Experimental results show that the new HE algorithm outperforms several state-of-the-art algorithms in improving perceptual contrast and enhancing details. In addition, the new algorithm is simple to implement, making it suitable for real-time applications. PMID:24339452

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.

Racial variation in the use of do-not-resuscitate orders.

PubMed

Shepardson, L B; Gordon, H S; Ibrahim, S A; Harper, D L; Rosenthal, G E

1999-01-01

To compare the use of do-not-resuscitate (DNR) orders in African-American and white patients using a large, multisite, community-based sample. Our sample included 90,821 consecutive admissions to 30 hospitals in a large metropolitan region with six nonsurgical conditions from 1993 through 1995. Demographic and clinical data were abstracted from medical records. Admission severity of illness was measured using multivariate risk-adjustment models with excellent discrimination (receiver-operating characteristic curve areas, 0.82-0.88). Multiple logistic regression analysis was used to determine the independent association between race and use of DNR orders, adjusting for age, admission severity, and other covariates. In all patients, the rate of DNR orders was lower in African Americans than whites (9% vs 18%; p <.001). Rates of orders were also lower ( p <. 001) among African Americans in analyses stratified by age, gender, diagnosis, severity of illness, and in-hospital death. After adjusting for severity and other important covariates, the odds of a DNR order remained lower ( p <.001) for African-Americans relative to whites for all diagnoses, ranging from 0.38 for obstructive airway disease to 0.71 for gastrointestinal hemorrhage. Results were similar in analyses limited to orders written by the first, second, or seventh hospital day. Finally, among patients with DNR orders, African Americans were less likely to have orders written on the first hospital day and more likely to have orders written on subsequent days. The use of DNR orders was substantially lower in African Americans than in whites, even after adjusting for severity of illness and other covariates. Identification of factors underlying such differences will improve our understanding of the degree to which expectations for care differ in African American and white patients.

Opioid Utilization and Opioid-Related Adverse Events in Non-Surgical Patients in U.S. Hospitals

PubMed Central

Herzig, Shoshana J.; Rothberg, Michael B.; Cheung, Michael; Ngo, Long H.; Marcantonio, Edward R.

2014-01-01

Background Recent studies in the outpatient setting have demonstrated high rates of opioid prescribing and overdose-related deaths. Prescribing practices in hospitalized patients are unexamined. Objective To investigate patterns and predictors of opioid utilization in non-surgical admissions to U.S. hospitals, variation in use, and the association between hospital-level use and rates of severe opioid-related adverse events. Design, Setting, and Patients Adult non-surgical admissions to 286 U.S. hospitals. Measurements Opioid exposure and severe opioid-related adverse events during hospitalization, defined using hospital charges and ICD-9-CM codes. Results Of 1.14 million admissions, opioids were used in 51%. The mean ± s.d. daily dose received in oral morphine equivalents (OME) was 68 ± 185 mg; 23% of exposed received a total daily dose of ≥ 100 mg OME. Opioid prescribing rates ranged from 5% in the lowest to 72% in the highest prescribing hospital (mean 51% ± 10%). After adjusting for patient characteristics, the adjusted opioid prescribing rates ranged from 33–64% (mean 50% ± s.d. 4%). Among exposed, 0.97% experienced severe opioid-related adverse events. Hospitals with higher opioid prescribing rates had higher adjusted relative risk of a severe opioid-related adverse event per patient exposed (RR 1.23 [1.14–1.33] for highest compared to lowest prescribing quartile). Conclusions The majority of hospitalized non-surgical patients were exposed to opioids, often at high doses. Hospitals that used opioids most frequently had increased adjusted risk of a severe opioid-related adverse event per patient exposed. Interventions to standardize and enhance the safety of opioid prescribing in hospitalized patients should be investigated. PMID:24227700

Utilization of small changes in serum creatinine with clinical risk factors to assess the risk of AKI in critically lll adults.

PubMed

Cruz, Dinna N; Ferrer-Nadal, Asunción; Piccinni, Pasquale; Goldstein, Stuart L; Chawla, Lakhmir S; Alessandri, Elisa; Belluomo Anello, Clara; Bohannon, Will; Bove, Tiziana; Brienza, Nicola; Carlini, Mauro; Forfori, Francesco; Garzotto, Francesco; Gramaticopolo, Silvia; Iannuzzi, Michele; Montini, Luca; Pelaia, Paolo; Ronco, Claudio

2014-04-01

Disease biomarkers require appropriate clinical context to be used effectively. Combining clinical risk factors, in addition to small changes in serum creatinine, has been proposed to improve the assessment of AKI. This notion was developed in order to identify the risk of AKI early in a patient's clinical course. We set out to assess the performance of this combination approach. A secondary analysis of data from a prospective multicenter intensive care unit cohort study (September 2009 to April 2010) was performed. Patients at high risk using this combination approach were defined as an early increase in serum creatinine of 0.1-0.4 mg/dl, depending on number of clinical factors predisposing to AKI. AKI was defined and staged using the Acute Kidney Injury Network criteria. The primary outcome was evolution to severe AKI (Acute Kidney Injury Network stages 2 and 3) within 7 days in the intensive care unit. Of 506 patients, 214 (42.2%) patients had early creatinine elevation and were deemed at high risk for AKI. This group was more likely to subsequently develop the primary endpoint (16.4% versus 1.0% [not at high risk], P<0.001). The sensitivity of this grouping for severe AKI was 92%, the specificity was 62%, the positive predictive value was 16%, and the negative predictive value was 99%. After adjustment for Sequential Organ Failure Assessment score, serum creatinine, and hazard tier for AKI, early creatinine elevation remained an independent predictor for severe AKI (adjusted relative risk, 12.86; 95% confidence interval, 3.52 to 46.97). Addition of early creatinine elevation to the best clinical model improved prediction of the primary outcome (area under the receiver operating characteristic curve increased from 0.75 to 0.83, P<0.001). Critically ill patients at high AKI risk, based on the combination of clinical factors and early creatinine elevation, are significantly more likely to develop severe AKI. As initially hypothesized, the high-risk combination group methodology can be used to identify patients at low risk for severe AKI in whom AKI biomarker testing may be expected to have low yield. The high risk combination group methodology could potentially allow clinicians to optimize biomarker use.

Sugar-sweetened beverage intake and cardiovascular risk factor profile in youth with type 1 diabetes: application of measurement error methodology in the SEARCH Nutrition Ancillary Study.

PubMed

Liese, Angela D; Crandell, Jamie L; Tooze, Janet A; Kipnis, Victor; Bell, Ronny; Couch, Sarah C; Dabelea, Dana; Crume, Tessa L; Mayer-Davis, Elizabeth J

2015-08-14

The SEARCH Nutrition Ancillary Study aims to investigate the role of dietary intake on the development of long-term complications of type 1 diabetes in youth, and capitalise on measurement error (ME) adjustment methodology. Using the National Cancer Institute (NCI) method for episodically consumed foods, we evaluated the relationship between sugar-sweetened beverage (SSB) intake and cardiovascular risk factor profile, with the application of ME adjustment methodology. The calibration sample included 166 youth with two FFQ and three 24 h dietary recall data within 1 month. The full sample included 2286 youth with type 1 diabetes. SSB intake was significantly associated with higher TAG, total and LDL-cholesterol concentrations, after adjusting for energy, age, diabetes duration, race/ethnicity, sex and education. The estimated effect size was larger (model coefficients increased approximately 3-fold) after the application of the NCI method than without adjustment for ME. Compared with individuals consuming one serving of SSB every 2 weeks, those who consumed one serving of SSB every 2 d had 3.7 mg/dl (0.04 mmol/l) higher TAG concentrations and 4.0 mg/dl (0.10 mmol/l) higher total cholesterol and LDL-cholesterol concentrations, after adjusting for ME and covariates. SSB intake was not associated with measures of adiposity and blood pressure. Our findings suggest that SSB intake is significantly related to increased lipid levels in youth with type 1 diabetes, and that estimates of the effect size of SSB on lipid levels are severely attenuated in the presence of ME. Future studies in youth with diabetes should consider a design that will allow for the adjustment for ME when studying the influence of diet on health status.

Evaluation of the magnitude and frequency of floods in urban watersheds in Phoenix and Tucson, Arizona

USGS Publications Warehouse

Kennedy, Jeffrey R.; Paretti, Nicholas V.

2014-01-01

Flooding in urban areas routinely causes severe damage to property and often results in loss of life. To investigate the effect of urbanization on the magnitude and frequency of flood peaks, a flood frequency analysis was carried out using data from urbanized streamgaging stations in Phoenix and Tucson, Arizona. Flood peaks at each station were predicted using the log-Pearson Type III distribution, fitted using the expected moments algorithm and the multiple Grubbs-Beck low outlier test. The station estimates were then compared to flood peaks estimated by rural-regression equations for Arizona, and to flood peaks adjusted for urbanization using a previously developed procedure for adjusting U.S. Geological Survey rural regression peak discharges in an urban setting. Only smaller, more common flood peaks at the 50-, 20-, 10-, and 4-percent annual exceedance probabilities (AEPs) demonstrate any increase in magnitude as a result of urbanization; the 1-, 0.5-, and 0.2-percent AEP flood estimates are predicted without bias by the rural-regression equations. Percent imperviousness was determined not to account for the difference in estimated flood peaks between stations, either when adjusting the rural-regression equations or when deriving urban-regression equations to predict flood peaks directly from basin characteristics. Comparison with urban adjustment equations indicates that flood peaks are systematically overestimated if the rural-regression-estimated flood peaks are adjusted upward to account for urbanization. At nearly every streamgaging station in the analysis, adjusted rural-regression estimates were greater than the estimates derived using station data. One likely reason for the lack of increase in flood peaks with urbanization is the presence of significant stormwater retention and detention structures within the watershed used in the study.

Family Economic Stress and Adjustment of Early Adolescent Girls.

ERIC Educational Resources Information Center

Conger, Rand D.; And Others

1993-01-01

Adolescent girls and their parents and a sibling completed questionnaires that measured several family variables and were observed interacting. Found that family economic pressures led to parents' depression, marital conflict, and disrupted parenting. Parents' depressed mood and disrupted child-rearing practices affected girls' adjustment. (BC)

Shyness-Sensitivity and Social, School, and Psychological Adjustment in Urban Chinese Children: A Four-Wave Longitudinal Study.

PubMed

Yang, Fan; Chen, Xinyin; Wang, Li

2015-01-01

This study examined reciprocal contributions between shyness-sensitivity and social, school, and psychological adjustment in urban Chinese children. Longitudinal data were collected once a year from Grade 3 to Grade 6 (ages 9-12 years) for 1,171 children from multiple sources. Shyness-sensitivity positively contributed to social, school, and psychological difficulties over time, with the most consistent effects on peer preference and loneliness. Social and school adjustment negatively contributed to the development of shyness-sensitivity. The initial levels of shyness-sensitivity and social and school adjustment moderated the growth of each other, mainly as a resource-potentiating factor. The results indicate the significance of shyness-sensitivity for adjustment and the role of adjustment in the development of shyness-sensitivity in today's urban Chinese society. © 2015 The Authors. Child Development © 2015 Society for Research in Child Development, Inc.

Episiotomy and severe perineal trauma among Eastern African immigrant women giving birth in public maternity care: A population based study in Victoria, Australia.

PubMed

Belihu, Fetene B; Small, Rhonda; Davey, Mary-Ann

2017-08-01

Eastern African immigrants from countries affected by female genital mutilation have resettled in many developed countries, including Australia. Although possibly at risk of perineal trauma and episiotomy, research investigating their perineal status post-migration is sparse. To investigate variations in episiotomy use and incidence of severe perineal tear for women born in Eritrea, Ethiopia, Somalia and Sudan compared with Australian-born women. A population-based study of 203,206 Australian-born and 3502 Eastern African immigrant women admitted as public patients, with singleton vaginal births between 1999 and 2007, was conducted using the Victorian Perinatal Data Collection. Descriptive and multivariable logistic regression analysis adjusting for confounders selected a priori, were performed to compute incidence and adjusted odds ratios. Overall, 30.5% Eastern African immigrants had episiotomy compared to 17.2% Australian-born women. Severe perineal trauma occurred in 2.1% of Eastern African immigrants and 1.6% of Australian-born women. While the odds of severe perineal trauma was significantly elevated only during non-instrumental vaginal births for Eastern African immigrants {OR adj 1.56 95%CI(1.17, 2.12)}; that of episiotomy was increased during both non-instrumental {OR adj 4.47 95%CI(4.10, 4.88)} and instrumental {OR adj 2.51 95%CI(1.91, 3.29)} vaginal births. Overall, Eastern African immigrant women experienced elevated odds of episiotomy and severe perineal tear. Health care providers need to be mindful of the increased risk of severe perineal tear in these women and enhance efforts in identification and treatment of severe perineal trauma to minimise associated short and long term morbidity. Strategies to reduce unneeded episiotomy and ways of enhancing perineal safety are also needed. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Does Pain Predict Frailty in Older Men and Women? Findings From the English Longitudinal Study of Ageing (ELSA).

PubMed

Wade, Katie F; Marshall, Alan; Vanhoutte, Bram; Wu, Frederick C W; O'Neill, Terence W; Lee, David M

2017-03-01

Pain has been suggested to act as a stressor during aging, potentially accelerating declines in health and functioning. Our objective was to examine the longitudinal association between self-reported pain and the development, or worsening, of frailty among older men and women. The study population consisted of 5,316 men and women living in private households in England, mean age 64.5 years, participating in the English Longitudinal Study of Ageing (ELSA). Data from Waves 2 and 6 of ELSA were used in this study with 8 years of follow-up. At Wave 2, participants were asked whether they were "often troubled with pain" and for those who reported yes, further information regarding the intensity of their pain (mild, moderate, or severe) was collected. Socioeconomic status (SES) was assessed using information about the current/most recent occupation and also net wealth. A frailty index (FI) was generated, with the presence of frailty defined as an FI >0.35. Among those without frailty at Wave 2, the association between pain at Wave 2 and frailty at Wave 6 was examined using logistic regression. We investigated whether pain predicted change in FI between Waves 2 and 6 using a negative binomial regression model. For both models adjustments were made for age, gender, lifestyle factors, depressive symptoms, and socioeconomic factors. At Wave 2, 455 (19.7%) men and 856 (28.7%) women reported they often experienced moderate or severe pain. Of the 5,159 participants who were nonfrail at Wave 2, 328 (6.4%) were frail by Wave 6. The mean FI was 0.11 (standard deviation [SD] = 0.1) at Wave 2 and 0.15 (SD = 0.1) at Wave 6. After adjustment for age, gender, body mass index, lifestyle factors, and depressive symptoms, compared to participants reporting no pain at Wave 2 those reporting moderate (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 2.28, 4.16) or severe pain (OR = 3.78, 95% CI = 2.51, 5.71) were significantly more likely to be frail at Wave 6. This association persisted after further adjustment for either occupational class and/or net wealth level. Compared to those without pain, those with mild, moderate, or severe pain were also more likely to develop worsening frailty, as assessed using the FI, and this association persisted after adjustment for SES. There was no evidence that the association between pain and frailty was influenced by gender. Pain is associated with an increased risk and intensity of frailty in older men and women. Socioeconomic factors contribute to the occurrence of frailty; though in our study do not explain the relationship between pain and frailty. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America.

Health care reform at trauma centers--mortality, complications, and length of stay.

PubMed

Shafi, Shahid; Barnes, Sunni; Nicewander, David; Ballard, David; Nathens, Avery B; Ingraham, Angela M; Hemmila, Mark; Goble, Sandra; Neal, Melanie; Pasquale, Michael; Fildes, John J; Gentilello, Larry M

2010-12-01

The Trauma Quality Improvement Program has demonstrated existence of significant variations in risk-adjusted mortality across trauma centers. However, it is unknown whether centers with lower mortality rates also have reduced length of stay (LOS), with associated cost savings. We hypothesized that LOS is not primarily determined by unmodifiable factors, such as age and injury severity, but is primarily dependent on the development of potentially preventable complications. The National Trauma Data Bank (2002-2006) was used to include patients (older than 16 years) with at least one severe injury (Abbreviated Injury Scale score ≥ 3) from Level I and II trauma centers (217,610 patients, 151 centers). A previously validated risk-adjustment algorithm was used to calculate observed-to-expected mortality ratios for each center. Poisson regression was used to determine the relationship between LOS, observed-to-expected mortality ratios, and complications while controlling for confounding factors, such as age, gender, mechanism, insurance status, comorbidities, and injuries and their severity. Large variations in LOS (median, 4-8 days) were observed across trauma centers. There was no relationship between mortality and LOS. The most important predictor of LOS was complications, which were associated with a 62% increase. Injury severity score, shock, gunshot wounds, brain injuries, intensive care unit admission, and comorbidities were less important predictors of LOS. Quality improvement programs focusing on mortality alone may not be associated with reduced LOS. Hence, the Trauma Quality Improvement Program should also focus on processes of care that reduce complications, thereby shortening LOS, which may lead to significant cost savings at trauma centers.

Respiratory Syncytial Virus Infection and Disease in Infants and Young Children Studied from Birth in Kilifi District, Kenya

PubMed Central

Nokes, D James; Okiro, Emelda A; Ngama, Mwanajuma; Ochola, Rachel; White, Lisa J; Scott, Paul D; English, Michael; Cane, Patricia A; Medley, Graham F

2008-01-01

Background Within the developing country setting data are few that characterise the disease burden due to RSV and which clearly define the age group to target vaccine intervention. Methods Children numbering 635, recruited 2002-03, were intensively monitored until each experienced three RSV epidemics. RSV was diagnosed by use of immunofluorescence on nasal washings collected on occurence of acute respiratory infection. Incidence estimates were adjusted for seasonality in RSV exposure. Results From 1187 child years of observation (cyo) a total of 409 RSV episodes were identifed; 365 primary and 82 repeat. Adjusted incidence estimates (per 1000cyo) of lower respiratory tract infection (LRTI), severe LRTI and hospital admission were 90, 43, and 10, respectively, and corresponding estimates in infants were 104, 66 and 13. The proportion of all-cause LRTI, severe-LRTI and hospitalizations in the cohort due to RSV was 13%, 19% and 5%, respectively. 55-65% of RSV LRTI and severe-LRTI occured in children over 6 months old. The risk of RSV disease following primary symptomatic infection remained significant beyond the first year of life and a quarter of all re-infections were associated with LRTI. Conclusions RSV accounts for a substantial proportion of the total respiratory disease in this rural population: we estimate 85,000 infant cases of severe LRTI annually in Kenya. The majority of this morbidity occurs in late infancy and early childhood; ages at which the risk of disease following infection remains significant. Disease from re-infection is common. Our results inform the debate on vaccine target age group and effectiveness. PMID:18171213

Infant muscle tone and childhood autistic traits: A longitudinal study in the general population.

PubMed

Serdarevic, Fadila; Ghassabian, Akhgar; van Batenburg-Eddes, Tamara; White, Tonya; Blanken, Laura M E; Jaddoe, Vincent W V; Verhulst, Frank C; Tiemeier, Henning

2017-05-01

In a longitudinal population-based study of 2,905 children, we investigated if infants' neuromotor development was associated with autistic traits in childhood. Overall motor development and muscle tone were examined by trained research assistants with an adapted version of Touwen's Neurodevelopmental Examination between ages 2 and 5 months. Tone was assessed in several positions and items were scored as normal, low, or high tone. Parents rated their children's autistic traits with the Social Responsiveness Scale (SRS) and the Pervasive Developmental Problems (PDP) subscale of the Child Behavior Checklist at 6 years. We defined clinical PDP if scores were >98th percentile of the norm population. Diagnosis of autism spectrum disorder (ASD) was clinically confirmed in 30 children. We observed a modest association between overall neuromotor development in infants and autistic traits. Low muscle tone in infancy predicted autistic traits measured by SRS (adjusted beta = 0.05, 95% CI for B: 0.00-0.02, P = 0.01), and PDP (adjusted beta = 0.08, 95% CI for B: 0.04-0.10, P < 0.001). Similar results emerged for the association of low muscle tone and clinical PDP (adjusted OR = 1.36, 95% CI: 1.08-1.72, P = 0.01) at age 6 years. Results remained unchanged if adjusted for child intelligence. There was no association between high muscle tone and SRS or PDP. Exclusion of children with ASD diagnosis did not change the association. This large study showed a prospective association of infant muscle tone with autistic traits in childhood. Our findings suggest that early detection of low muscle tone might be a gateway to improve early diagnosis of ASD. Autism Res 2017, 10: 757-768. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Severe Late Toxicities Following Concomitant Chemoradiotherapy Compared to Radiotherapy Alone in Cervical Cancer: An Inter-era Analysis

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

Gondi, Vinai, E-mail: gondi@humonc.wisc.edu; Bentzen, Soren M.; Sklenar, Kathryn L.

2012-11-15

Purpose: To compare rates of severe late toxicities following concomitant chemoradiotherapy and radiotherapy alone for cervical cancer. Methods and Materials: Patients with cervical cancer were treated at a single institution with radiotherapy alone or concomitant chemoradiotherapy for curative intent. Severe late toxicity was defined as grade {>=}3 vaginal, urologic, or gastrointestinal toxicity or any pelvic fracture, using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE), occurring {>=}6 months from treatment completion and predating any salvage therapy. Severe late toxicity rates were compared after adjusting for pertinent covariates. Results: At 3 years, probability of vaginal severe late toxicity was 20.2%more » for radiotherapy alone and 35.1% for concomitant chemoradiotherapy (P=.026). At 3 years, probability of skeletal severe late toxicity was 1.6% for radiotherapy alone and 7.5% for concomitant chemoradiotherapy (P=.010). After adjustment for case mix, concomitant chemoradiotherapy was associated with higher vaginal (hazard ratio [HR] 3.0, 95% confidence interval [CI], 1.7-5.2, P<.001), and skeletal (HR 7.0, 95% CI 1.4-34.1, P=.016) severe late toxicity. Compared to high dilator compliance, moderate (HR 3.6, 95% CI 2.0-6.5, P<.001) and poor (HR 8.5, 95% CI 4.3-16.9, P<.001) dilator compliance was associated with higher vaginal severe late toxicity. Age >50 was associated with higher vaginal (HR 1.8, 95% CI 1.1-3.0, P=.013) and skeletal (HR 5.7, 95% CI 1.2-27.0, P=.028) severe late toxicity. Concomitant chemoradiotherapy was not associated with higher gastrointestinal (P=.886) or urologic (unadjusted, P=.053; adjusted, P=.063) severe late toxicity. Conclusion: Compared to radiotherapy alone, concomitant chemoradiotherapy is associated with higher rates of severe vaginal and skeletal late toxicities. Other predictive factors include dilator compliance for severe vaginal late toxicity and age for severe vaginal and skeletal late toxicities.« less

The Medication Recommendation Tracking Form: a novel tool for tracking changes in prescribed medication, clinical decision making, and use in comparative effectiveness research.

PubMed

Reilly-Harrington, Noreen A; Sylvia, Louisa G; Leon, Andrew C; Shesler, Leah W; Ketter, Terence A; Bowden, Charles L; Calabrese, Joseph R; Friedman, Edward S; Ostacher, Michael J; Iosifescu, Dan V; Rabideau, Dustin J; Thase, Michael E; Nierenberg, Andrew A

2013-11-01

This paper describes the development and use of the Medication Recommendation Tracking Form (MRTF), a novel method for capturing physician prescribing behavior and clinical decision making. The Bipolar Trials Network developed and implemented the MRTF in a comparative effectiveness study for bipolar disorder (LiTMUS). The MRTF was used to assess the frequency, types, and reasons for medication adjustments. Changes in treatment were operationalized by the metric Necessary Clinical Adjustments (NCA), defined as medication adjustments to reduce symptoms, optimize treatment response and functioning, or to address intolerable side effects. Randomized treatment groups did not differ in rates of NCAs, however, responders had significantly fewer NCAs than non-responders. Patients who had more NCAs during their previous visit had significantly lower odds of responding at the current visit. For each one-unit increase in previous CGI-BP depression score and CGI-BP overall severity score, patients had an increased NCA rate of 13% and 15%, respectively at the present visit. Ten-unit increases in previous Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) scores resulted in an 18% and 14% increase in rates of NCAs, respectively. Patients with fewer NCAs had increased quality of life and decreased functional impairment. The MRTF standardizes the reporting and rationale for medication adjustments and provides an innovative metric for clinical effectiveness. As the first tool in psychiatry to track the types and reasons for medication changes, it has important implications for training new clinicians and examining clinical decision making. (ClinicalTrials.gov number NCT00667745). Copyright © 2013. Published by Elsevier Ltd.

Folate Deficiency, Atopy, and Severe Asthma Exacerbations in Puerto Rican Children.

PubMed

Blatter, Joshua; Brehm, John M; Sordillo, Joanne; Forno, Erick; Boutaoui, Nadia; Acosta-Pérez, Edna; Alvarez, María; Colón-Semidey, Angel; Weiss, Scott T; Litonjua, Augusto A; Canino, Glorisa; Celedón, Juan C

2016-02-01

Little is known about folate and atopy or severe asthma exacerbations. We examined whether folate deficiency is associated with number of positive skin tests to allergens or severe asthma exacerbations in a high-risk population and further assessed whether such association is explained or modified by vitamin D status. Cross-sectional study of 582 children aged 6 to 14 years with (n = 304) and without (n = 278) asthma in San Juan, Puerto Rico. Folate deficiency was defined as plasma folate less than or equal to 20 ng/ml. Our outcomes were the number of positive skin tests to allergens (range, 0-15) in all children and (in children with asthma) one or more severe exacerbations in the previous year. Logistic and negative binomial regression models were used for the multivariate analysis. All multivariate models were adjusted for age, sex, household income, residential proximity to a major road, and (for atopy) case/control status; those for severe exacerbations were also adjusted for use of inhaled corticosteroids and vitamin D insufficiency (a plasma 25[OH]D < 30 ng/ml). In a multivariate analysis, folate deficiency was significantly associated with an increased degree of atopy and 2.2 times increased odds of at least one severe asthma exacerbation (95% confidence interval for odds ratio, 1.1-4.6). Compared with children who had normal levels of both folate and vitamin D, those with both folate deficiency and vitamin D insufficiency had nearly eightfold increased odds of one or more severe asthma exacerbation (95% confidence interval for adjusted odds ratio, 2.7-21.6). Folate deficiency is associated with increased degree of atopy and severe asthma exacerbations in school-aged Puerto Ricans. Vitamin D insufficiency may further increase detrimental effects of folate deficiency on severe asthma exacerbations.

Predictors of Hospitalized Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease.

PubMed

Santibáñez, Miguel; Garrastazu, Roberto; Ruiz-Nuñez, Mario; Helguera, Jose Manuel; Arenal, Sandra; Bonnardeux, Cristina; León, Carlos; García-Rivero, Juan Luis

2016-01-01

Exacerbations of chronic obstructive pulmonary disease (COPD) carry significant consequences for patients and are responsible for considerable health-care costs-particularly if hospitalization is required. Despite the importance of hospitalized exacerbations, relatively little is known about their determinants. This study aimed to analyze predictors of hospitalized exacerbations and mortality in COPD patients. This was a retrospective population-based cohort study. We selected 900 patients with confirmed COPD aged ≥35 years by simple random sampling among all COPD patients in Cantabria (northern Spain) on December 31, 2011. We defined moderate exacerbations as events that led a care provider to prescribe antibiotics or corticosteroids and severe exacerbations as exacerbations requiring hospital admission. We observed exacerbation frequency over the previous year (2011) and following year (2012). We categorized patients according to COPD severity based on forced expiratory volume in 1 second (Global Initiative for Chronic Obstructive Lung Disease [GOLD] grades 1-4). We estimated the odds ratios (ORs) by logistic regression, adjusting for age, sex, smoking status, COPD severity, and frequent exacerbator phenotype the previous year. Of the patients, 16.4% had ≥1 severe exacerbations, varying from 9.3% in mild GOLD grade 1 to 44% in very severe COPD patients. A history of at least two prior severe exacerbations was positively associated with new severe exacerbations (adjusted OR, 6.73; 95% confidence interval [CI], 3.53-12.83) and mortality (adjusted OR, 7.63; 95%CI, 3.41-17.05). Older age and several comorbidities, such as heart failure and diabetes, were similarly associated. Hospitalized exacerbations occurred with all grades of airflow limitation. A history of severe exacerbations was associated with new hospitalized exacerbations and mortality.

Singaporean gifted adolescents under scrutiny: The gender factor

NASA Astrophysics Data System (ADS)

Kwan, Patrick C. F.

1993-05-01

Research on the sex-role problems of gifted adolescents rarely lifts its sight beyond Western developed countries, making generalizations to the Third World suspect. The present study, by exploring the relationship between gender and adjustment among gifted adolescents in Singapore, hopes to extend the consideration of developmental sex-role issues to a society different from the West. Specifically, it reports that Singaporean gifted girls, like some of their Western counterparts, had difficulty in reconciling their giftedness with societal notions of femininity. Conceivably, this conflict placed them on the threshold of stress, leaving them more vulnerable than the gifted boys to adjustment problems. In addition, having internalized the gender stereotypic view that academic excellence was less important to them than to the boys, the gifted girls might inadvertently put ceilings on their own achievements. The paper concludes with several remedies for educators, counsellors, and parents to help gifted girls embark upon their road to self-fulfilment.

Tunneling-injection in vertical quasi-2D heterojunctions enabled efficient and adjustable optoelectronic conversion

PubMed Central

Tan, Wei-Chun; Chiang, Chia-Wei; Hofmann, Mario; Chen, Yang-Fang

2016-01-01

The advent of 2D materials integration has enabled novel heterojunctions where carrier transport proceeds thrsough different ultrathin layers. We here demonstrate the potential of such heterojunctions on a graphene/dielectric/semiconductor vertical stack that combines several enabling features for optoelectronic devices. Efficient and stable light emission was achieved through carrier tunneling from the graphene injector into prominent states of a luminescent material. Graphene’s unique properties enable fine control of the band alignment in the heterojunction. This advantage was used to produce vertical tunneling-injection light-emitting transistors (VtiLET) where gating allows adjustment of the light emission intensity independent of applied bias. This device was shown to simultaneously act as a light detecting transistor with a linear and gate tunable sensitivity. The presented development of an electronically controllable multifunctional light emitter, light detector and transistor open up a new route for future optoelectronics. PMID:27507171

Tunneling-injection in vertical quasi-2D heterojunctions enabled efficient and adjustable optoelectronic conversion

NASA Astrophysics Data System (ADS)

Tan, Wei-Chun; Chiang, Chia-Wei; Hofmann, Mario; Chen, Yang-Fang

2016-08-01

The advent of 2D materials integration has enabled novel heterojunctions where carrier transport proceeds thrsough different ultrathin layers. We here demonstrate the potential of such heterojunctions on a graphene/dielectric/semiconductor vertical stack that combines several enabling features for optoelectronic devices. Efficient and stable light emission was achieved through carrier tunneling from the graphene injector into prominent states of a luminescent material. Graphene’s unique properties enable fine control of the band alignment in the heterojunction. This advantage was used to produce vertical tunneling-injection light-emitting transistors (VtiLET) where gating allows adjustment of the light emission intensity independent of applied bias. This device was shown to simultaneously act as a light detecting transistor with a linear and gate tunable sensitivity. The presented development of an electronically controllable multifunctional light emitter, light detector and transistor open up a new route for future optoelectronics.

Early life determinants of frailty in old age: the Helsinki Birth Cohort Study.

PubMed

Haapanen, M J; Perälä, M M; Salonen, M K; Kajantie, E; Simonen, M; Pohjolainen, P; Eriksson, J G; von Bonsdorff, M B

2018-04-12

there is evidence suggesting that several chronic diseases have their origins in utero and that development taking place during sensitive periods may affect the aging process. We investigated whether early life determinants would be associated with frailty in old age. at a mean age of 71 years, 1,078 participants belonging to the Helsinki Birth Cohort Study were assessed for frailty according to the Fried frailty criteria. Early life measurements (birth weight, length, mother body mass index [BMI] and parity) were obtained from birth, child welfare and school health records. Multinomial regression analysis was used to assess the association between early life determinants and frailty in old age. weight, length and BMI at birth were all inversely associated with frailty in old age. A 1 kg increase in birth weight was associated with a lower relative risk ratio (RRR) of frailty (age and sex-adjusted RRR = 0.40, 95% CI: 0.19, 0.82) compared to non-frailty. Associations persisted after adjusting for several confounding factors. Compared to cohort members in the upper middle class, those who as adults worked as manual workers or belonged to the lower middle class, were at an increased risk of frailty. those who were small at birth were at an increased risk of developing frailty in old age, suggesting that frailty is at least partly programmed in early life. A less privileged socioeconomic status in adulthood was associated with an increased risk of frailty in old age.

Electrowetting liquid lens array on curved substrates for wide field of view image sensor

NASA Astrophysics Data System (ADS)

Bang, Yousung; Lee, Muyoung; Won, Yong Hyub

2016-03-01

In this research, electrowetting liquid lens array on curved substrates is developed for wide field of view image sensor. In the conventional image sensing system, this lens array is usually in the form of solid state. However, in this state, the lens array which is similar to insect-like compound eyes in nature has several limitations such as degradation of image quality and narrow field of view because it cannot adjust focal length of lens. For implementation of the more enhanced system, the curved array of lenses based on electrowetting effect is developed in this paper, which can adjust focal length of lens. The fabrication of curved lens array is conducted upon the several steps, including chamber fabrication, electrode & dielectric layer deposition, liquid injection, and encapsulation. As constituent materials, IZO coated convex glass, UV epoxy (NOA 68), DI water, and dodecane are used. The number of lenses on the fabricated panel is 23 by 23 and each lens has 1mm aperture with 1.6mm pitch between adjacent lenses. When the voltage is applied on the device, it is observed that each lens is changed from concave state to convex state. From the unique optical characteristics of curved array of liquid lenses such as controllable focal length and wide field of view, we can expect that it has potential applications in various fields such as medical diagnostics, surveillance systems, and light field photography.

A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges.

PubMed

Juengst, Shannon B; Kumar, Raj G; Wagner, Amy K

2017-01-01

Depression is one of the most common conditions to emerge after traumatic brain injury (TBI), and despite its potentially serious consequences it remains undertreated. Treatment for post-traumatic depression (PTD) is complicated due to the multifactorial etiology of PTD, ranging from biological pathways to psychosocial adjustment. Identifying the unique, personalized factors contributing to the development of PTD could improve long-term treatment and management for individuals with TBI. The purpose of this narrative literature review was to summarize the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management. Overall, PTD has an estimated point prevalence of 30%, with 50% of individuals with moderate to severe TBI experiencing an episode of PTD in the first year after injury alone. PTD has significant implications for health, leading to more hospitalizations and greater caregiver burden, for participation, reducing rates of return to work and affecting social relationships, and for quality of life. PTD may develop directly or indirectly as a result of biological changes after injury, most notably post-injury inflammation, or through psychological and psychosocial factors, including pre injury personal characteristics and post-injury adjustment to disability. Current evidence for effective treatments is limited, although the strongest evidence supports antidepressants and cognitive behavioral interventions. More personalized approaches to treatment and further research into unique therapy combinations may improve the management of PTD and improve the health, functioning, and quality of life for individuals with TBI.

Antenatal exposure to Ureaplasma species exacerbates bronchopulmonary dysplasia synergistically with subsequent prolonged mechanical ventilation in preterm infants.

PubMed

Inatomi, Tadashi; Oue, Shinya; Ogihara, Tohru; Hira, Seigo; Hasegawa, Masashi; Yamaoka, Shigeo; Yasui, Masako; Tamai, Hiroshi

2012-03-01

The presence of microorganisms in gastric fluid in neonates at birth is postulated to reflect antenatal infection and also to be associated with the development of bronchopulmonary dysplasia (BPD). A logistic regression analysis, after controlling for other risk factors, indicated that Ureaplasma-positive infants were not at increased risk for moderate/severe BPD (adjusted odds ratio (OR): 2.58, 95% confidence interval (CI): 0.57-6.89, P = 0.12). However, the association between the presence of Ureaplasma species and the risk for moderate/severe BPD increased significantly in infants on mechanical ventilation (MV) ≥2 wk (adjusted OR: 4.17, 95% CI: 1.62-44.1, P = 0.009). An analysis using a lung injury marker indicated that Ureaplasma-positive infants with MV ≥2 wk, but not other infants, showed higher serum KL-6 levels in samples taken from cord blood, and that KL-6 levels increased time-dependently up to 4 wk of age. Antenatal exposure to Ureaplasma species induces lung injury prior to birth and synergistically contributes to the development of BPD in infants requiring prolonged MV (≥2 wk). We recovered gastric fluid specimens from 122 infants with gestational age (GA) <29 wk or birth weight <1,000 g to investigate whether these microorganisms influence respiratory outcome of BPD. A PCR analysis was used to detect urease and 16S ribosomal RNA (rRNA) genes to classify neonates into Ureaplasma-positive or Ureaplasma-negative infants.

Infection Rate and Acute Organ Dysfunction Risk as Explanations for Racial Differences in Severe Sepsis

PubMed Central

Mayr, Florian B.; Yende, Sachin; Linde-Zwirble, Walter T.; Peck-Palmer, Octavia M.; Barnato, Amber E.; Weissfeld, Lisa A.; Angus, Derek C.

2013-01-01

Context Severe sepsis, defined as infection complicated by acute organ dysfunction, occurs more frequently and leads to more deaths in black than in white individuals. The optimal approach to minimize these disparities is unclear. Objective To determine the extent to which higher severe sepsis rates in black than in white patients are due to higher infection rates or to a higher risk of acute organ dysfunction. Design, Setting, and Participants Analysis of infection-related hospitalizations from the 2005 hospital discharge data of 7 US states and infection-related emergency department visits from the 2003-2007 National Hospital Ambulatory Care Survey. Main Outcome Measure Age- and sex-standardized severe sepsis and infection hospitalization rates and the risk of acute organ dysfunction. Results Of 8 661 227 non–childbirth-related discharges, 2 261 857 were associated with an infection, and of these, 381 787 (16.8%) had severe sepsis. Black patients had a 67% higher age- and sex-standardized severe sepsis rate than did white patients (9.4; 95% confidence interval [CI], 9.3-9.5 vs 5.6; 95% CI, 5.6-5.6 per 1000 population; P<.001) and 80% higher standardized mortality (1.8, 95% CI, 1.8-1.9 vs 1.0, 95% CI, 1.0-1.1 per 1000 population; P<.001). The higher severe sepsis rate was explained by both a higher infection rate in black patients (47.3; 95% CI, 47.1-47.4 vs 34.0; 95% CI, 33.9-34.0 per 1000 population; incidence rate ratio, 1.39; P<.001) and a higher risk of developing acute organ dysfunction (age- and sex-adjusted odds ratio [OR],1.29; 95% CI, 1.27-1.30; P<.001). Differences in infection presented broadly across different sites and etiology of infection and for community- and hospital-acquired infections and occurred despite a lower likelihood of being admitted for infection from the emergency department (adjusted OR, 0.70; 95% CI, 0.64-0.76; P<.001). The higher risk of organ dysfunction persisted but was attenuated after adjusting for age, sex, comorbid conditions, poverty, and hospital effect (OR, 1.14; 95% CI, 1.13-1.16; P<.001). Racial disparities in infection and severe sepsis incidence and mortality rates were largest among younger adults (eg, the proportion of invasive pneumococcal disease occurring in adults <65 years was 73.9% among black patients vs 44.5% among white patients, P<.001). Conclusion Racial differences in severe sepsis are explained by both a higher infection rate and a higher risk of acute organ dysfunction in black than in white individuals. PMID:20571016

Effect of Depth and Duration of Cooling on Death or Disability at Age 18 Months Among Neonates With Hypoxic-Ischemic Encephalopathy

PubMed Central

Laptook, Abbot R.; Pappas, Athina; McDonald, Scott. A.; Das, Abhik; Tyson, Jon E.; Poindexter, Brenda B.; Schibler, Kurt; Bell, Edward F.; Heyne, Roy J.; Pedroza, Claudia; Bara, Rebecca; Van Meurs, Krisa P.; Huitema, Carolyn M. Petrie; Grisby, Cathy; Devaskar, Uday; Ehrenkranz, Richard A.; Harmon, Heidi M.; Chalak, Lina F.; DeMauro, Sara B.; Garg, Meena; Hartley-McAndrew, Michelle E.; Khan, Amir M.; Walsh, Michele C.; Ambalavanan, Namasivayam; Brumbaugh, Jane E.; Watterberg, Kristi L.; Shepherd, Edward G.; Hamrick, Shannon E. G.; Barks, John; Cotten, C. Michael; Kilbride, Howard W.; Higgins, Rosemary D.

2017-01-01

Importance Hypothermia for 72 hours at 33.5°C for neonatal hypoxic-ischemic encephalopathy reduces death or disability, but rates continue to be high. Objective To determine if cooling for 120 hours or to a temperature of 32.0°C reduces death or disability at age 18 months in infants with hypoxic-ischemic encephalopathy. Design, Setting, and Participants Randomized 2 × 2 factorial clinical trial in neonates (≥36 weeks’ gestation) with hypoxic-ischemic encephalopathy at 18 US centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network between October 2010 and January 2016. Interventions A total of 364 neonates were randomly assigned to 4 hypothermia groups: 33.5°C for 72 hours (n = 95), 32.0°C for 72 hours (n = 90), 33.5°C for 120 hours (n = 96), or 32.0°C for 120 hours (n = 83). Main Outcomes and Measures The primary outcome was death or moderate or severe disability at 18 to 22 months of age adjusted for center and level of encephalopathy. Severe disability included any of Bayley Scales of Infant Development III cognitive score less than 70, Gross Motor Function Classification System (GMFCS) level of 3 to 5, or blindness or hearing loss despite amplification. Moderate disability was defined as a cognitive score of 70 to 84 and either GMFCS level 2, active seizures, or hearing with amplification. Results The trial was stopped for safety and futility in November 2013 after 364 of the planned 726 infants were enrolled. Among 347 infants (95%) with primary outcome data (mean age at follow-up, 20.7 [SD, 3.5] months; 42% female), death or disability occurred in 56 of 176 (31.8%) cooled for 72 hours and 54 of 171 (31.6%) cooled for 120 hours (adjusted risk ratio, 0.92 [95% CI, 0.68-1.25]; adjusted absolute risk difference, −1.0% [95% CI, −10.2% to 8.1%]) and in 59 of 185 (31.9%) cooled to 33.5°C and 51 of 162 (31.5%) cooled to 32.0°C (adjusted risk ratio, 0.92 [95% CI, 0.68-1.26]; adjusted absolute risk difference, −3.1% [95% CI, −12.3% to 6.1%]). A significant interaction between longer and deeper cooling was observed (P = .048), with primary outcome rates of 29.3% at 33.5°C for 72 hours, 34.5% at 32.0°C for 72 hours, 34.4% at 33.5°C for 120 hours, and 28.2% at 32.0°C for 120 hours. Conclusions and Relevance Among term neonates with moderate or severe hypoxic-ischemic encephalopathy, cooling for longer than 72 hours, cooling to lower than 33.5°C, or both did not reduce death or moderate or severe disability at 18 months of age. However, the trial may be underpowered, and an interaction was found between longer and deeper cooling. These results support the current regimen of cooling for 72 hours at 33.5°C. Trial Registration clinicaltrials.gov Identifier: NCT01192776 PMID:28672318

Psychosocial Adjustment of Adolescents and Young Adults with Intellectual Disabilities

ERIC Educational Resources Information Center

Mueller, Christian E.; Prout, H. Thompson

2009-01-01

Issues with adolescents with intellectual disabilities have received little attention in the research literature. This study compared adolescents with and without intellectual disabilities on several indices of psychosocial adjustment. The participants were selected from a large longitudinal database and comparisons were made at three points in…

Examining the Correlation between Objective Injury Parameters, Personality Traits, and Adjustment Measures among Burn Victims

PubMed Central

Weissman, Oren; Domniz, Noam; Petashnick, Yoel R.; Gilboa, Dalia; Raviv, Tal; Barzilai, Liran; Farber, Nimrod; Harats, Moti; Winkler, Eyal; Haik, Josef

2015-01-01

Background: Burn victims experience immense physical and mental hardship during their process of rehabilitation and regaining functionality. We examined different objective burn-related factors as well as psychological ones, in the form of personality traits that may affect the rehabilitation process and its outcome. Objective: To assess the influence and correlation of specific personality traits and objective injury-related parameters on the adjustment of burn victims post-injury. Methods: Sixty-two male patients admitted to our burn unit due to burn injuries were compared with 36 healthy male individuals by use of questionnaires to assess each group’s psychological adjustment parameters. Multivariate and hierarchical regression analysis was conducted to identify differences between the groups. Results: A significant negative correlation was found between the objective burn injury severity (e.g., total body surface area and burn depth) and the adjustment of burn victims (p < 0.05, p < 0.001, Table 3). Moreover, patients more severely injured tend to be more neurotic (p < 0.001), and less extroverted and agreeable (p < 0.01, Table 4). Conclusion: Extroverted burn victims tend to adjust better to their post-injury life while the neurotic patients tend to have difficulties adjusting. This finding may suggest new tools for early identification of maladjustment-prone patients and therefore provide them with better psychological support in a more dedicated manner. PMID:25874193

When does female multiple mating evolve to adjust inbreeding? Effects of inbreeding depression, direct costs, mating constraints, and polyandry as a threshold trait.

PubMed

Duthie, A Bradley; Bocedi, Greta; Reid, Jane M

2016-09-01

Polyandry is often hypothesized to evolve to allow females to adjust the degree to which they inbreed. Multiple factors might affect such evolution, including inbreeding depression, direct costs, constraints on male availability, and the nature of polyandry as a threshold trait. Complex models are required to evaluate when evolution of polyandry to adjust inbreeding is predicted to arise. We used a genetically explicit individual-based model to track the joint evolution of inbreeding strategy and polyandry defined as a polygenic threshold trait. Evolution of polyandry to avoid inbreeding only occurred given strong inbreeding depression, low direct costs, and severe restrictions on initial versus additional male availability. Evolution of polyandry to prefer inbreeding only occurred given zero inbreeding depression and direct costs, and given similarly severe restrictions on male availability. However, due to its threshold nature, phenotypic polyandry was frequently expressed even when strongly selected against and hence maladaptive. Further, the degree to which females adjusted inbreeding through polyandry was typically very small, and often reflected constraints on male availability rather than adaptive reproductive strategy. Evolution of polyandry solely to adjust inbreeding might consequently be highly restricted in nature, and such evolution cannot necessarily be directly inferred from observed magnitudes of inbreeding adjustment. © 2016 The Author(s). Evolution published by Wiley Periodicals, Inc. on behalf of The Society for the Study of Evolution.

Cytokine response signatures in disease progression and development of severe clinical outcomes for leptospirosis.

PubMed

Reis, Eliana A G; Hagan, José E; Ribeiro, Guilherme S; Teixeira-Carvalho, Andrea; Martins-Filho, Olindo A; Montgomery, Ruth R; Shaw, Albert C; Ko, Albert I; Reis, Mitermayer G

2013-01-01

The role of the immune response in influencing leptospirosis clinical outcomes is not yet well understood. We hypothesized that acute-phase serum cytokine responses may play a role in disease progression, risk for death, and severe pulmonary hemorrhage syndrome (SPHS). We performed a case-control study design to compare cytokine profiles in patients with mild and severe forms of leptospirosis. Among patients hospitalized with severe disease, we compared those with fatal and nonfatal outcomes. During active outpatient and hospital-based surveillance we prospectively enrolled 172 patients, 23 with mild disease (outpatient) and 149 with severe leptospirosis (hospitalized). Circulating concentrations of pro- and anti-inflammatory cytokines at the time of patient presentation were measured using a multiplex bead array assay. Concentrations of IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17A, and TNF-α were significantly higher (P<0.05) in severe disease compared to mild disease. Among severe patients, levels of IL-6 (P<0.001), IL-8 (P = 0.0049) and IL-10 (P<0.001), were higher in fatal compared to non-fatal cases. High levels of IL-6 and IL-10 were independently associated (P<0.05) with case fatality after adjustment for age and days of symptoms. IL-6 levels were higher (P = 0.0519) among fatal cases who developed SPHS than among who did not. This study shows that severe cases of leptospirosis are differentiated from mild disease by a "cytokine storm" process, and that IL-6 and IL-10 may play an immunopathogenic role in the development of life-threatening outcomes in human leptospirosis.

Precision mechanisms for optics in a vacuum cryogenic environment

NASA Astrophysics Data System (ADS)

Navarro, R.; Elswijk, E.; Tromp, N.; Kragt, J.; Kroes, G.; Hanenburg, H.; de Haan, M.; Schuil, M.; Teuwen, M.; Janssen, H.; Venema, L.

2017-11-01

To achieve superb stability in cryogenic optical systems, NOVA-ASTRON generally designs optical instruments on the basis of a 'no adjustments' philosophy. This means that in principle no corrections are possible after assembly. The alignment precision and consequently the performance of the instrument is guaranteed from the design, the tolerance analysis and the detailed knowledge of the material behavior and manufacturing process. This resulted in a higher degree of integrated optomechanical-cryogenic design with fewer parts, but with a higher part complexity. The 'no adjustments' strategy is successful because in the end the risk on instrument performance and project delays is much reduced. Astronomical instrument specifications have become more challenging over the years. Recent designs of the European Southern Observatory Very Large Telescope Interferometer (ESO VLTI) 4 Telescope combiner MATISSE include hundreds of optical components in a cryogenic environment. Despite the large number of optical components the alignment accuracy and stability requirements are in the order of nanometers. The 'no adjustments' philosophy would be too costly in this case, because all components would need to meet extremely tight manufacturing specifications. These specifications can be relaxed dramatically if cryogenic mechanisms are used for alignment. Several mechanisms have been developed: a tip-tilt mirror mechanism, an optical path distance mechanism, a slider mechanism, a bistable cryogenic shutter and a mirror mounting clip. Key aspects of these mechanisms are that the optical element and mechanism are combined in a compact single component, driven by e.g. self braking piezo actuators in order to hold position without power. The design, realization and test results of several mechanisms are presented in this paper.

The Staff Observation Aggression Scale - Revised (SOAS-R) - adjustment and validation for emergency primary health care.

PubMed

Morken, Tone; Baste, Valborg; Johnsen, Grethe E; Rypdal, Knut; Palmstierna, Tom; Johansen, Ingrid Hjulstad

2018-05-08

Many emergency primary health care workers experience aggressive behaviour from patients or visitors. Simple incident-reporting procedures exist for inpatient, psychiatric care, but a similar and simple incident-report for other health care settings is lacking. The aim was to adjust a pre-existing form for reporting aggressive incidents in a psychiatric inpatient setting to the emergency primary health care settings. We also wanted to assess the validity of the severity scores in emergency primary health care. The Staff Observation Scale - Revised (SOAS-R) was adjusted to create a pilot version of the Staff Observation Scale - Revised Emergency (SOAS-RE). A Visual Analogue Scale (VAS) was added to the form to judge the severity of the incident. Data for validation of the pilot version of SOAS-RE were collected from ten casualty clinics in Norway during 12 months. Variance analysis was used to test gender and age differences. Linear regression analysis was performed to evaluate the relative impact that each of the five SOAS-RE columns had on the VAS score. The association between SOAS-RE severity score and VAS severity score was calculated by the Pearson correlation coefficient. The SOAS-R was adjusted to emergency primary health care, refined and called The Staff Observation Aggression Scale - Revised Emergency (SOAS-RE). A total of 350 SOAS-RE forms were collected from the casualty clinics, but due to missing data, 291 forms were included in the analysis. SOAS-RE scores ranged from 1 to 22. The mean total severity score of SOAS-RE was 10.0 (standard deviation (SD) =4.1) and the mean VAS score was 45.4 (SD = 26.7). We found a significant correlation of 0.45 between the SOAS-RE total severity scores and the VAS severity ratings. The linear regression analysis showed that individually each of the categories, which described the incident, had a low impact on the VAS score. The SOAS-RE seems to be a useful instrument for research, incident-recording and management of incidents in emergency primary care. The moderate correlation between SOAS-RE severity score and the VAS severity score shows that application of both the severity ratings is valuable to follow-up of workers affected by workplace violence.

Intakes and adequacy of potentially important nutrients for cognitive development among 5-year-old children in the Seychelles Child Development and Nutrition Study

PubMed Central

McAfee, Alison J; Mulhern, Maria S; McSorley, Emeir M; Wallace, Julie MW; Bonham, Maxine P; Faure, Jude; Romain, Sarah; Esther, Christina; Shamlaye, Conrad F; Watson, Gene E; Myers, Gary J; Clarkson, Thomas W; Davidson, Philip W; Strain, JJ

2013-01-01

Objective To assess the nutritional adequacy of Seychellois children in relation to nutrients reported to be important for cognitive development. Design Dietary intakes were assessed by 4 d weighed food diaries and analysed using dietary analysis software (WISP version 3·0; Tinuviel Software, UK). Individual nutrient intakes were adjusted to usual intakes and, in order to investigate adequacy, were compared with the UK Estimated Average Requirements for children aged 4–6 years. Setting Children 5 years old were followed up as part of the Seychelles Child Development Nutrition Study (SCDNS), located in the high-fish-consuming population of Mahé, Republic of Seychelles. Subjects Analysis was carried out on a sample of 229 children (118 boys, 111 girls). Results Children consumed a diet of which fortified cereal and milk products contributed the most to nutrient intakes. The majority (≥80 %) of children met requirements for several nutrients important for child development including Fe, folate and Se. Adjusted dietary intakes of Cu, Zn, iodine, niacin and vitamin A were below the Estimated Average Requirement or Recommended Nutrient Intake. Mean adjusted energy intakes (boys 4769 kJ/d (1139·84 kcal/d), girls 4759 kJ/d (1137·43 kcal/d)) were lower than the estimated energy requirement (boys 5104 kJ/d (1220 kcal/d), girls 5042 kJ/d (1205 kcal/d)) for 88% of boys and 86% of girls. Conclusions Nutrition was adequate for most children within the SCDNS cohort. Low intakes of some nutrients (including Zn, niacin and vitamin A) could reflect nutritional database inaccuracies, but may require further investigation. The study provides valuable information on the adequacy of intakes of nutrients which could affect the growth and development of Seychellois children. PMID:22321870

Longitudinal Study of Oropharyngeal Dysphagia in Preschool Children With Cerebral Palsy.

PubMed

Benfer, Katherine A; Weir, Kelly A; Bell, Kristie L; Ware, Robert S; Davies, Peter S; Boyd, Roslyn N

2016-04-01

To determine changes in prevalence and severity of oropharyngeal dysphagia (OPD) in children with cerebral palsy (CP) and the relationship to health outcomes. Longitudinal cohort study. Community and tertiary institutions. Children (N=53, 33 boys) with a confirmed diagnosis of CP assessed first at 18 to 24 months (Assessment 1: mean age ± SD, 22.9±2.9 mo corrected age; Gross Motor Function Classification System [GMFCS]: I, n=22; II, n=7; III, n=11; IV, n=5; V, n=8) and at 36 months (Assessment 2). Not applicable. OPD was classified using the Dysphagia Disorders Survey (DDS) and signs suggestive of pharyngeal dysphagia. Nutritional status was measured using Z scores for weight, height, and body mass index (BMI). Gross motor skills were classified on GMFCS and motor type/distribution. Prevalence of OPD decreased from 62% to 59% between the ages of 18 to 24 months and 36 months. Thirty percent of children had an improvement in severity of OPD (greater than smallest detectable change), and 4% had worse OPD. Gross motor function was strongly associated with OPD at both assessments, on the DDS (Assessment 1: odds ratio [OR]=20.3, P=.011; Assessment 2: OR=28.9, P=.002), pharyngeal signs (Assessment 1: OR=10.6, P=.007; Assessment 2: OR=15.8, P=.003), and OPD severity (Assessment 1: β=6.1, P<.001; Assessment 2: β=5.5, P<.001). OPD at 18 to 24 months was related to health outcomes at 36 months: low Z scores for weight (adjusted β=1.2, P=.03) and BMI (adjusted β=1.1, P=.048), and increased parent stress (adjusted OR=1.1, P=.049). Classification and severity of OPD remained relatively stable between 18 to 24 months and 36 months. Gross motor function was the best predictor of OPD. These findings contribute to developing more effective screening processes that consider critical developmental transitions that are anticipated to present challenges for children from each of the GMFCS levels. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Diagnostic specificity of poor premorbid adjustment: comparison of schizophrenia, schizoaffective disorder, and mood disorder with psychotic features.

PubMed

Tarbox, Sarah I; Brown, Leslie H; Haas, Gretchen L

2012-10-01

Individuals with schizophrenia have significant deficits in premorbid social and academic adjustment compared to individuals with non-psychotic diagnoses. However, it is unclear how severity and developmental trajectory of premorbid maladjustment compare across psychotic disorders. This study examined the association between premorbid functioning (in childhood, early adolescence, and late adolescence) and psychotic disorder diagnosis in a first-episode sample of 105 individuals: schizophrenia (n=68), schizoaffective disorder (n=22), and mood disorder with psychotic features (n=15). Social and academic maladjustment was assessed using the Cannon-Spoor Premorbid Adjustment Scale. Worse social functioning in late adolescence was associated with higher odds of schizophrenia compared to odds of either schizoaffective disorder or mood disorder with psychotic features, independently of child and early adolescent maladjustment. Greater social dysfunction in childhood was associated with higher odds of schizoaffective disorder compared to odds of schizophrenia. Premorbid decline in academic adjustment was observed for all groups, but did not predict diagnosis at any stage of development. Results suggest that social functioning is disrupted in the premorbid phase of both schizophrenia and schizoaffective disorder, but remains fairly stable in mood disorders with psychotic features. Disparities in the onset and time course of social dysfunction suggest important developmental differences between schizophrenia and schizoaffective disorder. Copyright © 2012 Elsevier B.V. All rights reserved.

Demographic and social variables associated with psychiatric and school-related indicators for Asian/Pacific-Islander adolescents.

PubMed

Hishinuma, Earl S; Johnson, Ronald C; Carlton, Barry S; Andrade, Naleen N; Nishimura, Stephanie T; Goebert, Deborah A; Yuen, Noelle Y C; Wegner, Eldon L; Makini, George K; Nahulu, Linda B; Else, Iwalani R N; Chang, Janice Y

2004-12-01

Factors associated with Asian/Pacific-Islander adolescent adjustment is a greatly neglected research area. The purpose of the present study was to investigate the relation between demographic, social and adjustment measures based on a large-scale investigation of Asian/Pacific-Islander youths. A total of 2577 adolescents were surveyed across 4 public schools in Hawai'i during the 1992--1993 school year. Three social variables (number of relatives frequently seen, family support and friends' support) exhibited statistically significant but low correlations. Family support had the highest negative association with the four psychiatric symptoms (depression, anxiety, aggression, substance use). Friends' support was inconsistently associated with the adjustment measures, and the number of relatives frequently seen resulted in negligible effects. In contrast, demographic variables, especially ethnicity, played a much greater role in the association with the four school-related measures (grade-point average, absences, suspensions, conduct infractions). For Asian/Pacific-Islander youths, the quality of the social supports, including family relations, may be particularly important in the adolescents' adjustment. When examining school-related outcomes, demographic variables, with particular emphases on ethnicity and culture, must be considered. When developing and implementing prevention and intervention services and programs, consideration of family and ethnic-cultural influences should be taken into account, with further research needed in several related domains: other SES influences, life stressors, migration-generational effects, ethnic identity, self-concept indicators and socio-political aspects.

External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China.

PubMed

Yu, Ping; Pan, Yuesong; Wang, Yongjun; Wang, Xianwei; Liu, Liping; Ji, Ruijun; Meng, Xia; Jing, Jing; Tong, Xu; Guo, Li; Wang, Yilong

2016-01-01

A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke. The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS) score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson's correlation coefficient. The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79-0.82), and the c-statistic of model B was 0.82 (95% confidence interval, 0.81-0.84). Excellent calibration was reported in the two models with Pearson's correlation coefficient (0.892 for model A, p<0.001; 0.927 for model B, p = 0.008). The case-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke.

Assessment of prescription opioid intentional exposures across the rural-urban continuum in the United States using both population and drug availability rates.

PubMed

Le Lait, Marie-Claire; Martinez, Erin M; Severtson, Stevan G; Lavery, Sarah A; Bucher-Bartelson, Becki; Dart, Richard C

2014-12-01

Prescription opioid abuse and misuse are a serious problem in the U.S. today. Several studies have shown that the epidemic disproportionately affects rural areas. This paper uses three different rates to gain a more complete picture of opioid abuse in rural areas. This study examines prescription opioid intentional exposures using opioid classes tracked in the RADARS(®) System Poison Center Program. Intentional exposure rates were calculated adjusting for population and unique recipients of dispensed drug (URDD). These rates were analyzed using time (quarter) and the proportion of a three-digit zip code residing in a rural area as covariates. Additionally, the URDD per population rate was calculated to examine the proportion of the population filling prescriptions for opioids. After adjusting for population, intentional exposure cases significantly increased as the proportion of the population residing in a rural area increased. However, when adjusting for URDD, intentional exposure cases decreased with increasing rural population. The URDD per population increased as the proportion of people residing in a rural area increased. Using both population and URDD adjusted intentional exposure rates gives a more complete picture of opioid abuse in rural areas. Considering product availability can be used to develop opioid abuse prevention strategies and further the education of physicians serving rural areas about this epidemic. Copyright © 2014 John Wiley & Sons, Ltd.

24 CFR 570.911 - Reduction, withdrawal, or adjustment of a grant or other appropriate action.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 3 2011-04-01 2010-04-01 true Reduction, withdrawal, or adjustment of a grant or other appropriate action. 570.911 Section 570.911 Housing and Urban Development... DEVELOPMENT BLOCK GRANTS Performance Reviews § 570.911 Reduction, withdrawal, or adjustment of a grant or...

24 CFR 570.911 - Reduction, withdrawal, or adjustment of a grant or other appropriate action.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 3 2013-04-01 2013-04-01 false Reduction, withdrawal, or adjustment of a grant or other appropriate action. 570.911 Section 570.911 Housing and Urban Development... DEVELOPMENT BLOCK GRANTS Performance Reviews § 570.911 Reduction, withdrawal, or adjustment of a grant or...

24 CFR 570.911 - Reduction, withdrawal, or adjustment of a grant or other appropriate action.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Reduction, withdrawal, or adjustment of a grant or other appropriate action. 570.911 Section 570.911 Housing and Urban Development... DEVELOPMENT BLOCK GRANTS Performance Reviews § 570.911 Reduction, withdrawal, or adjustment of a grant or...

24 CFR 570.911 - Reduction, withdrawal, or adjustment of a grant or other appropriate action.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 3 2012-04-01 2012-04-01 false Reduction, withdrawal, or adjustment of a grant or other appropriate action. 570.911 Section 570.911 Housing and Urban Development... DEVELOPMENT BLOCK GRANTS Performance Reviews § 570.911 Reduction, withdrawal, or adjustment of a grant or...

Dairy cow disability weights.

PubMed

McConnel, Craig S; McNeil, Ashleigh A; Hadrich, Joleen C; Lombard, Jason E; Garry, Franklyn B; Heller, Jane

2017-08-01

Over the past 175 years, data related to human disease and death have progressed to a summary measure of population health, the Disability-Adjusted Life Year (DALY). As dairies have intensified there has been no equivalent measure of the impact of disease on the productive life and well-being of animals. The development of a disease-adjusted metric requires a consistent set of disability weights that reflect the relative severity of important diseases. The objective of this study was to use an international survey of dairy authorities to derive disability weights for primary disease categories recorded on dairies. National and international dairy health and management authorities were contacted through professional organizations, dairy industry publications and conferences, and industry contacts. Estimates of minimum, most likely, and maximum disability weights were derived for 12 common dairy cow diseases. Survey participants were asked to estimate the impact of each disease on overall health and milk production. Diseases were classified from 1 (minimal adverse effects) to 10 (death). The data was modelled using BetaPERT distributions to demonstrate the variation in these dynamic disease processes, and to identify the most likely aggregated disability weights for each disease classification. A single disability weight was assigned to each disease using the average of the combined medians for the minimum, most likely, and maximum severity scores. A total of 96 respondents provided estimates of disability weights. The final disability weight values resulted in the following order from least to most severe: retained placenta, diarrhea, ketosis, metritis, mastitis, milk fever, lame (hoof only), calving trauma, left displaced abomasum, pneumonia, musculoskeletal injury (leg, hip, back), and right displaced abomasum. The peaks of the probability density functions indicated that for certain disease states such as retained placenta there was a relatively narrow range of expected impact whereas other diseases elicited a wider breadth of impact. This was particularly apparent with respect to calving trauma, lameness and musculoskeletal injury, all of which could be redefined using gradients of severity or accounting for sequelae. These disability weight distributions serve as an initial step in the development of the disease-adjusted lactation (DALact) metric. They will be used to assess the time lost due to dynamic phases of dairy cow diseases and injuries. Prioritizing health interventions based on time expands the discussion of animal health to view profits and losses in light of the quality and length of life. Copyright © 2017 Elsevier B.V. All rights reserved.

Urine Biomarkers and Perioperative Acute Kidney Injury: The Impact of Preoperative Estimated GFR

PubMed Central

Koyner, Jay L.; Coca, Steven G.; Thiessen-Philbrook, Heather; Patel, Uptal D.; Shlipak, Michael; Garg, Amit X.; Parikh, Chirag R.

2015-01-01

Background The interaction between baseline kidney function and the performance of biomarkers of acute kidney injury (AKI) on the development of AKI is unclear. Study Design Post-hoc analysis of prospective cohort study. Setting & Participants The 1,219 TRIBE-AKI Consortium adult cardiac surgery cohort participants. Predictor Unadjusted post-operative urinary biomarkers of AKI measured within 6 hours of surgery. Outcome AKI was defined as greater than or equal to AKI Network stage 1 (any AKI) as well as a doubling of serum creatinine from the pre-operative value or the need for emergent dialysis (severe AKI). Measurements Stratified analyses by a pre-operative eGFR ≤ 60 ml/min/1.73 m2 vs. > 60 ml/min/1.73 m2. Results 180 (42%) patients with a pre-operative eGFR ≤ 60 ml/min/1.73m2 developed clinical AKI compared to 246 (31%) in those with an eGFR >60 ml/min//1.73m2 (p<0.001). For log2-transformed biomarker concentrations there was a significant interaction between any AKI and baseline eGFR for interleukin 18 (IL-18; p=0.007) and borderline significance for liver-type fatty acid binding protein (p=0.06). For all biomarkers, the adjusted relative risk (RR) point estimates for the risk of any AKI were higher in those with elevated baseline eGFRs compared to those with an eGFR ≤ 60 ml/min/1.73m2. However the difference in magnitude of these risks were quite low (adjusted RRs were 1.04 [95% CI, 0.99–1.09] and 1.11 [95% CI, 1.07–1.15] for those with a pre-operative eGFR ≤ 60 ml/min/1.73 m2 and those with higher eGFRs, respectively). Although no biomarker displayed an interaction for baseline eGFR and severe AKI, log2-transformed IL-18 and kidney injury molecule 1 (KIM-1) had significant adjusted RRs for severe AKI in those with and without baseline eGFR ≤ 60 ml/min/1.73 m2. Limitations Limited numbers of patients with severe AKI and emergent dialysis. Conclusions The association between early post-operative AKI urinary biomarkers and AKI is modified by preoperative eGFR. The degree of this modification and its impact on the biomarker-AKI association is small across biomarkers. Our findings suggest that distinct biomarker cut-offs for those with and without a pre-operative eGFR ≤ 60 ml/min/1.73 m2 is not necessary. PMID:26386737

Ileus in children presenting with diarrhea and severe acute malnutrition: A chart review

PubMed Central

Shahid, Abu SMSB; Shahunja, K. M.; Bardhan, Pradip Kumar; Faruque, Abu Syeed Golam; Shahrin, Lubaba; Das, Sumon Kumar; Barua, Dipesh Kumar; Hossain, Md Iqbal; Ahmed, Tahmeed

2017-01-01

Background Severely malnourished children aged under five years requiring hospital admission for diarrheal illness frequently develop ileus during hospitalization with often fatal outcomes. However, there is no data on risk factors and outcome of ileus in such children. We intended to evaluate predictive factors for ileus during hospitalization and their outcomes. Methodology/Principal findings This was a retrospective chart review that enrolled severely malnourished children under five years old with diarrhea, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh between April 2011 and August 2012. We used electronic database to have our chart abstraction from previously admitted children in the hospital. The clinical and laboratory characteristics of children with (cases = 45), and without ileus (controls = 261) were compared. Cases were first identified by observation of abnormal bowel sounds on physical examination and confirmed with abdominal radiographs. For this comparison, Chi-square test was used to measure the difference in proportion, Student’s t-test to calculate the difference in mean for normally distributed data and Mann-Whitney test for data that were not normally distributed. Finally, in identifying independent risk factors for ileus, logistical regression analysis was performed. Ileus was defined if a child developed abdominal distension and had hyperactive or sluggish or absent bowel sound and a radiologic evidence of abdominal gas-fluid level during hospitalization. Logistic regression analysis adjusting for potential confounders revealed that the independent risk factors for admission for ileus were reluctance to feed (odds ratio [OR] = 3.22, 95% confidence interval [CI] = 1.24–8.39, p = 0.02), septic shock (OR = 3.62, 95% CI = 1.247–8.95, p<0.01), and hypokalemia (OR = 1.99, 95% CI = 1.03–3.86, p = 0.04). Mortality was significantly higher in cases compared to controls (22% vs. 8%, p<0.01) in univariate analysis; however, in multivariable regression analysis, after adjusting for potential confounders such as septic shock, no association was found between ileus and death (OR = 2.05, 95% CI = 0.68–6.14, p = 0.20). In a separate regression analysis model, after adjusting for potential confounders such as ileus, reluctance to feed, hypokalemia, hypocalcemia, and blood transfusion, septic shock (OR = 168.84, 95% CI = 19.27–1479.17, p<0.01) emerged as the only independent predictor of death in severely malnourished diarrheal children. Conclusions/Significance This study suggests that the identification of simple independent admission risk factors for ileus and risk factors for death in hospitalized severely malnourished diarrheal children may prompt clinicians to be more vigilant in managing these conditions, especially in resource-limited settings in order to decrease ileus and ileus-related fatal outcomes in such children. PMID:28493871

Ileus in children presenting with diarrhea and severe acute malnutrition: A chart review.

PubMed

Chisti, Mohammod Jobayer; Shahid, Abu Smsb; Shahunja, K M; Bardhan, Pradip Kumar; Faruque, Abu Syeed Golam; Shahrin, Lubaba; Das, Sumon Kumar; Barua, Dipesh Kumar; Hossain, Md Iqbal; Ahmed, Tahmeed

2017-05-01

Severely malnourished children aged under five years requiring hospital admission for diarrheal illness frequently develop ileus during hospitalization with often fatal outcomes. However, there is no data on risk factors and outcome of ileus in such children. We intended to evaluate predictive factors for ileus during hospitalization and their outcomes. This was a retrospective chart review that enrolled severely malnourished children under five years old with diarrhea, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh between April 2011 and August 2012. We used electronic database to have our chart abstraction from previously admitted children in the hospital. The clinical and laboratory characteristics of children with (cases = 45), and without ileus (controls = 261) were compared. Cases were first identified by observation of abnormal bowel sounds on physical examination and confirmed with abdominal radiographs. For this comparison, Chi-square test was used to measure the difference in proportion, Student's t-test to calculate the difference in mean for normally distributed data and Mann-Whitney test for data that were not normally distributed. Finally, in identifying independent risk factors for ileus, logistical regression analysis was performed. Ileus was defined if a child developed abdominal distension and had hyperactive or sluggish or absent bowel sound and a radiologic evidence of abdominal gas-fluid level during hospitalization. Logistic regression analysis adjusting for potential confounders revealed that the independent risk factors for admission for ileus were reluctance to feed (odds ratio [OR] = 3.22, 95% confidence interval [CI] = 1.24-8.39, p = 0.02), septic shock (OR = 3.62, 95% CI = 1.247-8.95, p<0.01), and hypokalemia (OR = 1.99, 95% CI = 1.03-3.86, p = 0.04). Mortality was significantly higher in cases compared to controls (22% vs. 8%, p<0.01) in univariate analysis; however, in multivariable regression analysis, after adjusting for potential confounders such as septic shock, no association was found between ileus and death (OR = 2.05, 95% CI = 0.68-6.14, p = 0.20). In a separate regression analysis model, after adjusting for potential confounders such as ileus, reluctance to feed, hypokalemia, hypocalcemia, and blood transfusion, septic shock (OR = 168.84, 95% CI = 19.27-1479.17, p<0.01) emerged as the only independent predictor of death in severely malnourished diarrheal children. This study suggests that the identification of simple independent admission risk factors for ileus and risk factors for death in hospitalized severely malnourished diarrheal children may prompt clinicians to be more vigilant in managing these conditions, especially in resource-limited settings in order to decrease ileus and ileus-related fatal outcomes in such children.

Parental divorce during adolescence and adjustment in early adulthood.

PubMed

Richardson, S; McCabe, M P

2001-01-01

The present study examined the impact of parental divorce during adolescence, interparental conflict, and intimacy with parents on young adult adjustment. One hundred sixty-seven undergraduate students (146 females, 21 males) completed a questionnaire regarding their psychosocial adjustment, their present relationships with their parents, the level of interparental conflict experienced during adolescence, and the marital status of their parents during adolescence. High levels of interparental conflict were found to be negatively associated with adjustment and current intimacy with parents. A poor relationship with both parents was negatively associated with several domains of psychosocial adjustment, while high intimacy with at least one parent was positively associated with adjustment. Intimacy with mother and with father were found to be the most important predictors of psychosocial adjustment. This investigation highlights the importance of maintaining a good parent-young adult relationship, particularly in divorced families. The findings indicate that future research should examine multiple family variables when assessing the impact of parental divorce or conflict on young adult adjustment.

Effectiveness of two community-based strategies on disease knowledge and health behaviour regarding malaria, diarrhoea and pneumonia in Ghana.

PubMed

Escribano-Ferrer, Blanca; Gyapong, Margaret; Bruce, Jane; Narh Bana, Solomon A; Narh, Clement T; Allotey, Naa-Korkor; Glover, Roland; Azantilow, Charity; Bart-Plange, Constance; Sagoe-Moses, Isabella; Webster, Jayne

2017-12-12

Ghana has developed two community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia, and to improve household and family practices: integrated Community Case Management (iCCM) and Community-based Health Planning and Services (CHPS). The objective of the study was to assess the effectiveness of iCCM and CHPS on disease knowledge and health behaviour regarding malaria, diarrhoea and pneumonia. A household survey was conducted two and eight years after implementation of iCCM in the Volta and Northern Regions of Ghana respectively, and more than ten years of CHPS implementation in both regions. The study population included 1356 carers of children under- five years of age who had fever, diarrhoea and/or cough in the two weeks prior to the interview. Disease knowledge was assessed based on the knowledge of causes and identification of signs of severe disease and its association with the sources of health education messages received. Health behaviour was assessed based on reported prompt care seeking behaviour, adherence to treatment regime, utilization of mosquito nets and having improved sanitation facilities, and its association with the sources of health education messages received. Health education messages from community-based agents (CBAs) in the Northern Region were associated with the identification of at least two signs of severe malaria (adjusted Odds Ratio (OR) 1.8, 95%CI 1.0, 3.3, p = 0.04), two practices that can cause diarrhoea (adjusted OR 4.7, 95%CI 1.4, 15.5, p = 0.02) 0and two signs of severe pneumonia (adjusted OR 7.7, 95%CI2.2, 26.5, p = 0.01)-the later also associated with prompt care seeking behaviour (p = 0.04). In the Volta Region, receiving messages on diarrhoea from CHPS was associated with the identification of at least two signs of severe diarrhoea (adjusted OR 3.6, 95%CI 1.4, 9.0), p = 0.02). iCCM was associated with prompt care seeking behaviour in the Volta Region and CHPS with prompt care seeking behaviour in the Northern Region (p < 0.5). Both iCCM and CHPS were associated with disease knowledge and health behaviour, but this was more pronounced for iCCM and in the Northern Region. HBC should continue to be considered as the strategy through which community-IMCI is implemented.

Depressive symptoms in nonresident african american fathers and involvement with their sons.

PubMed

Davis, R Neal; Caldwell, Cleopatra Howard; Clark, Sarah J; Davis, Matthew M

2009-12-01

Our objective was to determine whether paternal depressive symptoms were associated with less father involvement among African American fathers not living with their children (ie, nonresident fathers). We analyzed survey data for 345 fathers enrolled in a program for nonresident African American fathers and their preteen sons. Father involvement included measures of contact, closeness, monitoring, communication, and conflict. We used bivariate analyses and multivariate logistic regression analysis to examine associations between father involvement and depressive symptoms. Thirty-six percent of fathers reported moderate depressive symptoms, and 11% reported severe depressive symptoms. In bivariate analyses, depressive symptoms were associated with less contact, less closeness, low monitoring, and increased conflict. In multivariate analyses controlling for basic demographic features, fathers with moderate depressive symptoms were more likely to have less contact (adjusted odds ratio: 1.7 [95% confidence interval: 1.1-2.8]), less closeness (adjusted odds ratio: 2.1 [95% confidence interval: 1.3-3.5]), low monitoring (adjusted odds ratio: 2.7 [95% confidence interval: 1.4-5.2]), and high conflict (adjusted odds ratio: 2.1 [95% confidence interval: 1.2-3.6]). Fathers with severe depressive symptoms also were more likely to have less contact (adjusted odds ratio: 3.1 [95% confidence interval: 1.4-7.2]), less closeness (adjusted odds ratio: 2.6 [95% confidence interval: 1.2-5.7]), low monitoring (adjusted odds ratio: 2.8 [95% confidence interval: 1.1-7.1]), and high conflict (adjusted odds ratio: 2.6 [95% confidence interval: 1.1-5.9]). Paternal depressive symptoms may be an important, but modifiable, barrier for nonresident African American fathers willing to be more involved with their children.

Influence of socioeconomic status on trauma center performance evaluations in a Canadian trauma system.

PubMed

Moore, Lynne; Turgeon, Alexis F; Sirois, Marie-Josée; Murat, Valérie; Lavoie, André

2011-09-01

Trauma center performance evaluations generally include adjustment for injury severity, age, and comorbidity. However, disparities across trauma centers may be due to other differences in source populations that are not accounted for, such as socioeconomic status (SES). We aimed to evaluate whether SES influences trauma center performance evaluations in an inclusive trauma system with universal access to health care. The study was based on data collected between 1999 and 2006 in a Canadian trauma system. Patient SES was quantified using an ecologic index of social and material deprivation. Performance evaluations were based on mortality adjusted using the Trauma Risk Adjustment Model. Agreement between performance results with and without additional adjustment for SES was evaluated with correlation coefficients. The study sample comprised a total of 71,784 patients from 48 trauma centers, including 3,828 deaths within 30 days (4.5%) and 5,549 deaths within 6 months (7.7%). The proportion of patients in the highest quintile of social and material deprivation varied from 3% to 43% and from 11% to 90% across hospitals, respectively. The correlation between performance results with or without adjustment for SES was almost perfect (r = 0.997; 95% CI 0.995-0.998) and the same hospital outliers were identified. We observed an important variation in SES across trauma centers but no change in risk-adjusted mortality estimates when SES was added to adjustment models. Results suggest that after adjustment for injury severity, age, comorbidity, and transfer status, disparities in SES across trauma center source populations do not influence trauma center performance evaluations in a system offering universal health coverage. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Prevalence of musculoskeletal injuries sustained by students while attending a chiropractic college.

PubMed

Ndetan, Harrison T; Rupert, Ronald L; Bae, Sejong; Singh, Karan P

2009-02-01

The purpose of this study was to assess the prevalence, distribution, severity, risk factors of, and response to musculoskeletal injuries to the low back, hand/wrist, and neck/shoulder among chiropractic students while receiving and/or administering adjustments/manipulation while attending a chiropractic college. The study was an epidemiologic survey of chiropractic students at all levels of training (n = 890) at one chiropractic college. A self-administered anonymous 3-paged questionnaire was used. The questionnaire was divided into sections for collecting data separately on injuries associated with receiving or administering chiropractic adjustments. The response rate was 64.3% with 62.6% male respondents. The overall prevalence of injuries sustained in college was 31.5%, 44.4% of which was exacerbations of prior complaints. Injuries from receiving adjustments/manipulation were most prevalent to neck/shoulder (65.7%), whereas hand/wrist injuries were most common when administering adjustments (45.6%). The risk difference among students receiving adjustments was 81.6/1000 neck/shoulder injuries, and the etiologic fraction was 76.6%. The risk difference was 170/1000 hand/wrist injuries with etiologic fraction of 96.5% among students administering adjustments. Diversified, Gonstead, and upper cervical adjusting techniques were perceived to be the most injury-related. Some students enroll in a chiropractic college with preexisting injuries that can easily be exacerbated. Others sustain new injuries of moderate severity from receiving and administering adjustments. Potential risk factors may include height, body mass index, and nonexercising. The risk factors and mechanisms responsible for the high levels of hand/wrist injuries need further examination. This research identifies an important need to design a comprehensive and logical protocol to prevent injury to chiropractic students.

Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study.

PubMed

Chen, Chien-Min; Yang, Yao-Hsu; Chang, Chia-Hao; Chen, Pau-Chung

2017-12-01

To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward. Long-term mortality rates of first-time stroke survivors during hospitalization were compared among the following sets of patients: patients transferred to the rehabilitation ward, patients receiving rehabilitation without being transferred to the rehabilitation ward, and patients receiving no rehabilitation. Retrospective cohort study. Patients (N = 11,419) with stroke from 2005 to 2008 were initially assessed for eligibility. After propensity score matching, 390 first-time stroke survivors were included. None. Cox proportional hazards regression model was used to assess differences in 5-year poststroke mortality rates. Based on adjusted hazard ratios (HRs), the patients receiving rehabilitation without being transferred to the rehabilitation ward (adjusted HR, 2.20; 95% confidence interval [CI], 1.36-3.57) and patients receiving no rehabilitation (adjusted HR, 4.00; 95% CI, 2.55-6.27) had significantly higher mortality risk than the patients transferred to the rehabilitation ward. Mortality rate of the stroke survivors was affected by age ≥65 years (compared with age <45y; adjusted HR, 3.62), being a man (adjusted HR, 1.49), having ischemic stroke (adjusted HR, 1.55), stroke severity (Stroke Severity Index [SSI] score≥20, compared with SSI score<10; adjusted HR, 2.68), and comorbidity (Charlson-Deyo Comorbidity Index [CCI] score≥3, compared with CCI score=0; adjusted HR, 4.23). First-time stroke survivors transferred to the rehabilitation ward had a 5-year mortality rate 2.2 times lower than those who received rehabilitation without transfer to the rehabilitation ward and 4 times lower than those who received no rehabilitation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Association between the severity of symptomatic knee osteoarthritis and cumulative metabolic factors.

PubMed

Yasuda, Emi; Nakamura, Ryuichi; Matsugi, Ryo; Goto, Shinsuke; Ikenaga, Yasunori; Kuroda, Kazunari; Nakamura, Syunsuke; Katsuki, Yasuo; Katsuki, Tatsuo

2018-05-01

The association between cumulative metabolic syndrome (MS) factors and knee osteoarthritis (KOA) has been highlighted over the past two decades. To clarify the relationship between cumulative MS factors and symptomatic KOA. A cross-sectional survey involving 119 women aged 45-88 years who were scheduled to undergo knee surgery was conducted. They were stratified into tertiles of symptoms as assessed by the Japanese Orthopedic Association score for KOA. Multinomial logistic regressions were performed using the severity of symptomatic KOA as the dependent variable and each MS factor or the cumulative MS factors as the independent variables. Logistic regression analyses were performed with the upper tertile of stratified symptoms of subjects used as the reference group. After adjustment for confounders, KOA patients who had two (p = 0.004) or three or more (p < 0.0001) MS factors were significantly more likely to have severe symptoms compared to those who had no MS factors. MS factors excluding obesity were similarly analyzed. Even after additional adjustment for body mass index (BMI), KOA patients who had two or more (p = 0.005) MS factors were significantly more likely to have severe symptoms. Among KOA female patients diagnosed using radiographic definition, the severity of symptomatic KOA was significantly associated with hypertension, dyslipidemia, and the number of MS factors after adjustment for age, BMI, strength of the knee extensor, and Kellgren-Lawrence grade. The severity of radiographic KOA was not associated with any MS factor or cumulative MS factors.

Comparative Effectiveness of Vancomycin and Metronidazole for the Prevention of Recurrence and Death in Patients With Clostridium difficile Infection.

PubMed

Stevens, Vanessa W; Nelson, Richard E; Schwab-Daugherty, Elyse M; Khader, Karim; Jones, Makoto M; Brown, Kevin A; Greene, Tom; Croft, Lindsay D; Neuhauser, Melinda; Glassman, Peter; Goetz, Matthew Bidwell; Samore, Matthew H; Rubin, Michael A

2017-04-01

Metronidazole hydrochloride has historically been considered first-line therapy for patients with mild to moderate Clostridium difficile infection (CDI) but is inferior to vancomycin hydrochloride for clinical cure. The choice of therapy may likewise have substantial consequences on other downstream outcomes, such as recurrence and mortality, although these secondary outcomes have been less studied. To evaluate the risk of recurrence and all-cause 30-day mortality among patients receiving metronidazole or vancomycin for the treatment of mild to moderate and severe CDI. This retrospective, propensity-matched cohort study evaluated patients treated for CDI, defined as a positive laboratory test result for the presence of C difficile toxins or toxin genes in a stool sample, in the US Department of Veterans Affairs health care system from January 1, 2005, through December 31, 2012. Data analysis was performed from February 7, 2015, through November 22, 2016. Treatment with vancomycin or metronidazole. The outcomes of interest in this study were CDI recurrence and all-cause 30-day mortality. Recurrence was defined as a second positive laboratory test result within 8 weeks of the initial CDI diagnosis. All-cause 30-day mortality was defined as death from any cause within 30 days of the initial CDI diagnosis. A total of 47 471 patients (mean [SD] age, 68.8 [13.3] years; 1947 women [4.1%] and 45 524 men [95.9%]) developed CDI, were treated with vancomycin or metronidazole, and met criteria for entry into the study. Of 47 147 eligible first treatment episodes, 2068 (4.4%) were with vancomycin. Those 2068 patients were matched to 8069 patients in the metronidazole group for a total of 10 137 included patients. Subcohorts were constructed that comprised 5452 patients with mild to moderate disease and 3130 patients with severe disease. There were no differences in the risk of recurrence between patients treated with vancomycin vs those treated with metronidazole in any of the disease severity cohorts. Among patients in the any severity cohort, those who were treated with vancomycin were less likely to die (adjusted relative risk, 0.86; 95% CI, 0.74 to 0.98; adjusted risk difference, -0.02; 95% CI, -0.03 to -0.01). No significant difference was found in the risk of mortality between treatment groups among patients with mild to moderate CDI, but vancomycin significantly reduced the risk of all-cause 30-day mortality among patients with severe CDI (adjusted relative risk, 0.79; 95% CI, 0.65 to 0.97; adjusted risk difference, -0.04; 95% CI, -0.07 to -0.01). Recurrence rates were similar among patients treated with vancomycin and metronidazole. However, the risk of 30-day mortality was significantly reduced among patients who received vancomycin. Our findings may further justify the use of vancomycin as initial therapy for severe CDI.

Developing mathematics edutainment media for Android based on students’ understanding and interest: a teachers’ review

NASA Astrophysics Data System (ADS)

Setyaningrum, W.; Waryanto, N. H.

2018-03-01

This paper aimed to describe the development of interactive edutainment mathematics media using Construct 2 software for grade 7 Junior High School, and to determine the quality of the interactive edutainment media developed in regards to improve students’ understanding and interest. This research employs Research and Development design, which media was developed using ADDIE model consisting of analysing, designing, developing, implementing and evaluating. This paper focuses on the steps of development and validity of the interactive media from teachers’ point of view. The teachers review focuses on three aspects – instructional, audio-visual and operational design. The review suggested that the media was very good in regard to the three aspects, with the average score was 144.55 from the maximum score of 175. Several contexts used in the game, however, need to be adjusted to students age.

Consequences of self-handicapping: effects on coping, academic performance, and adjustment.

PubMed

Zuckerman, M; Kieffer, S C; Knee, C R

1998-06-01

Self-handicappers erect impediments to performance to protect their self-esteem. The impediments may interfere with the ability to do well and, as such, may result in poor adjustment. Using a longitudinal design, the present studies examined prospective effects of self-handicapping on coping, academic performance, and several adjustment-related variables (e.g., self-esteem). It was found that, compared to low self-handicappers, high self-handicappers reported higher usage of coping strategies implying withdrawal and negative focus. High self-handicappers performed less well academically, an effect that was mediated in part by poor study habits. Finally, high self-handicapping resulted in poorer adjustment over time, and poorer adjustment resulted in higher self-handicapping over time. These relations are consistent with the idea of a vicious cycle in which self-handicapping and poor adjustment reinforce one another.

Patients With Carbon Monoxide Poisoning and Subsequent Dementia

PubMed Central

Lai, Ching-Yuan; Huang, Yu-Wei; Tseng, Chun-Hung; Lin, Cheng-Li; Sung, Fung-Chang; Kao, Chia-Hung

2016-01-01

Abstract The present study evaluated the dementia risk after carbon monoxide poisoning (CO poisoning). Using the National Health Insurance Research Database of Taiwan, a total of 9041 adults newly diagnosed with CO poisoning from 2000 to 2011 were identified as the CO poisoning cohort. Four-fold (N = 36,160) of non-CO poisoning insured people were randomly selected as controls, frequency-matched by age, sex, and hospitalization year. Incidence and hazard ratio (HR) of dementia were measured by the end 2011. The dementia incidence was 1.6-fold higher in the CO exposed cohort than in the non-exposed cohort (15.2 vs 9.76 per 10,000 person-years; n = 62 vs 174) with an adjusted HR of 1.50 (95% CI = 1.11–2.04). The sex- and age-specific hazards were higher in male patients (adjusted HR = 1.74, 95% CI = 1.20–2.54), and those aged <=49 years (adjusted HR = 2.62, 95% CI = 1.38–4.99). CO exposed patients with 7-day or longer hospital stay had an adjusted HR of 2.18 (95% CI = 1.42, 3.36). The CO poisoning patients on hyperbaric oxygen (HBO2) therapy had an adjusted HR of 1.80 (95% CI = 0.96–3.37). This study suggests that CO poisoning may have association with the risk of developing dementia, which is significant for severe cases. The effectiveness of HBO2 therapy remains unclear in preventing dementia. Patients with CO poisoning are more prevalent with depression. PMID:26735545

Prevalence of and Factors Associated with Negative Microscopic Diagnosis of Cutaneous Leishmaniasis in Rural Peru.

PubMed

Lamm, Ryan; Alves, Clark; Perrotta, Grace; Murphy, Meagan; Messina, Catherine; Sanchez, Juan F; Perez, Erika; Rosales, Luis Angel; Lescano, Andres G; Smith, Edward; Valdivia, Hugo; Fuhrer, Jack; Ballard, Sarah-Blythe

2018-06-04

Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results were identified using χ 2 test, t -test, and multivariate logistic regression analyses. Negative microscopy with positive PCR occurred in 31% (123/403) of the 403 cases. After adjusting for confounders, binary multivariate logistic regression analyses revealed that negative microscopy with positive PCR was associated with patients who were male (adjusted OR = 1.93 [1.06-3.53], P = 0.032), had previous leishmaniasis (adjusted OR = 2.93 [1.65-5.22], P < 0.0001), had larger lesions (adjusted OR = 1.02 [1.003-1.03], P = 0.016), and/or had a longer duration between lesion appearance and PCR testing (adjusted OR = 1.12 [1.02-1.22], P = 0.017). Future research should focus on further exploration of these underlying variables, discovery of other factors that may be associated with negative microscopy diagnosis, and the development and implementation of improved testing in endemic regions.

Association between bullying at work and mental disorders: gender differences in the Italian people.

PubMed

Nolfe, Giovanni; Petrella, Claudio; Zontini, Gemma; Uttieri, Simona; Nolfe, Giuseppe

2010-11-01

In the last few years the international literature has shown an increasing attention for the work as life-event stressor, for its organizational characteristics as well as for job insecurity and interpersonal conflicts. We have studied 707 subjects who approached the Work Psychopathology Medical Centre of Naples to evaluate the DSM IV diagnoses and the degree of bullying at the workplace according to Leymann's definition. Two groups, with high and with low severity of bullying, were compared, mainly in relation to gender differences. The more frequent diagnoses were anxiety disorders (8.7% of the total), mood disorders (31.5%) and adjustment disorders (58.3%). The patients with higher degree of bullying were 55.7% among the subjects with anxiety disorders, 51.4% among the patients with adjustment disorders and 81.25% in the group with mood disorders. The odds of patients with severe bullying was 1.602 times higher for males than for females. Independently by the gender, the odds of patients being in the group with severe bullying were more than three times higher for subjects with mood disorders than for patients suffering from anxiety and adjustment disorders. In the male gender, the psychiatric disturbances are more correlated to bullying at the workplace and this datum is especially linked to the gender differences found in the relationship between severity of bullying and adjustment disorders. Among female employees the psychopathological dimensions could be linked with a more multifactorial genesis in relation to their psychosocial role in the cultural context we examined (Southern Italy).

Trauma, comorbidity, and mortality following diagnoses of severe stress and adjustment disorders: a nationwide cohort study.

PubMed

Gradus, Jaimie L; Antonsen, Sussie; Svensson, Elisabeth; Lash, Timothy L; Resick, Patricia A; Hansen, Jens Georg

2015-09-01

Longitudinal outcomes following stress or trauma diagnoses are receiving attention, yet population-based studies are few. The aims of the present cohort study were to examine the cumulative incidence of traumatic events and psychiatric diagnoses following diagnoses of severe stress and adjustment disorders categorized using International Classification of Diseases, Tenth Revision, codes and to examine associations of these diagnoses with all-cause mortality and suicide. Data came from a longitudinal cohort of all Danes who received a diagnosis of reaction to severe stress or adjustment disorders (International Classification of Diseases, Tenth Revision, code F43.x) between 1995 and 2011, and they were compared with data from a general-population cohort. Cumulative incidence curves were plotted to examine traumatic experiences and psychiatric diagnoses during the study period. A Cox proportional hazards regression model was used to examine the associations of the disorders with mortality and suicide. Participants with stress diagnoses had a higher incidence of traumatic events and psychiatric diagnoses than did the comparison group. Each disorder was associated with a higher rate of all-cause mortality than that seen in the comparison cohort, and strong associations with suicide were found after adjustment. This study provides a comprehensive assessment of the associations of stress disorders with a variety of outcomes, and we found that stress diagnoses may have long-lasting and potentially severe consequences. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Factors protecting against the development of adjustment difficulties in young adults exposed to childhood sexual abuse.

PubMed

Lynskey, M T; Fergusson, D M

1997-12-01

The aims of this study were to identify the factors which discriminated young people exposed to childhood sexual abuse (CSA) who developed psychiatric disorder or adjustment difficulties in young adulthood from those young people exposed to CSA who did not develop psychiatric disorder or adjustment difficulties by age 18. Data were gathered on a birth cohort of 1,025 New Zealand children studied from birth to the age of 18 on (a) exposure to CSA; (b) patterns of psychiatric disorder and adjustment difficulties at age 18 years; (c) factors that may have influenced responses to CSA including characteristics of the abuse, parental bonding, parental characteristics, and adolescent peer affiliations. Just over 10% of the cohort reported CSA. Those reporting CSA were at increased risks of a range of difficulties at age 18 (depression, anxiety, conduct disorder, alcohol abuse/dependence, other substance abuse/dependence, post sexual abuse trauma, attempted suicide). However, not all of those exposed to CSA developed difficulties and approximately a quarter of those exposed to CSA did not meet criteria for any adjustment difficulty. Further analysis suggested that the extent of adjustment difficulties in those exposed to CSA was influenced by two additional factors: (a) the extent of affiliations with delinquent or substance using peers in adolescence; and (b) the extent of paternal care or support in childhood. The findings of this study suggest that while young people exposed to CSA are at increased risks of psychiatric disorder and adjustment difficulties in young adulthood, not all individuals exposed to CSA will develop adjustment difficulties. Important factors protecting against the development of adjustment difficulties in young people experiencing CSA appear to be the nature and quality of peer and family relationships.

Development and characterization of adjustable refractive index scattering epoxy acrylate polymer layers

NASA Astrophysics Data System (ADS)

Eiselt, Thomas; Preinfalk, Jan; Gleißner, Uwe; Lemmer, Uli; Hanemann, Thomas

2017-03-01

Several polymer films for improved optical properties in optoelectronic devices are presented. In such optical applications, it is sometimes important to have a film with an adjusted refractive index, scattering properties, and a low surface roughness. These diffusing films can be used to increase the efficiency of optoelectronic components, such as organic light-emitting diodes. Three different epoxy acrylate mixtures containing Syntholux 291 EA, bisphenol A glycerolate dimethacrylate, and Sartomer SR 348 L are characterized and optimized with different additives. The adjustable refractive index of the material is achieved by chemical doping using 9-vinylcarbazole. Titanium nanoparticles in the mixtures generate light scattering and increase the refractive index additionally. A high-power stirrer is used to mix and disperse all chemical substances together to a homogenous mixture. The viscosity behavior of the mixtures is an important property for the selection of the production method and, therefore, the viscosity measurement results are presented. After the mixing, the monomer mixture is applied on glass substrates by screen printing. To initiate polymerization, the produced films are irradiated for 10 min with ultraviolet radiation and heat. Transmission measurements of the polymer matrix and roughness measurements complement the characterization.

Coping with persistent pain: a comparison of persistent pain sufferers in a specialty pain clinic and in a family practice clinic.

PubMed

Crook, J; Tunks, E; Kalaher, S; Roberts, J

1988-08-01

Coping has been defined as an effort to manage external and internal demands and conflicts that tax or exceed a person's resources. This paper examines the types of coping strategies used by two groups of persistent pain sufferers: one from a family practice clinic and the other from a specialty pain clinic. The relationship between the use of different types of coping strategies and adjustment was determined. The two study groups of persistent pain sufferers differed significantly from each other on many of the indices developed to tap adjustment but did not differ on any of the Billings and Moos original categories of coping strategies. When a factor analysis of coping items was performed, 5 valid clusters relevant to the chronic pain patient samples were determined. The factor the authors entitled 'adversarialness' with the qualities of dysphoric withdrawal, avoidant behavior and catastrophizing was found to explain adjustment defined by several indices. The authors conclude that it may be important to help persistent pain sufferers to alter their attitudes and behavior that tend toward catastrophizing, avoidance and withdrawal, rather than simply concentrate on trying to teach them techniques for 'coping with stress.'

Bundle Block Adjustment of Airborne Three-Line Array Imagery Based on Rotation Angles

PubMed Central

Zhang, Yongjun; Zheng, Maoteng; Huang, Xu; Xiong, Jinxin

2014-01-01

In the midst of the rapid developments in electronic instruments and remote sensing technologies, airborne three-line array sensors and their applications are being widely promoted and plentiful research related to data processing and high precision geo-referencing technologies is under way. The exterior orientation parameters (EOPs), which are measured by the integrated positioning and orientation system (POS) of airborne three-line sensors, however, have inevitable systematic errors, so the level of precision of direct geo-referencing is not sufficiently accurate for surveying and mapping applications. Consequently, a few ground control points are necessary to refine the exterior orientation parameters, and this paper will discuss bundle block adjustment models based on the systematic error compensation and the orientation image, considering the principle of an image sensor and the characteristics of the integrated POS. Unlike the models available in the literature, which mainly use a quaternion to represent the rotation matrix of exterior orientation, three rotation angles are directly used in order to effectively model and eliminate the systematic errors of the POS observations. Very good experimental results have been achieved with several real datasets that verify the correctness and effectiveness of the proposed adjustment models. PMID:24811075

Bundle block adjustment of airborne three-line array imagery based on rotation angles.

PubMed

Zhang, Yongjun; Zheng, Maoteng; Huang, Xu; Xiong, Jinxin

2014-05-07

In the midst of the rapid developments in electronic instruments and remote sensing technologies, airborne three-line array sensors and their applications are being widely promoted and plentiful research related to data processing and high precision geo-referencing technologies is under way. The exterior orientation parameters (EOPs), which are measured by the integrated positioning and orientation system (POS) of airborne three-line sensors, however, have inevitable systematic errors, so the level of precision of direct geo-referencing is not sufficiently accurate for surveying and mapping applications. Consequently, a few ground control points are necessary to refine the exterior orientation parameters, and this paper will discuss bundle block adjustment models based on the systematic error compensation and the orientation image, considering the principle of an image sensor and the characteristics of the integrated POS. Unlike the models available in the literature, which mainly use a quaternion to represent the rotation matrix of exterior orientation, three rotation angles are directly used in order to effectively model and eliminate the systematic errors of the POS observations. Very good experimental results have been achieved with several real datasets that verify the correctness and effectiveness of the proposed adjustment models.

Workplace standing time and the incidence of obesity and type 2 diabetes: a longitudinal study in adults.

PubMed

Chaput, Jean-Philippe; Saunders, Travis J; Tremblay, Mark S; Katzmarzyk, Peter T; Tremblay, Angelo; Bouchard, Claude

2015-02-10

It is increasingly recognized that standing represents a simple solution to extended periods of sitting. However, it is currently unknown whether workplace standing time is prospectively associated with a lower incidence of chronic diseases. The objective of this study was to examine the association between workplace standing time and the incidence of overweight/obesity (OW/OB) and impaired glucose tolerance/type 2 diabetes (IGT/T2D) in adults. A longitudinal analysis from the Quebec Family Study (Canada) was conducted on 293 participants, aged 18 to 65 years, followed for a mean of 6 years. Information on self-reported occupational standing time as well as several covariates was collected at both baseline and follow-up. Outcome measures included the development of OW/OB (i.e. body mass index ≥25 kg/m(2)) and IGT/T2D (i.e. 2-h postload plasma glucose level ≥7.8 mmol/L). The incidence rates of OW/OB and IGT/T2D over the 6-year follow-up period were 17.4% and 12.6%, respectively. Significant negative associations were observed between the amount of occupational standing time and the development of outcome measures. However, the associations were no longer significant after adjustment for age, sex, smoking habits, total annual family income, daily caloric intake, and submaximal working capacity. In age- and sex-adjusted logistic regression analysis, significant negative linear trends were observed across levels of standing time and the outcome variables. However, the associations were no longer significant after further adjustment for the other covariates. Finally, we observed that the change in standing time from baseline to year 6 was significantly associated with the development of outcome measures, with higher incidence rates in adults reporting a reduction in standing time at follow-up. However, the associations became non-significant after adjustment for covariates. Greater occupational standing time is not sufficient in and of itself to prevent the development of OW/OB and IGT/T2D in adults. Future efforts are needed to better understand the potential benefits of higher amounts of standing time throughout the day on the prevention of chronic diseases.

Angiographic evidence of proliferative retinopathy predicts neuropsychiatric morbidity in diabetic patients.

PubMed

Serlin, Yonatan; Shafat, Tali; Levy, Jaime; Winter, Aaron; Shneck, Marina; Knyazer, Boris; Parmet, Yisrael; Shalev, Hadar; Ur, Ehud; Friedman, Alon

2016-05-01

Diabetic retinopathy (DR) is a common vasculopathy categorized as either non-proliferative (NPDR) or proliferative (PDR),characterized by dysfunctional blood-retinal barrier (BRB) and diagnosed using fluorescein angiography (FA). Since the BRB is similar in structure and function to the blood-brain barrier (BBB) and BBB dysfunction plays a key role in the pathogenesis of brain disorders, we hypothesized that PDR, the severe form of DR, is likely to mirror BBB damage and to predict a worse neuropsychiatric outcome. A retrospective cohort study was conducted among subjects with diabetes (N=2982) with FA-confirmed NPDR (N=2606) or PDR (N=376). Incidence and probability to develop brain pathologies and mortality were investigated in a 10-year follow-up study. We used Kaplan-Meier, Cox and logistic regression analyses to examine association between DR severity and neuropsychiatric morbidity adjusting for confounders. Patients with PDR had significantly higher rates of all-cause brain pathologies (P<0.001), specifically stroke (P=0.005), epilepsy (P=0.006) and psychosis (P=0.024), and a shorter time to develop any neuropsychiatric event (P<0.001) or death (P=0.014) compared to NPDR. Cox adjusted hazard ratio for developing all-cause brain impairments was higher for PDR (HR=1.37, 95% CI 1.16-1.61, P<0.001) which was an independent predictor for all-cause brain impairments (OR 1.30, 95% CI 1.04-1.64, P=0.022), epilepsy (OR 2.16, 95% CI 1.05-4.41, P=0.035) and mortality (HR=1.35, 95% CI 1.06-1.70, P=0.014). This is the first study to confirm that angiography-proven microvasculopathy identifies patients at high risk for neuropsychiatric morbidity and mortality. Copyright © 2016. Published by Elsevier Ltd.

Estimating vaccine effectiveness against severe influenza in England and Scotland 2011/2012: applying the screening method to data from intensive care surveillance systems.

PubMed

Thomas, H L; Andrews, N; Green, H K; Boddington, N L; Zhao, H; Reynolds, A; McMenamin, J; Pebody, R G

2014-01-01

Methods for estimating vaccine effectiveness (VE) against severe influenza are not well established. We used the screening method to estimate VE against influenza resulting in intensive care unit (ICU) admission in England and Scotland in 2011/2012. We extracted data on confirmed influenza ICU cases from severe influenza surveillance systems, and obtained their 2011/2012 trivalent influenza vaccine (TIV) status from primary care. We compared case vaccine uptake with population vaccine uptake obtained from routine monitoring systems, adjusting for age group, specific risk group, region and week. Of 60 influenza ICU cases reported, vaccination status was available for 56 (93%). Adjusted VE against ICU admission for those aged ≥ 65 years was -10% [95% confidence interval (CI) -207 to 60], consistent with evidence of poor protection from the 2011/2012 TIV in 2011/2012. Adjusted VE for those aged <65 years in risk groups was -296% (95% CI -930 to -52), suggesting significant residual confounding using the screening method in those subject to selective vaccination.

Morbidity and mortality risk among patients with screening-detected severe hypertension in the Malmö Preventive Project.

PubMed

Westerdahl, Christina; Zöller, Bengt; Arslan, Eren; Erdine, Serap; Nilsson, Peter M

2014-12-01

Screening of hypertension has been advocated for early detection and treatment. Severe hypertension (grade 3 hypertension) is a strong predictor for cardiovascular disease. This study aimed to evaluate not only the risk factors for developing severe hypertension, but also the prospective morbidity and mortality risk associated with severe hypertension in a population-based screening and intervention programme. In all, 18,200 individuals from a population-based cohort underwent a baseline examination in 1972-1992 and were re-examined in 2002-2006 in Malmö, Sweden. In total, 300 (1.6%) patients with severe hypertension were identified at re-examination, and predictive risk factors from baseline were calculated. Total and cause-specific morbidity and mortality were followed in national registers in all severe hypertension patients, as well as in age and sex-matched normotensive controls. Cox analyses for hazard ratios were used. Men developing severe hypertension differed from matched controls in baseline variables associated with the metabolic syndrome, as well as paternal history of hypertension (P < 0.001). Women with later severe hypertension were characterized by elevated BMI and a positive maternal history for hypertension at baseline. The risk of mortality, coronary events, stroke and diabetes during follow-up was higher among severe hypertension patients compared to controls. For coronary events, the risk remained elevated adjusted for other risk factors [hazard ratio 2.31, 95% confidence interval (CI) 1.22-4.40, P = 0.011]. Family history and variables associated with metabolic syndrome are predictors for severe hypertension after a long-term follow-up. Severe hypertension is associated with increased mortality, cardiovascular morbidity and incident diabetes in spite of treatment. This calls for improved risk factor control in patients with severe hypertension.

Original Article: Preeclampsia, Placental Insufficiency and Autism Spectrum Disorder or Developmental Delay

PubMed Central

Walker, Cheryl K.; Krakowiak, Paula; Baker, Alice; Hansen, Robin L.; Ozonoff, Sally; Hertz-Picciotto, Irva

2014-01-01

Importance Increasing evidence suggests that autism spectrum disorder (ASD) and many forms of developmental delay (DD) originate during fetal development. Preeclampsia may trigger aberrant neurodevelopment through placental, maternal and fetal physiologic mechanisms. Objective To determine whether preeclampsia is associated with ASD and/or DD. Design, Setting and Participants The CHildhhood Autism Risks from Genetics and the Environment (CHARGE) Study is a population-based case-control investigation of ASD and/or DD origins. Children from 20 California counties aged 24-60 months at the time of recruitment, and living in catchment areas with a biologic parent fluent in English or Spanish were enrolled from January 29, 2003 through April 7, 2011. Children with ASD (n=517) and DD (n=194) were recruited through the California Department of Developmental Services, the Medical Investigation of Neurodevelopmental Disorders (MIND) Institute and referrals. Controls with typical development (TD) controls (n=350) were randomly selected from birth records and frequency-matched on age, sex, and broad geographic region. Physicians diagnosing preeclampsia were masked to neurodevelopmental outcome, and those assessing neurodevelopmental function were masked to preeclampsia status. Exposure Preeclampsia and placental insufficiency were self-reported and abstracted from medical records. Main Outcome Measure The Autism Diagnostic Observation Schedule and Autism Diagnostic Interview–Revised were used to confirm ASD, whereas children with DD and TD were confirmed by Mullen Scales of Early Learning and Vineland Adaptive Behavior Scales and were free of autistic symptoms. Hypotheses were formulated before data collection. Results Children with ASD were twice as likely to have been exposed in utero to preeclampsia as controls with TD after adjustment for maternal educational level, parity, and prepregnancy obesity (adjusted odds ratio, 2.36; 95% CI, 1.18-4.68); risk increased with greater preeclampsia severity (test for trend p=0.02). Placental insufficiency appeared responsible for the increase in DD risk associated with severe preeclampsia (adjusted odds ratio, 5.49; 95% CI, 2.06-14.64). Conclusions and Relevance Preeclampsia, particularly severe disease, is associated with ASD and DD. Faulty placentation manifests in the mother as preeclampsia with vascular damage, enhanced systemic inflammation and insulin resistance; in the placenta as oxygen and nutrient transfer restriction and oxidative stress; and in the fetus as growth restriction and progressive hypoxemia. All are potential mechanisms for neurodevelopmental compromise. PMID:25485869

Sickle Cell Disease Pain: Relation of Coping Strategies to Adjustment.

ERIC Educational Resources Information Center

Gil, Karen M.; And Others

1989-01-01

Examined pain coping strategies in 79 adult sickle cell disease (SCD) patients. Results revealed that coping strategies factors were important predictors of pain and adjustment. Subjects high on Negative Thinking and Passive Adherence had more severe pain, were less active and more distressed, and used more health services. Individuals high on…

Curvilinear Associations between Benefit Finding and Psychosocial Adjustment to Breast Cancer

ERIC Educational Resources Information Center

Lechner, Suzanne C.; Carver, Charles S.; Antoni, Michael H.; Weaver, Kathryn E.; Phillips, Kristin M.

2006-01-01

Two previously studied cohorts of women with nonmetastatic breast cancer (Ns = 230 and 136) were reexamined. Participants were assessed during the year after surgery and 5-8 years later. Associations were examined between benefit finding (BF) and several indicators of psychosocial adjustment (e.g., perceived quality of life, positive affect,…

Bench-top soldering aid for PC boards

NASA Technical Reports Server (NTRS)

Manton, N. R.; Schroff, R. A.

1978-01-01

Multiple-board rack allows technician to insert components into several boards, flip them all in single motion, and then systematically solder leads on reverse side. Two adjustable crossbars allow boards of any size up to 10 by 24 inches. Operator can rotate racks and adjust angle of boards from standing or sitting position.

Children's adjustment following Hurricane Katrina: the role of primary caregivers.

PubMed

Gil-Rivas, Virginia; Kilmer, Ryan P

2013-01-01

Hurricane Katrina severely disrupted the lives of many children and families in the central Gulf Coast of the United States. Face-to-face interviews with child-caregiver dyads were conducted at approximately 1 year posthurricane (T1) and 6-10 months later (T2). The contribution of several factors-caregiver's self-reported symptomatology and coping advice and child perceptions of caregiver distress, unavailability, warmth, and caregiver-child conflict-to child-reported posttraumatic stress symptoms (PTSS) and depressive symptoms was examined. Findings provide partial support for the importance of the caregiving context to children's adjustment. Specifically, higher levels of caregiver-child conflict at T1 were associated with more PTSS at T2, controlling for baseline symptoms. In contrast, higher levels of caregiver education were negatively related to child PTSS at T2. After adjusting for objective hurricane exposure and symptoms at T1, none of the caregiving variables was related to child-reported depressive symptoms at T2. The implications of these findings for efforts to promote children's adjustment after disaster are discussed. © 2013 American Orthopsychiatric Association.

Developments in Sensitivity Methodologies and the Validation of Reactor Physics Calculations

DOE PAGES

Palmiotti, Giuseppe; Salvatores, Massimo

2012-01-01

The sensitivity methodologies have been a remarkable story when adopted in the reactor physics field. Sensitivity coefficients can be used for different objectives like uncertainty estimates, design optimization, determination of target accuracy requirements, adjustment of input parameters, and evaluations of the representativity of an experiment with respect to a reference design configuration. A review of the methods used is provided, and several examples illustrate the success of the methodology in reactor physics. A new application as the improvement of nuclear basic parameters using integral experiments is also described.

Some design considerations for a synthetic aperture optical telescope array

NASA Astrophysics Data System (ADS)

Scott, P. W.

1984-01-01

Several design considerations inherent in the configuration of phased array transmission of multiwavelength laser beams are discussed. Attention is focused on the U.S.A.F. phased array (PHASAR) demonstration project, where problems have been encountered in dividing the beam(s), controlling the optical path differences between subapertures, and expanding individual beams.A piston-driven path length adjustment mechanism has been selected, along with an active control system and proven components for stability maintenance. The necessity of developing broadband, high reflectivity low phase shift coatings for the system mirrors is stressed.

Robotic Processing Of Rocket-Engine Nozzles

NASA Technical Reports Server (NTRS)

Gilbert, Jeffrey L.; Maslakowski, John E.; Gutow, David A.; Deily, David C.

1994-01-01

Automated manufacturing cell containing computer-controlled robotic processing system developed to implement some important related steps in fabrication of rocket-engine nozzles. Performs several tedious and repetitive fabrication, measurement, adjustment, and inspection processes and subprocesses now performed manually. Offers advantages of reduced processing time, greater consistency, excellent collection of data, objective inspections, greater productivity, and simplified fixturing. Also affords flexibility: by making suitable changes in hardware and software, possible to modify process and subprocesses. Flexibility makes work cell adaptable to fabrication of heat exchangers and other items structured similarly to rocket nozzles.

Impact of Human Immunodeficiency Virus on the Burden and Severity of Influenza Illness in Malawian Adults: A Prospective Cohort and Parallel Case-Control Study

PubMed Central

Ho, Antonia; Aston, Stephen J; Jary, Hannah; Mitchell, Tamara; Alaerts, Maaike; Menyere, Mavis; Mallewa, Jane; Nyirenda, Mulinda; Everett, Dean; Heyderman, Robert S; French, Neil

2018-01-01

Abstract Background The impact of human immunodeficiency virus (HIV) infection on influenza incidence and severity in adults in sub-Saharan Africa is unclear. Seasonal influenza vaccination is recommended for HIV-infected persons in developed settings but is rarely implemented in Africa. Methods We conducted a prospective cohort study to compare the incidence of laboratory-confirmed influenza illness between HIV-infected and HIV-uninfected adults in Blantyre, Malawi. In a parallel case-control study, we explored risk factors for severe influenza presentation of severe (hospitalized) lower respiratory tract infection, and mild influenza (influenza-like illness [ILI]). Results The cohort study enrolled 608 adults, of whom 360 (59%) were HIV infected. Between April 2013 and March 2015, 24 of 229 ILI episodes (10.5%) in HIV-infected and 5 of 119 (4.2%) in HIV-uninfected adults were positive for influenza by means of polymerase chain reaction (incidence rate, 46.0 vs 14.5 per 1000 person-years; incidence rate ratio, 2.75; 95% confidence interval, 1.02–7.44; P = .03; adjusted for age, sex, household crowding, and food security). In the case-control study, influenza was identified in 56 of 518 patients (10.8%) with hospitalized lower respiratory tract infection, and 88 or 642 (13.7%) with ILI. The HIV prevalence was 69.6% and 29.6%, respectively, among influenza-positive case patients and controls. HIV was a significant risk factor for severe influenza (odds ratio, 4.98; 95% confidence interval, 2.09–11.88; P < .001; population-attributable fraction, 57%; adjusted for season, sanitation facility, and food security). Conclusions HIV is an important risk factor for influenza-associated ILI and severe presentation in this high–HIV prevalence African setting. Targeted influenza vaccination of HIV-infected African adults should be reevaluated, and the optimal mechanism for vaccine introduction in overstretched health systems needs to be determined. PMID:29045699

Evaluating the cost-effectiveness of insulin detemir versus neutral protamine Hagedorn insulin in patients with type 1 or type 2 diabetes in the UK using a short-term modeling approach.

PubMed

Pollock, Richard F; Chubb, Barrie; Valentine, William J; Heller, Simon

2018-01-01

To estimate the short-term cost-effectiveness of insulin detemir (IDet) versus neutral protamine Hagedorn (NPH) insulin based on the incidence of non-severe hypoglycemia and changes in body weight in subjects with type 1 diabetes (T1D) or type 2 diabetes (T2D) in the UK. A model was developed to evaluate cost-effectiveness based on non-severe hypoglycemia, body mass index, and pharmacy costs over 1 year. Published rates of non-severe hypoglycemia were employed in the T1D and T2D analyses, while reduced weight gain with IDet was modeled in the T2D analysis only. Effectiveness was calculated in terms of quality-adjusted life expectancy using published utility scores. Pharmacy costs were captured using published prices and defined daily doses. Costs were expressed in 2016 pounds sterling (GBP). Sensitivity analyses were performed (including probabilistic sensitivity analysis). In T1D, IDet was associated with fewer non-severe hypoglycemic events than NPH insulin (126.7 versus 150.8 events per person-year), leading to an improvement of 0.099 quality-adjusted life years (QALYs). Costs with IDet were GBP 60 higher, yielding an incremental cost-effectiveness ratio (ICER) of GBP 610 per QALY gained. In T2D, mean non-severe hypoglycemic event rates and body weight were lower with IDet than NPH insulin, leading to a total incremental utility of 0.120, accompanied by an annual cost increase of GBP 171, yielding an ICER of GBP 1,422 per QALY gained for IDet versus NPH insulin. Short-term health economic evaluation showed IDet to be a cost-effective alternative to NPH insulin in the UK due to lower rates of non-severe hypoglycemia (T1D and T2D) and reduced weight gain (T2D only).

Peak-flow frequency estimates based on data through water year 2001 for selected streamflow-gaging stations in South Dakota

USGS Publications Warehouse

Sando, Steven K.; Driscoll, Daniel G.; Parrett, Charles

2008-01-01

Numerous users, including the South Dakota Department of Transportation, have continuing needs for peak-flow information for the design of highway infrastructure and many other purposes. This report documents results from a cooperative study between the South Dakota Department of Transportation and the U.S. Geological Survey to provide an update of peak-flow frequency estimates for South Dakota. Estimates of peak-flow magnitudes for 2-, 5-, 10-, 25-, 50-, 100-, 200-, and 500-year recurrence intervals are reported for 272 streamflow-gaging stations, which include most gaging stations in South Dakota with 10 or more years of systematic peak-flow records through water year 2001. Recommended procedures described in Bulletin 17B were used as primary guidelines for developing peak-flow frequency estimates. The computer program PEAKFQ developed by the U.S. Geological Survey was used to run the frequency analyses. Flood frequencies for all stations were initially analyzed by using standard Bulletin 17B default procedures for fitting the log-Pearson III distribution. The resulting preliminary frequency curves were then plotted on a log-probability scale, and fits of the curves with systematic data were evaluated. In many cases, results of the default Bulletin 17B analyses were determined to be satisfactory. In other cases, however, the results could be improved by using various alternative procedures for frequency analysis. Alternative procedures for some stations included adjustments to skew coefficients or use of user-defined low-outlier criteria. Peak-flow records for many gaging stations are strongly influenced by low- or zero-flow values. This situation often results in a frequency curve that plots substantially above the systematic record data points at the upper end of the frequency curve. Adjustments to low-outlier criteria reduced the influence of very small peak flows and generally focused the analyses on the upper parts of the frequency curves (10- to 500-year recurrence intervals). The most common alternative procedures involved several different methods to extend systematic records, which was done primarily to address biases resulting from nonrepresentative climatic conditions during several specific periods of record and to reduce inconsistencies among multiple gaging stations along common stream channels with different periods of record. In some cases, records for proximal stations could be combined directly. In other cases, the two-station comparison procedure recommended in Bulletin 17B was used to adjust the mean and standard deviation of the logs of the systematic data for a target station on the basis of correlation with concurrent records from a nearby long-term index station. In some other cases, a 'mixed-station procedure' was used to adjust the log-distributional parameters for a target station, on the basis of correlation with one or more index stations, for the purpose of fitting the log-Pearson III distribution. Historical adjustment procedures were applied to peak-flow frequency analyses for 17 South Dakota gaging stations. A historical adjustment period extending back to 1881 (121 years) was used for 12 gaging stations in the James and Big Sioux River Basins, and various other adjustment periods were used for additional stations. Large peak flows that occurred in 1969 and 1997 accounted for 13 of the 17 historical adjustments. Other years for which historical peak flows were used include 1957, 1962, 1992, and 2001. A regional mixed-population analysis was developed to address complications associated with many high outliers for the Black Hills region. This analysis included definition of two populations of flood events. The population of flood events that composes the main body of peak flows for a given station is considered the 'ordinary-peaks population,' and the population of unusually large peak flows that plot substantially above the main body of peak flows on log-probability scale is co

Development of regionalized SPFs for two-lane rural roads in Pennsylvania.

PubMed

Li, Lingyu; Gayah, Vikash V; Donnell, Eric T

2017-11-01

The American Association of State Highway and Transportation Officials' Highway Safety Manual (HSM) contains safety performance functions (SPFs) to predict annual crash frequencies for several roadway types. When applying these SPFs in a jurisdiction whose data were not used to develop the SPF, a calibration factor can be applied to adjust the expected crash frequency estimate to statewide or local conditions. Alternatively, the HSM suggests that transportation agencies may develop their own SPFs in lieu of applying the calibration factor to the HSM SPFs. However, the HSM does not provide guidance on the appropriate level of regionalization that should be adopted for either method, even though safety performance may vary considerably within a state. In light of this, the present study considers the development of local or regionalized SPFs for two-lane rural highways within the Commonwealth of Pennsylvania. Three regionalization levels were considered: statewide, engineering district and individual counties. The expected crash frequency for each level of regionalization was compared to the reported crash frequency over an eight-year analysis period. The results indicate that district-level SPFs with county-level adjustment factors provide better predictive accuracy than the development of a statewide SPF or application of the HSM-calibrated SPF. The findings suggest that there are significant differences in safety performance across engineering districts within Pennsylvania. As such, other state transportation agencies developing SPFs or using calibration factors may also consider how variations across jurisdictions will affect predicted crash frequencies. Copyright © 2017 Elsevier Ltd. All rights reserved.

NDVI saturation adjustment: a new approach for improving cropland performance estimates in the Greater Platte River Basin, USA

USGS Publications Warehouse

Gu, Yingxin; Wylie, Bruce K.; Howard, Daniel M.; Phuyal, Khem P.; Ji, Lei

2013-01-01

In this study, we developed a new approach that adjusted normalized difference vegetation index (NDVI) pixel values that were near saturation to better characterize the cropland performance (CP) in the Greater Platte River Basin (GPRB), USA. The relationship between NDVI and the ratio vegetation index (RVI) at high NDVI values was investigated, and an empirical equation for estimating saturation-adjusted NDVI (NDVIsat_adjust) based on RVI was developed. A 10-year (2000–2009) NDVIsat_adjust data set was developed using 250-m 7-day composite historical eMODIS (expedited Moderate Resolution Imaging Spectroradiometer) NDVI data. The growing season averaged NDVI (GSN), which is a proxy for ecosystem performance, was estimated and long-term NDVI non-saturation- and saturation-adjusted cropland performance (CPnon_sat_adjust, CPsat_adjust) maps were produced over the GPRB. The final CP maps were validated using National Agricultural Statistics Service (NASS) crop yield data. The relationship between CPsat_adjust and the NASS average corn yield data (r = 0.78, 113 samples) is stronger than the relationship between CPnon_sat_adjust and the NASS average corn yield data (r = 0.67, 113 samples), indicating that the new CPsat_adjust map reduces the NDVI saturation effects and is in good agreement with the corn yield ground observations. Results demonstrate that the NDVI saturation adjustment approach improves the quality of the original GSN map and better depicts the actual vegetation conditions of the GPRB cropland systems.

Geomorphic Assessment of the Brazos River, Texas

NASA Astrophysics Data System (ADS)

Hamilton, P.; May, D.; Haring, C.

2017-12-01

The Brazos River is a large lowland river that traverses Texas before reaching the Gulf of Mexico. Of particular interest is the Brazos River reach through Fort Bend County, TX. This area is rapidly developing and as such there are concerns regarding infrastructure near the river. Rivers maintain a state of dynamic equilibrium wherein the system makes adjustments to external perturbations. This is of no concern in the abstract; the boundary conditions for the river change and the river adjusts to accommodate the change. However, because of development near the river, natural river adjustment can have catastrophic consequences. For example, bank failure along the Brazos River in Fort Bend County threatens SH 99, a major hurricane evacuation route, as well as flood control levees and county offices. Herein we present the results of hydraulic modeling conducted through the project area as well as the results of a geomorphic assessment. The Brazos River has a regional degradational trend throughout the project area in conjunction with subtly increasing sinuosity. Additionally, headcutting has greatly widened many of the tributary valleys and increased the local sediment supply to the river. Bank failure is an issue at several locations and there have been various solutions proposed for different sites. Part of the fear in addressing issues at a particular site is that money will be spent curing the symptoms along the river without confronting the underlying regional illness. Here we show some of the regional issues and how it they potentially interact with local solutions.

The role of premorbid adjustment in schizophrenia: Focus on cognitive remediation outcome.

PubMed

Buonocore, Mariachiara; Bosinelli, Francesca; Bechi, Margherita; Spangaro, Marco; Piantanida, Marco; Cocchi, Federica; Bianchi, Laura; Guglielmino, Carmelo; Mastromatteo, Antonella Rita; Cavallaro, Roberto; Bosia, Marta

2018-02-19

Premorbid adjustment has been associated with several outcomes in schizophrenia and has been proposed as an index of cognitive reserve. This study aims to comprehensively analyse the relation between premorbid adjustment and clinical, neurocognitive, socio-cognitive and functional assessments, as well as to investigate the effect of premorbid adjustment on cognitive improvements after a cognitive remediation therapy protocol. Seventy-nine clinically stabilised outpatients with schizophrenia underwent a combined intervention consisting of cognitive remediation therapy added to standard rehabilitation therapy. All patients were assessed at baseline for psychopathology, premorbid adjustment, intellectual level, cognition and functioning. Cognitive evaluations were also repeated after the intervention. At baseline, significant correlations were observed between premorbid adjustment and working memory. The global cognitive improvement after treatment was significantly predicted by age and premorbid adjustment. This study confirms the association between premorbid adjustment and cognitive impairment and is the first to highlight the possible role of premorbid adjustment on the capacity to recover from cognitive deficits through a cognitive remediation therapy protocol. The data suggest that cognitive remediation may be particularly effective for people in the early course and that the assessment of premorbid adjustment could be of value to design individualised interventions.

Development of a music group psychotherapy intervention for the primary prevention of adjustment difficulties in Korean adolescent girls.

PubMed

Kim, Sunah; Kverno, Karan; Lee, Eun Mi; Park, Jeong Hwa; Lee, Hyun Hwa; Kim, Hyun Lye

2006-08-01

Traditionally, adolescent mental health in Korea has not been a prime focus for educators, health workers, and politicians, yet a majority of sampled adolescents report interpersonal sensitivity (Kim, 2003). Thirty-five adolescent girls took part in a six-session school-based music group psychotherapy pilot intervention designed to promote relationships and improve self-control skills. Participants identified several outcome benefits that may serve as protective factors in their continued social and emotional development. Music is a medium that promotes interpersonal relatedness among Korean adolescent girls. More research is necessary to identify long-term benefits of preventive music group psychotherapy interventions among the adolescent population.

Modeling of an Adjustable Beam Solid State Light Project

NASA Technical Reports Server (NTRS)

Clark, Toni

2015-01-01

This proposal is for the development of a computational model of a prototype variable beam light source using optical modeling software, Zemax Optics Studio. The variable beam light source would be designed to generate flood, spot, and directional beam patterns, while maintaining the same average power usage. The optical model would demonstrate the possibility of such a light source and its ability to address several issues: commonality of design, human task variability, and light source design process improvements. An adaptive lighting solution that utilizes the same electronics footprint and power constraints while addressing variability of lighting needed for the range of exploration tasks can save costs and allow for the development of common avionics for lighting controls.

Examining the Relationships between Outsourcing and Downsizing to Mishap Rates at NASA (FYs 1985-2011)

NASA Astrophysics Data System (ADS)

Charles, Sterlin Neil

Outsourcing and downsizing practices within American businesses have been topics of investigation over the past four decades. With the intention of saving diminishing resources, many North American aerospace and governmental organizations have embraced both practices. During the 1990s the National Aeronautics and Space Administration (NASA) increased contractor outsourcing and reduced the civil servant population in response to mandated federal budget cuts. Major human capital adjustments were made within NASA as management elected to place the shuttle's operations under a single contract. The problem addressed is increased outsourcing and downsizing has been associated with reduced safety outcomes. The purpose of this quantitative archival study was to examine the relationships of outsourcing and downsizing to mishaps rates at NASA between fiscal year (FY) 1985 and FY 2011. Twenty-seven samples of outsourcing and downsizing data were examined to determine the relationships with high-severity mishaps (HSMs), moderate-severity mishaps (MSMs), and low-severity mishaps (LSMs). A quantitative design utilizing weighted least squares (WLS) regression analysis measured the relationships between predictor and outcome variables. Neither outsourcing nor downsizing predicted HSM rates, adjusted R2 = .32, F (3, 23) = 5.01, p = .53 (outsourcing); adjusted R2 = .49, F (3, 23) = 9.34, p = .41 (downsizing). Both outsourcing and downsizing predicted MSM rates, adjusted R2 = .21, F (3, 23) = 3.24, p = .006 (outsourcing); adjusted R2 = .49, F (3, 23) = 9.55, p = <.001 (downsizing); and LSM rates, adjusted R2 = .77, F (3, 23) = 30.61, p = .003 (outsourcing); adjusted R2 = .89, F (3, 23) = 68.99, p = <.001 (downsizing). Future research could focus more on the causes of mishaps; mishaps unrelated to human factors issues could be eliminated from the analysis. Further research could involve a larger sample size (as the years pass), alternate sources of data for outsourcing and downsizing variables, and additional covariates. The added variables would offer a more convincing model for analyzing the impact of outsourcing and downsizing on mishaps. All-in-all, the efficacy of outsourcing and downsizing as a combined practice and its relationship to safety needs.

Sex differences in mortality following acute coronary syndromes.

PubMed

Berger, Jeffrey S; Elliott, Laine; Gallup, Dianne; Roe, Matthew; Granger, Christopher B; Armstrong, Paul W; Simes, R John; White, Harvey D; Van de Werf, Frans; Topol, Eric J; Hochman, Judith S; Newby, L Kristin; Harrington, Robert A; Califf, Robert M; Becker, Richard C; Douglas, Pamela S

2009-08-26

Conflicting information exists about whether sex differences modulate short-term mortality following acute coronary syndromes (ACS). To investigate the relationship between sex and 30-day mortality in ACS, and to determine whether this relationship was modified by clinical syndrome or coronary anatomy using a large database across the spectrum of ACS and adjusting for potentially confounding clinical covariates. A convenience sample of patients pooled from 11 independent, international, randomized ACS clinical trials between 1993 and 2006 whose databases are maintained at the Duke Clinical Research Institute, Durham, North Carolina. Of 136 247 patients, 38 048 (28%) were women; 102 004 (26% women) with ST-segment elevation myocardial infarction (STEMI), 14 466 (29% women) with non-STEMI (NSTEMI), and 19 777 (40% women) with unstable angina. Thirty-day mortality following ACS. Thirty-day mortality was 9.6% in women and 5.3% in men (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.83-2.00). After multivariable adjustment, mortality was not significantly different between women and men (adjusted OR, 1.06; 95% CI, 0.99-1.15). A significant sex by type of ACS interaction was demonstrated (P < .001). In STEMI, 30-day mortality was higher among women (adjusted OR, 1.15; 95% CI, 1.06-1.24), whereas in NSTEMI (adjusted OR, 0.77; 95% CI, 0.63-0.95) and unstable angina, mortality was lower among women (adjusted OR, 0.55; 95% CI, 0.43-0.70). In a cohort of 35 128 patients with angiographic data, women more often had nonobstructive (15% vs 8%) and less often had 2-vessel (25% vs 28%) and 3-vessel (23% vs 26%) coronary disease, regardless of ACS type. After additional adjustment for angiographic disease severity, 30-day mortality among women was not significantly different than men, regardless of ACS type. The relationship between sex and 30-day mortality was similar across the levels of angiographic disease severity (P for interaction = .70). Sex-based differences existed in 30-day mortality among patients with ACS and vary depending on clinical presentation. However, these differences appear to be largely explained by clinical differences at presentation and severity of angiographically documented disease.

Confounding by Pre-Morbid Functional Status in Studies of Apparent Sex Differences in Severity and Outcome of Stroke

PubMed Central

Coulombe, Janie; Li, Linxin; Ganesh, Aravind; Silver, Louise; Rothwell, Peter M.

2017-01-01

Background and Purpose— Several studies have reported unexplained worse outcomes after stroke in women but none included the full spectrum of symptomatic ischemic cerebrovascular events while adjusting for prior handicap. Methods— Using a prospective population-based incident cohort of all transient ischemic attack/stroke (OXVASC [Oxford Vascular Study]) recruited between April 2002 and March 2014, we compared pre-morbid and post-event modified Rankin Scale score (mRS) in women and men and change in mRS score 1 month, 6 months, 1 year, and 5 years after stroke. Baseline stroke-related neurological impairment was measured with the National Institutes of Health Stroke Scale. Results— Among 2553 patients (50.6% women) with a first transient ischemic attack/ischemic stroke, women had a worse handicap 1 month after ischemic stroke (age-adjusted odds ratio for mRS score, 1.35; 95% confidence interval, 1.12–1.63). However, women also had a higher pre-morbid mRS score compared with men (age-adjusted odds ratio, 1.58; 95% confidence interval, 1.36–1.84). There was no difference in stroke severity when adjusting for age and pre-morbid mRS (odds ratio, 1.10; 95% confidence interval, 0.90–1.35) and no difference in the pre-/poststroke change in mRS at 1 month (age-adjusted odds ratio, 1.00; 95% confidence interval, 0.82–1.21), 6 months, 1 year, and 5 years. Women had a lower mortality rate, and there was no sex difference in risk of recurrent stroke. Conclusions— We found no evidence of a worse outcome of stroke in women when adjusting for age and pre-morbid mRS. Failure to account for sex differences in pre-morbid handicap could explain contradictory findings in previous studies. Properties of the mRS may also contribute to these inconsistencies. PMID:28798261

Confounding by Pre-Morbid Functional Status in Studies of Apparent Sex Differences in Severity and Outcome of Stroke.

PubMed

Renoux, Christel; Coulombe, Janie; Li, Linxin; Ganesh, Aravind; Silver, Louise; Rothwell, Peter M

2017-10-01

Several studies have reported unexplained worse outcomes after stroke in women but none included the full spectrum of symptomatic ischemic cerebrovascular events while adjusting for prior handicap. Using a prospective population-based incident cohort of all transient ischemic attack/stroke (OXVASC [Oxford Vascular Study]) recruited between April 2002 and March 2014, we compared pre-morbid and post-event modified Rankin Scale score (mRS) in women and men and change in mRS score 1 month, 6 months, 1 year, and 5 years after stroke. Baseline stroke-related neurological impairment was measured with the National Institutes of Health Stroke Scale. Among 2553 patients (50.6% women) with a first transient ischemic attack/ischemic stroke, women had a worse handicap 1 month after ischemic stroke (age-adjusted odds ratio for mRS score, 1.35; 95% confidence interval, 1.12-1.63). However, women also had a higher pre-morbid mRS score compared with men (age-adjusted odds ratio, 1.58; 95% confidence interval, 1.36-1.84). There was no difference in stroke severity when adjusting for age and pre-morbid mRS (odds ratio, 1.10; 95% confidence interval, 0.90-1.35) and no difference in the pre-/poststroke change in mRS at 1 month (age-adjusted odds ratio, 1.00; 95% confidence interval, 0.82-1.21), 6 months, 1 year, and 5 years. Women had a lower mortality rate, and there was no sex difference in risk of recurrent stroke. We found no evidence of a worse outcome of stroke in women when adjusting for age and pre-morbid mRS. Failure to account for sex differences in pre-morbid handicap could explain contradictory findings in previous studies. Properties of the mRS may also contribute to these inconsistencies. Copyright © 2017 The Author(s).

The association between previous and future severe exacerbations of chronic obstructive pulmonary disease: Updating the literature using robust statistical methodology.

PubMed

Sadatsafavi, Mohsen; Xie, Hui; Etminan, Mahyar; Johnson, Kate; FitzGerald, J Mark

2018-01-01

There is minimal evidence on the extent to which the occurrence of a severe acute exacerbation of COPD that results in hospitalization affects the subsequent disease course. Previous studies on this topic did not generate causally-interpretable estimates. Our aim was to use corrected methodology to update previously reported estimates of the associations between previous and future exacerbations in these patients. Using administrative health data in British Columbia, Canada (1997-2012), we constructed a cohort of patients with at least one severe exacerbation, defined as an episode of inpatient care with the main diagnosis of COPD based on international classification of diseases (ICD) codes. We applied a random-effects 'joint frailty' survival model that is particularly developed for the analysis of recurrent events in the presence of competing risk of death and heterogeneity among individuals in their rate of events. Previous severe exacerbations entered the model as dummy-coded time-dependent covariates, and the model was adjusted for several observable patient and disease characteristics. 35,994 individuals (mean age at baseline 73.7, 49.8% female, average follow-up 3.21 years) contributed 34,271 severe exacerbations during follow-up. The first event was associated with a hazard ratio (HR) of 1.75 (95%CI 1.69-1.82) for the risk of future severe exacerbations. This risk decreased to HR = 1.36 (95%CI 1.30-1.42) for the second event and to 1.18 (95%CI 1.12-1.25) for the third event. The first two severe exacerbations that occurred during follow-up were also significantly associated with increased risk of all-cause mortality. There was substantial heterogeneity in the individual-specific rate of severe exacerbations. Even after adjusting for observable characteristics, individuals in the 97.5th percentile of exacerbation rate had 5.6 times higher rate of severe exacerbations than those in the 2.5th percentile. Using robust statistical methodology that controlled for heterogeneity in exacerbation rates among individuals, we demonstrated potential causal associations among past and future severe exacerbations, albeit the magnitude of association was noticeably lower than previously reported. The prevention of severe exacerbations has the potential to modify the disease trajectory.

24 CFR 200.97 - Adjustments resulting from cost certification.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Adjustments resulting from cost certification. 200.97 Section 200.97 Housing and Urban Development Regulations Relating to Housing and Urban... Adjustments resulting from cost certification. (a) Fee simple site. Upon receipt of the mortgagor's...

24 CFR 200.97 - Adjustments resulting from cost certification.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Adjustments resulting from cost certification. 200.97 Section 200.97 Housing and Urban Development Regulations Relating to Housing and Urban... Adjustments resulting from cost certification. (a) Fee simple site. Upon receipt of the mortgagor's...

24 CFR 200.97 - Adjustments resulting from cost certification.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Adjustments resulting from cost certification. 200.97 Section 200.97 Housing and Urban Development Regulations Relating to Housing and Urban... Adjustments resulting from cost certification. (a) Fee simple site. Upon receipt of the mortgagor's...

24 CFR 200.97 - Adjustments resulting from cost certification.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Adjustments resulting from cost certification. 200.97 Section 200.97 Housing and Urban Development Regulations Relating to Housing and Urban... Adjustments resulting from cost certification. (a) Fee simple site. Upon receipt of the mortgagor's...

24 CFR 203.288 - Discontinuance of adjusted premium charge.

Code of Federal Regulations, 2010 CFR

2010-04-01

... instrument, there shall be no adjusted mortgage insurance premium due the Commissioner on account of the... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Discontinuance of adjusted premium... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER...

24 CFR 203.288 - Discontinuance of adjusted premium charge.

Code of Federal Regulations, 2011 CFR

2011-04-01

... instrument, there shall be no adjusted mortgage insurance premium due the Commissioner on account of the... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Discontinuance of adjusted premium... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER...

Risk factors and pathogenic significance of severe sepsis and septic shock in 2286 patients with gram-negative bacteremia.

PubMed

Kang, Cheol-In; Song, Jae-Hoon; Chung, Doo Ryeon; Peck, Kyong Ran; Ko, Kwan Soo; Yeom, Joon-Sup; Ki, Hyun Kyun; Son, Jun Seong; Lee, Seung Soon; Kim, Yeon-Sook; Jung, Sook-In; Kim, Shin-Woo; Chang, Hyun-Ha; Ryu, Seong Yeol; Kwon, Ki Tae; Lee, Hyuck; Moon, Chisook

2011-01-01

The aim of this study was to identify risk factors for development of severe sepsis or septic shock and to evaluate the clinical impact of severe sepsis on outcome in patients with gram-negative bacteremia (GNB). From the database of a nationwide surveillance for bacteremia, patients with GNB were analyzed. Data of patients with severe sepsis or septic shock were compared with those of patient with sepsis. Of 2286 patients with GNB, 506 (22.1%) fulfilled the criteria of severe sepsis or septic shock. Factors associated with severe sepsis or septic shock in the multivariate analysis included renal disease, indwelling urinary catheter, hematologic malignancy, and neutropenia. The 30-day mortality of patients with severe sepsis or septic shock was significantly higher than that of patients with sepsis (39.5% [172/435] vs. 7.4% [86/1170]; P < 0.001). Multivariable analysis revealed that solid tumor, liver disease, pulmonary disease, pneumonia, and pathogens other than Escherichia coli, which were risk factors of development of severe sepsis or septic shock, were also found to be strong predictors of mortality. Severe sepsis or septic shock was a significant factor associated with mortality (OR, 3.34; 95% CI, 2.35-4.74), after adjustment for other variables predicting poor prognosis. Severe sepsis or septic shock was a common finding in patients with GNB, predicting a higher mortality rate. Renal disease and indwelling urinary catheter were the most important risk factors significantly associated with severe sepsis or septic shock among patients with GNB. Copyright © 2010 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Robust Control Algorithm for a Two Cart System and an Inverted Pendulum

NASA Technical Reports Server (NTRS)

Wilson, Chris L.; Capo-Lugo, Pedro

2011-01-01

The Rectilinear Control System can be used to simulate a launch vehicle during liftoff. Several control schemes have been developed that can control different dynamic models of the rectilinear plant. A robust control algorithm was developed that can control a pendulum to maintain an inverted position. A fluid slosh tank will be attached to the pendulum in order to test robustness in the presence of unknown slosh characteristics. The rectilinear plant consists of a DC motor and three carts mounted in series. Each cart s weight can be adjusted with brass masses and the carts can be coupled with springs. The pendulum is mounted on the first cart and an adjustable air damper can be attached to the third cart if desired. Each cart and the pendulum have a quadrature encoder to determine position. Full state feedback was implemented in order to develop the control algorithm along with a state estimator to determine the velocity states of the system. A MATLAB program was used to convert the state space matrices from continuous time to discrete time. This program also used a desired phase margin and damping ratio to determine the feedback gain matrix that would be used in the LabVIEW program. This experiment will allow engineers to gain a better understanding of liquid propellant slosh dynamics, therefore enabling them to develop more robust control algorithms for launch vehicle systems

Pattern Adaptation and Normalization Reweighting.

PubMed

Westrick, Zachary M; Heeger, David J; Landy, Michael S

2016-09-21

Adaptation to an oriented stimulus changes both the gain and preferred orientation of neural responses in V1. Neurons tuned near the adapted orientation are suppressed, and their preferred orientations shift away from the adapter. We propose a model in which weights of divisive normalization are dynamically adjusted to homeostatically maintain response products between pairs of neurons. We demonstrate that this adjustment can be performed by a very simple learning rule. Simulations of this model closely match existing data from visual adaptation experiments. We consider several alternative models, including variants based on homeostatic maintenance of response correlations or covariance, as well as feedforward gain-control models with multiple layers, and we demonstrate that homeostatic maintenance of response products provides the best account of the physiological data. Adaptation is a phenomenon throughout the nervous system in which neural tuning properties change in response to changes in environmental statistics. We developed a model of adaptation that combines normalization (in which a neuron's gain is reduced by the summed responses of its neighbors) and Hebbian learning (in which synaptic strength, in this case divisive normalization, is increased by correlated firing). The model is shown to account for several properties of adaptation in primary visual cortex in response to changes in the statistics of contour orientation. Copyright © 2016 the authors 0270-6474/16/369805-12$15.00/0.

Curved adjustable fibre-optic diode laser in microscopic cholesteatoma surgery: description of use and review of the relevant literature.

PubMed

McCaffer, C J; Pabla, L; Watson, C

2018-04-01

The use of lasers in cholesteatoma surgery is common and well accepted. The most commonly used laser fibres are straight and non-adjustable; these have several limitations. This paper describes the use of an alternative laser fibre. This 'How I Do It' paper describes and illustrates the use of an alternative curved adjustable fibre-optic diode laser in microscopic cholesteatoma surgery. The curved, adjustable laser fibre allows accurate and atraumatic disease removal when the use of a straight laser fibre may be less effective or accurate. It reduces potential damage to delicate structures without the need for extra drilling or bone removal. It is suggested that the curved adjustable laser fibre is superior to the traditional straight fibre for cholesteatoma surgery.

Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: a prospective observational study

PubMed Central

Mettler, Julian; Simcock, Mathew; Sendi, Pedram; Widmer, Andreas F; Bingisser, Roland; Battegay, Manuel; Fluckiger, Ursula; Bassetti, Stefano

2007-01-01

Background Several strategies to optimise the use of antibiotics have been developed. Most of these interventions can be classified as educational or restrictive. Restrictive measures are considered to be more effective, but the enforcement of these measures may be difficult and lead to conflicts with prescribers. Any intervention should be aimed at targets with the highest impact on antibiotic prescribing. The aim of the present study was to assess the adequacy of empirical and adjusted antibiotic therapies in a Swiss university hospital where no antibiotic use restrictions are enforced, and to identify risk factors for inadequate treatment and targets for intervention. Methods A prospective observational study was performed during 9 months. All patients admitted through the emergency department who received an antibiotic therapy within 24 hours of admission were included. Data on demographic characteristics, diagnoses, comorbidities, systemic inflammatory response syndrome (SIRS) parameters, microbiological tests, and administered antibiotics were collected prospectively. Antibiotic therapy was considered adequate if spectrum, dose, application modus, and duration of therapy were appropriate according to local recommendations or published guidelines. Results 2943 admitted patients were evaluated. Of these, 572 (19.4%) received antibiotics within 24 hours and 539 (94%) were analysed in detail. Empirical antibiotic therapy was inadequate in 121 patients (22%). Initial therapy was adjusted in 168 patients (31%). This adjusted antibiotic therapy was inadequate in 46 patients (27%). The main reason for inadequacy was the use of antibiotics with unnecessarily broad spectrum (24% of inadequate empirical, and 52% of inadequate adjusted therapies). In 26% of patients with inadequate adjusted therapy, antibiotics used were either ineffective against isolated pathogenic bacteria or antibiotic therapy was continued despite negative results of microbiological investigations. Conclusion The rate of inadequate antibiotic therapies was similar to the rates reported from other institutions despite the absence of a restrictive antibiotic policy. Surprisingly, adjusted antibiotic therapies were more frequently inappropriate than empirical therapies. Interventions aiming at improving antibiotic prescribing should focus on both initial empirical therapy and streamlining and adjustment of therapy once microbiological results become available. PMID:17386104

Occupational exposure and ovarian cancer risk.

PubMed

Le, Nhu D; Leung, Andy; Brooks-Wilson, Angela; Gallagher, Richard P; Swenerton, Kenneth D; Demers, Paul A; Cook, Linda S

2014-07-01

Relatively little work has been done concerning occupational risk factors in ovarian cancer. Although studies conducted in occupational settings have reported positive associations, their usefulness is generally limited by the lack of information on important confounders. In a population-based case-control study, we assessed risk for developing epithelial ovarian cancer (EOC) associated with occupational exposure while accounting for important confounders. Participants were identified through provincial population-based registries. Lifetime occupational history and information on potential confounding factors were obtained through a self-administered questionnaire. Unconditional logistic regression and the likelihood ratio test were used to assess EOC risk with each occupation (or industry), relative to all other occupations (or industries), adjusting for potential confounders including body mass index, oral contraceptive use, menopausal hormone therapy, parity, age at first childbirth, age at menarche, age at menopause, family history of breast and ovarian cancer in mother and sister(s), tubal ligation, partial oophorectomy, and hysterectomy. Occupations and industries were coded according to the Canadian Standard Occupational Classification (SOC) and Standard Industrial Classification (SIC). Significant excess risk was observed for several groups of teaching occupations, including SOC 27, teaching and related (adjusted OR 1.77, 95% CI 1.15-2.81) and SOC 279, other teaching and related (adjusted OR 3.11, 95% CI 1.35-8.49). Significant excess was also seen for a four-digit occupational group SOC 4131, bookkeepers and accounting clerks (adjusted OR 2.80, 95% CI 1.30-6.80). Industrial sub-groups showing significant excess risk included SIC 65, other retail stores (adjusted OR 2.19, 95 % CI 1.16-4.38); SIC 85, educational service (adjusted OR 1.45, 95% CI 1.00-2.13); and SIC 863, non-institutional health services (adjusted OR 2.54, 95% CI 1.13-6.52). Our study found an elevated EOC risk for teaching occupations and is the first study to observe such an increased risk after adjustment for potential confounders. Further studies with more detailed assessment of the work environment and unique lifestyle characteristics may be fruitful in elucidating this etiology.

Parental divorce and adjustment in adulthood: findings from a community sample. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

PubMed

O'Connor, T G; Thorpe, K; Dunn, J; Golding, J

1999-07-01

The current study examines the link between the experience of divorce in childhood and several indices of adjustment in adulthood in a large community sample of women. Results replicated previous research on the long-term correlation between parental divorce and depression and divorce in adulthood. Results further suggested that parental divorce was associated with a wide range of early risk factors, life course patterns, and several indices of adult adjustment. Regression analyses indicated that the long-term correlation between parental divorce and depression in adulthood is explained by quality of parent-child and parental marital relations (in childhood), concurrent levels of stressful life events and social support, and cohabitation. The long-term association between parental divorce and experiencing a divorce in adulthood was partly mediated through quality of parent-child relations, teenage pregnancy, leaving home before 18 years, and educational attainment.

Cardioband, a transcatheter surgical-like direct mitral valve annuloplasty system: early results of the feasibility trial.

PubMed

Maisano, Francesco; Taramasso, Maurizio; Nickenig, Georg; Hammerstingl, Christoph; Vahanian, Alec; Messika-Zeitoun, David; Baldus, Stephan; Huntgeburth, Michael; Alfieri, Ottavio; Colombo, Antonio; La Canna, Giovanni; Agricola, Eustachio; Zuber, Michel; Tanner, Felix C; Topilsky, Yan; Kreidel, Felix; Kuck, Karl-Heinz

2016-03-07

Cardioband system is a direct annuloplasty adjustable device that is implanted in the beating heart on the posterior annulus under fluoroscopic and transoesophageal echocardiographic (TEE) guidance. We report the early (1 month) outcomes of the first-in-man pre-CE-mark feasibility and safety trial. The study enrolled high-risk adult individuals at five institutions in Europe with symptomatic secondary mitral regurgitation (MR) despite optimal medical therapy. The primary efficacy endpoints included the technical success rate of implantation, feasibility of the Cardioband adjustment (technical performance), and ability to reduce the annular septolateral dimension and MR grade at hospital discharge and at 30 days. The study group included 31 consecutively enrolled high-risk patients with moderate-to-severe or severe secondary MR with at least 1 month of follow-up (mean age 71.8 ± 6.9 years). All patients received the full implant of a Cardioband. Adjustment of the Cardioband resulted in a significant reduction in the septolateral dimension in all but two patients (septolateral dimension from 36.8 ± 4.8 to 29 ± 5.5 mm after the procedure, P < 0.01). Following Cardioband adjustment (29 of 31 patients) MR was none or trace in 6 (21%), mild in 21 (72%), and moderate in 2 (7%). No patient had severe MR after adjustment. Procedural mortality was zero and in-hospital mortality was 6.5% (2 of 31 patients, neither procedure- nor device-related). At 30 days, 22 of the 25 patients (88%) had MR ≤2+. This study demonstrates the feasibility and safety of percutaneous direct mitral annuloplasty with the Cardioband device in high-risk patients with MR. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Gauge-adjusted rainfall estimates from commercial microwave links

NASA Astrophysics Data System (ADS)

Fencl, Martin; Dohnal, Michal; Rieckermann, Jörg; Bareš, Vojtěch

2017-01-01

Increasing urbanization makes it more and more important to have accurate stormwater runoff predictions, especially with potentially severe weather and climatic changes on the horizon. Such stormwater predictions in turn require reliable rainfall information. Especially for urban centres, the problem is that the spatial and temporal resolution of rainfall observations should be substantially higher than commonly provided by weather services with their standard rainfall monitoring networks. Commercial microwave links (CMLs) are non-traditional sensors, which have been proposed about a decade ago as a promising solution. CMLs are line-of-sight radio connections widely used by operators of mobile telecommunication networks. They are typically very dense in urban areas and can provide path-integrated rainfall observations at sub-minute resolution. Unfortunately, quantitative precipitation estimates (QPEs) from CMLs are often highly biased due to several epistemic uncertainties, which significantly limit their usability. In this manuscript we therefore suggest a novel method to reduce this bias by adjusting QPEs to existing rain gauges. The method has been specifically designed to produce reliable results even with comparably distant rain gauges or cumulative observations. This eliminates the need to install reference gauges and makes it possible to work with existing information. First, the method is tested on data from a dedicated experiment, where a CML has been specifically set up for rainfall monitoring experiments, as well as operational CMLs from an existing cellular network. Second, we assess the performance for several experimental layouts of ground truth from rain gauges (RGs) with different spatial and temporal resolutions. The results suggest that CMLs adjusted by RGs with a temporal aggregation of up to 1 h (i) provide precise high-resolution QPEs (relative error < 7 %, Nash-Sutcliffe efficiency coefficient > 0.75) and (ii) that the combination of both sensor types clearly outperforms each individual monitoring system. Unfortunately, adjusting CML observations to RGs with longer aggregation intervals of up to 24 h has drawbacks. Although it substantially reduces bias, it unfavourably smoothes out rainfall peaks of high intensities, which is undesirable for stormwater management. A similar, but less severe, effect occurs due to spatial averaging when CMLs are adjusted to remote RGs. Nevertheless, even here, adjusted CMLs perform better than RGs alone. Furthermore, we provide first evidence that the joint use of multiple CMLs together with RGs also reduces bias in their QPEs. In summary, we believe that our adjustment method has great potential to improve the space-time resolution of current urban rainfall monitoring networks. Nevertheless, future work should aim to better understand the reason for the observed systematic error in QPEs from CMLs.

Night-eating syndrome and the severity of self-reported depressive symptoms from the Korea Nurses' Health Study: analysis of propensity score matching and ordinal regression.

PubMed

Kim, O-S; Kim, M S; Lee, J E; Jung, H

2016-12-01

The prevalence of night-eating syndrome (NES) and depression is increasing worldwide. Although nurses, in particular, are exposed to work in an environment of irregular eating, shift work, and stressful settings, limited research exist. In fact, the prevalence of NES among Korean nurses has never been reported. The aim of this study was to determine the prevalence of NES as well as the association between NES and severity of self-reported depressive symptoms among South Korean female nurses. The Korea Nurses' Health Study, following the protocols of the Nurses' Health Study led by the Harvard University, collected data on Korean female nurses. Survey responses from 3617 participants were included, and 404 responses were analyzed in this cross-sectional study using propensity score matching. Descriptive, Spearman's and Cramer's correlations, propensity score matching, and multivariable ordinal logistic regression were conducted as statistical analysis. The prevalence of both NES and self-reported depressive symptoms among Korean female nurses were higher compared with nurses in prior studies. Nurses with NES were 1.65 times more likely to have greater severity of depressive symptoms than those without NES (95% confidence interval [1.19-2.10], odds ratio = 1.65) after adjusting for covariates including sociodemographic characteristics, health behavioural factors, and shift work. This study suggests significant association between NES and the severity of self-reported depressive symptoms among Korean female nurses after adjusting for covariates. Policy makers and hospital managers need to develop strategies to reduce depression and NES among nurses for enhancement of nurses' mental and physical health as well as for improvement of care quality. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Exposure to Famine at a Young Age and Unhealthy Lifestyle Behavior Later in Life.

PubMed

Fransen, Heidi P; Peeters, Petra H M; Beulens, Joline W J; Boer, Jolanda M A; de Wit, G Ardine; Onland-Moret, N Charlotte; van der Schouw, Yvonne T; Bueno-de-Mesquita, H Bas; Hoekstra, Jeljer; Elias, Sjoerd G; May, Anne M

2016-01-01

A healthy diet is important for normal growth and development. Exposure to undernutrition during important developmental periods such as childhood and adolescence can have effects later in life. Inhabitants of the west of the Netherlands were exposed to severe undernutrition during the famine in the last winter of the second World War (1944-1945). We investigated if exposure of women to the Dutch famine during childhood and adolescence was associated with an unhealthy lifestyle later in life. We studied 7,525 women from the Prospect-EPIC cohort, recruited in 1993-97 and aged 0-18 years during the Dutch famine. An individual famine score was calculated based on self-reported information about experience of hunger and weight loss. We investigated the association between famine exposure in early life and four lifestyle factors in adulthood: smoking, alcohol consumption, physical activity level and a Mediterranean-style diet. Of the 7,525 included women, 46% were unexposed, 38% moderately exposed and 16% severely exposed to the Dutch famine. Moderately and severely exposed women were more often former or current smokers compared to women that did not suffer from the famine: adjusted prevalence ratio 1.10 (95% CI: 1.05; 1.14) and 1.18 (1.12; 1.25), respectively. They also smoked more pack years than unexposed women. Severely exposed women were more often physically inactive than unexposed women, adjusted prevalence ratio 1.32 (1.06; 1.64). Results did not differ between exposure age categories (0-9 and 10-17 years). We found no associations of famine exposure with alcohol consumption and no dose-dependent relations with diet. Exposure to famine early in female life may be associated with higher prevalence of smoking and physical inactivity later in life, but not with unhealthy diet and alcohol consumption.

Summed and Weighted Summary Scores for the Medsger Disease Severity Scale Compared with the Physician's Global Assessment of Disease Severity in Systemic Sclerosis.

PubMed

Harel, Daphna; Hudson, Marie; Iliescu, Alexandra; Baron, Murray; Steele, Russell

2016-08-01

To develop a weighted summary score for the Medsger Disease Severity Scale (DSS) and to compare its measurement properties with those of a summed DSS score and a physician's global assessment (PGA) of severity score in systemic sclerosis (SSc). Data from 875 patients with SSc enrolled in a multisite observational research cohort were extracted from a central database. Item response theory was used to estimate weights for the DSS weighted score. Intraclass correlation coefficients (ICC) and convergent, discriminative, and predictive validity of the 3 summary measures in relation to patient-reported outcomes (PRO) and mortality were compared. Mean PGA was 2.69 (SD 2.16, range 0-10), mean DSS summed score was 8.60 (SD 4.02, range 0-36), and mean DSS weighted score was 8.11 (SD 4.05, range 0-36). ICC were similar for all 3 measures [PGA 6.9%, 95% credible intervals (CrI) 2.1-16.2; DSS summed score 2.5%, 95% CrI 0.4-6.7; DSS weighted score 2.0%, 95% CrI 0.1-5.6]. Convergent and discriminative validity of the 3 measures for PRO were largely similar. In Cox proportional hazards models adjusting for age and sex, the 3 measures had similar predictive ability for mortality (adjusted R(2) 13.9% for PGA, 12.3% for DSS summed score, and 10.7% DSS weighted score). The 3 summary scores appear valid and perform similarly. However, there were some concerns with the weights computed for individual DSS scales, with unexpected low weights attributed to lung, heart, and kidney, leading the PGA to be the preferred measure at this time. Further work refining the DSS could improve the measurement properties of the DSS summary scores.

Job strain as a risk factor for the onset of type 2 diabetes mellitus: findings from the MONICA/KORA Augsburg cohort study.

PubMed

Huth, Cornelia; Thorand, Barbara; Baumert, Jens; Kruse, Johannes; Emeny, Rebecca Thwing; Schneider, Andrea; Meisinger, Christa; Ladwig, Karl-Heinz

2014-09-01

To examine whether job strain is associated with an increased risk of subsequent Type 2 diabetes mellitus (T2DM) development in a population-based study of men and women. Data were derived from the prospective MONICA/KORA Augsburg study. We investigated 5337 working participants aged 29 to 66 years without diabetes at one of the three baseline surveys. Job strain was measured by the Karasek job content questionnaire. High job strain was defined by the quadrant approach, where high job demands combined with low job control were classified as high job strain. Continuous job strain (quotient of job demands divided by job control) was additionally analyzed as sensitivity analysis. Hazard ratios (HRs) were estimated using multivariable Cox proportional hazards models with adjustment for age, sex, survey, socioeconomic and life-style variables, parental history of diabetes, and body mass index. During a median follow-up of 12.7 years, 291 incident cases of T2DM were observed. The participants with high job strain at baseline had a 45% higher fully adjusted risk to develop T2DM than did those with low job strain (HR = 1.45 [95% confidence interval = 1.00-2.10], p = .048). On the continuous scale, more severe job strain in the magnitude of 1 standard deviation corresponded to a 12% increased fully adjusted T2DM risk (HR = 1.12 [95% confidence interval = 1.00-1.25], p = .045). Men and women who experience high job strain are at higher risk for developing T2DM independently of traditional risk factors. Preventive strategies to combat the globally increasing T2DM epidemic should take into consideration the adverse effects of high strain in the work environment.

Optimal Combinations of Diagnostic Tests Based on AUC.

PubMed

Huang, Xin; Qin, Gengsheng; Fang, Yixin

2011-06-01

When several diagnostic tests are available, one can combine them to achieve better diagnostic accuracy. This article considers the optimal linear combination that maximizes the area under the receiver operating characteristic curve (AUC); the estimates of the combination's coefficients can be obtained via a nonparametric procedure. However, for estimating the AUC associated with the estimated coefficients, the apparent estimation by re-substitution is too optimistic. To adjust for the upward bias, several methods are proposed. Among them the cross-validation approach is especially advocated, and an approximated cross-validation is developed to reduce the computational cost. Furthermore, these proposed methods can be applied for variable selection to select important diagnostic tests. The proposed methods are examined through simulation studies and applications to three real examples. © 2010, The International Biometric Society.

Association between all-cause mortality and severity of depressive symptoms in patients with type 2 diabetes: Analysis from the Japan Diabetes Complications Study (JDCS).

PubMed

Matsunaga, Satoshi; Tanaka, Shiro; Fujihara, Kazuya; Horikawa, Chika; Iimuro, Satoshi; Kitaoka, Masafumi; Sato, Asako; Nakamura, Jiro; Haneda, Masakazu; Shimano, Hitoshi; Akanuma, Yasuo; Ohashi, Yasuo; Sone, Hirohito

2017-08-01

The aims of this study are to confirm whether the excess mortality caused by depressive symptoms is independent of severe hypoglycemia in patients with type 2 diabetes mellitus (T2DM) and to evaluate the association between all-cause mortality and degrees of severity of depressive symptoms in Japanese patients with T2DM. A total of 1160 Japanese patients with T2DM were eligible for this analysis. Participants were followed prospectively for 3years and their depressive states were evaluated at baseline by the Center for Epidemiologic Studies Depression Scale (CES-D). Cox proportional hazards model was used to evaluate the relative risk of all-cause mortality and was adjusted by possible confounding factors, including severe hypoglycemia, all of which are known as risk factors for both depression and mortality. After adjustment for severe hypoglycemia, each 5-point increase in the CES-D score was significantly associated with excess all-cause mortality (hazard ratio 1.69 [95% CI 1.26-2.17]). The spline curve of HRs for mortality according to total CES-D scores showed that mortality risk was slightly increased at lower scores but was sharply elevated at higher scores. A high score on the CES-D at baseline was significantly associated with all-cause mortality in patients with T2DM after adjusting for confounders including severe hypoglycemia. However, only a small effect on mortality risk was found at relatively lower levels of depressive symptoms in this population. Further research is needed to confirm this relationship between the severity of depressive symptoms and mortality in patients with T2DM. Copyright © 2017 Elsevier Inc. All rights reserved.

Severity and duration of diabetic foot ulcer (DFU) before seeking care as predictors of healing time: A retrospective cohort study

PubMed Central

Iversen, Marjolein M.; Igland, Jannicke; Østbye, Truls; Graue, Marit; Skeie, Svein; Wu, Bei; Rokne, Berit

2017-01-01

Objectives To investigate whether A) duration of ulcer before start of treatment in specialist health care, and B) severity of ulcer according to University of Texas classification system (UT) at start of treatment (baseline), are independent predictors of healing time. Methods This retrospective cohort study, based on electronic medical record data, included 105 patients from two outpatient clinics in Western Norway with a new diabetic foot ulcer during 2009–2011. The associations of duration of ulcer and ulcer severity with healing time were assessed using cumulative incidence curves and subdistribution hazard ratio estimated using competing risk regression with adjustment for potential confounders. Results Of the 105 participants, 45.7% achieved ulcer healing, 36.2% underwent amputations, 9.5% died before ulcer healing and 8.5% were lost to follow-up. Patients who were referred to specialist health care by a general practitioner ≥ 52 days after ulcer onset had a 58% (SHR 0.42, CI 0.18–0.98) decreased healing rate compared to patients who were referred earlier, in the adjusted model. High severity (grade 2/3, stage C/D) according to the UT classification system was associated with a decreased healing rate compared to low severity (grade1, stage A/B or grade 2, stage A) with SHR (95% CI) equal to 0.14 (0.05–0.43) after adjustment for referral time and other potential confounders. Conclusion Early detection and referral by both the patient and general practitioner are crucial for optimal foot ulcer healing. Ulcer grade and severity are also important predictors for healing time, and early screening to assess the severity and initiation of prompt treatment is important. PMID:28498862

Relationship between Illness Severity, Social/Familial Variables and Adjustment in Children and Adolescents with Sickle Cell Disease.

ERIC Educational Resources Information Center

Hurtig, Anita Landau; Koepke, David

The study examined the effects of social support and family functioning on illness and adjustment in 70 children and adolescents with sickle cell disease. Four sources of information were used: patient interview and standardized tests; parent interview and standardized tests; teacher interview; and medical records. Results revealed several…

There Is No Shame in Pain: Coping and Functional Ability in Adolescents with Sickle Cell Disease.

ERIC Educational Resources Information Center

Robinson, M. Renee

1999-01-01

Discusses coping and personal adjustment to chronic pain for adolescents with sickle cell anemia and presents a model of illness behavior for these adolescents. Offers a framework of disease severity and disease impact, and suggests using functional ability as an index of coping and personal adjustment. Contains 59 references. (SLD)

The Contribution of Personal and Exposure Characteristics to the Adjustment of Adolescents Following War

ERIC Educational Resources Information Center

Lavi, T.; Green, O.; Dekel, R.

2013-01-01

The study examined the unique contribution of both personal characteristics and several types of exposure variables to the adjustment of Israeli adolescents following the Second Lebanon War. Two thousand three hundred and fourteen adolescents, who lived in areas that were the target of multiple missile attacks, completed self-report questionnaires…

"Try Walking in Our Shoes": Teaching Acculturation and Related Cultural Adjustment Processes through Role-Play

ERIC Educational Resources Information Center

Zamboanga, Byron L.; Ham, Lindsay S.; Tomaso, Cara C.; Audley, Shannon; Pole, Nnamdi

2016-01-01

In this article, we describe several role-playing exercises on acculturation and relevant cultural adjustment processes that we incorporated into Tomcho and Foel's classroom activity on acculturation, and we report data that examine subsequent changes in students' responses on pretest and posttest measures shortly after the activity and present…

Relations of SARS-Related Stressors and Coping to Chinese College Students' Psychological Adjustment during the 2003 Beijing SARS Epidemic

ERIC Educational Resources Information Center

Main, Alexandra; Zhou, Qing; Ma, Yue; Luecken, Linda J.; Liu, Xin

2011-01-01

This study examined the main and interactive relations of stressors and coping related to severe acute respiratory syndrome (SARS) with Chinese college students' psychological adjustment (psychological symptoms, perceived general health, and life satisfaction) during the 2003 Beijing SARS epidemic. All the constructs were assessed by self-report…

Psychosocial Variables as Predictors of School Adjustment of Gifted Students with Learning Disabilities in Nigeria

ERIC Educational Resources Information Center

Fakolade, O. A.; Oyedokun, S. O.

2015-01-01

The paper considered several psychosocial variables as predictors of school adjustment of 40 gifted students with learning disabilities in Junior Secondary School in Ikenne Local Government Council Area of Ogun State, Nigeria. Purposeful random sampling was employed to select four schools from 13 junior secondary schools in the area, six…

[Maternal effects of prolonged expulsive efforts].

PubMed

Korb, D; Merazka, R; Théau, A; Goffinet, F; Le Ray, C

2016-02-01

Some studies found an association between duration of expulsive efforts (DEE) and risk of postpartum haemorrhage (PPH). But none demonstrated an association between DEE and severe perineal lacerations. Our aim was to evaluate the impact of prolonged expulsive efforts (EE) beyond 45min on the risk of maternal complication, especially risk of severe perineal laceration. We performed a retrospective study comparing 2 groups, 1: women with an instrumental vaginal delivery performed before 45min for non-fetal progression without FHR abnormalities (VBI for NP<45min) and 2: women with a DEE longer than 45min (DEE≥45min). We compared maternal issues (3rd and 4th degrees perineal lacerations and PPH), using uni- and multivariate analysis. We compared 85 women in group VBI for NP<45min with 124 women in group EE≥45min. In the group EE≥45min, 39% of women had an instrumental vaginal delivery versus 100% in the group VBI for NP<45min (P<0.001). The rate of severe perineal lacerations was significantly higher in the group VBI for NP<45min (8.2% versus 1.7%, P=0.027) and its risk remained significant after adjustment (adjusted OR=6.5 [1.1-40.1]). The rate of PPH was higher in the group EE≥45min (12.9% versus 3.5%, P=0.016), however this association was not significant after adjustment (adjusted OR=3.4 [0.9-12.4]). There was no difference about neonatal issues between the two studied groups. In comparison with a limitation of EE, to prolong EE beyond 45min allows a spontaneous vaginal delivery for more than half of women, if FHR is normal. Such strategy should also decrease the risk of severe perineal laceration. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Premature and delayed ejaculation: two ends of a single continuum influenced by hormonal milieu.

PubMed

Corona, G; Jannini, E A; Lotti, F; Boddi, V; De Vita, G; Forti, G; Lenzi, A; Mannucci, E; Maggi, M

2011-02-01

Although it is well established that all the aspects of male reproduction are hormonally regulated, the endocrine control of the ejaculatory reflex is still not completely clarified. Sex steroids, thyroid and pituitary hormones (oxytocin and prolactin) have been proposed to control the ejaculatory process at various levels; however, only a few reports are currently available. The aim of this study was to evaluate the contribution of testosterone, thyrotropin (TSH) and prolactin (PRL) in the pathogenesis of ejaculatory dysfunction in a large series of subjects consulting for sexual dysfunction. Among the 2652 patients studied, 674 (25.2%) and 194 (7.3%) reported premature and delayed ejaculation (PE and DE), respectively. Categorizing ejaculatory difficulties on an eight-point scale starting from severe PE and ending with anejaculation (0 = severe PE, 1 = moderate PE, 2 = mild PE, 3 = no difficulties, 4 = mild DE, 5 = moderate DE, 6 = severe DE and 7 = anejaculation), PRL as well as TSH levels progressively increased from patients with severe PE towards those with anejaculation. Conversely, the opposite was observed for testosterone levels. All of these associations were confirmed after adjustment for age (adjusted r = 0.050, 0.053 and -0.038 for PRL, TSH and testosterone, respectively; all p < 0.05). When all hormonal parameters were introduced in the same regression model, adjusting for age, ΣMHQ (an index of general psychopathology) and use of selective serotonin reuptake inhibitor antidepressants, they were independently associated with ejaculatory problems (adjusted r = 0.056, 0.047 and -0.059 for PRL, TSH and testosterone, respectively; all p < 0.05). This study indicates endocrine system is involved in the control of ejaculatory function and that PRL, TSH and testosterone play an independent role. © 2010 The Authors. International Journal of Andrology © 2010 European Academy of Andrology.

Vocational Rehabilitation of the Person with Cystic Fibrosis.

ERIC Educational Resources Information Center

Isralsky, Marc; And Others

1979-01-01

Explored vocational development, self-concept, and vocational adjustment of persons with cystic fibrosis. The following measures of vocational development correlated with work adjustment: vocational plans, educational plans, initiative, occupational information, and average vocational development score. Vocational development did not correlate…

The Stability of Rater Severity in Large-Scale Assessment Programs.

ERIC Educational Resources Information Center

Congdon, Peter J.; McQueen, Joy

2000-01-01

Studied the stability of rater severity over an extended rating period by applying multifaceted Rasch analysis to ratings of 16 raters of writing performances of 8,285 elementary school students. Findings cast doubt on the practice of using a single calibration of rate severity as the basis for adjustment of person measures. (SLD)

How to Implement Differentiated Instruction? Adjust, Adjust, Adjust: North Carolina Project Begins with Encouragement from Administrators

ERIC Educational Resources Information Center

Lewis, Sylvia G.; Batts, Kelly

2005-01-01

To help teachers meet the diverse needs of individual students, North Topsail Elementary School in North Carolina developed a differentiated instruction program. North Topsail began its change with staff focusing on the principles of Accelerated Schools, including differentiation. Teachers reflected, developed a vision, and set priorities for…

Definitive care in level 3 trauma centres after severe injury: A comparison of clinical characteristics and outcomes.

PubMed

Gomez, David; Alali, Aziz S; Xiong, Wei; Zarzaur, Ben L; Mann, N Clay; Nathens, Avery B

2015-09-01

The role of level 3 trauma centres (TC) in inclusive trauma systems has not been well defined. The absence of nationally recognised inter-facility transfer criteria for inclusive systems has often left individual level 3 TCs to decide upon their own what their spectrum of care is and particularly which severely injured patients to admit for definitive care. Retrospective cohort study in which the principal objective was to compare the characteristics and outcomes of severely injured (injury severity score>15) adult patients (≥18 years) who received definitive care at level 3 centres with severely injured adult patients who were transferred to level 1-2 TCs during the same time period. Data were derived from the National Trauma Data Bank (2010-2011). First, we utilised hierarchical logistic regression models to evaluate the risk-adjusted mortality of patients admitted at level 3 TCs compared to those who were transferred to level 1-2 TCs. Subgroup analysis was carried out for patients with isolated traumatic brain injury (iTBI). Finally, we explored the extent of variation in risk-adjusted mortality across level 3 TCs. We identified 6433 severely injured patients who received definitive care across 150 level 3 TCs and 41,165 severely injured patients transferred to level 1-2 centres. Patients who received definitive care at level 3 TCs had a lower comorbidity burden and different injury profiles compared to those transferred to level 1-2 centres. There was no difference in crude mortality (10% vs. 11%, standardised difference 0.04); however, after risk-adjustment, the odds of death for patients who received definitive care at level 3 TCs were 1.24-fold higher (95%CI 1.08-1.43) when compared to those transferred to level 1-2 centres. A trend towards a higher likelihood of death at level 3 centres was observed when analysis was limited to patients with iTBI. Risk-adjusted mortality across level 3 TCs was with few exceptions, homogeneous (<10% of level 3 TCs were outliers with higher/lower mortality). Level 3 trauma centres are providing definitive care for a subset of severely injured patients. Our findings suggest that the outcomes of severely injured patients admitted at level 3 centres might be worse compared to those transferred to level 1-2 centres; a finding independent of performance outliers. Further work is required to elucidate the determinants of admission after severe injury at level 3 trauma centres. Copyright © 2015 Elsevier Ltd. All rights reserved.

Which Kindergarten Children are at Greatest Risk for Attention-deficit/Hyperactivity and Conduct Disorder Symptomatology as Adolescents?

PubMed Central

Morgan, Paul L.; Li, Hui; Cook, Michael; Farkas, George; Hillemeier, Marianne M.; Lin, Yu-chu

2015-01-01

Objective We sought to identify which kindergarten children are simultaneously at risk of moderate or severe symptomatology in both attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) as adolescents. These risk factor estimates have not been previously available. Method Multinomial logistic regression analyses of multi-informant ratings by the end of middle school of a population-based, longitudinal sample of children followed from kindergarten to eighth grade (N = 7,456). Results Kindergarten children from low SES households, those raised by mothers with depressive symptoms or experiencing emotional problems or substance abuse, or those who were punished by spanking were significantly more likely to later display severe levels of ADHD-CD symptomatology in eighth grade. Kindergarten children frequently engaging in ADHD-CD-type behaviors were more likely to later experience both moderate (covariate adjusted OR = 2.37) and severe (covariate adjusted OR = 3.63) ADHD-CD symptomatology. Low academic achievement uniquely increased the risk of both moderate and severe symptomatology (adjusted OR range = 1.7 to 2.24). Conclusions The results should guide early screening and school-based intervention efforts for ADHD-CD. Reducing children’s risk for adolescent ADHD-CD symptomatology may require remediating low behavioral and academic functioning by the end of kindergarten. When these two modifiable factors occur together they increase kindergarten children’s odds of experiencing severe ADHD-CD symptomatology in eighth grade by a multiplicative factor of 8.1. PMID:26192391

Dental Anxiety and the Use of Oral Health Services Among People Attending Two HIV Primary Care Clinics in Miami

PubMed Central

Singer, Richard; Cardenas, Gabriel; Xavier, Jessica; Jeanty, Yves; Pereyra, Margaret; Rodriguez, Allan; Metsch, Lisa R.

2012-01-01

Objectives We examined factors associated with dental anxiety among a sample of HIV primary care patients and investigated the independent association of dental anxiety with oral health care. Methods Cross-sectional data were collected in 2010 from 444 patients attending two HIV primary care clinics in Miami-Dade County, Florida. Corah Dental Anxiety Scores and use of oral health-care services were obtained from all HIV-positive patients in the survey. Results The prevalence of moderate to severe dental anxiety in this sample was 37.8%, while 7.9% of the sample was characterized with severe dental anxiety. The adjusted odds of having severe dental anxiety were 3.962 times greater for females than for males (95% confidence interval [CI] 1.688, 9.130). After controlling for age, ethnicity, gender, education, access to dental care, and HIV primary clinic experience, participants with severe dental anxiety had 69.3% lower adjusted odds of using oral health-care services within the past 12 months (vs. longer than 12 months ago) compared with participants with less-than-severe dental anxiety (adjusted odds ratio = 0.307, 95% CI 0.127, 0.742). Conclusion A sizable number of patients living with HIV have anxiety associated with obtaining needed dental care. Routine screening for dental anxiety and counseling to reduce dental anxiety are supported by this study as a means of addressing the impact of dental anxiety on the use of oral health services among HIV-positive individuals. PMID:22547875

Cumulative hardship and wellness of low-income, young children: multisite surveillance study.

PubMed

Frank, Deborah A; Casey, Patrick H; Black, Maureen M; Rose-Jacobs, Ruth; Chilton, Mariana; Cutts, Diana; March, Elizabeth; Heeren, Timothy; Coleman, Sharon; de Cuba, Stephanie Ettinger; Cook, John T

2010-05-01

The goals were to generate a cumulative hardship index and to evaluate its association with the well-being of children 4 to 36 months of age without private health insurance. Cross-sectional surveys were linked to anthropometric measures and medical record review at 5 urban medical centers (July 1, 2004, to December 31, 2007). Cumulative hardship index scores ranged from 0 to 6, with food, housing, and energy each contributing a possible score of 0 (secure), 1 (moderately insecure), or 2 (severely insecure) to generate scores indicating no hardship (score of 0), moderate hardship (scores of 1-3), or severe hardship (scores of 4-6). The outcome was a composite indicator of child wellness, including caregivers' reports of children's good/excellent heath, no hospitalizations, not being developmentally at risk, and anthropometric measurements within normal limits. Covariates were selected a priori and through association with predictors and outcomes. Of 7141 participants, 37% reported no material hardship, 57% moderate hardship, and 6% severe hardship. Multivariate logistic regression analyses showed ordinal association between the cumulative hardship index and children's adjusted odds of wellness (severe versus no hardship, adjusted odds ratio [AOR]: 0.65 [95% confidence interval [CI]: 0.51-0.83]; severe versus moderate hardship, AOR: 0.73 [95% CI: 0.58-0.92]; moderate versus no hardship, AOR: 0.89 [95% CI: 0.79-0.99]). Increasing levels of a composite measure of remediable adverse material conditions correlated with decreasing adjusted odds of wellness among young US children.

Dietary Fiber Intake Is Inversely Associated with Periodontal Disease among US Adults.

PubMed

Nielsen, Samara Joy; Trak-Fellermeier, Maria Angelica; Joshipura, Kaumudi; Dye, Bruce A

2016-12-01

Approximately 47% of adults in the United States have periodontal disease. Dietary guidelines recommend a diet providing adequate fiber. Healthier dietary habits, particularly an increased fiber intake, may contribute to periodontal disease prevention. Our objective was to evaluate the relation of dietary fiber intake and its sources with periodontal disease in the US adult population (≥30 y of age). Data from 6052 adults participating in NHANES 2009-2012 were used. Periodontal disease was defined (according to the CDC/American Academy of Periodontology) as severe, moderate, mild, and none. Intake was assessed by 24-h dietary recalls. The relation between periodontal disease and dietary fiber, whole-grain, and fruit and vegetable intakes were evaluated by using multivariate models, adjusting for sociodemographic characteristics and dentition status. In the multivariate logistic model, the lowest quartile of dietary fiber was associated with moderate-severe periodontitis (compared with mild-none) compared with the highest dietary fiber intake quartile (OR: 1.30; 95% CI: 1.00, 1.69). In the multivariate multinomial logistic model, intake in the lowest quartile of dietary fiber was associated with higher severity of periodontitis than dietary fiber intake in the highest quartile (OR: 1.27; 95% CI: 1.00, 1.62). In the adjusted logistic model, whole-grain intake was not associated with moderate-severe periodontitis. However, in the adjusted multinomial logistic model, adults consuming whole grains in the lowest quartile were more likely to have more severe periodontal disease than were adults consuming whole grains in the highest quartile (OR: 1.32; 95% CI: 1.08, 1.62). In fully adjusted logistic and multinomial logistic models, fruit and vegetable intake was not significantly associated with periodontitis. We found an inverse relation between dietary fiber intake and periodontal disease among US adults ≥30 y old. Periodontal disease was associated with low whole-grain intake but not with low fruit and vegetable intake. © 2016 American Society for Nutrition.

The Impact of Rheumatoid Arthritis Disease Characteristics on Heart Failure

PubMed Central

Myasoedova, Elena; Crowson, Cynthia S.; Nicola, Paulo J.; Maradit-Kremers, Hilal; Davis, John M.; Roger, Véronique L.; Therneau, Terry M.; Gabriel, Sherine E.

2011-01-01

Objective To examine the impact of rheumatoid arthritis (RA) characteristics and antirheumatic medications on the risk of heart failure (HF) in RA. Methods A population-based incidence cohort of RA patients aged ≥18 (1987 ACR criteria first met between 1/1/1980 and 1/1/2008) without a history of HF was followed until HF onset (defined by Framingham criteria), death, or 1/1/2008. We collected data on RA characteristics, antirheumatic medications and cardiovascular (CV) risk factors. Cox models adjusting for age, sex and calendar year were used to analyze the data. Results The study included 795 RA patients (mean age 55.3 years, 69% females, 66% rheumatoid factor [RF] positive). During the mean follow-up of 9.7 years, 92 patients developed HF. The risk of HF was associated with RF positivity (HR 1.6, 95%CI 1.0, 2.5), erythrocyte sedimentation rate (ESR) at RA incidence (HR 1.6, 95%CI 1.2, 2.0), repeatedly high ESR (HR 2.1, 95%CI 1.2, 3.5), severe extra-articular manifestations (HR 3.1, 95%CI 1.9, 5.1) and corticosteroid use (HR 2.0, 95%CI 1.3, 3.2), adjusting for CV risk factors and coronary heart disease (CHD). Methotrexate users were half as likely to have HF as non-users (HR 0.5, 95%CI 0.3, 0.9). Conclusion Several RA characteristics and the use of corticosteroids were associated with HF adjusting for CV risk factors and CHD. Methotrexate use appeared to be protective against HF. These findings suggest an independent impact of RA on HF which may be further modified by antirheumatic treatment. PMID:21572155

Metabolic network failures in Alzheimer’s disease: A biochemical road map

PubMed Central

Toledo, Jon B.; Arnold, Matthias; Kastenmüuller, Gabi; Chang, Rui; Baillie, Rebecca A.; Han, Xianlin; Thambisetty, Madhav; Tenenbaum, Jessica D.; Suhre, Karsten; Thompson, J. Will; St. John-Williams, Lisa; MahmoudianDehkordi, Siamak; Rotroff, Daniel M.; Jack, John R.; Motsinger-Reif, Alison; Risacher, Shannon L.; Blach, Colette; Lucas, Joseph E.; Massaro, Tyler; Louie, Gregory; Zhu, Hongjie; Dallmann, Guido; Klavins, Kristaps; Koal, Therese; Kim, Sungeun; Nho, Kwangsik; Shen, Li; Casanova, Ramon; Varma, Sudhir; Legido-Quigley, Cristina; Moseley, M. Arthur; Zhu, Kuixi; Henrion, Marc Y. R.; van der Lee, Sven J.; Harms, Amy C.; Demirkan, Ayse; Hankemeier, Thomas; van Duijn, Cornelia M.; Trojanowski, John Q.; Shaw, Leslie M.; Saykin, Andrew J.; Weiner, Michael W.; Doraiswamy, P. Murali; Kaddurah-Daouk, Rima

2018-01-01

Introduction The Alzheimer’s Disease Research Summits of 2012 and 2015 incorporated experts from academia, industry, and nonprofit organizations to develop new research directions to transform our understanding of Alzheimer’s disease (AD) and propel the development of critically needed therapies. In response to their recommendations, big data at multiple levels are being generated and integrated to study network failures in disease. We used metabolomics as a global biochemical approach to identify peripheral metabolic changes in AD patients and correlate them to cerebrospinal fluid pathology markers, imaging features, and cognitive performance. Methods Fasting serum samples from the Alzheimer’s Disease Neuroimaging Initiative (199 control, 356 mild cognitive impairment, and 175 AD participants) were analyzed using the AbsoluteIDQ-p180 kit. Performance was validated in blinded replicates, and values were medication adjusted. Results Multivariable-adjusted analyses showed that sphingomyelins and ether-containing phosphatidylcholines were altered in preclinical biomarker-defined AD stages, whereas acylcarnitines and several amines, including the branched-chain amino acid valine and α-aminoadipic acid, changed in symptomatic stages. Several of the analytes showed consistent associations in the Rotterdam, Erasmus Rucphen Family, and Indiana Memory and Aging Studies. Partial correlation networks constructed for Aβ1–42, tau, imaging, and cognitive changes provided initial biochemical insights for disease-related processes. Coexpression networks interconnected key metabolic effectors of disease. Discussion Metabolomics identified key disease-related metabolic changes and disease-progression-related changes. Defining metabolic changes during AD disease trajectory and its relationship to clinical phenotypes provides a powerful roadmap for drug and biomarker discovery. PMID:28341160

Spirometry, Static Lung Volumes, and Diffusing Capacity.

PubMed

Vaz Fragoso, Carlos A; Cain, Hilary C; Casaburi, Richard; Lee, Patty J; Iannone, Lynne; Leo-Summers, Linda S; Van Ness, Peter H

2017-09-01

Spirometric Z-scores from the Global Lung Initiative (GLI) rigorously account for age-related changes in lung function and are thus age-appropriate when establishing spirometric impairments, including a restrictive pattern and air-flow obstruction. However, GLI-defined spirometric impairments have not yet been evaluated regarding associations with static lung volumes (total lung capacity [TLC], functional residual capacity [FRC], and residual volume [RV]) and gas exchange (diffusing capacity). We performed a retrospective review of pulmonary function tests in subjects ≥40 y old (mean age 64.6 y), including pre-bronchodilator measures for: spirometry ( n = 2,586), static lung volumes by helium dilution with inspiratory capacity maneuver ( n = 2,586), and hemoglobin-adjusted single-breath diffusing capacity ( n = 2,508). Using multivariable linear regression, adjusted least-squares means (adj LS Means) were calculated for TLC, FRC, RV, and hemoglobin-adjusted single-breath diffusing capacity. The adj LS Means were expressed with and without height-cubed standardization and stratified by GLI-defined spirometry, including normal ( n = 1,251), restrictive pattern ( n = 663), and air-flow obstruction (mild, [ n = 128]; moderate, [ n = 150]; and severe, [ n = 394]). Relative to normal spirometry, restrictive-pattern had lower adj LS Means for TLC, FRC, RV, and hemoglobin-adjusted single-breath diffusing capacity ( P ≤ .001). Conversely, relative to normal spirometry, mild, moderate, and severe air-flow obstruction had higher adj LS Means for FRC and RV ( P < .001). However, only mild and moderate air-flow obstruction had higher adj LS Means for TLC ( P < .001), while only moderate and severe air-flow obstruction had higher adj LS Means for RV/TLC ( P < .001) and lower adj LS Means for hemoglobin-adjusted single-breath diffusing capacity ( P < .001). Notably, TLC (calculated as FRC + inspiratory capacity) was not increased in severe air-flow obstruction ( P ≥ .11) because inspiratory capacity decreased with increasing air-flow obstruction ( P < .001), thus opposing the increased FRC ( P < .001). Finally, P values were similar whether adj LS Means were height-cubed standardized. A GLI-defined spirometric restrictive pattern is strongly associated with a restrictive ventilatory defect (decreased TLC, FRC, and RV), while GLI-defined spirometric air-flow obstruction is strongly associated with hyperinflation (increased FRC) and air trapping (increased RV and RV/TLC). Both spirometric impairments were strongly associated with impaired gas exchange (decreased hemoglobin-adjusted single-breath diffusing capacity). Copyright © 2017 by Daedalus Enterprises.

A neurorobotic platform for locomotor prosthetic development in rats and mice

NASA Astrophysics Data System (ADS)

von Zitzewitz, Joachim; Asboth, Leonie; Fumeaux, Nicolas; Hasse, Alexander; Baud, Laetitia; Vallery, Heike; Courtine, Grégoire

2016-04-01

Objectives. We aimed to develop a robotic interface capable of providing finely-tuned, multidirectional trunk assistance adjusted in real-time during unconstrained locomotion in rats and mice. Approach. We interfaced a large-scale robotic structure actuated in four degrees of freedom to exchangeable attachment modules exhibiting selective compliance along distinct directions. This combination allowed high-precision force and torque control in multiple directions over a large workspace. We next designed a neurorobotic platform wherein real-time kinematics and physiological signals directly adjust robotic actuation and prosthetic actions. We tested the performance of this platform in both rats and mice with spinal cord injury. Main Results. Kinematic analyses showed that the robotic interface did not impede locomotor movements of lightweight mice that walked freely along paths with changing directions and height profiles. Personalized trunk assistance instantly enabled coordinated locomotion in mice and rats with severe hindlimb motor deficits. Closed-loop control of robotic actuation based on ongoing movement features enabled real-time control of electromyographic activity in anti-gravity muscles during locomotion. Significance. This neurorobotic platform will support the study of the mechanisms underlying the therapeutic effects of locomotor prosthetics and rehabilitation using high-resolution genetic tools in rodent models.

A neurorobotic platform for locomotor prosthetic development in rats and mice.

PubMed

von Zitzewitz, Joachim; Asboth, Leonie; Fumeaux, Nicolas; Hasse, Alexander; Baud, Laetitia; Vallery, Heike; Courtine, Grégoire

2016-04-01

We aimed to develop a robotic interface capable of providing finely-tuned, multidirectional trunk assistance adjusted in real-time during unconstrained locomotion in rats and mice. We interfaced a large-scale robotic structure actuated in four degrees of freedom to exchangeable attachment modules exhibiting selective compliance along distinct directions. This combination allowed high-precision force and torque control in multiple directions over a large workspace. We next designed a neurorobotic platform wherein real-time kinematics and physiological signals directly adjust robotic actuation and prosthetic actions. We tested the performance of this platform in both rats and mice with spinal cord injury. Kinematic analyses showed that the robotic interface did not impede locomotor movements of lightweight mice that walked freely along paths with changing directions and height profiles. Personalized trunk assistance instantly enabled coordinated locomotion in mice and rats with severe hindlimb motor deficits. Closed-loop control of robotic actuation based on ongoing movement features enabled real-time control of electromyographic activity in anti-gravity muscles during locomotion. This neurorobotic platform will support the study of the mechanisms underlying the therapeutic effects of locomotor prosthetics and rehabilitation using high-resolution genetic tools in rodent models.

Adjustable fetal phantom for pulse oximetry

NASA Astrophysics Data System (ADS)

Stubán, Norbert; Niwayama, Masatsugu

2009-05-01

As the measuring head of a fetal pulse oximeter must be attached to the head of the fetus inside the mother's uterus during labor, testing, and developing of fetal pulse oximeters in real environment have several difficulties. A fetal phantom could enable evaluation of pulse oximeters in a simulated environment without the restrictions and difficultness of medical experiments in the labor room. Based on anatomic data we developed an adjustable fetal head phantom with three different tissue layers and artificial arteries. The phantom consisted of two arteries with an inner diameter of 0.2 and 0.4 mm. An electronically controlled pump produced pulse waves in the arteries. With the phantom we investigated the sensitivity of a custom-designed wireless pulse oximeter at different pulsation intensity and artery diameters. The results showed that the oximeter was capable of identifying 4% and 2% changes in diameter between the diastolic and systolic point in arteries of over 0.2 and 0.4 mm inner diameter, respectively. As the structure of the phantom is based on reported anatomic values, the results predict that the investigated custom-designed wireless pulse oximeter has sufficient sensitivity to detect the pulse waves and to calculate the R rate on the fetal head.

Burden of Noncommunicable Diseases and National Strategies to Control Them in Korea

PubMed Central

2013-01-01

Noncommunicable diseases (NCDs) are the most important causes of premature mortality and disability-adjusted life years in Korea. NCDs are also the main contributor to socioeconomic inequalities in mortality and life expectancy. Reduction of NCDs and NCD inequalities would result in significant improvement in healthy life expectancy and health equity in Korea. Major NCD risk factors such as dietary risks (including salt intake), alcohol consumption, cigarette smoking, and high blood pressure were found to be the leading modifiable risk factors of disability-adjusted life years in Korea, based on the 2010 Global Burden of Disease Study. Several Korean studies have shown that these risk factors play an important role in creating socioeconomic inequalities in NCD mortality and total mortality. Current international discussions on NCD policies in the United Nations and the World Health Organization would provide better opportunities for developing aggressive population-wide policy measures in Korea. Considering the paucity of population-wide policies to control major NCD risk factors in Korea, rigorous population approaches such as taxation and regulation of unhealthy commodities as well as public education and mass campaigns should be further developed in Korea. PMID:23946873

Neonatal Pain-Related Stress Predicts Cortical Thickness at Age 7 Years in Children Born Very Preterm

PubMed Central

Ranger, Manon; Chau, Cecil M. Y.; Garg, Amanmeet; Woodward, Todd S.; Beg, Mirza Faisal; Bjornson, Bruce; Poskitt, Kenneth; Fitzpatrick, Kevin; Synnes, Anne R.; Miller, Steven P.; Grunau, Ruth E.

2013-01-01

Background Altered brain development is evident in children born very preterm (24–32 weeks gestational age), including reduction in gray and white matter volumes, and thinner cortex, from infancy to adolescence compared to term-born peers. However, many questions remain regarding the etiology. Infants born very preterm are exposed to repeated procedural pain-related stress during a period of very rapid brain development. In this vulnerable population, we have previously found that neonatal pain-related stress is associated with atypical brain development from birth to term-equivalent age. Our present aim was to evaluate whether neonatal pain-related stress (adjusted for clinical confounders of prematurity) is associated with altered cortical thickness in very preterm children at school age. Methods 42 right-handed children born very preterm (24–32 weeks gestational age) followed longitudinally from birth underwent 3-D T1 MRI neuroimaging at mean age 7.9 yrs. Children with severe brain injury and major motor/sensory/cognitive impairment were excluded. Regional cortical thickness was calculated using custom developed software utilizing FreeSurfer segmentation data. The association between neonatal pain-related stress (defined as the number of skin-breaking procedures) accounting for clinical confounders (gestational age, illness severity, infection, mechanical ventilation, surgeries, and morphine exposure), was examined in relation to cortical thickness using constrained principal component analysis followed by generalized linear modeling. Results After correcting for multiple comparisons and adjusting for neonatal clinical factors, greater neonatal pain-related stress was associated with significantly thinner cortex in 21/66 cerebral regions (p-values ranged from 0.00001 to 0.014), predominately in the frontal and parietal lobes. Conclusions In very preterm children without major sensory, motor or cognitive impairments, neonatal pain-related stress appears to be associated with thinner cortex in multiple regions at school age, independent of other neonatal risk factors. PMID:24204657

ATF6α/β-mediated adjustment of ER chaperone levels is essential for development of the notochord in medaka fish

PubMed Central

Ishikawa, Tokiro; Okada, Tetsuya; Ishikawa-Fujiwara, Tomoko; Todo, Takeshi; Kamei, Yasuhiro; Shigenobu, Shuji; Tanaka, Minoru; Saito, Taro L.; Yoshimura, Jun; Morishita, Shinichi; Toyoda, Atsushi; Sakaki, Yoshiyuki; Taniguchi, Yoshihito; Takeda, Shunichi; Mori, Kazutoshi

2013-01-01

ATF6α and ATF6β are membrane-bound transcription factors activated by regulated intramembrane proteolysis in response to endoplasmic reticulum (ER) stress to induce various ER quality control proteins. ATF6α- and ATF6β single-knockout mice develop normally, but ATF6α/β double knockout causes embryonic lethality, the reason for which is unknown. Here we show in medaka fish that ATF6α is primarily responsible for transcriptional induction of the major ER chaperone BiP and that ATF6α/β double knockout, but not ATF6α- or ATF6β single knockout, causes embryonic lethality, as in mice. Analyses of ER stress reporters reveal that ER stress occurs physiologically during medaka early embryonic development, particularly in the brain, otic vesicle, and notochord, resulting in ATF6α- and ATF6β-mediated induction of BiP, and that knockdown of the α1 chain of type VIII collagen reduces such ER stress. The absence of transcriptional induction of several ER chaperones in ATF6α/β double knockout causes more profound ER stress and impaired notochord development, which is partially rescued by overexpression of BiP. Thus ATF6α/β-mediated adjustment of chaperone levels to increased demands in the ER is essential for development of the notochord, which synthesizes and secretes large amounts of extracellular matrix proteins to serve as the body axis before formation of the vertebra. PMID:23447699

A musculoskeletal foot model for clinical gait analysis.

PubMed

Saraswat, Prabhav; Andersen, Michael S; Macwilliams, Bruce A

2010-06-18

Several full body musculoskeletal models have been developed for research applications and these models may potentially be developed into useful clinical tools to assess gait pathologies. Existing full-body musculoskeletal models treat the foot as a single segment and ignore the motions of the intrinsic joints of the foot. This assumption limits the use of such models in clinical cases with significant foot deformities. Therefore, a three-segment musculoskeletal model of the foot was developed to match the segmentation of a recently developed multi-segment kinematic foot model. All the muscles and ligaments of the foot spanning the modeled joints were included. Muscle pathways were adjusted with an optimization routine to minimize the difference between the muscle flexion-extension moment arms from the model and moment arms reported in literature. The model was driven by walking data from five normal pediatric subjects (aged 10.6+/-1.57 years) and muscle forces and activation levels required to produce joint motions were calculated using an inverse dynamic analysis approach. Due to the close proximity of markers on the foot, small marker placement error during motion data collection may lead to significant differences in musculoskeletal model outcomes. Therefore, an optimization routine was developed to enforce joint constraints, optimally scale each segment length and adjust marker positions. To evaluate the model outcomes, the muscle activation patterns during walking were compared with electromyography (EMG) activation patterns reported in the literature. Model-generated muscle activation patterns were observed to be similar to the EMG activation patterns. Published by Elsevier Ltd.

ATF6α/β-mediated adjustment of ER chaperone levels is essential for development of the notochord in medaka fish.

PubMed

Ishikawa, Tokiro; Okada, Tetsuya; Ishikawa-Fujiwara, Tomoko; Todo, Takeshi; Kamei, Yasuhiro; Shigenobu, Shuji; Tanaka, Minoru; Saito, Taro L; Yoshimura, Jun; Morishita, Shinichi; Toyoda, Atsushi; Sakaki, Yoshiyuki; Taniguchi, Yoshihito; Takeda, Shunichi; Mori, Kazutoshi

2013-05-01

ATF6α and ATF6β are membrane-bound transcription factors activated by regulated intramembrane proteolysis in response to endoplasmic reticulum (ER) stress to induce various ER quality control proteins. ATF6α- and ATF6β single-knockout mice develop normally, but ATF6α/β double knockout causes embryonic lethality, the reason for which is unknown. Here we show in medaka fish that ATF6α is primarily responsible for transcriptional induction of the major ER chaperone BiP and that ATF6α/β double knockout, but not ATF6α- or ATF6β single knockout, causes embryonic lethality, as in mice. Analyses of ER stress reporters reveal that ER stress occurs physiologically during medaka early embryonic development, particularly in the brain, otic vesicle, and notochord, resulting in ATF6α- and ATF6β-mediated induction of BiP, and that knockdown of the α1 chain of type VIII collagen reduces such ER stress. The absence of transcriptional induction of several ER chaperones in ATF6α/β double knockout causes more profound ER stress and impaired notochord development, which is partially rescued by overexpression of BiP. Thus ATF6α/β-mediated adjustment of chaperone levels to increased demands in the ER is essential for development of the notochord, which synthesizes and secretes large amounts of extracellular matrix proteins to serve as the body axis before formation of the vertebra.

External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China

PubMed Central

Yu, Ping; Pan, Yuesong; Wang, Yongjun; Wang, Xianwei; Liu, Liping; Ji, Ruijun; Meng, Xia; Jing, Jing; Tong, Xu; Guo, Li; Wang, Yilong

2016-01-01

Background and Purpose A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke. Methods The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS) score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson’s correlation coefficient. Results The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79–0.82), and the c-statistic of model B was 0.82 (95% confidence interval, 0.81–0.84). Excellent calibration was reported in the two models with Pearson’s correlation coefficient (0.892 for model A, p<0.001; 0.927 for model B, p = 0.008). Conclusions The case-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke. PMID:27846282

Incorporating Comorbidity Within Risk Adjustment for UK Pediatric Cardiac Surgery.

PubMed

Brown, Katherine L; Rogers, Libby; Barron, David J; Tsang, Victor; Anderson, David; Tibby, Shane; Witter, Thomas; Stickley, John; Crowe, Sonya; English, Kate; Franklin, Rodney C; Pagel, Christina

2017-07-01

When considering early survival rates after pediatric cardiac surgery it is essential to adjust for risk linked to case complexity. An important but previously less well understood component of case mix complexity is comorbidity. The National Congenital Heart Disease Audit data representing all pediatric cardiac surgery procedures undertaken in the United Kingdom and Ireland between 2009 and 2014 was used to develop and test groupings for comorbidity and additional non-procedure-based risk factors within a risk adjustment model for 30-day mortality. A mixture of expert consensus based opinion and empiric statistical analyses were used to define and test the new comorbidity groups. The study dataset consisted of 21,838 pediatric cardiac surgical procedure episodes in 18,834 patients with 539 deaths (raw 30-day mortality rate, 2.5%). In addition to surgical procedure type, primary cardiac diagnosis, univentricular status, age, weight, procedure type (bypass, nonbypass, or hybrid), and era, the new risk factor groups of non-Down congenital anomalies, acquired comorbidities, increased severity of illness indicators (eg, preoperative mechanical ventilation or circulatory support) and additional cardiac risk factors (eg, heart muscle conditions and raised pulmonary arterial pressure) all independently increased the risk of operative mortality. In an era of low mortality rates across a wide range of operations, non-procedure-based risk factors form a vital element of risk adjustment and their presence leads to wide variations in the predicted risk of a given operation. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Advanced illumination control algorithm for medical endoscopy applications

NASA Astrophysics Data System (ADS)

Sousa, Ricardo M.; Wäny, Martin; Santos, Pedro; Morgado-Dias, F.

2015-05-01

CMOS image sensor manufacturer, AWAIBA, is providing the world's smallest digital camera modules to the world market for minimally invasive surgery and one time use endoscopic equipment. Based on the world's smallest digital camera head and the evaluation board provided to it, the aim of this paper is to demonstrate an advanced fast response dynamic control algorithm of the illumination LED source coupled to the camera head, over the LED drivers embedded on the evaluation board. Cost efficient and small size endoscopic camera modules nowadays embed minimal size image sensors capable of not only adjusting gain and exposure time but also LED illumination with adjustable illumination power. The LED illumination power has to be dynamically adjusted while navigating the endoscope over changing illumination conditions of several orders of magnitude within fractions of the second to guarantee a smooth viewing experience. The algorithm is centered on the pixel analysis of selected ROIs enabling it to dynamically adjust the illumination intensity based on the measured pixel saturation level. The control core was developed in VHDL and tested in a laboratory environment over changing light conditions. The obtained results show that it is capable of achieving correction speeds under 1 s while maintaining a static error below 3% relative to the total number of pixels on the image. The result of this work will allow the integration of millimeter sized high brightness LED sources on minimal form factor cameras enabling its use in endoscopic surgical robotic or micro invasive surgery.

Folate Deficiency, Atopy, and Severe Asthma Exacerbations in Puerto Rican Children

PubMed Central

Blatter, Joshua; Brehm, John M.; Sordillo, Joanne; Forno, Erick; Boutaoui, Nadia; Acosta-Pérez, Edna; Alvarez, María; Colón-Semidey, Angel; Weiss, Scott T.; Litonjua, Augusto A.; Canino, Glorisa

2016-01-01

Background: Little is known about folate and atopy or severe asthma exacerbations. We examined whether folate deficiency is associated with number of positive skin tests to allergens or severe asthma exacerbations in a high-risk population and further assessed whether such association is explained or modified by vitamin D status. Methods: Cross-sectional study of 582 children aged 6 to 14 years with (n = 304) and without (n = 278) asthma in San Juan, Puerto Rico. Folate deficiency was defined as plasma folate less than or equal to 20 ng/ml. Our outcomes were the number of positive skin tests to allergens (range, 0–15) in all children and (in children with asthma) one or more severe exacerbations in the previous year. Logistic and negative binomial regression models were used for the multivariate analysis. All multivariate models were adjusted for age, sex, household income, residential proximity to a major road, and (for atopy) case/control status; those for severe exacerbations were also adjusted for use of inhaled corticosteroids and vitamin D insufficiency (a plasma 25[OH]D < 30 ng/ml). Measurements and Main Results: In a multivariate analysis, folate deficiency was significantly associated with an increased degree of atopy and 2.2 times increased odds of at least one severe asthma exacerbation (95% confidence interval for odds ratio, 1.1–4.6). Compared with children who had normal levels of both folate and vitamin D, those with both folate deficiency and vitamin D insufficiency had nearly eightfold increased odds of one or more severe asthma exacerbation (95% confidence interval for adjusted odds ratio, 2.7–21.6). Conclusions: Folate deficiency is associated with increased degree of atopy and severe asthma exacerbations in school-aged Puerto Ricans. Vitamin D insufficiency may further increase detrimental effects of folate deficiency on severe asthma exacerbations. PMID:26561879

Explaining poorer stroke outcomes in women: women surviving 3 months have more severe strokes than men despite a lower 3-month case fatality.

PubMed

Olsen, Tom Skyhøj; Andersen, Zorana Jovanovic; Andersen, Klaus Kaae

2012-06-01

Women who survive stroke are more disabled and more often institutionalized than men. We explore this phenomenon by studying case fatality and stroke severity in stroke survivors separately for men and women. A Danish stroke registry (2000-2007) contains information about 26,818 patients with first-ever ischemic stroke, including stroke severity (Scandinavian Stroke Scale, 0 worst to 58 best), computed tomography scan, cardiovascular risk factors, and death 3 months after stroke. We modeled stroke severity by generalized additive linear model and 3-month case fatality with logistic model adjusting for age and cardiovascular risk factors. Male to female ratio was 51.5% to 48.5%. Mean age was 68.8 (SD 12.6) years in men; 73.7 (13.8) years in women. Stroke was more severe in women (mean [SD] Scandinavian Stroke Scale, 42.2 [16.0]) than in men (mean [SD] Scandinavian Stroke Scale, 45.6 [14.2]) also after adjustment for age and cardiovascular risk factors; significant in patients older than 75 years. In survivors at 3 months, stroke was more severe in women than men, given same age and cardiovascular risk factor profile; significant in patients older than 75 years. More women (11.9%) had died within 3 months than men (8.6%). However, adjusting for age, stroke severity, and risk factor profile, 3-month case fatality was lower in women than men; significant in patients older than 78 years. Although 3-month case fatality was lower in women than men, strokes were more severe among survivors at 3 months in women than in men. In addition, strokes were more severe in women. Our data help elucidate why women survive stroke better but have poorer functional outcomes that require more care than men. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

Understanding the mediating role of corporal punishment in the association between maternal stress, efficacy, co-parenting and children's adjustment difficulties among Arab mothers.

PubMed

Khoury-Kassabri, Mona; Attar-Schwartz, Shalhevet; Zur, Hana

2014-06-01

This study, guided by the Family Systems Theory, examines the direct effect of maternal use of corporal punishment on children's adjustment difficulties. Also, it explores whether corporal punishment serves as a mediating factor in the relationship between several maternal characteristics, marital relationships, and children's adjustment difficulties. A total of 2,447 Arab mothers completed anonymous, structured, self-report questionnaires. The use of corporal punishment was generally strongly supported by the Arab mothers in our sample. A greater likelihood of using corporal punishment was found among mothers of boys rather than girls, among mothers with lower perceived self-efficacy to discipline children, and among mothers with a lower perception of their husbands' participation in child-related labor. In addition, the higher a mother's reports on disagreement with her husband about discipline methods and the stronger her level of maternal stress, the more likely she was to use corporal punishment. Corporal punishment also mediated the association between the above mentioned factors and child adjustment difficulties. Furthermore, a husband's emotional support and family socioeconomic status were directly associated to children's adjustment difficulties. The results of the current study emphasize the need to observe children's development within the context of their family systems and to consider the mutual influences of different subsystems such as marital relationships and mother-child interactions. Prevention and intervention programs should raise parents' awareness concerning the harmful effects of corporal punishment and take into account the impact of dynamic transactions of parental conflicts and disagreements regarding discipline methods on child outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Cyclic coordinate descent: A robotics algorithm for protein loop closure.

PubMed

Canutescu, Adrian A; Dunbrack, Roland L

2003-05-01

In protein structure prediction, it is often the case that a protein segment must be adjusted to connect two fixed segments. This occurs during loop structure prediction in homology modeling as well as in ab initio structure prediction. Several algorithms for this purpose are based on the inverse Jacobian of the distance constraints with respect to dihedral angle degrees of freedom. These algorithms are sometimes unstable and fail to converge. We present an algorithm developed originally for inverse kinematics applications in robotics. In robotics, an end effector in the form of a robot hand must reach for an object in space by altering adjustable joint angles and arm lengths. In loop prediction, dihedral angles must be adjusted to move the C-terminal residue of a segment to superimpose on a fixed anchor residue in the protein structure. The algorithm, referred to as cyclic coordinate descent or CCD, involves adjusting one dihedral angle at a time to minimize the sum of the squared distances between three backbone atoms of the moving C-terminal anchor and the corresponding atoms in the fixed C-terminal anchor. The result is an equation in one variable for the proposed change in each dihedral. The algorithm proceeds iteratively through all of the adjustable dihedral angles from the N-terminal to the C-terminal end of the loop. CCD is suitable as a component of loop prediction methods that generate large numbers of trial structures. It succeeds in closing loops in a large test set 99.79% of the time, and fails occasionally only for short, highly extended loops. It is very fast, closing loops of length 8 in 0.037 sec on average.

Light-adjustable lens.

PubMed Central

Schwartz, Daniel M

2003-01-01

PURPOSE: First, to determine whether a silicone light-adjustable intraocular lens (IOL) can be fabricated and adjusted precisely with a light delivery device (LDD). Second, to determine the biocompatibility of an adjustable IOL and whether the lens can be adjusted precisely in vivo. METHODS: After fabrication of a light-adjustable silicone formulation, IOLs were made and tested in vitro for cytotoxicity, leaching, precision of adjustment, optical quality after adjustment, and mechanical properties. Light-adjustable IOLs were then tested in vivo for biocompatibility and precision of adjustment in a rabbit model. In collaboration with Zeiss-Meditec, a digital LDD was developed and tested to correct for higher-order aberrations in light-adjustable IOLs. RESULTS: The results establish that a biocompatible silicone IOL can be fabricated and adjusted using safe levels of light. There was no evidence of cytotoxicity or leaching. Testing of mechanical properties revealed no significant differences from commercial controls. Implantation of light-adjustable lenses in rabbits demonstrated- excellent biocompatibility after 6 months, comparable to a commercially available IOL. In vivo spherical (hyperopic and myopic) adjustment in rabbits was achieved using an analog light delivery system. The digital light delivery system was tested and achieved correction of higher-order aberrations. CONCLUSION: A silicone light-adjustable IOL and LDD have been developed to enable postoperative, noninvasive adjustment of lens power. The ability to correct higher-order aberrations in these materials has broad potential applicability for optimization of vision in patients undergoing cataract and refractive surgery. PMID:14971588

The Effect of Birth Order on Neonatal Morbidity and Mortality in Very Preterm Twins.

PubMed

Mei-Dan, Elad; Shah, Jyotsna; Lee, Shoo; Shah, Prakesh S; Murphy, Kellie E

2017-07-01

Objective  This retrospective cohort study examined the effect of birth order on neonatal morbidity and mortality in very preterm twins. Study Design  Using 2005 to 2012 data from the Canadian Neonatal Network, very preterm twins born between 24 0/7 and 32 6/7 weeks of gestation were included. Odds of morbidity and mortality of second-born cotwins compared with first-born cotwins were examined by matched-pair analysis. Outcomes were neonatal death, severe brain injury (intraventricular hemorrhage grade 3 or 4 or persistent periventricular echogenicity), bronchopulmonary dysplasia, severe retinopathy of prematurity (ROP) (> stage 2), necrotizing enterocolitis (≥ stage 2), and respiratory distress syndrome (RDS). Multivariable analysis was performed adjusting for confounders. Result  There were 6,636 twins (3,318 pairs) included with a mean gestational age (GA) of 28.9 weeks. A higher rate of small for GA occurred in second-born twins (10 vs. 6%). Mortality was significantly lower for second-born twins (4.3 vs. 5.3%; adjusted odds ratio: 0.75; 95% confidence interval [CI]: 0.59-0.95). RDS (66 vs. 60%; adjusted odds ratio: 1.40; 95% CI: 1.29-1.52) and severe retinopathy (9 vs. 7%; adjusted odds ratio: 1.46; 95% CI: 1.07-2.01) were significantly higher in second-born twins. Conclusion  Thus, while second-born twins had reduced odds of mortality, they also had increased odds of RDS and ROP. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Poor knowledge and faulty thinking regarding hemolysis and potassium elevation.

PubMed

Hawkins, Robert C

2005-01-01

A questionnaire to assess knowledge of the expected elevation in serum K measurement with different grades of hemolysis was administered to medical technologists working in biochemistry laboratories, hospital physicians and nurses. The questions involved different grades of hemolysis (mild, 1.0, moderate, 2.5 and severe, 5.0 g/L) and different final K measurements (2.9, 4.0, 5.2 and 8.2 mmol/L). Subjects estimated the K concentration in a non-hemolyzed sample for each scenario. Adjustment values (difference between final hemolyzed K concentration and subject's response) were calculated. For the 132 respondees, the mean correct score was 1.7/12. Mean adjustment values were: mild, 0.43 mmol/L (K 2.9), 0.55 (4.0), 0.88 (5.2) and 1.53 (8.2); moderate, 0.85 (2.9), 0.92 (4.0), 1.33 (5.2) and 2.50 (8.2); and severe, 0.93 (2.9), 1.48 (4.0), 1.96 (5.2), 2.96 (8.2). Correct adjustments were: mild, 0.28; moderate, 0.70; and severe, 1.40 mmol/L. Healthcare staff overestimated the effect of hemolysis on potassium measurement and used an incorrect proportional adjustment approach to the problem. Such poor knowledge and faulty thinking could lead to diagnostic delays or misdiagnoses. There is potential for such faulty thinking in all areas of laboratory medicine, and laboratories should review their educational responsibilities and reporting practices in light of this.

Excess mortality in winter in Finnish intensive care.

PubMed

Reinikainen, M; Uusaro, A; Ruokonen, E; Niskanen, M

2006-07-01

In the general population, mortality from acute myocardial infarctions, strokes and respiratory causes is increased in winter. The winter climate in Finland is harsh. The aim of this study was to find out whether there are seasonal variations in mortality rates in Finnish intensive care units (ICUs). We analysed data on 31,040 patients treated in 18 Finnish ICUs. We measured severity of illness with acute physiology and chronic health evaluation II (APACHE II) scores and intensity of care with therapeutic intervention scoring system (TISS) scores. We assessed mortality rates in different months and seasons and used logistic regression analysis to test the independent effect of various seasons on hospital mortality. We defined 'winter' as the period from December to February, inclusive. The crude hospital mortality rate was 17.9% in winter and 16.4% in non-winter, P = 0.003. Even after adjustment for case mix, winter season was an independent risk factor for increased hospital mortality (adjusted odds ratio 1.13, 95% confidence interval 1.04-1.22, P = 0.005). In particular, the risk of respiratory failure was increased in winter. Crude hospital mortality was increased during the main holiday season in July. However, the severity of illness-adjusted risk of death was not higher in July than in other months. An increase in the mean daily TISS score was an independent predictor of increased hospital mortality. Severity of illness-adjusted hospital mortality for Finnish ICU patients is higher in winter than in other seasons.

Thrombin-antithrombin levels are associated with survival in patients resuscitated from cardiac arrest.

PubMed

Wertz, Jonathon; Doshi, Ankur A; Guyette, Francis X; Callaway, Clifton W; Rittenberger, Jon C

2013-10-01

Following successful resuscitation from cardiac arrest, a prothrombotic state may contribute to end-organ dysfunction. We examined whether the level of serum thrombin-antithrombin (TAT) in patients hospitalized after cardiac arrest was associated with survival or the development of multiple organ failure (MOF). A prospective cohort study of subjects with in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) treated between 1/1/2007 and 5/30/2010 at a single tertiary care referral center. TAT levels were measured at hospital arrival and 24h after cardiac arrest. Logistic regression was used to determine associations between TAT levels and survival and development of MOF. Data were available for 86 subjects. TAT levels decreased over time. Initial TAT levels (OR 0.03; 95%CI 0.001, 0.62) and category of illness severity (OR 0.39; 95% CI 0.21, 0.73) were associated with survival. Male gender (OR 3.86; 95% CI 1.17, 12.75) and category of illness severity (OR 1.86; 95% CI 1.09, 3.20), but not TAT levels were associated with development of MOF. Neither the 24-h TAT level, nor the change in TAT from initial to 24h was associated with survival when adjusted for category of illness severity. Initial serum TAT levels and category of illness severity are associated with survival. TAT levels are not associated with development of MOF. Initial TAT levels may be a useful prognostic adjunct in the post arrest population. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Utilization of psychiatric care and antidepressants among people with different severity of depression: a population-based cohort study in Stockholm, Sweden.

PubMed

Sun, Yuying; Möller, Jette; Lundin, Andreas; Wong, Samuel Y S; Yip, Benjamin H K; Forsell, Yvonne

2018-06-01

To identify how severity of depression predicts future utilization of psychiatric care and antidepressants. Data derived from a longitudinal population-based study in Stockholm, Sweden, include 10443 participants aged 20-64 years. Depression was assessed by Major Depression Inventory and divided into subsyndromal, mild, moderate and severe depression. Outcomes were the first time of hospitalization, specialized outpatient care and prescribed drugs obtained from national register records. The association between severity of depression and outcomes was tested by Cox regression analysis, after adjusting for gender, psychiatric treatment history and socio-environmental factors. The cumulative incidences of hospitalizations, outpatient care and antidepressants were 4.0, 11.2, and 21.9% respectively. Compared to the non-depressed group, people with different severity of depression (subsyndromal, mild, moderate and severe depression) all had significantly higher risk of all three psychiatric services (all log-rank test P < 0.001). Use of psychiatric care and antidepressants increased by rising severity of depression. Although the associations between severity of depression and psychiatric services were significant, the dose relationship was not present in people with previous psychiatric history or after adjusting for gender and other factors. People with subsyndromal to severe depression all have increased future psychiatric service utilization compared to non-depressed people.

Relationship Between Beta Cell Dysfunction and Severity of Disease Among Critically Ill Children: A STROBE-Compliant Prospective Observational Study.

PubMed

Liu, Ping-Ping; Lu, Xiu-Lan; Xiao, Zheng-Hui; Qiu, Jun; Zhu, Yi-Min

2016-05-01

Although beta cell dysfunction has been proved to predict prognosis among humans and animals, its prediction on severity of disease remains unclear among children. The present study was aimed to examine the relationship between beta cell dysfunction and severity of disease among critically ill children.This prospective study included 1146 critically ill children, who were admitted to Pediatric Intensive Care Unit (PICU) of Hunan Children's Hospital from November 2011 to August 2013. Information on characteristics, laboratory tests, and prognostic outcomes was collected. Homeostasis model assessment (HOMA)-β, evaluating beta cell function, was used to divide all participants into 4 groups: HOMA-β = 100% (group I, n = 339), 80% ≤ HOMA-β < 100% (group II, n = 71), 40% ≤ HOMA-β < 80% (group III, n = 293), and HOMA-β < 40% (group IV, n = 443). Severity of disease was assessed using the worst Sequential Organ Failure Assessment (SOFA) score, Pediatric Risk of Mortality (PRISM) III score, incidence of organ damage, septic shock, multiple organ dysfunction syndrome (MODS), mechanical ventilation (MV) and mortality. Logistic regression analysis was used to evaluate the risk of developing poor outcomes among patients in different HOMA-β groups, with group I as the reference group.Among 1146 children, incidence of HOMA-β < 100% was 70.41%. C-peptide and insulin declined with the decrement of HOMA-β (P < 0.01). C-reactive protein and procalcitonin levels, rather than white blood cell, were significantly different among 4 groups (P < 0.01). In addition, the worst SOFA score and the worst PRISMIII score increased with declined HOMA-β. For example, the worst SOFA score in group I, II, III, and IV was 1.55 ± 1.85, 1.71 ± 1.93, 1.92 ± 1.63, and 2.18 ± 1.77, respectively. Furthermore, patients with declined HOMA-β had higher risk of developing septic shock, MODS, MV, and mortality, even after adjusting age, gender, myocardial injury, and lung injury. For instance, compared with group I, the multivariate-adjusted odds ratio (95% confidence interval) for developing septic shock was 2.17 (0.59, 8.02), 2.94 (2.18, 6.46), and 2.76 (1.18, 6.46) among patients in group II, III, and IV, respectively.Beta cell dysfunction reflected the severity of disease among critically ill children. Therefore, assessment of beta cell function is critically important to reduce incidence of adverse events in PICU.

Association of Fibroblast Growth Factor 23 With Atrial Fibrillation in Chronic Kidney Disease, From the Chronic Renal Insufficiency Cohort Study

PubMed Central

Mehta, Rupal; Cai, Xuan; Lee, Jungwha; Scialla, Julia J.; Bansal, Nisha; Sondheimer, James H.; Chen, Jing; Hamm, L. Lee; Ricardo, Ana C.; Navaneethan, Sankar D.; Deo, Rajat; Rahman, Mahboob; Feldman, Harold I.; Go, Alan S.; Isakova, Tamara; Wolf, Myles

2016-01-01

Importance Levels of fibroblast growth factor 23 (FGF23) are elevated in chronic kidney disease (CKD) and strongly associated with left ventricular hypertrophy, heart failure, and death. Whether FGF23 is an independent risk factor for atrial fibrillation in CKD is unknown. Objective To investigate the association of FGF23 with atrial fibrillation in CKD. Design, Setting, and Participants Prospective cohort study of 3876 individuals with mild to severe CKD who enrolled in the Chronic Renal Insufficiency Cohort Study between June 19, 2003, and September 3, 2008, and were followed up through March 31, 2013. Exposures Baseline plasma FGF23 levels. Main Outcomes and Measures Prevalent and incident atrial fibrillation. Results The study cohort comprised 3876 participants. Their mean (SD) age was 57.7 (11.0) years, and 44.8% (1736 of 3876) were female. Elevated FGF23 levels were independently associated with increased odds of prevalent atrial fibrillation (n = 660) after adjustment for cardiovascular and CKD-specific factors (odds ratio of highest vs lowest FGF23 quartile, 2.30; 95% CI, 1.69-3.13; P < .001 for linear trend across quartiles). During a median follow-up of 7.6 years (interquartile range, 6.3-8.6 years), 247 of the 3216 participants who were at risk developed incident atrial fibrillation (11.9 events per 1000 person-years). In fully adjusted models, elevated FGF23 was independently associated with increased risk of incident atrial fibrillation after adjustment for demographic, cardiovascular, and CKD-specific factors, and other markers of mineral metabolism (hazard ratio of highest vs lowest FGF23 quartile, 1.59; 95% CI, 1.00-2.53; P = .02 for linear trend across quartiles). The results were unchanged when further adjusted for ejection fraction, but individual adjustments for left ventricular mass index, left atrial area, and interim heart failure events partially attenuated the association of elevated FGF23 with incident atrial fibrillation. Conclusions and Relevance Elevated FGF23 is independently associated with prevalent and incident atrial fibrillation in patients with mild to severe CKD. The effect may be partially mediated through a diastolic dysfunction pathway that includes left ventricular hypertrophy, atrial enlargement, and heart failure events. PMID:27434583

A comparative evaluation of risk-adjustment models for benchmarking amputation-free survival after lower extremity bypass.

PubMed

Simons, Jessica P; Goodney, Philip P; Flahive, Julie; Hoel, Andrew W; Hallett, John W; Kraiss, Larry W; Schanzer, Andres

2016-04-01

Providing patients and payers with publicly reported risk-adjusted quality metrics for the purpose of benchmarking physicians and institutions has become a national priority. Several prediction models have been developed to estimate outcomes after lower extremity revascularization for critical limb ischemia, but the optimal model to use in contemporary practice has not been defined. We sought to identify the highest-performing risk-adjustment model for amputation-free survival (AFS) at 1 year after lower extremity bypass (LEB). We used the national Society for Vascular Surgery Vascular Quality Initiative (VQI) database (2003-2012) to assess the performance of three previously validated risk-adjustment models for AFS. The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL), Finland National Vascular (FINNVASC) registry, and the modified Project of Ex-vivo vein graft Engineering via Transfection III (PREVENT III [mPIII]) risk scores were applied to the VQI cohort. A novel model for 1-year AFS was also derived using the VQI data set and externally validated using the PIII data set. The relative discrimination (Harrell c-index) and calibration (Hosmer-May goodness-of-fit test) of each model were compared. Among 7754 patients in the VQI who underwent LEB for critical limb ischemia, the AFS was 74% at 1 year. Each of the previously published models for AFS demonstrated similar discriminative performance: c-indices for BASIL, FINNVASC, mPIII were 0.66, 0.60, and 0.64, respectively. The novel VQI-derived model had improved discriminative ability with a c-index of 0.71 and appropriate generalizability on external validation with a c-index of 0.68. The model was well calibrated in both the VQI and PIII data sets (goodness of fit P = not significant). Currently available prediction models for AFS after LEB perform modestly when applied to national contemporary VQI data. Moreover, the performance of each model was inferior to that of the novel VQI-derived model. Because the importance of risk-adjusted outcome reporting continues to increase, national registries such as VQI should begin using this novel model for benchmarking quality of care. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

The Cascade of Medical Services and Associated Longitudinal Costs Due to Nonadherent Magnetic Resonance Imaging for Low Back Pain

PubMed Central

Webster, Barbara S.; Choi, YoonSun; Bauer, Ann Z.; Cifuentes, Manuel

2014-01-01

Study Design. Retrospective cohort study. Objective. To compare type, timing, and longitudinal medical costs incurred after adherent versus nonadherent magnetic resonance imaging (MRI) for work-related low back pain. Summary of Background Data. Guidelines advise against MRI for acute uncomplicated low back pain, but is an option for persistent radicular pain after a trial of conservative care. Yet, MRI has become frequent and often nonadherent. Few studies have documented the nature and impact of medical services (including type and timing) initiated by nonadherent MRI. Methods. A longitudinal, workers' compensation administrative data source was accessed to select low back pain claims filed between January 1, 2006 and December 31, 2006. Cases were grouped by MRI timing (early, timely, no MRI) and subgrouped by severity (“less severe,” “more severe”) (final cohort = 3022). Health care utilization for each subgroup was evaluated at 3, 6, 9, and 12 months post-MRI. Multivariate logistic regression models examined risk of receiving subsequent diagnostic studies and/or treatments, adjusting for pain indicators and demographic covariates. Results. The adjusted relative risks for MRI group cases to receive electromyography, nerve conduction testing, advanced imaging, injections, and surgery within 6 months post-MRI risks in the range from 6.5 (95% CI: 2.20–19.09) to 54.9 (95% CI: 22.12–136.21) times the rate for the referent group (no MRI less severe). The timely and early MRI less severe subgroups had similar adjusted relative risks to receive most services. The early MRI more severe subgroup cases had generally higher adjusted relative risks than timely MRI more severe subgroup cases. Medical costs for both early MRI subgroups were highest and increased the most over time. Conclusion. The impact of nonadherent MRI includes a wide variety of expensive and potentially unnecessary services, and occurs relatively soon post-MRI. Study results provide evidence to promote provider and patient conversations to help patients choose care that is based on evidence, free from harm, less costly, and truly necessary. Level of Evidence: N/A PMID:24831502

Alcohol and Other Addictive Disorders Following Bariatric Surgery: Prevalence, Risk Factors and Possible Etiologies.

PubMed

Steffen, Kristine J; Engel, Scott G; Wonderlich, Joseph A; Pollert, Garrett A; Sondag, Cindy

2015-11-01

Bariatric surgery is currently the most effective intervention for significant and sustained weight loss in obese individuals. While patients often realize numerous improvements in obesity-related comorbidities and health-related quality of life, a small minority of patients have less optimal outcomes following bariatric surgery. The literature on the emergence of alcohol use disorders (AUDs) following bariatric surgery has grown in the past several years and collectively provides convincing evidence that a significant minority of patients develop new-onset AUDs following bariatric surgery. Rouxen-Y gastric bypass (RYGB) has generally been associated with the risk of developing an AUD, while laparoscopic adjustable gastric banding generally has not, in several large studies. One theory that has been discussed at some length is the idea of 'addiction transfer' wherein patients substitute one 'addiction' (food) for a new 'addiction' (alcohol) following surgery. Animal work suggests a neurobiological basis for increased alcohol reward following RYGB. In addition, several pharmacokinetic studies have shown rapid and dramatically increased peak alcohol concentrations following RYGB. The prevalence of alcohol and other addictive disorders and potential etiological contributors to post-operative AUDs will be explored. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

Delayed-onset dementia after stroke or transient ischemic attack.

PubMed

Mok, Vincent C T; Lam, Bonnie Y K; Wang, Zhaolu; Liu, Wenyan; Au, Lisa; Leung, Eric Y L; Chen, Sirong; Yang, Jie; Chu, Winnie C W; Lau, Alexander Y L; Chan, Anne Y Y; Shi, Lin; Fan, Florence; Ma, Sze H; Ip, Vincent; Soo, Yannie O Y; Leung, Thomas W H; Kwok, Timothy C Y; Ho, Chi L; Wong, Lawrence K S; Wong, Adrian

2016-11-01

Patients surviving stroke without immediate dementia are at high risk of delayed-onset dementia. Mechanisms underlying delayed-onset dementia are complex and may involve vascular and/or neurodegenerative diseases. Dementia-free patients with stroke and/or transient ischemic attack (TIA; n = 919) were studied for 3 years prospectively, excluding those who developed dementia 3 to 6 months after stroke and/or TIA. Forty subjects (4.4%) developed dementia during the study period. Imaging markers of severe small vessel disease (SVD), namely presence of ≥3 lacunes and confluent white matter changes; history of hypertension and diabetes mellitus independently predicted delayed-onset dementia after adjustment for age, gender, and education. Only 6 of 31 (19.4%) subjects with delayed cognitive decline harbored Alzheimer's disease-like Pittsburg compound B (PiB) retention. Most PiB cases (16/25, 64%) had evidence of severe SVD. Severe SVD contributes importantly to delayed-onset dementia after stroke and/or TIA. Future clinical trials aiming to prevent delayed-onset dementia after stroke and/or TIA should target this high-risk group. Copyright © 2016 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.