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Sample records for failure prevention perspective

  1. Dietary guidance in heart failure: a perspective on needs for prevention and management.

    PubMed

    Ershow, Abby G; Costello, Rebecca B

    2006-03-01

    The role that dietary factors play in preventing heart failure (HF) and in improving prognosis is increasingly recognized, indicating a need for well-grounded guidelines that can provide recommendations for daily nutrient intakes. At present, however, the state of dietary guidance is more satisfactory for persons at risk of HF (Stages A and B) than for those with a diagnosis of HF (Stages C and D). For individuals at risk of HF, a good starting point is provided by governmental and professional society guidance directed at dietary management of cardiovascular risk factors such as hypertension, hyperlipidemia, and obesity. These dietary recommendations are consonant with epidemiologic research suggesting that improving risk factor profiles likely will lower the risk of developing HF. For patients with diagnosed HF, however, little information is available to define optimal nutrient intakes and optimal food patterns. Dietary services have been shown useful in improving clinical outcomes, but nutritional management must be individualized to the patient's needs and must accommodate pharmacologic therapy, multiple co-morbidities, the possible need for nutritional supplements, repeated hospitalizations, salt and fluid retention, voluntary vs. involuntary weight loss, and other nutritional issues relevant to the aged population who comprise the majority of HF patients. Progress in the field will require well-designed clinical investigations addressing nutrient intake, nutrient metabolism, and nutritional status while mindful of the complex pathophysiology of HF.

  2. PREVENTION OF FAILURE.

    ERIC Educational Resources Information Center

    National Education Association, Washington, DC.

    THE IMPORTANCE OF THE PREVENTION OF FAILURE IN SCHOOL IS THE MAIN THEME OF THIS PAMPHLET. THE DIFFERENT FORCES WHICH INFLUENCE THE SELF-IMAGES OF CHILDREN, THEIR SCHOOL PERFORMANCE, ACCEPTANCE OR REJECTION BY OTHER CHILDREN, AND, MOST IMPORTANT, ACCEPTANCE OR REJECTION BY THE TEACHER HERSELF, ARE DISCUSSED IN A GROUP OF PAPERS UNDER ELEVEN…

  3. Preventing Early Learning Failure.

    ERIC Educational Resources Information Center

    Sornson, Bob, Ed.

    Noting that thousands of young children with the capacity to experience school success do not because they are unprepared for school learning activities, have experienced physical or emotional setbacks that cause them to be at risk for early learning failure, have never experienced limits on their behavior, or have mild sensory or motor deficits,…

  4. Preventing Early Learning Failure.

    ERIC Educational Resources Information Center

    Sornson, Bob, Ed.

    Noting that thousands of young children with the capacity to experience school success do not because they are unprepared for school learning activities, have experienced physical or emotional setbacks that cause them to be at risk for early learning failure, have never experienced limits on their behavior, or have mild sensory or motor deficits,…

  5. Early Prevention of School Failure.

    ERIC Educational Resources Information Center

    Anderson, Kent C.

    The Early Prevention of School Failure (EPSF) program developed by Dr. Luceille Werner is presented. The program is designed to identify and remediate developmental deficiencies of four-, five-, and six-year-old children and has been accepted in the National Diffusion Network as a nationally validated program. The main program components are…

  6. Preventing Spacecraft Failures Due to Tribological Problems

    NASA Technical Reports Server (NTRS)

    Fusaro, Robert L.

    2001-01-01

    Many mechanical failures that occur on spacecraft are caused by tribological problems. This publication presents a study that was conducted by the author on various preventatives, analyses, controls and tests (PACTs) that could be used to prevent spacecraft mechanical system failure. A matrix is presented in the paper that plots tribology failure modes versus various PACTs that should be performed before a spacecraft is launched in order to insure success. A strawman matrix was constructed by the author and then was sent out to industry and government spacecraft designers, scientists and builders of spacecraft for their input. The final matrix is the result of their input. In addition to the matrix, this publication describes the various PACTs that can be performed and some fundamental knowledge on the correct usage of lubricants for spacecraft applications. Even though the work was done specifically to prevent spacecraft failures the basic methodology can be applied to other mechanical system areas.

  7. Heart Failure Epidemiology: European Perspective

    PubMed Central

    Guha, K; McDonagh, T

    2013-01-01

    Heart failure poses an increasing problem for global healthcare systems. The epidemiological data which has been accrued over the last thirty years has predominantly been accumulated from experience within North America and Europe. Initial large cohort, prospective longitudinal studies produced the first publications; however latterly the focus has shifted onto epidemiological data governing hospitalisation and mortality. The emphasis behind this shift has been the resource implications with regards to repetitive, costly and prolonged hospitalisation. The European experience in heart failure, though similar to North America has recently demonstrated differences in hospitalisation which may underlie the differences between healthcare system configuration. Heart failure however remains an increasing global problem and the endpoint of a variety of cardiovascular diseases. Allied with the fact of increasingly elderly populations and prior data demonstrating a steep rise in prevalent cases within more elderly populations, it is likely that the increasing burden of disease will continue to pose challenges for modern healthcare. Despite the predicted increase in the number of patients affected by heart failure, over the last thirty years, a clear management algorithm has evolved for the use of pharmacotherapies (neuro-hormonal antagonists), device based therapies (Implantable Cardioverting Defibrillator (ICD) and Cardiac Resynchronisation Therapy (CRT)) and mechanical therapies including left ventricular assist devices and cardiac transplantation. Though the management of such patients has been clearly delineated in national and international guidelines, the underuse of all available and appropriate therapies remains a significant problem. When comparing various epidemiological studies from different settings and timepoints, it should be remembered that rates of prevalence and incidence may vary depending upon the definition used, methods of accumulating information (with

  8. [Acute heart failure: precipitating factors and prevention].

    PubMed

    Aramburu Bodas, Oscar; Conde Martel, Alicia; Salamanca Bautista, Prado

    2014-03-01

    Acute heart failure episodes, whether onset or decompensation of a chronic form, are most often precipitated by a concurrent process or disease, described as precipitating factors of heart failure. In this article, we review these precipitating factors, their proportions and clinical relevance in general and in subgroups of patients, their relationship with prognosis, and their possible prevention. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  9. Perspectives in coronary prevention.

    PubMed Central

    Turner, R. W.

    1978-01-01

    The seeds of premature coronary heart disease are often sown in childhood and it is the developing arteries of children which are the most susceptible. Paediatricians and all who work with them have the earliest and most promising opportunities for prevention. Coronary protection can be added to the potential advantages of breast feeding and to ensure appropriate fatty acid balance throughout weaning. It is reasonable to accept the strong consensus of opinion on diet reflected in the reports of the eighteen national committees. They are: to reduce total fat intake to 30-35% of the energy, to restrict consumption of saturated fat, cholesterol, sugar, and salt, to increase unrefined carbohydrate and polyunsaturated fat, and to maintain a P/S balance of 1.0-1.5:1. Food is the fundamental coronary risk factor, but others may add insult to injury. Smoking, hypertension, obesity, lack of exercise, and stress, each of which is related to behaviour, may start in childhood. Smoking doubles the overall risk CHD and increases it ten times in males under 45 years old. Good habits, including food preferences and eating patterns learned early, are those most likely to be continued. School meals require and should match revised nutritional education. The co-operation of the food industry is essential and can be anticipated, but it requires a clear lead by paediatricians. The nutritional advice should come from the medical profession. Every contact with children and their parents provides an opportunity for enquiry and giving advice. PMID:349532

  10. Preventing Early Reading Failure: An Argument

    ERIC Educational Resources Information Center

    Morris, Darrell

    2015-01-01

    Across the pendulum-like changes in beginning reading instruction over the past 30 years, three interrelated ideas emerge as the key to preventing reading failure in kindergarten and first grade: (1) an interesting, carefully-leveled book curriculum; (2) a leveled phonics curriculum; and (3) a well-trained teacher who knows how to integrate guided…

  11. Preventing Early Reading Failure: An Argument

    ERIC Educational Resources Information Center

    Morris, Darrell

    2015-01-01

    Across the pendulum-like changes in beginning reading instruction over the past 30 years, three interrelated ideas emerge as the key to preventing reading failure in kindergarten and first grade: (1) an interesting, carefully-leveled book curriculum; (2) a leveled phonics curriculum; and (3) a well-trained teacher who knows how to integrate guided…

  12. Pyrotechnic system failures: Causes and prevention

    NASA Technical Reports Server (NTRS)

    Bement, Laurence J.

    1988-01-01

    Although pyrotechnics have successfully accomplished many critical mechanical spacecraft functions, such as ignition, severance, jettisoning and valving (excluding propulsion), failures continue to occur. Provided is a listing of 84 failures of pyrotechnic hardware with completed design over a 23-year period, compiled informally by experts from every NASA Center, as well as the Air Force Space Division and the Naval Surface Warfare Center. Analyses are presented as to when and where these failures occurred, their technical source or cause, followed by the reasons why and how these kinds of failures persist. The major contributor is a fundamental lack of understanding of the functional mechanisms of pyrotechnic devices and systems, followed by not recognizing pyrotechnics as an engineering technology, insufficient manpower with hands-on experience, too few test facilities, and inadequate guidelines and specifications for design, development, qualification and acceptance. Recommendations are made on both a managerial and technical basis to prevent failures, increase reliability, improve existing and future designs, and develop the technology to meet future requirements.

  13. Postoperative respiratory failure: pathogenesis, prediction, and prevention.

    PubMed

    Canet, Jaume; Gallart, Lluís

    2014-02-01

    This review discusses our present understanding of postoperative respiratory failure (PRF) pathogenesis, risk factors, and perioperative-risk reduction strategies. PRF, the most frequent postoperative pulmonary complication, is defined by impaired blood gas exchange appearing after surgery. PRF leads to longer hospital stays and higher mortality. The time frame for recognizing when respiratory failure is related to the surgical-anesthetic insult remains imprecise, however, and researchers have used different clinical events instead of blood gas measures to define the outcome. Still, studies in specific surgical populations or large patient samples have identified a range of predictors of PRF risk: type of surgery and comorbidity, mechanical ventilation, and multiple hits to the lung have been found to be relevant in most of these studies. Recently, risk-scoring systems for PRF have been developed and are being applied in new controlled trials of PRF-risk reduction measures. Current evidence favors carefully managing intraoperative ventilator use and fluids, reducing surgical aggression, and preventing wound infection and pain. PRF is a life-threatening event that is challenging for the surgical team. Risk prediction scales based on large population studies are being developed and validated. We need high-quality trials of preventive measures, particularly those related to ventilator use in both high risk and general populations.

  14. Preventing medical errors by designing benign failures.

    PubMed

    Grout, John R

    2003-07-01

    One way to successfully reduce medical errors is to design health care systems that are more resistant to the tendencies of human beings to err. One interdisciplinary approach entails creating design changes, mitigating human errors, and making human error irrelevant to outcomes. This approach is intended to facilitate the creation of benign failures, which have been called mistake-proofing devices and forcing functions elsewhere. USING FAULT TREES TO DESIGN FORCING FUNCTIONS: A fault tree is a graphical tool used to understand the relationships that either directly cause or contribute to the cause of a particular failure. A careful analysis of a fault tree enables the analyst to anticipate how the process will behave after the change. EXAMPLE OF AN APPLICATION: A scenario in which a patient is scalded while bathing can serve as an example of how multiple fault trees can be used to design forcing functions. The first fault tree shows the undesirable event--patient scalded while bathing. The second fault tree has a benign event--no water. Adding a scald valve changes the outcome from the undesirable event ("patient scalded while bathing") to the benign event ("no water") Analysis of fault trees does not ensure or guarantee that changes necessary to eliminate error actually occur. Most mistake-proofing is used to prevent simple errors and to create well-defended processes, but complex errors can also result. The utilization of mistake-proofing or forcing functions can be thought of as changing the logic of a process. Errors that formerly caused undesirable failures can be converted into the causes of benign failures. The use of fault trees can provide a variety of insights into the design of forcing functions that will improve patient safety.

  15. Preventing dance injuries: current perspectives

    PubMed Central

    Russell, Jeffrey A

    2013-01-01

    Dancers are clearly athletes in the degree to which sophisticated physical capacities are required to perform at a high level. The standard complement of athletic attributes – muscular strength and endurance, anaerobic and aerobic energy utilization, speed, agility, coordination, motor control, and psychological readiness – all are essential to dance performance. In dance, as in any athletic activity, injuries are prevalent. This paper presents the research background of dance injuries, characteristics that distinguish dance and dancers from traditional sports and athletes, and research-based perspectives into how dance injuries can be reduced or prevented, including the factors of physical training, nutrition and rest, flooring, dancing en pointe, and specialized health care access for dancers. The review concludes by offering five essential components for those involved with caring for dancers that, when properly applied, will assist them in decreasing the likelihood of dance-related injury and ensuring that dancers receive optimum attention from the health care profession: (1) screening; (2) physical training; (3) nutrition and rest; (4) specialized dance health care; and (5) becoming acquainted with the nature of dance and dancers. PMID:24379726

  16. Rehospitalization for heart failure: problems and perspectives.

    PubMed

    Gheorghiade, Mihai; Vaduganathan, Muthiah; Fonarow, Gregg C; Bonow, Robert O

    2013-01-29

    With a prevalence of 5.8 million in the United States alone, heart failure (HF) is associated with high morbidity, mortality, and healthcare expenditures. Close to 1 million hospitalizations for heart failure (HHF) occur annually, accounting for over 6.5 million hospital days and a substantial portion of the estimated $37.2 billion that is spent each year on HF in the United States. Although some progress has been made in reducing mortality in patients hospitalized with HF, rates of rehospitalization continue to rise, and approach 30% within 60 to 90 days of discharge. Approximately half of HHF patients have preserved or relatively preserved ejection fraction (EF). Their post-discharge event rate is similar to those with reduced EF. HF readmission is increasingly being used as a quality metric, a basis for hospital reimbursement, and an outcome measure in HF clinical trials. In order to effectively prevent HF readmissions and improve overall outcomes, it is important to have a complete and longitudinal characterization of HHF patients. This paper highlights management strategies that when properly implemented may help reduce HF rehospitalizations and include adopting a mechanistic approach to cardiac abnormalities, treating noncardiac comorbidities, increasing utilization of evidence-based therapies, and improving care transitions, monitoring, and disease management.

  17. Pacific Islanders’ Perspectives on Heart Failure Management

    PubMed Central

    Kaholokula, Joseph Keawe‘aimoku; Saito, Erin; Mau, Marjorie K.; Latimer, Renee; Seto, Todd B.

    2008-01-01

    Objective To identify the health beliefs, attitudes, practices and social and family relations important in heart failure treatment among Pacific Islanders. Methods Four focus groups were convened with 36 Native Hawaiians and Samoans with heart failure and their family caregivers. Thematic data analysis was used to categorize data into four domains: health beliefs and attitudes, preferred health practices, social support systems, and barriers to heart failure care. Results Common coping styles and emotional experiences of heart failure in this population included avoidance or denial of illness, hopelessness and despair, and reliance on spiritual/religious beliefs as a means of support. Among study participants, more Samoans preferred to be treated by physicians whereas more Native Hawaiians preferred traditional Hawaiian methods of healing. Two types of social support (informational and tangible-instrumental) were identified as important in heart failure care. Barriers to heart failure care included poor knowledge of heart failure, lack of trust in physicians’ care, poor physician-patient relations, finances, dietary changes, and competing demands on time. Conclusion The recruitment, retention, and adherence of Pacific Islanders to heart failure interventions are affected by an array of psychosocial and socio-cultural factors. Practice Implications Interventions might be improved by offering participants accurate and detailed information about heart failure and its treatment, engaging the extended family in providing necessary supports, and providing tools to facilitate physician-patient relationships, among others, within the context of a larger socio-cultural system. PMID:18068939

  18. Progress toward a Prevention Perspective

    ERIC Educational Resources Information Center

    Stagner, Matthew W.; Lansing, Jiffy

    2009-01-01

    Matthew Stagner and Jiffy Lansing chart developments in the field of child maltreatment and propose a new framework for preventing child abuse and neglect. They begin by describing the concept of investment-prevention as it has been applied recently in fields such as health care and welfare. They then explain how the new framework applies to…

  19. Risky business: failure to prevent and failure to communicate.

    PubMed

    Moore, Dorothy L; Ste-Marie, Micheline

    2009-01-01

    Healthcare-associated infections (HAIs), important threats to patient safety, are considered differently from other adverse events. Gardam and his colleagues discuss several reasons for this and outline approaches that may bring about changes in attitudes and enhance HAI prevention. We comment on the potential preventability of HAIs, the need for improved communication strategies and the different vision of the role of infection control personnel suggested by Gardam et al. Recent developments in infection control structure and management and patient safety in Quebec are summarized.

  20. Failure and preventive costs of mastitis on Dutch dairy farms.

    PubMed

    van Soest, Felix J S; Santman-Berends, Inge M G A; Lam, Theo J G M; Hogeveen, Henk

    2016-10-01

    Mastitis is an important disease from an economic perspective, but most cost assessments of mastitis include only the direct costs associated with the disease (e.g., production losses, culling, and treatment), which we call failure costs (FC). However, farmers also invest time and money in controlling mastitis, and these preventive costs (PC) also need to be taken into account. To estimate the total costs of mastitis, we estimated both FC and PC. We combined multiple test-day milk records from 108 Dutch dairy farms with information on applied mastitis prevention measures and farmers' registration of clinical mastitis for individual dairy cows. The aim was to estimate the total costs of mastitis and to give insight into variations between farms. We estimated the average total costs of mastitis to be €240/lactating cow per year, in which FC contributed €120/lactating cow per year and PC contributed another €120/lactating cow per year. Milk production losses, discarded milk, and culling were the main contributors to FC, at €32, €20, and €20/lactating cow per year, respectively. Labor costs were the main contributor to PC, next to consumables and investments, at €82, €34, and €4/lactating cow per year, respectively. The variation between farmers was substantial, and some farmers faced both high FC and PC. This variation may have been due to structural differences between farms, different mastitis-causing pathogens, the time at which preventive action is initiated, stockmanship, or missing measures in PC estimates. We estimated the minimum FC to be €34 per lactating cow per yr. All farmers initiated some preventive action to control or reduce mastitis, indicating that farmers will always have mastitis-related costs, because mastitis will never be fully eradicated from a farm. Insights into both the PC and FC of a specific farm will allow veterinary advisors and farmers to assess whether current udder health strategies are appropriate or whether there

  1. Progress toward a prevention perspective.

    PubMed

    Stagner, Matthew W; Lansing, Jiffy

    2009-01-01

    Matthew Stagner and Jiffy Lansing chart developments in the field of child maltreatment and propose a new framework for preventing child abuse and neglect. They begin by describing the concept of investment-prevention as it has been applied recently in fields such as health care and welfare. They then explain how the new framework applies to maltreatment prevention, noting in particular how it differs from the traditional child protective services response to maltreatment. Whereas the traditional response aims to prevent a recurrence of maltreatment once it has already taken place, the new framework focuses on preventing maltreatment from occurring at all. Rather than identifying risk factors for maltreatment and addressing the problems and deficiencies of the primary caretaker, the new framework focuses on strengthening protective factors and building family and social networks to reinforce the ability of parents to care for their children. Whereas the orientation of the traditional child welfare service approach is legal and medical, the new framework has a more developmental and ecological orientation. It aims to build on the strengths children have at particular points of the life stage and enhance the social context of the child. Rather than putting families into the hands of unknown professionals who shuffle them from one program to another, including foster care, the investment-prevention model seeks to integrate professionals and paraprofessionals from the family's community into their everyday life, as well as to ensure an interconnected system of services. Finally, rather than seeking to minimize harm to the child, it aims to maximize potential--to strengthen the capacity of parents and communities to care for their children in ways that promote well-being. Researchers have struggled to define maltreatment, identify its causes, and assess its consequences and costs. In recent years, however, researchers have clarified the severe consequences of child

  2. Utility-scale system preventive and failure-related maintenance

    SciTech Connect

    Jennings, C.; Hutchinson, P.

    1995-11-01

    This paper describes the design and performance background on PVUSA utility-scale systems at Davis and Kerman, California, and reports on a preventative and failure-related maintenance approach and costs.

  3. Expose hidden failures to prevent cascading outages

    SciTech Connect

    Phadke, A.G.; Thorp, J.S.

    1996-07-01

    This article describes how to identify lines and buses that present the greatest hazard to system reliability, and add digital equipment to supervise and control hidden failures of the associated relays. Major blackouts are rare events, but their impact can be catastrophic. A study of significant disturbances reported by NERC in the period from 1984 through 1988 indicates that protective relays are involved in one way or another in 75% of major disturbances. A common scenario is that the relay has an undetected (hidden) defect that was exposed due to the conditions created by other disturbances. For example, near-by faults, overloads, or reverse power flows expose the defective relay and cause a false trip, which exacerbates the situation. Given the importance of hidden failure modes in traditional relaying systems, intervention by computer-based rational control schemes is proposed in this article. Relays with high-vulnerability indices can be identified, and their vulnerable functions and failure modes identified. Countermeasures to reduce or eliminate the likelihood of the hidden failure of key relays can be provided.

  4. Epidemiological Perspectives on Maltreatment Prevention

    ERIC Educational Resources Information Center

    Wulczyn, Fred

    2009-01-01

    Fred Wulczyn explores how data on the incidence and distribution of child maltreatment shed light on planning and implementing maltreatment prevention programs. He begins by describing and differentiating among the three primary sources of national data on maltreatment. Wulczyn then points out several important patterns in the data. The first…

  5. Teen pregnancy prevention: current perspectives.

    PubMed

    Lavin, Claudia; Cox, Joanne E

    2012-08-01

    Teen pregnancy has been subject of public concern for many years. In the United States, despite nearly 2 decades of declining teen pregnancy and birth rates, the problem persists, with significant disparities present across racial groups and in state-specific rates. This review examines recent trends, pregnancy prevention initiatives and family planning policies that address the special needs of vulnerable youth. Unintended teen pregnancies impose potentially serious social and health burdens on teen parents and their children, as well as costs to society. Trends in teen pregnancy and birth rates show continued decline, but state and racial disparities have widened. Demographic factors and policy changes have contributed to these disparities. Research supports comprehensive pregnancy prevention initiatives that are multifaceted and promote consistent and correct use of effective methods of contraception for youth at risk of becoming pregnant. There is strong consensus that effective teen pregnancy prevention strategies should be multifaceted, focusing on delay of sexual activity especially in younger teens while promoting consistent and correct use of effective methods of contraception for those youth who are or plan to be sexually active. There is a need for further research to identify effective interventions for vulnerable populations.

  6. Preventing heart failure: the role of physical activity.

    PubMed

    Nayor, Matthew; Vasan, Ramachandran S

    2015-09-01

    Heart failure prevention is an important public health goal. Increased physical activity and exercise may help to prevent heart failure, as they are associated with reduced heart failure incidence and potentially act through a variety of mechanisms to slow disease progression. Increased physical activity, higher cardiorespiratory fitness, and lower sedentary time are associated with reduced heart failure incidence. These associations are consistent for occurrence of heart failure with both preserved and reduced ejection fraction, the common subphenotypes of the condition. Physiologic cardiac and vascular remodeling occurs across the normal range of physical activity in the community, and regular exercise (four to five sessions per week) is necessary to mitigate age-associated reductions in ventricular compliance and cardiac mass. Greater physical activity, less sedentary time, and improved cardiorespiratory fitness are associated with reductions in heart failure risk. Various mechanisms may explain these findings, including: reducing the prevalence of standard and novel cardiovascular risk factors, inhibiting pathologic cardiovascular remodeling, promoting physiologic remodeling, and improving cardiac, neurohormonal, skeletal muscle, pulmonary, renal, and vascular performance. Future research is needed to elucidate the optimal timing, duration, and modality of physical activity and exercise training necessary to prevent the development of heart failure.

  7. Acute heart failure: Epidemiology, risk factors, and prevention.

    PubMed

    Farmakis, Dimitrios; Parissis, John; Lekakis, John; Filippatos, Gerasimos

    2015-03-01

    Acute heart failure represents the first cause of hospitalization in elderly persons and is the main determinant of the huge healthcare expenditure related to heart failure. Despite therapeutic advances, the prognosis of acute heart failure is poor, with in-hospital mortality ranging from 4% to 7%, 60- to 90-day mortality ranging from 7% to 11%, and 60- to 90-day rehospitalization from 25% to 30%. Several factors including cardiovascular and noncardiovascular conditions as well as patient-related and iatrogenic factors may precipitate the rapid development or deterioration of signs and symptoms of heart failure, thus leading to an acute heart failure episode that usually requires patient hospitalization. The primary prevention of acute heart failure mainly concerns the prevention, early diagnosis, and treatment of cardiovascular risk factors and heart disease, including coronary artery disease, while the secondary prevention of a new episode of decompensation requires the optimization of heart failure therapy, patient education, and the development of an effective transition and follow-up plan. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  8. Preventing Heart Failure: The Role of Physical Activity

    PubMed Central

    Nayor, Matthew; Vasan, Ramachandran S.

    2015-01-01

    Purpose of review Heart failure prevention is an important public health goal. Increased physical activity and exercise may help to prevent heart failure, as they are associated with reduced heart failure incidence and potentially act through a variety of mechanisms to slow disease progression. Recent findings Increased physical activity, higher cardiorespiratory fitness, and lower sedentary time are associated with reduced heart failure incidence. These associations are consistent for occurrence of both heart failure with preserved versus reduced ejection fraction, the common subphenotypes of the condition. Physiologic cardiac and vascular remodeling occur across the normal range of physical activity in the community, and regular exercise (4–5 sessions per week) is necessary to mitigate age-associated reductions in ventricular compliance and cardiac mass. Summary Greater physical activity, lesser sedentary time and improved cardiorespiratory fitness are associated with reductions in heart failure risk. Various mechanisms may explain these findings including: reducing the prevalence of standard and novel cardiovascular risk factors, inhibiting pathologic cardiovascular remodeling, promoting physiologic remodeling, and improving cardiac, neurohormonal, skeletal muscle, pulmonary, renal, and vascular performance. Future research is needed to elucidate the optimal timing, duration, and modality of physical activity and exercise training necessary to prevent the development of heart failure. PMID:26154074

  9. On-Board Particulate Filter Failure Prevention and Failure Diagnostics Using Radio Frequency Sensing

    DOE PAGES

    Sappok, Alexander; Ragaller, Paul; Herman, Andrew; ...

    2017-03-28

    The increasing use of diesel and gasoline particulate filters requires advanced on-board diagnostics (OBD) to prevent and detect filter failures and malfunctions. Early detection of upstream (engine-out) malfunctions is paramount to preventing irreversible damage to downstream aftertreatment system components. Such early detection can mitigate the failure of the particulate filter resulting in the escape of emissions exceeding permissible limits and extend the component life. However, despite best efforts at early detection and filter failure prevention, the OBD system must also be able to detect filter failures when they occur. In this paper, radio frequency (RF) sensors were used to directlymore » monitor the particulate filter state of health for both gasoline particulate filter (GPF) and diesel particulate filter (DPF) applications. The testing included controlled engine dynamometer evaluations, which characterized soot slip from various filter failure modes, as well as on-road fleet vehicle tests. The results show a high sensitivity to detect conditions resulting in soot leakage from the particulate filter, as well as potential for direct detection of structural failures including internal cracks and melted regions within the filter media itself. Finally and furthermore, the measurements demonstrate, for the first time, the capability to employ a direct and continuous monitor of particulate filter diagnostics to both prevent and detect potential failure conditions in the field.« less

  10. On-Board Particulate Filter Failure Prevention and Failure Diagnostics Using Radio Frequency Sensing

    SciTech Connect

    Sappok, Alex; Ragaller, Paul; Herman, Andrew; Bromberg, L.; Prikhodko, Vitaly Y; Parks, II, James E; Storey, John Morse

    2017-01-01

    The increasing use of diesel and gasoline particulate filters requires advanced on-board diagnostics (OBD) to prevent and detect filter failures and malfunctions. Early detection of upstream (engine-out) malfunctions is paramount to preventing irreversible damage to downstream aftertreatment system components. Such early detection can mitigate the failure of the particulate filter resulting in the escape of emissions exceeding permissible limits and extend the component life. However, despite best efforts at early detection and filter failure prevention, the OBD system must also be able to detect filter failures when they occur. In this study, radio frequency (RF) sensors were used to directly monitor the particulate filter state of health for both gasoline particulate filter (GPF) and diesel particulate filter (DPF) applications. The testing included controlled engine dynamometer evaluations, which characterized soot slip from various filter failure modes, as well as on-road fleet vehicle tests. The results show a high sensitivity to detect conditions resulting in soot leakage from the particulate filter, as well as potential for direct detection of structural failures including internal cracks and melted regions within the filter media itself. Furthermore, the measurements demonstrate, for the first time, the capability to employ a direct and continuous monitor of particulate filter diagnostics to both prevent and detect potential failure conditions in the field.

  11. How to Prevent Workplace Incivility?: Nurses' Perspective.

    PubMed

    Abdollahzadeh, Farahnaz; Asghari, Elnaz; Ebrahimi, Hossein; Rahmani, Azad; Vahidi, Maryam

    2017-01-01

    Many articles have studied workplace incivility and its influence on outcomes, but very few have been conducted to assess how to prevent this issue. In this study, we aimed to determine how to prevent workplace incivility from the nurses' perspective. This was a qualitative study which was based on a conventional content analysis approach. Thirty four nurses (25 to 52 years old) from seven training hospitals in Tabriz, Iran were selected through purposive sampling. Thirty six semi-structured interviews and eight field notes were analyzed. The data analysis revealed 417 codes, ten categories, three subthemes and one theme, that is, A Need for a Comprehensive Attempt. Attempt of organization, nurses, and public as subthemes are needed to prevent workplace incivility. The findings of the study indicated that a comprehensive and systematic attempt was needed to prevent incivility. Nurses should try to improve their skills; officials should try to show the real image and position of nurses and hospitals to the community.

  12. Cardiac Cachexia: Perspectives for Prevention and Treatment

    PubMed Central

    Okoshi, Marina Politi; Capalbo, Rafael Verardino; Romeiro, Fernando G; Okoshi, Katashi

    2017-01-01

    Cachexia is a prevalent pathological condition associated with chronic heart failure. Its occurrence predicts increased morbidity and mortality independent of important clinical variables such as age, ventricular function, or heart failure functional class. The clinical consequences of cachexia are dependent on both weight loss and systemic inflammation, which accompany cachexia development. Skeletal muscle wasting is an important component of cachexia; it often precedes cachexia development and predicts poor outcome in heart failure. Cachexia clinically affects several organs and systems. It is a multifactorial condition where underlying pathophysiological mechanisms are not completely understood making it difficult to develop specific prevention and treatment therapies. Preventive strategies have largely focused on muscle mass preservation. Different treatment options have been described, mostly in small clinical studies or experimental settings. These include nutritional support, neurohormonal blockade, reducing intestinal bacterial translocation, anemia and iron deficiency treatment, appetite stimulants, immunomodulatory agents, anabolic hormones, and physical exercise regimens. Currently, nonpharmacological therapy such as nutritional support and physical exercise are considered central to cachexia prevention and treatment. PMID:27812676

  13. Environmental testing to prevent on-orbit TDRS failures

    NASA Technical Reports Server (NTRS)

    Cutler, Robert M.

    1994-01-01

    Can improved environmental testing prevent on-orbit component failures such as those experienced in the Tracking and Data Relay Satellite (TDRS) constellation? TDRS communications have been available to user spacecraft continuously for over 11 years, during which the five TDRS's placed in orbit have demonstrated their redundancies and robustness by surviving 26 component failures. Nevertheless, additional environmental testing prior to launch could prevent the occurrence of some types of failures, and could help to maintain communication services. Specific testing challenges involve traveling wave tube assemblies (TWTA's) whose lives may decrease with on-off cycling, and heaters that are subject to thermal cycles. The development of test conditions and procedures should account for known thermal variations. Testing may also have the potential to prevent failures in which components such as diplexers have had their lives dramatically shortened because of particle migration in a weightless environment. Reliability modeling could be used to select additional components that could benefit from special testing, but experience shows that this approach has serious limitations. Through knowledge of on-orbit experience, and with advances in testing, communication satellite programs might avoid the occurrence of some types of failures, and extend future spacecraft longevity beyond the current TDRS design life of ten years. However, determining which components to test, and how must testing to do, remain problematical.

  14. CXCR4 gene transfer prevents pressure overload induced heart failure

    PubMed Central

    LaRocca, Thomas J.; Jeong, Dongtak; Kohlbrenner, Erik; Lee, Ahyoung; Chen, JiQiu; Hajjar, Roger J.; Tarzami, Sima T.

    2012-01-01

    Stem cell and gene therapies are being pursued as strategies for repairing damaged cardiac tissue following myocardial infarction in an attempt to prevent heart failure. The chemokine receptor-4 (CXCR4) and its ligand, CXCL12, play a critical role in stem cell recruitment post-acute myocardial infarction. Whereas progenitor cell migration via the CXCL12/CXCR4 axis is well characterized, little is known about the molecular mechanisms of CXCR4 mediated modulation of cardiac hypertrophy and failure. We used gene therapy to test the effects of CXCR4 gene delivery on adverse ventricular remodeling due to pressure overload. We assessed the effect of cardiac overexpression of CXCR4 during trans-aortic constriction (TAC) using a cardiotropic adeno-associated viral vector (AAV9) carrying the CXCR4 gene. Cardiac overexpression of CXCR4 in mice with pressure overload prevented ventricular remodeling, preserved capillary density and maintained function as determined by echocardiography and in vivo hemodynamics. In isolated adult rat cardiac myocytes, CXCL12 treatment prevented isoproterenol induced hypertrophy and interrupted the calcineurin/NFAT pathway. Finally, a complex involving the L-type calcium channel, β2-adenoreceptor, and CXCR4 (Cav1.2/β2AR/CXCR4) was identified in healthy cardiac myocytes and was shown to dissociate as a consequence of heart failure. CXCR4 administered to the heart via gene transfer prevents pressure overload induced heart failure. The identification of CXCR4 participation in a Cav1.2-β2AR regulatory complex provides further insight into the mechanism by which CXCR4 modulates calcium homeostasis and chronic pressure overload responses in the cardiac myocyte. Together these results suggest AAV9.CXCR4 gene therapy is a potential therapeutic approach for congestive heart failure. PMID:22668785

  15. How to Prevent Workplace Incivility?: Nurses' Perspective

    PubMed Central

    Abdollahzadeh, Farahnaz; Asghari, Elnaz; Ebrahimi, Hossein; Rahmani, Azad; Vahidi, Maryam

    2017-01-01

    Background: Many articles have studied workplace incivility and its influence on outcomes, but very few have been conducted to assess how to prevent this issue. In this study, we aimed to determine how to prevent workplace incivility from the nurses' perspective. Materials and Methods: This was a qualitative study which was based on a conventional content analysis approach. Thirty four nurses (25 to 52 years old) from seven training hospitals in Tabriz, Iran were selected through purposive sampling. Thirty six semi-structured interviews and eight field notes were analyzed. Results: The data analysis revealed 417 codes, ten categories, three subthemes and one theme, that is, A Need for a Comprehensive Attempt. Attempt of organization, nurses, and public as subthemes are needed to prevent workplace incivility. Conclusions: The findings of the study indicated that a comprehensive and systematic attempt was needed to prevent incivility. Nurses should try to improve their skills; officials should try to show the real image and position of nurses and hospitals to the community. PMID:28584555

  16. Failure Prevention of Hydraulic System Based on Oil Contamination

    NASA Astrophysics Data System (ADS)

    Singh, M.; Lathkar, G. S.; Basu, S. K.

    2012-07-01

    Oil contamination is the major source of failure and wear of hydraulic system components. As per literature survey, approximately 70 % of hydraulic system failures are caused by oil contamination. Hence, to operate the hydraulic system reliably, the hydraulic oil should be of perfect condition. This requires a proper `Contamination Management System' which involves monitoring of various parameters like oil viscosity, oil temperature, contamination level etc. A study has been carried out on vehicle mounted hydraulically operated system used for articulation of heavy article, after making the platform levelled with outrigger cylinders. It is observed that by proper monitoring of contamination level, there is considerably increase in reliability, economy in operation and long service life. This also prevents the frequent failure of hydraulic system.

  17. Preventive strategies of renal failure in the Arab world.

    PubMed

    Shaheen, Faissal A M; Al-Khader, Abdullah A

    2005-09-01

    The prevalence of both acute and chronic renal failure is high in the Arab world. Data available on the exact prevalence of various renal diseases are very limited. Nevertheless, the reported prevalence of chronic renal failure is 80 to 120 per million population (pmp) in the Kingdom of Saudi Arabia and 225 pmp in Egypt. This is in comparison with the reported prevalence of 283 pmp in Europe, 975 pmp in the United States, and 1149 pmp in Japan. Lower prevalence rates reported in this region could be due to underreporting. The economic burden of renal replacement on health care providers is enormous. In the Kingdom of Saudi Arabia, the estimated cost per annum incurred toward maintenance hemodialysis is US 19,400 US dollars and, considering that there are more than 7200 patients on regular dialysis in this country, the total expenditure is enormous. Such large amounts may be beyond the monetary capacity of many countries in this region because of limited financial resources. These figures clearly suggest that there is an urgent need to establish a massive prevention program. The strategy adapted should be innovative and imaginative and should be one that is maximally cost effective. Paradoxically, in the Arab world, we have a good opportunity to reduce the incidence of kidney failure (chronic and acute) substantially by appropriately chosen models. This is because many of the causes of renal failure are eminently preventable. In fact, a rough estimate is that these programs, if successful, can reduce the incidence by as much as 40% (personal communication, Shaheen, 2003). It is worthy of mention that, in the Arab world, the budget for research is about 0.15% of the national domestic product compared with the international average of 1.5%. In this article, we concentrate on some of the main causes of renal failure in the Arab world that we feel can be prevented and suggest ways that can best address this issue.

  18. Diastolic heart failure: progress, treatment challenges, and prevention.

    PubMed

    Wood, Philip; Piran, Sanaz; Liu, Peter P

    2011-01-01

    Diastolic heart failure (DHF) is an important entity, the significance of which is increasingly recognized. This report examines the available evidence regarding the role, significance, and mechanisms of DHF. Epidemiologic studies have documented the rising burden of DHF, and experimental data are revealing the unique mechanisms distinguishing it from systolic heart failure. Despite controversies on the definition of DHF, or heart failure with preserved ejection fraction, standardized clinical criteria with supplementary imaging and structural data have identified DHF as a distinct pathophysiological entity. The mechanisms underlying DHF include abnormal matrix dynamics, altered myocyte cytoskeleton, and impaired active relaxation. The commonly held belief that survival of patients with DHF is better than that of patients with systolic heart failure has been challenged by updated data. The heterogeneous etiologies or risk factors for the condition include aging, diabetes, hypertension, and ischemia, making a common diagnostic or treatment pathway difficult. Novel therapeutic targets that address the pathophysiology of this disease are under consideration, although there are no proven therapies for DHF to date. Exacerbating factors include volume and sodium indiscretion, arrhythmias, ischemia, and comorbidities. Strategies to ameliorate or to obviate these precipitating factors are most effective in preventing DHF and its exacerbations. Meanwhile, prevention of DHF through appropriate and aggressive risk factor identification and management must remain the cornerstone of clinical intervention. Copyright © 2011. Published by Elsevier Inc.

  19. The Prevention of Hospital Readmissions in Heart Failure

    PubMed Central

    Ziaeian, Boback; Fonarow, Gregg C.

    2016-01-01

    Heart failure (HF) is a growing healthcare burden and one of the leading causes of hospitalizations and readmission. Preventing readmissions for HF patients is an increasing priority for clinicians, researchers, and various stakeholders. The following review will discuss the interventions found to reduce readmissions for patients and improve hospital performance on the 30-day readmission process measure. While evidence-based therapies for HF management have proliferated, the consistent implementation of these therapies and development of new strategies to more effectively prevent readmissions remain areas for continued improvement. PMID:26432556

  20. How to prevent deep-well liner failure

    SciTech Connect

    Durham, K.S.

    1987-11-01

    This article discusses three liner design rules to prevent deep-well liner failure. They are: 1) Always select heavier weight casing, all other things being equal. 2) Always suspect that liner tops and casing shoes will leak. Design accordingly. 3) Liner tension designs should always include ballooning and temperature effects of stimulation. The article also gives some guidelines that will lead to better deep-well liner designs and reduce mechanical risk, according to the author.

  1. Preventing blood transfusion failures: FMEA, an effective assessment method.

    PubMed

    Najafpour, Zhila; Hasoumi, Mojtaba; Behzadi, Faranak; Mohamadi, Efat; Jafary, Mohamadreza; Saeedi, Morteza

    2017-06-30

    Failure Mode and Effect Analysis (FMEA) is a method used to assess the risk of failures and harms to patients during the medical process and to identify the associated clinical issues. The aim of this study was to conduct an assessment of blood transfusion process in a teaching general hospital, using FMEA as the method. A structured FMEA was recruited in our study performed in 2014, and corrective actions were implemented and re-evaluated after 6 months. Sixteen 2-h sessions were held to perform FMEA in the blood transfusion process, including five steps: establishing the context, selecting team members, analysis of the processes, hazard analysis, and developing a risk reduction protocol for blood transfusion. Failure modes with the highest risk priority numbers (RPNs) were identified. The overall RPN scores ranged from 5 to 100 among which, four failure modes were associated with RPNs over 75. The data analysis indicated that failures with the highest RPNs were: labelling (RPN: 100), transfusion of blood or the component (RPN: 100), patient identification (RPN: 80) and sampling (RPN: 75). The results demonstrated that mis-transfusion of blood or blood component is the most important error, which can lead to serious morbidity or mortality. Provision of training to the personnel on blood transfusion, knowledge raising on hazards and appropriate preventative measures, as well as developing standard safety guidelines are essential, and must be implemented during all steps of blood and blood component transfusion.

  2. When is total hip arthroplasty a failure? The patients' perspective.

    PubMed Central

    Hellman, E. J.; Feinberg, J. R.; Capello, W. N.

    1996-01-01

    Total hip arthroplasty (THA) patients (186 primary, 92 revision) were surveyed regarding their satisfaction, their expectations regarding longevity, of the hip implant, and their perspective on the potential or actual need for revision surgery. The vast majority of patients were glad they had the original THA, would do it again if faced with a similar choice, and would recommend it to others. One-third of patients believed their current implants would last the rest of their life. The most common responses to either potential or actual failure were happiness it lasted as long as it did, accepting it as "one of those things," and disappointment. No primary THA patients and only 7% of revision of THA patients indicated that they would consider the primary THA a failure when revision surgery was indicated. PMID:9129281

  3. New perspectives for preventing hepatitis C virus liver graft infection

    PubMed Central

    Felmlee, Daniel J.; Coilly, Audrey; Chung, Raymond T.; Samuel, Didier; Baumert, Thomas F.

    2016-01-01

    Hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease that necessitates liver transplantation. The incidence of virus-induced cirrhosis and hepatocellular carcinoma continues to increase, making liver transplantation increasingly common1–3. Infection of the engrafted liver is universal and increases progression to advanced liver disease, with 20–30% displaying cirrhosis within 5 years. While treatments of chronic HCV infection have improved dramatically, albeit with remaining challenges of failure and access, therapeutic options to prevent graft infection during liver transplantation are emerging. Recent developments in directed use of novel direct-acting antiviral (DAA) agents4–6 to eliminate circulating HCV prior or following transplantation bring renewed hope for prevention and treatment of liver graft infection. Identifying the ideal regimen and use of DAAs reveals new paradigms of treatment for this special population6–8. Complementing DAAs, entry inhibitors have been shown to prevent liver graft infection in animal models9–13 and delay graft infection in clinical trials14, providing a perspective to be used concomitant to transplantation. We review the challenges and pathology associated with HCV liver graft infection, highlight current and future strategies of DAA treatment timing, and discuss the potential role of entry inhibitors that might be employed synergistically with DAAs to inhibit graft infection. PMID:27301929

  4. Prevent boiler tube failures -- Part 2: Water-side mechanisms

    SciTech Connect

    Colannino, J. )

    1993-11-01

    Boiler tubes can fail due to problems on either the fire-side or the water-side of the tube. Part 1 of this article discussed fire-side failure mechanisms and measures for preventing failures. Here the author focuses on the tubes' water-side. The term water-side mechanisms'' refers to damage on the water side of the boiler tube (as opposed to the fire side). However, the water itself is often not the culprit. Water-side corrosion mechanisms may be classified into two major categories: physical and chemical. Physical mechanisms include steam blanketing and overheating. Chemical mechanisms include: deposition; caustic, acidic, and chelant corrosion; oxidation; and hydrogen embrittlement.

  5. Burn prevention mechanisms and outcomes: pitfalls, failures and successes.

    PubMed

    Atiyeh, Bishara S; Costagliola, Michel; Hayek, Shady N

    2009-03-01

    -risk groups. Depending on the population of the country, burns prevention could be a national programme. This can ensure sufficient funds are available and lead to proper coordination of district, regional, and tertiary care centres. It could also provide for compulsory reporting of all burn admissions to a central registry, and these data could be used to evaluate strategies and prevention programmes that should be directed at behavioural and environmental changes which can be easily adopted into lifestyle. Particularly in LMICs, the emphasis in burn prevention should be by advocating change from harmful cultural practices. This needs to be done with care and sensitivity. The present review is a summary of what has already been accomplished in terms of burn prevention highlighting some of the successes but above all the numerous pitfalls and failures. Recognizing these failures is the first step towards development of more effective burn prevention strategies particularly in LMICs in which burn injury remains endemic and associated with a high mortality rate. Burn prevention is not easy, but easy or not, we have no options; burns must be prevented.

  6. Preventive interventions for ADHD: a neurodevelopmental perspective.

    PubMed

    Halperin, Jeffrey M; Bédard, Anne-Claude V; Curchack-Lichtin, Jocelyn T

    2012-07-01

    It is proposed that the time is ripe for the development of secondary preventive interventions for attention-deficit/hyperactivity disorder (ADHD). By targeting preschool children, a developmental stage during which ADHD symptoms first become evident in most children with the disorder, many of the adverse long-term consequences that typify the trajectory of ADHD may be avoided. A dynamic/interactive model of the biological and environmental factors that contribute to the emergence and persistence of ADHD throughout the lifespan is proposed. Based on this model, it is argued that environmental influences and physical exercise can be used to enhance neural growth and development, which in turn should have an enduring and long-term impact on the trajectory of ADHD. Central to this notion are 2 hypotheses: 1) environmental influences can facilitate structural and functional brain development, and 2) changes in brain structure and function are directly related to ADHD severity over the course of development and the degree to which the disorder persists or remits with time. We present experimental and correlational data supporting the first hypothesis and longitudinal data in individuals with ADHD supporting the second. The case is made for initiating such an intervention during the preschool years, when the brain is likely to be more "plastic" and perhaps susceptible to lasting modifications, and before complicating factors, such as comorbid psychiatric disorders, academic failure, and poor social and family relationships emerge, making successful treatment more difficult. Finally, we review recent studies in young children with ADHD that might fall under the umbrella of secondary prevention.

  7. Expanded Polytetrafluoroethylene for Chordal Replacement: Preventing Knot Failure.

    PubMed

    Miller, Jacob R; Deeken, Corey R; Ray, Shuddhadeb; Henn, Matthew C; Lancaster, Timothy S; Schuessler, Richard B; Damiano, Ralph J; Melby, Spencer J

    2015-12-01

    Expanded polytetrafluoroethylene suture is commonly used for chordal replacement in mitral valve repair, but due to material characteristics, knots can unravel. Our aim was to determine the knot security, including how many throws are necessary to prevent knot failure, with Gore-Tex (W.L. Gore and Associates, Elkton, MD) and the newly available Chord-X (On-X Life Technologies Inc, Austin, TX). Knots were evaluated for maximal load based on: number of throws (6, 8, 10, and 12), tension to secure each throw (10%, 50%, and 85%) and suture type (Gore-Tex CV-5 and Chord-X 3-0). A physiologic force of 2 N was used for comparison. We evaluated 240 knots. For all knots, the mean load to failure was 11.1 ± 5.8 N. Failure occurred due to unraveling in 141 knots (59%) at 7.1 ± 4.1 N and to breaking in 99 (41%) at 16.7 ± 2.0 N (p < 0.01). Gore-Tex failed at higher loads (12.6 ± 6.0 N vs 9.5 ± 5.2 N, p < 0.01); however, an equivalent number, 6 Gore-Tex and 6 Chord-X, unraveled at 2 N, all with fewer than 10 throws. Expanded polytetrafluoroethylene has adequate strength to prevent breakage; however, a risk of knot unraveling at physiologic conditions exists when fewer than 10 throws are performed. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Cachexia in chronic heart failure: endocrine determinants and treatment perspectives.

    PubMed

    Mangner, Norman; Matsuo, Yae; Schuler, Gerhard; Adams, Volker

    2013-04-01

    It is well documented in the current literature that chronic heart failure is often associated with cachexia, defined as involuntary weight loss of 5 % in 12 month or less. Clinical studies unraveled that the presence of cachexia decreases significantly mean survival of the patient. At the molecular level mainly myofibrillar proteins are degraded, although a reduced protein synthesis may also contribute to the loss of muscle mass. Endocrine factors clearly regulate muscle mass and function by influencing the normally precisely controlled balance between protein breakdown and protein synthesis The aim of the present article is to review the knowledge in the field with respect to the role of endocrine factors for the regulation of cachexia in patients with CHF and deduce treatment perspectives.

  9. Information needs of patients with heart failure: Health professionals' perspectives.

    PubMed

    Yu, Mingming; Chair, Sek Ying; Chan, Carmen Wh; Choi, Kai Chow

    2016-08-01

    This study aimed to understand information needs of patients with heart failure from the perspectives of health professionals. The exploratory qualitative study was conducted in 2011. Face-to-face interviews were performed to collect data from 24 health professionals. Data were evaluated through content analysis. Information identified by health professionals as essential for patients' learning included risk factors and symptom management, prognosis, medication and lifestyle adjustment. Factors related to both patients and health professionals were recognized as barriers to information acquisition. Moreover, health professionals provided several recommendations for improving the health condition of patients. Information needs identified by health professionals, as well as actual needs expressed by patients, can be incorporated in health education. The effectiveness of educating patients can be improved by addressing needs perceived by both patients and health professionals. © 2016 John Wiley & Sons Australia, Ltd.

  10. Right ventricular failure after LVAD implantation: prevention and treatment.

    PubMed

    Meineri, Massimiliano; Van Rensburg, Adriaan E; Vegas, Annette

    2012-06-01

    Right ventricular failure (RVF) complicates 20-50% of left ventricular assist device (LVAD) implantation cases and contributes to increased postoperative morbidity and mortality. Normal LVAD function alters the highly compliant right ventricular (RV) physiology, which may unmask RVF. Risk scores for predicting RVF post-LVAD incorporate multiple risk factors but have not been prospectively validated. Prevention of RVF consists of optimising RV function by modifying RV preload and afterload, providing adequate intra-operative RV protection and minimising blood transfusions. Treatment of RVF relies on inotropic support, decreasing pulmonary vascular resistance and adjusting LVAD flows to minimise distortion of RV geometry. RVAD insertion is a last recourse when RVF is refractory to medical treatment.

  11. A perspective on the surgical management of congestive heart failure.

    PubMed

    Massad, Malek G; Prasad, Sunil M; Chedrawy, Edgar G; Lele, Himalaya

    2008-03-01

    Surgical treatment of patients with congestive heart failure (CHF) has steadily advanced from rescue procedures such as aneurysmectomy, rupture repair, ventricular assist devices (VADs), and transplantation to procedures that can prevent or delay the progression of cardiac dysfunction and failure. The latter include operations such as coronary artery bypass grafting (CABG) and mitral valve repair for patients with ischemic cardiomyopathy (ICMP) and mitral annular dilatation, ventricular restoration and remodeling, and cardiac resynchronization therapy. As the number of heart transplants reported worldwide continues to decline over the past decade (by over 30%), newer surgical therapies have emerged. A need arises for clinical registries such as the NIH-sponsored LVAD registry and registries for biventricular pacing and AICD implantation, for total artificial heart implants, and for mitral valve repair in patients with ICMP. Prospective trials comparing sole ventricular restoration therapy (SVR) to SVR with concomitant CABG/MVR, coronary sinus versus epicardial LV pacing for ventricular resynchronization therapy, trials comparing LVAD as destination therapy to AICD implants, mitral valve repair versus chordal-sparing valve replacement for ischemic and valvular cardiomyopathy, and off-pump versus on-pump CABG for patients with ICMP are urgently needed. Future research should also be directed toward drugs targeting "B-cell mediated" humeral vascular rejection--the Achilles heel of cardiac transplantation, xenotransplantation, permanently implantable VADs, gene therapy, and myocardial cell regeneration therapy.

  12. Exercise Training Prevents Diaphragm Contractile Dysfunction in Heart Failure.

    PubMed

    Mangner, Norman; Bowen, T Scott; Werner, Sarah; Fischer, Tina; Kullnick, Yvonne; Oberbach, Andreas; Linke, Axel; Steil, Leif; Schuler, Gerhard; Adams, Volker

    2016-11-01

    Patient studies have demonstrated the efficacy of exercise training in attenuating respiratory muscle weakness in chronic heart failure (HF), yet direct assessment of muscle fiber contractile function together with data on the underlying intracellular mechanisms remains elusive. The present study, therefore, used a mouse model of HF to assess whether exercise training could prevent diaphragm contractile fiber dysfunction by potentially mediating the complex interplay between intracellular oxidative stress and proteolysis. Mice underwent sham operation (n = 10) or a ligation of the left coronary artery and were randomized to sedentary HF (n = 10) or HF with aerobic exercise training (HF + AET; n = 10). Ten weeks later, echocardiography and histological analyses confirmed HF. In vitro diaphragm fiber bundles demonstrated contractile dysfunction in sedentary HF compared with sham mice that was prevented by AET, with maximal force 21.0 ± 0.7 versus 26.7 ± 1.4 and 25.4 ± 1.4 N·cm, respectively (P < 0.05). Xanthine oxidase enzyme activity and MuRF1 protein expression, markers of oxidative stress and protein degradation, were ~20% and ~70% higher in sedentary HF compared with sham mice (P < 0.05) but were not different when compared with the HF + AET group. Oxidative modifications to numerous contractile proteins (i.e., actin and creatine kinase) and markers of proteolysis (i.e., proteasome and calpain activity) were elevated in sedentary HF compared with HF + AET mice (P < 0.05); however, these indices were not significantly different between sedentary HF and sham mice. Antioxidative enzyme activities were also not different between groups. Our findings demonstrate that AET can protect against diaphragm contractile fiber dysfunction induced by HF, but it remains unclear whether alterations in oxidative stress and/or protein degradation are primarily responsible.

  13. Diabetes mellitus and renal failure: Prevention and management.

    PubMed

    Nasri, Hamid; Rafieian-Kopaei, Mahmoud

    2015-11-01

    Nowadays, diabetes mellitus (DM) and hypertension are considered as the most common causes of end-stage renal disease (ESRD). In this paper, other than presenting the role of DM in ESRD, glucose metabolism and the management of hyperglycemia in these patients are reviewed. Although in several large studies there was no significant relationship found between tight glycemic control and the survival of ESRD patients, it is recommended that glycemic control be considered as the main therapeutic goal in the treatment of these patients to prevent damage to other organs. Glycemic control is perfect when fasting blood sugar is less than 140 mg/dL, 1-h postprandial blood glucose is less than 200 mg/dL, and glycosylated hemoglobin (HbA1c) is 6-7 in patients with type 1 diabetes and 7-8 in patients with type 2 diabetes. Administration of metformin should be avoided in chronic renal failure (CRF) because of lactic acidosis, the potentially fatal complication of metformin, but glipizide and repaglinide seem to be good choices.

  14. Diabetes mellitus and renal failure: Prevention and management

    PubMed Central

    Nasri, Hamid; Rafieian-Kopaei, Mahmoud

    2015-01-01

    Nowadays, diabetes mellitus (DM) and hypertension are considered as the most common causes of end-stage renal disease (ESRD). In this paper, other than presenting the role of DM in ESRD, glucose metabolism and the management of hyperglycemia in these patients are reviewed. Although in several large studies there was no significant relationship found between tight glycemic control and the survival of ESRD patients, it is recommended that glycemic control be considered as the main therapeutic goal in the treatment of these patients to prevent damage to other organs. Glycemic control is perfect when fasting blood sugar is less than 140 mg/dL, 1-h postprandial blood glucose is less than 200 mg/dL, and glycosylated hemoglobin (HbA1c) is 6-7 in patients with type 1 diabetes and 7-8 in patients with type 2 diabetes. Administration of metformin should be avoided in chronic renal failure (CRF) because of lactic acidosis, the potentially fatal complication of metformin, but glipizide and repaglinide seem to be good choices. PMID:26941817

  15. Rural Residents' Perspectives on Multiple Morbidity Management and Disease Prevention.

    PubMed

    Bardach, Shoshana H; Schoenberg, Nancy E; Tarasenko, Yelena N; Fleming, Steven T

    2011-12-01

    Middle-aged and older adults often experience several simultaneously occurring chronic conditions or "multiple morbidity" (MM). The task of both managing MM and preventing chronic conditions can be overwhelming, particularly in populations with high disease burdens, low socioeconomic status, and health care provider shortages. This article sought to understand Appalachian residents' perspectives on MM management and prevention. Forty-one rural Appalachian residents aged 50 and above with MM were interviewed about disease management and colorectal cancer (CRC) prevention. Transcripts were examined for overall analytic categories and coded using techniques to enhance transferability and rigor. Participants indicate facing various challenges to prevention due, in part, to conditions within their rural environment. Patients and providers spend significant time and energy on MM management, often precluding prevention activities. This article discusses implications of MM management for CRC prevention and strategies to increase disease prevention among this rural, vulnerable population burdened by MM.

  16. Perspectives for Cancer Prevention With Natural Compounds

    PubMed Central

    Amin, A.R.M. Ruhul; Kucuk, Omer; Khuri, Fadlo R.; Shin, Dong M.

    2009-01-01

    Cancer is the second leading cause of death in the United States. Despite the estimated 565,650 deaths in 2008 of Americans as a result of cancer, it is mostly a preventable disease. Simply by modification of diet, maintenance of optimum body weight, and regular physical activity, 30% to 40% of all instances of cancer could be prevented. Modification of diet alone by increasing vegetable and fruit intake could prevent 20% or more of all cases of cancer and may potentially prevent approximately 200,000 cancer-related deaths annually. Because of their safety, low toxicity, antioxidant properties, and general acceptance as dietary supplements, fruits, vegetables, and other dietary elements (phytochemicals and minerals) are being investigated for the prevention of cancer. Extensive research over the past several decades has identified numerous dietary and botanical natural compounds that have chemopreventive potential. In this review, we discuss promising natural chemopreventive compounds, their molecular targets, and their mechanisms, which may help the further design and conduct of preclinical and clinical trials. PMID:19414669

  17. Perspectives in the prevention of premature birth.

    PubMed

    Ancel, Pierre-Yves

    2004-11-15

    Obstetric and neonatal interventions have improved the survival of preterm infants, but there has not been an equivalent reduction in long-term neurological disability. Thus, some effort must be invested in finding ways of preventing preterm birth. Numerous programmes have been promoted to address the matter of how the frequency of preterm birth could be prevented. Most interventions intended to prevent preterm labour do not have the desired effect, except for antibiotic treatment in cases of asymptomatic bacteriuria or bacterial vaginosis and progesterone administered prophylactically in high-risk women. Tocolytic drugs appear to delay delivery long enough for successful administration of corticosteroids in women in preterm labour, but without decreasing the risk of preterm birth. Some authors promote public health approaches that address all risk factors and affect the entire population of pregnant women, given that prevention programmes directed only at high-risk women have had little effect in preventing preterm births. However, the lack of progress in reducing the frequency of preterm births is also due to our limited understanding of the aetiology of preterm delivery. Although there is growing evidence that infection and neuroendocrine processes are involved, progress has remained slow. Recently, the hypothesis of a genetic predisposition to preterm delivery has been set up. Additional research exploring the pathophysiology of preterm labour is obviously needed, which will hopefully lead to the development of new therapeutic approaches.

  18. Violence Prevention and Students with Disabilities: Perspectives from the Field of Youth Violence Prevention

    ERIC Educational Resources Information Center

    Gorman-Smith, Deborah

    2012-01-01

    Much of the work in youth violence prevention has been based in a public health model and guided by a developmental-ecological perspective on risk and prevention (Bronfenbrenner, 1979, 1988). A central tenet of developmental-ecological theory is that individual development is influenced by the ongoing qualities of the social settings in which the…

  19. Violence Prevention and Students with Disabilities: Perspectives from the Field of Youth Violence Prevention

    ERIC Educational Resources Information Center

    Gorman-Smith, Deborah

    2012-01-01

    Much of the work in youth violence prevention has been based in a public health model and guided by a developmental-ecological perspective on risk and prevention (Bronfenbrenner, 1979, 1988). A central tenet of developmental-ecological theory is that individual development is influenced by the ongoing qualities of the social settings in which the…

  20. Women's perspectives on falls and fall prevention during pregnancy.

    PubMed

    Brewin, Dorothy; Naninni, Angela

    2014-01-01

    Falls are the leading cause of unintentional injury in women. During pregnancy, even a minor fall can result in adverse consequences. Evidence to inform effective and developmentally appropriate pregnancy fall prevention programs is lacking. Early research on pregnancy fall prevention suggests that exercise may reduce falls. However, acceptability and effectiveness of pregnancy fall prevention programs are untested. To better understand postpartum women's perspective and preferences on fall prevention strategies during pregnancy to formulate an intervention. Focus groups and individual interviews were conducted with 31 postpartum women using descriptive qualitative methodology. Discussion of falls during pregnancy and fall prevention strategies was guided by a focus group protocol and enhanced by 1- to 3-minute videos on proposed interventions. Focus groups were audio recorded, transcribed, and analyzed using NVivo 10 software. Emerging themes were environmental circumstances and physical changes of pregnancy leading to a fall, prevention strategies, barriers, safety concerns, and marketing a fall prevention program. Wet surfaces and inappropriate footwear commonly contributed to falls. Women preferred direct provider counseling and programs including yoga and Pilates. Fall prevention strategies tailored to pregnant women are needed. Perspectives of postpartum women support fall prevention through provider counseling and individual or supervised exercise programs.

  1. Perspectives of public health and prevention.

    PubMed

    Spencer, H C

    1995-12-01

    The average life expectancy at birth of Americans has increased 30 years since the turn of the century and is mostly attributable to public health measures. Although death rates for cardiovascular diseases have declined in the past two decades, cardiovascular diseases still cause more deaths in the United States than all other causes combined. The major etiologies of heart disease, atherosclerosis and hypertension, are associated with modifiable risk factors--high blood cholesterol, high blood pressure, cigarette smoking, diet, and inactivity. Social status and access to medical care are also important contributors. Consequently, the greatest potential for reducing heart disease mortality and morbidity rests with prevention and public health practice. Recent directions in health-care reform emphasize fiscal management, medical care, and clinical medicine, and not general health. This emphasis exacerbates policy and financing imbalances between preventive and curative medicine. Consequently, the concept of a health system needs to be designed more rationally to allocate resources that include prevention and health promotion. The Bogalusa Heart Study provides understanding of the early origin of cardiovascular problems and the environmental and lifestyle factors that contribute to development of adult heart disease. To apply this information, public health models of intervention, like the school Health Ahead/Heart Smart program, are needed to address heart disease in the population. Changes in the true determinants of poor health, such as environmental factors and unhealthy behaviors, are the directions for prevention and future improvement in quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. New perspectives of curcumin in cancer prevention

    PubMed Central

    Park, Wungki; Amin, A.R.M Ruhul; Chen, Zhuo Georgia; Shin, Dong M.

    2013-01-01

    Numerous natural compounds have been extensively investigated for their potential for cancer prevention over decades. Curcumin, from Curcuma longa, is a highly promising natural compound that can be potentially used for chemoprevention of multiple cancers. Curcumin modulates multiple molecular pathways involved in the lengthy carcinogenesis process to exert its chemopreventive effects through several mechanisms: promoting apoptosis, inhibiting survival signals, scavenging reactive oxidative species (ROS), and reducing the inflammatory cancer microenvironment. Curcumin fulfills the characteristics for an ideal chemopreventive agent with its low toxicity, affordability, and easy accessibility. Nevertheless, the clinical application of curcumin is currently compromised by its poor bioavailability. Here we review the potential of curcumin in cancer prevention, its molecular targets, and action mechanisms. Finally, we suggest specific recommendations to improve its efficacy and bioavailability for clinical applications. PMID:23466484

  3. Prevention Trials in Alzheimer's Disease: Current Status and Future Perspectives.

    PubMed

    Wang, Jun; Tan, Lan; Yu, Jin-Tai

    2016-01-01

    Alzheimer's disease (AD) is the most common form of dementia in the elderly. Over the past 20 years, both pharmacological and lifestyle interventions have been studied for AD prevention, but the overall results have been disappointing. The majority of disappointing results have raised questions and great challenges for the future of AD prevention trials. Ongoing advances in the knowledge of pathogenesis, in the identification of novel targets, in improved outcome measures, and in identification and validation of biomarkers may lead to effective strategies for AD prevention. In this paper, we review the selection of participants and interventions, trial design, outcome assessments, and promising biomarkers in prevention trials, and summarize the lessons learned from completed trials and perspectives from ongoing trials in AD prevention. Selection of optimal participants and interventions, coupled with more refined outcomes and more efficient trial design, may have the capacity to deliver a new era of preventive discovery in this challenging area.

  4. Perspectives of Maryland Adults Regarding Caries Prevention

    PubMed Central

    Kleinman, Dushanka V.; Child, Wendy; Maybury, Catherine

    2015-01-01

    Objectives. We obtained in-depth information from low-income parents and caregivers of young children about their knowledge and understanding of and practices related to the prevention and control of dental caries (tooth decay). Methods. In 2010, we conducted 4 focus groups in Maryland communities with low-income, English-speaking parents and caregivers who had at least 1 child aged 6 years or younger or who were pregnant. We developed a focus group guide based on findings of a previous statewide random telephone survey of adults with young children. Results. Most participants had limited understanding of and extensive misinformation about how to prevent dental caries. They were confused about the use of juice and its impact on their child’s teeth and had limited understanding of the use of fluorides to prevent caries. Most did not drink tap water and did not give it to their children; rather, they used bottled water. Conclusions. These results and those of the statewide telephone survey strongly suggest the need for educational interventions designed for those with limited levels of education. PMID:25790422

  5. Spacecraft Parachute Recovery System Testing from a Failure Rate Perspective

    NASA Technical Reports Server (NTRS)

    Stewart, Christine E.

    2013-01-01

    Spacecraft parachute recovery systems, especially those with a parachute cluster, require testing to identify and reduce failures. This is especially important when the spacecraft in question is human-rated. Due to the recent effort to make spaceflight affordable, the importance of determining a minimum requirement for testing has increased. The number of tests required to achieve a mature design, with a relatively constant failure rate, can be estimated from a review of previous complex spacecraft recovery systems. Examination of the Apollo parachute testing and the Shuttle Solid Rocket Booster recovery chute system operation will clarify at which point in those programs the system reached maturity. This examination will also clarify the risks inherent in not performing a sufficient number of tests prior to operation with humans on-board. When looking at complex parachute systems used in spaceflight landing systems, a pattern begins to emerge regarding the need for a minimum amount of testing required to wring out the failure modes and reduce the failure rate of the parachute system to an acceptable level for human spaceflight. Not only a sufficient number of system level testing, but also the ability to update the design as failure modes are found is required to drive the failure rate of the system down to an acceptable level. In addition, sufficient data and images are necessary to identify incipient failure modes or to identify failure causes when a system failure occurs. In order to demonstrate the need for sufficient system level testing prior to an acceptable failure rate, the Apollo Earth Landing System (ELS) test program and the Shuttle Solid Rocket Booster Recovery System failure history will be examined, as well as some experiences in the Orion Capsule Parachute Assembly System will be noted.

  6. Right ventricular strain in heart failure: Clinical perspective.

    PubMed

    Tadic, Marijana; Pieske-Kraigher, Elisabeth; Cuspidi, Cesare; Morris, Daniel A; Burkhardt, Franziska; Baudisch, Ana; Haßfeld, Sabine; Tschöpe, Carsten; Pieske, Burket

    2017-06-29

    The number of studies demonstrating the importance of right ventricular remodelling in a wide range of cardiovascular diseases has increased in the past two decades. Speckle-tracking imaging provides new variables that give comprehensive information about right ventricular function and mechanics. In this review, we summarize current knowledge of right ventricular mechanics in heart failure with reduced ejection fraction and preserved ejection fraction. We searched PubMed, MEDLINE, Ovid and Embase databases for studies published from January 2000 to December 2016 in the English language using the following keywords: "right ventricle"; "strain"; "speckle tracking"; "heart failure with reduced ejection fraction"; and "heart failure with preserved ejection fraction". Investigations showed that right ventricular dysfunction is associated with higher cardiovascular and overall mortality in patients with heart failure, irrespective of ejection fraction. The number of studies investigating right ventricular strain in patients with heart failure with reduced ejection fraction is constantly increasing, whereas data on right ventricular mechanics in patients with heart failure with preserved ejection fraction are limited. Given the high feasibility, accuracy and clinical implications of right ventricular strain in the population with heart failure, it is of great importance to try to include the evaluation of right ventricular strain as a regular part of each echocardiographic examination in patients with heart failure. However, further investigations are necessary to establish right ventricular strain as a standard variable for decision-making. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. Some airline experience in preventing engine rotor failures

    NASA Technical Reports Server (NTRS)

    Morelli, J. J.

    1977-01-01

    Methods used by airlines, with the assistance of the engine manufacturers to achieve control over the type of problems which lead to uncontained failure and avoid many potential problems are discussed.

  8. New Perspectives on Drug Education/Prevention.

    PubMed

    Rosenbaum, Marsha

    2016-01-01

    In 2014, Oregon, Alaska, and the District of Columbia joined Colorado and Washington as voters approved initiatives to legally regulate and tax marijuana for adults. Other states, including California, are likely to follow in 2016. While none of these new laws allow sales to minors, there is widespread concern about the potential impact of these reforms on teenagers. Many worry that legalization will "send the wrong message," and increase access and availability, leading to an escalation in teenage use. This new social, political and cultural context presents a new challenge, as marijuana gradually becomes a normal part of the adult world, akin to alcohol. The movement toward legalization provides an opportunity to re-think our approach to teen drug education/prevention. This is the moment to examine current approaches, and devise innovative, pragmatic strategies for dealing with teens and marijuana (and other drug use). As we examine the issue of drug education/prevention in the context of legalization, we detail efforts that have been tried, and what is realistically possible to accomplish, with the health and safety of teenagers our highest priority. A reality-based approach advocates honest, science-based information; encourages moderation, if experimentation persists; promotes an understanding of the legal consequences and social context of drug use; emphasizes safety through personal responsibility and knowledge; and encourages the delay of experimentation with all intoxicating substances until adulthood.

  9. Nebivolol in chronic heart failure: current evidence and future perspectives.

    PubMed

    Lipsic, Erik; van Veldhuisen, Dirk J

    2010-04-01

    Chronic activation of the sympathetic nervous system leads to deterioration of cardiovascular function in heart failure patients. In systolic heart failure, beta-blockers were proven to be effective in decreasing the number of deaths and improving morbidity. However, beta-blockers are a heterogeneous drug group, consisting of agents with different selectivity for adrenergic receptors and/or additional effects in heart or peripheral circulation. We describe the role of the sympathetic nervous system, beta-blockers and specifically nebivolol in chronic heart failure. Nebivolol is a third-generation beta-blocker, with high beta(1)/beta(2) selectivity. Moreover, it has important vasodilating properties, by stimulating the production of nitric oxide. Smaller studies have already shown beneficial effects of nebivolol treatment on surrogate end points in heart failure patients. The recently published SENIORS (Phase III) study in an elderly heart failure population demonstrated a decreased number of clinical events in patients treated with nebivolol. Importantly, this effect was observed in patients with both impaired and preserved left ventricular systolic function. Specific beta-blockers may have distinct effects in various subgroups of heart failure patients. So far, nebivolol is the only beta-blocker to have been shown effective in elderly heart failure patients, regardless of their left ventricular ejection fraction.

  10. Perspective on precision medicine in paediatric heart failure.

    PubMed

    Fridman, Michael D; Mital, Seema

    2017-03-01

    In 2015, President Obama launched the Precision Medicine Initiative (PMI), which introduced new funding to a method of research with the potential to study rare and complex diseases. Paediatric heart failure, a heterogeneous syndrome affecting approximately 1 in 100000 children, is one such condition in which precision medicine techniques may be applied with great benefit. Current heart failure therapies target downstream effects of heart failure rather than the underlying cause of heart failure. As such, they are often ineffective in paediatric heart failure, which is typically of primary (e.g. genetic) rather than secondary (e.g. acquired) aetiology. It is, therefore, important to develop therapies that can target the causes of heart failure in children with greater specificity thereby decreasing morbidity, mortality and burden of illness on both patients and their families. The benefits of co-ordinated research in genomics, proteomics, metabolomics, transcriptomics and phenomics along with dietary, lifestyle and social factors have led to novel therapeutic and prognostic applications in other fields such as oncology. Applying such co-ordinated research efforts to heart failure constitutes an important step in advancing care and improving the lives of those affected.

  11. International Perspectives on Radiology in Preventive Screening.

    PubMed

    Brus-Ramer, Marcel; Lexa, Frank J; Kassing, Pamela; McGinty, Geraldine

    2016-11-01

    Several years ago, the International Economics Committee of the ACR began a study of comparisons among nations regarding the practice of radiology. This article is the second in a series. The purpose here is to compare the use across countries of imaging modalities in the screening algorithms of a variety of common diseases. In conjunction with the initial study, this will allow radiologists to understand in greater detail how health system practices differ among a selected set of nations. In this study, a standardized survey was administered to committee members from 10 countries in the developed and developing world. As with the prior study, there were both striking differences and similarities, even among a small cohort of nations that are all (except India) members of the Organisation for Economic Co-operation and Development. For example, breast cancer screening with mammography involves similar radiographic techniques for screening evaluations and has similarly high levels of insurance coverage, but the recommended ages at initial screening and end of screening differ. Other diseases, such as lung cancer and abdominal aortic aneurysm, have variable, but overall lower, levels of estimated participation among surveyed countries and significantly lower insurance coverage. Although this data set relies on survey data from individual practitioners, it provides an important perspective of the role of radiology in screening programs. Given the increasing pressure from domestic and foreign governments to reign in health care costs, the comparative differences in screening programs, and especially their use of (often costly) imaging techniques, may be a harbinger for future health policy decisions in the United States and abroad. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  12. Topiramate in Migraine Prevention: A 2016 Perspective.

    PubMed

    Silberstein, Stephen D

    2017-01-01

    In evidence-based guidelines published in 2000, topiramate was a third-tier migraine preventive with no scientific evidence of efficacy; recommendation for its use reflected consensus opinion and clinical experience. Its neurostabilizing activity, coupled with its favorable weight profile, made topiramate an attractive alternative to other migraine preventives that caused weight gain. When guidelines for migraine prevention in episodic migraine were published in 2012, topiramate was included as a first-line option based on double-blind, randomized controlled trials involving nearly 3000 patients. The scientific and clinical interest in topiramate has generated a large body of data from randomized controlled trials, meta-analyses, patient registries, cohort studies, and claims data analyses that have more fully characterized its role as a migraine preventive. This article will review the profile of topiramate that has emerged out of the past decade of research and clinical use in migraine prophylaxis. It will also address the rationale for extended-release (XR) formulations in optimizing topiramate therapy in migraine. Topiramate has activity at multiple molecular targets, which may account for why it is effective in migraine and most other, more specific, anticonvulsants are not. Based on randomized controlled trials, topiramate reduces migraine frequency and acute medication use, improves quality of life, and reduces disability in patients with episodic migraine and in those with chronic migraine with or without medication overuse headache. Its efficacy in chronic migraine is not improved by the addition of propranolol. Topiramate's ability to prevent progression from high-frequency episodic migraine to chronic migraine remains unclear. Consistent with clinicians' perceptions, migraineurs are more sensitive to topiramate-associated side effects than patients with epilepsy. Paresthesia is a common occurrence early in treatment but is rarely cause for terminating

  13. Prevention of mechanical failures in implanted spinal cord stimulation systems.

    PubMed

    Henderson, Jaimie M; Schade, C M; Sasaki, John; Caraway, David L; Oakley, John C

    2006-07-01

    Introduction.  Spinal cord stimulation (SCS) is an effective procedure for the treatment of neuropathic extremity pain, with success rates approaching 70%. However, mechanical failures, including breakage and migration, can significantly limit the long-term effectiveness of SCS. A systematic analysis of surgical techniques was undertaken by a consensus group, coupled with extensive in vivo and in vitro biomechanical testing of system components. Methods.  A computer model based on morphometric data was used to predict movement in a standard SCS system between an anchored lead and pulse generator placed in various locations. These displacements were then used to determine a realistic range of forces exerted on components of the SCS system. Laboratory fixtures were constructed to subject leads and anchors to repetitive stresses until failure occurred. An in vivo sheep model also was used to determine system compliances and failure thresholds in a biologically realistic setting. A panel of experienced implanters then interpreted the results and related them to clinical observations. Results.  Use of a soft silastic anchor pushed through the fascia to provide a larger bend radius for the lead was associated with a time to failure 65 times longer than an anchored but unsupported lead. In addition, failures of surgical paddle leads occurred when used with an anchor, whereas without an anchor, no failures occurred to 1 million cycles. Based on these findings, the panel recommended a paramedian approach, abdominal pulse generator placement, maximizing bend radius by pushing the anchor through the fascia, and anchoring of the extension connector near the lead anchor. Discussion.  Several factors are important in longevity of SCS systems. We discovered that technical factors can make a large difference in SCS reliability and that strict attention to these "best practices" will provide the best chance for maintaining the integrity of SCS systems over the long term.

  14. Emotions in memories of success and failure: a cultural perspective.

    PubMed

    Zhang, Meng; Cross, Susan E

    2011-08-01

    Americans and Chinese tend to behave differently in response to success and failure: Americans tend to persist on a task after success, whereas Chinese tend to persist after failure. This study examined whether cultural differences in emotional reactions to success and failure account for these differences. American and Chinese students recalled personal success and failure events, evaluated the primary emotion evoked by the event, and responded to measures of concerns, appraisals, and willingness to try the same task again. Americans were more likely than Chinese to report that their success enhanced their self-esteem. Chinese were more likely than Americans to estimate that their success would make others jealous and enhance others' respect for their family. Chinese, compared to Americans, viewed failures as more tolerable, as less problematic for their goals, and as less damaging to their self-esteem. Culture moderated the relations between these components of emotion and willingness to try the task again. In short, culturally framed emotional reactions to success and failure result in different patterns of anticipated self-regulation. 2011 APA, all rights reserved

  15. Preventing Intelligence Failures in an Unpredictable 21st Century

    DTIC Science & Technology

    2012-03-20

    Ultimately, intelligence will always be imperfect and, as history demonstrates, surprise can never be completely prevented. Despite intelligence reform...recurring theme in this paper is that I&W intelligence will always be imperfect and, as history demonstrates, surprise can never be completely prevented... history shows us, surprise can never be completely prevented. Walter Laqueur, Mark Lowenthal, Robert Jervis, and Richard Betts have attributed the

  16. From treating to preventing psychosis: personal perspectives.

    PubMed

    McGlashan, Thomas H

    2015-05-01

    The psychoanalytic treatment model of neurotic disorders was applied "experimentally," usually without concomitant pharmacotherapy, to psychotic disorders in the mid to late 20th century at a private institution (Chestnut Lodge) in Maryland. A long-term follow-up (by this author) essentially documented such an approach to be ineffective but suggested that initial treatment earlier in the development of disorder might prevent or ameliorate the "dementia" of dementia praecox. The opportunity to actually measure the effect of earlier detection and treatment became apparent to this author on sabbatical leave in Stavanger, Norway. The sectorized Norwegian health care system made it possible to engineer early detection of first psychosis in an "experimental" health care sector and compare their outcome to that of first onset patients from two control "usual detection" health care sectors. Early detection was engineered in the experimental sector with educational campaigns about the signs and symptoms of first psychosis targeting the sector's doctors, educators, and the general public through massive educational campaigns. The result was clear. Early detection and treatment resulted in a significantly better symptomatic, social, and instrumental outcome in the experimental sectors compared with "usual detection" sectors, a difference that lasted up to a 10-year follow-up (and perhaps permanently). These events and findings will be reviewed to assert that intervention timing may be far more important than intervention type in the overall strategy of antipsychotic interventions.

  17. Rosemary and cancer prevention: preclinical perspectives.

    PubMed

    Ngo, Suong N T; Williams, Desmond B; Head, Richard J

    2011-12-01

    Colorectal cancer is the second leading cause of cancer death in Australia. Nutrition, particularly intake of vegetables and certain plant components, has been reported to have a major role in cancer risk reduction. Recently, there has been a growing research interest in rosemary, a common household plant grown in many parts of the world. This study aims to review scientific evidence from all studies, published from 1996 to March 2010 that examined the protective effects of rosemary on colorectal cancer and other types of cancer. Literature evidence from animal and cell culture studies demonstrates the anticancer potential of rosemary extract, carnosol, carnosic acid, ursolic acid, and rosmarinic acid. No evidence for other rosemary constituents was found. The reported anticancer properties were found to arise through the molecular changes in the multiple-stage process of cancer development, which are dose related and not tissue or species specific. This is evidenced by the ability of rosemary to suppress the development of tumors in several organs including the colon, breast, liver, stomach, as well as melanoma and leukemia cells. The results suggested that the different molecular targets modulated by rosemary and its active constituents are useful indicators of success in clinical cancer chemo-prevention trials.

  18. Preventing Reading Failure: A Review of Five Effective Programs.

    ERIC Educational Resources Information Center

    Pikulski, John J.

    1994-01-01

    Describes five programs of early intervention for the prevention of reading problems (Success for All, the Winston-Salem Project, Early Intervention in Reading, the Boulder Project, and Reading Recovery). Compares these five programs on a number of dimensions, identifying common features that seem related to preventing reading problems. Draws…

  19. Rational Emotive Behavior Therapy Successes and Failures: Eight Personal Perspectives.

    ERIC Educational Resources Information Center

    Weinrach, Stephen G.; Ellis, Albert; MacLaren, Catharine; DiGiuseppe, Raymond; Vernon, Ann; Wolfe, Janet; Malkinson, Ruth; Backx, Wouter

    2001-01-01

    Eight experts in Rational Emotive Behavior Therapy (REBT) provide personal examples of their own successes and failures in applying REBT to themselves. The experts actively talked to themselves both rationally and irrationally. Rational self-talk was more prevalent in the examples of how REBT was successfully used by the experts. (GCP)

  20. Volume Overload in Heart Failure: An Evidence-Based Review of Strategies for Treatment and Prevention.

    PubMed

    Houston, Brian A; Kalathiya, Rohan J; Kim, Daniel A; Zakaria, Sammy

    2015-09-01

    Acute decompensated heart failure is the leading cause of hospital admission in the United States, with a high risk of readmission within 30 days. Most acute decompensated heart failure admissions are driven by congestive signs and symptoms resulting from fluid and sodium overload. We reviewed the evidence base addressing the management and prevention of fluid overload in heart failure, focusing on recent clinical trials. All the references in this review were obtained through PubMed and had at least 1 of the following key words: heart failure and volume overload, congestion, loop diuretics, thiazide diuretics, aldosterone antagonists, dopamine, cardiorenal syndrome, nesiritide, vasopressin antagonists, ultrafiltration, sodium restriction, fluid restriction, telemonitoring, and invasive hemodynamic monitoring. We also reviewed relevant references cited in the obtained articles, especially articles addressing methods of treating or preventing volume overload in patients with heart failure.

  1. [Early detection, prevention and management of renal failure in liver transplantation].

    PubMed

    Castells, Lluís; Baliellas, Carme; Bilbao, Itxarone; Cantarell, Carme; Cruzado, Josep Maria; Esforzado, Núria; García-Valdecasas, Juan Carlos; Lladó, Laura; Rimola, Antoni; Serón, Daniel; Oppenheimer, Federico

    2014-10-01

    Renal failure is a frequent complication in liver transplant recipients and is associated with increased morbidity and mortality. A variety of risk factors for the development of renal failure in the pre- and post-transplantation periods have been described, as well as at the time of surgery. To reduce the negative impact of renal failure in this population, an active approach is required for the identification of those patients with risk factors, the implementation of preventive strategies, and the early detection of progressive deterioration of renal function. Based on published evidence and on clinical experience, this document presents a series of recommendations on monitoring RF in LT recipients, as well as on the prevention and management of acute and chronic renal failure after LT and referral of these patients to the nephrologist. In addition, this document also provides an update of the various immunosuppressive regimens tested in this population for the prevention and control of post-transplantation deterioration of renal function.

  2. Young women's perspectives on cervical cancer prevention in Appalachian Kentucky.

    PubMed

    Head, Katharine J; Cohen, Elisia L

    2012-04-01

    Human papillomavirus (HPV) vaccination coupled with routine Papanicolaou (Pap) tests can prevent pervasive HPV infections causing cervical cancer. However, both HPV vaccination rates and Pap testing rates in Appalachian Kentucky are lower among all age groups than the rest of the United States. We recruited 19 young women residing in Appalachian Kentucky from university-based and rural clinical settings for group and individual interviews. After considering an integrated behavioral framework, we illustrate these women's perspectives by detailing five themes, including (a) experiential beliefs pose barriers to performing behaviors, (b) three vaccine doses complicate vaccination intention, (c) women have misunderstandings about HPV and the HPV vaccination function, (d) normative influences cue action (and inaction), and (e) specific environmental and contextual barriers exist to performing cervical cancer prevention behaviors in Appalachian Kentucky. These findings related to cervical cancer prevention in Appalachian Kentucky have implications for health-message design and clinical practice.

  3. Low-protein diet for the prevention of renal failure

    PubMed Central

    WATANABE, Shaw

    2017-01-01

    The prevalence of chronic kidney disease (CKD) is estimated to be 8–16% worldwide, and it is increasing. CKD is a risk factor for heart attack and stroke, and it can progress to kidney failure requiring dialysis or transplantation. Recently, diabetic nephropathy has become the most common cause of CKD. In Japan, the cumulative probability of requiring hemodialysis by the age 80 years is 1/50 in males and 1/100 in females. The number of patients under hemodialysis in Japan exceeded 320,000 in 2014, among which 38,000 were newcomers and 27,000 died. The annual medical costs of hemodialysis are 1.25 trillion yen in Japan, representing 4% of the total national medical expenditures in 2014. A low-protein diet (less than 0.5 g/kg b.wt.) is a very effective intervention. Low-protein rice (1/10 to 1/25 of the normal protein contents) is helpful to control the consumption of proteins, decreasing at the same time the intake of potassium and phosphate. Protein restriction is indicated as soon as the eGFR becomes lower than 60 ml/min/1.73 m2 body surface, in order, to slow disease progression. The newly developed low-protein Indica rice is expected to help many CKD patients in China and Southeast Asia. PMID:28077806

  4. Priming as a means of preventing skill failure under pressure.

    PubMed

    Ashford, Kelly J; Jackson, Robin C

    2010-08-01

    The present study examined the effectiveness of a priming paradigm in alleviating skill failure under stress. The priming intervention took the form of a scrambled sentence task. Experiment 1: Thirty-four skilled field-hockey players performed a dribbling task in low- and high-pressure situations under single task, skill-focused, and priming conditions. Results revealed a significant increase in performance time from low to high pressure. In addition, performance in the priming condition was significantly better than in the control and skill-focused conditions. Experiment 2: Thirty skilled field-hockey players completed the same dribbling task as in Experiment 1; however, in addition to the control and skill-focused conditions, participants were allocated to either a positive, neutral, or negative priming condition. Results revealed significant improvements in performance time from the skill focus to the control to the priming condition for the positive and neutral groups. For the negative group, times were significantly slower in the priming condition. Results are discussed in terms of utilizing priming in a sporting context.

  5. Prevention perspective in orthodontics and dento–facial orthopedics

    PubMed Central

    Teodorescu, E; Badarau, A; Grigore, R; Popa, M

    2008-01-01

    In the present context of the public health directions, considering WHO main objective, that ‘all people of the world could reach the highest possible health level’, in medicine, the accent is put on prevention. In spite of the important progresses achieved in orthodontics field, the treatment still remains a symptomatic one. In this context, we must ask ourselves what are the prevention theoretical and practical coordinates in orthodontics, which measures are available or could be elaborated for preventing the malocclusions development. From the clinical point of view, the most important element of the new perspective is that most of the cases of anomalies which in the present are cured by orthodontics are induced by functional and environmental factors and they can theoretically be prevented. Thus, the identification, control and guidance of the environmental factors which adjust the growing of the maxillaries and of the other cranio-facial structures would be the main target of a prevention program in orthodontics. PMID:20108519

  6. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives

    PubMed Central

    Jankowska, Ewa A.; von Haehling, Stephan; Anker, Stefan D.; Macdougall, Iain C.; Ponikowski, Piotr

    2013-01-01

    Iron is a micronutrient essential for cellular energy and metabolism, necessary for maintaining body homoeostasis. Iron deficiency is an important co-morbidity in patients with heart failure (HF). A major factor in the pathogenesis of anaemia, it is also a separate condition with serious clinical consequences (e.g. impaired exercise capacity) and poor prognosis in HF patients. Experimental evidence suggests that iron therapy in iron-deficient animals may activate molecular pathways that can be cardio-protective. Clinical studies have demonstrated favourable effects of i.v. iron on the functional status, quality of life, and exercise capacity in HF patients. It is hypothesized that i.v. iron supplementation may become a novel therapy in HF patients with iron deficiency. PMID:23100285

  7. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives.

    PubMed

    Jankowska, Ewa A; von Haehling, Stephan; Anker, Stefan D; Macdougall, Iain C; Ponikowski, Piotr

    2013-03-01

    Iron is a micronutrient essential for cellular energy and metabolism, necessary for maintaining body homoeostasis. Iron deficiency is an important co-morbidity in patients with heart failure (HF). A major factor in the pathogenesis of anaemia, it is also a separate condition with serious clinical consequences (e.g. impaired exercise capacity) and poor prognosis in HF patients. Experimental evidence suggests that iron therapy in iron-deficient animals may activate molecular pathways that can be cardio-protective. Clinical studies have demonstrated favourable effects of i.v. iron on the functional status, quality of life, and exercise capacity in HF patients. It is hypothesized that i.v. iron supplementation may become a novel therapy in HF patients with iron deficiency.

  8. Failure mode and effects analysis: A community practice perspective.

    PubMed

    Schuller, Bradley W; Burns, Angi; Ceilley, Elizabeth A; King, Alan; LeTourneau, Joan; Markovic, Alexander; Sterkel, Lynda; Taplin, Brigid; Wanner, Jennifer; Albert, Jeffrey M

    2017-09-25

    To report our early experiences with failure mode and effects analysis (FMEA) in a community practice setting. The FMEA facilitator received extensive training at the AAPM Summer School. Early efforts focused on department education and emphasized the need for process evaluation in the context of high profile radiation therapy accidents. A multidisciplinary team was assembled with representation from each of the major department disciplines. Stereotactic radiosurgery (SRS) was identified as the most appropriate treatment technique for the first FMEA evaluation, as it is largely self-contained and has the potential to produce high impact failure modes. Process mapping was completed using breakout sessions, and then compiled into a simple electronic format. Weekly sessions were used to complete the FMEA evaluation. Risk priority number (RPN) values > 100 or severity scores of 9 or 10 were considered high risk. The overall time commitment was also tracked. The final SRS process map contained 15 major process steps and 183 subprocess steps. Splitting the process map into individual assignments was a successful strategy for our group. The process map was designed to contain enough detail such that another radiation oncology team would be able to perform our procedures. Continuous facilitator involvement helped maintain consistent scoring during FMEA. Practice changes were made responding to the highest RPN scores, and new resulting RPN scores were below our high-risk threshold. The estimated person-hour equivalent for project completion was 258 hr. This report provides important details on the initial steps we took to complete our first FMEA, providing guidance for community practices seeking to incorporate this process into their quality assurance (QA) program. Determining the feasibility of implementing complex QA processes into different practice settings will take on increasing significance as the field of radiation oncology transitions into the new TG-100 QA

  9. Failure of interpositional membrane to prevent recurrent arthrofibrosis.

    PubMed

    Meehan, John P; Abbi, Gaurav

    2010-09-01

    Silicone has been used in numerous health care roles, from catheters to finger joint arthroplasties, with proven success. Its use as an interpositional membrane for the prevention of adhesions has been attempted in various anatomic sites with unpredictable results. We present a case report of a patient with recurrent arthrofibrosis requiring multiple operative procedures including manipulations under anesthesia, arthroscopies, and unicompartmental and eventual total knee replacement. After developing stiffness after total knee arthroplasty, the patient received placement of a silicone interpositional membrane with the goal of minimizing scar formation. Arthrofibrosis recurred, and only eventual removal of the membrane and correction of the underlying overstuffed patellofemoral compartment has allowed for maintained functional improvement in motion after 3 years.

  10. Failure in the application of fragility fracture prevention guidelines.

    PubMed

    Elvey, M H; Pugh, H; Schaller, G; Dhotar, G; Patel, B; Oddy, M J

    2014-07-01

    The cost of fragility fractures to the UK economy is predicted to reach £2.2 billion by 2025. We studied our hip fracture population to establish whether national guidelines on fragility fracture prevention were being followed, and whether high risk patients were identified and treated by local care services. Data on a consecutive series of trauma hip fracture admissions were collected prospectively over 14 months. National Institute for Health and Care Excellence (NICE) and National Osteoporosis Guideline Group (NOGG) recommendations and FRAX(®) risk calculations were applied to patients prior to their admission with a new hip fracture. Overall, 94 patients were assessed against national guidelines. The mean population age was 77 years. Almost a quarter (22%) of patients had suffered a previous fragility fracture. The mean FRAX(®) ten-year probability of hip fracture was 7%. According to guidelines, 45% of the study population required treatment, 35% fulfilled criteria for investigation and reassessment, and 20% needed no further management. In practice, 27% received treatment, 4% had undergone dual energy x-ray absorptiometry and were untreated, and 69% had not been investigated and were untreated. In patients meeting intervention thresholds, only 33% of those who required treatment were receiving treatment in practice. In conjunction with NICE and NOGG recommendations, FRAX(®) was able to identify 80% of our fracture population as intermediate or high risk on the day of fracture. Correct management was evident in a third of cases with a pattern of inferior guideline compliance seen in a London population. There remains a lack of clarity over the duty of care in fragility fracture prevention.

  11. Staff and consumer perspectives on defining treatment success and failure in assertive community treatment.

    PubMed

    Stull, Laura G; McGrew, John H; Salyers, Michelle P

    2010-09-01

    Although assertive community treatment (ACT) has been consistently recognized as effective, there has been little research as to what constitutes success in ACT. The purpose of this study was to understand how ACT consumers and staff define treatment success and failure and to examine whether definitions varied between staff and consumers. Investigators conducted semistructured interviews with 25 staff and 23 consumers from four ACT teams. Across perspectives, success and failure were most clearly related to consumer factors. Other themes included having basic needs met, being socially involved, and taking medications. Reduced hospitalizations were mentioned infrequently. Consumers were more likely than staff to identify the level or type of treatment as defining success and failure, whereas staff were more likely than consumers to discuss substance abuse when defining failure and improved symptoms when defining success. Success in ACT should be viewed more broadly than reduced hospitalizations and include domains such as social involvement.

  12. Older users' perspectives on the benefits of preventive home visits.

    PubMed

    Tøien, Mette; Bjørk, Ida Torunn; Fagerström, Lisbeth

    2015-05-01

    In this article we explore older people's perspectives on the benefits of preventive home visits (PHVs), after long-term follow-up. PHVs are health services intended to promote older people's health and independence, prevent disease, and postpone functional decline. We applied an explorative and descriptive design and analyzed qualitative research interviews of 10 PHV users who had received multiple visits for at least 6 years. We sought manifest and latent content in our analysis. The participants reported benefits falling within four main categories: to feel safe, to manage everyday life, to live well, and to be somebody. Two latent themes emerged: living with an underlying, realistic concern about an uncertain future, and striving to maintain oneself as a person. The perceived benefits of PHVs differed significantly from the outcome measures commonly used in randomized, controlled trials. PHV interventions should have a longitudinal approach and support each person's current needs and valued goals.

  13. Module failure isolation circuit for paralleled inverters. [preventing system failure during power conditioning for spacecraft applications

    NASA Technical Reports Server (NTRS)

    Nagano, S. (Inventor)

    1979-01-01

    A module failure isolation circuit is described which senses and averages the collector current of each paralled inverter power transistor and compares the collector current of each power transistor the average collector current of all power transistors to determine when the sensed collector current of a power transistor in any one inverter falls below a predetermined ratio of the average collector current. The module associated with any transistor that fails to maintain a current level above the predetermined radio of the average collector current is then shut off. A separate circuit detects when there is no load, or a light load, to inhibit operation of the isolation circuit during no load or light load conditions.

  14. Public health and the prevention of obesity: failure or success?

    PubMed

    Aranceta Bartrina, Javier

    2013-09-01

    In recent decades, obesity has become a major public health problem in developed societies and economies in transition. Rapid social changes that have occurred since the mid 20th century prompted major changes in eating habits and lifestyles, with the gradual abandonment of traditional dietary patterns and culinary techniques, significant decrease in physical activity and increased sedentary time, giving as result in an imbalance in the energy balance. Obesity is a risk factor for many chronic diseases. There is evidence that childhood obesity influences adult health condition. Additionally, obesity in children affects their physical, emotional and social wellbeing. According to some estimates the cost of obesity may represent up to 12% of health cost in some countries. Many actions have been developed since around the year 2000 WHO alerted about the problem. The analysis of the factors involved in the origin of the problem have led to recognize the importance of creating supportive environments for healthier food choices and physical activity to be the easiest and accessible options in common everyday environments, such as schools, workplace or community environment. Evidence is long available that the most effective interventions to prevent childhood obesity should consider multiple strategies and last longer. Today it is also recognized the importance of implementing policies that encourage supportive friendly environments for physical activity and help decisions to opt for healthy eating habits.

  15. The genetics of premature ovarian failure: current perspectives

    PubMed Central

    Chapman, Chevy; Cree, Lynsey; Shelling, Andrew N

    2015-01-01

    Premature ovarian failure (POF) is a common cause of infertility in women, characterized by amenorrhea, hypoestrogenism, and elevated gonadotropin levels in women under the age of 40. Many genes have been identified over the past few years that contribute to the development of POF. However, few genes have been identified that can explain a substantial proportion of cases of POF. The unbiased approaches of genome-wide association studies and next-generation sequencing technologies have identified several novel genes implicated in POF. As only a small proportion of genes influencing idiopathic POF have been identified thus far, it remains to be determined how many genes and molecular pathways may influence idiopathic POF development. However, owing to POF’s diverse etiology and genetic heterogeneity, we expect to see the contribution of several new and novel molecular pathways that will greatly enhance our understanding of the regulation of ovarian function. Future genetic studies in large cohorts of well-defined, unrelated, idiopathic POF patients will provide a great opportunity to identify the missing heritability of idiopathic POF. The identification of several causative genes may allow for early detection and would provide better opportunity for early intervention, and furthermore, the identification of specific gene defects will help direct potential targets for future treatment. PMID:26445561

  16. Perspectives on legal strategies to prevent workplace violence.

    PubMed

    Lipscomb, Jane; Silverstein, Barbara; Slavin, Thomas J; Cody, Eileen; Jenkins, Lynn

    2002-01-01

    Workplace violence is a continuing problem in the United States, accounting for approximately 1,000 deaths each year and for more than 1.5 million incidents of nonfatal injuries. State and federal agencies have published guidelines for preventing workplace assaults, but there is a need for a strong research agenda to address the effectiveness of intervention strategies. After an overview, this article provides a discussion of workplace violence from three perspectives. One section discusses the process used in a manufacturing setting to install a workplace violence prevention program. A second section provides insight into the processes used to fully implement a workplace violence prevention program in a health care setting. A final section provides insight to the processes brought to bear in one state to mandate prevention of workplace violence in the health care setting. There is a critical need to evaluate alternative strategies to address workplace violence, to make the findings available to legislative and executive branches of government, and to implement effective strategies to counter violence in the workplace.

  17. New perspectives for preventing hepatitis C virus liver graft infection.

    PubMed

    Felmlee, Daniel J; Coilly, Audrey; Chung, Raymond T; Samuel, Didier; Baumert, Thomas F

    2016-06-01

    Hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease that necessitates liver transplantation. The incidence of virus-induced cirrhosis and hepatocellular carcinoma continues to increase, making liver transplantation increasingly common. Infection of the engrafted liver is universal and accelerates progression to advanced liver disease, with 20-30% of patients having cirrhosis within 5 years of transplantation. Treatments of chronic HCV infection have improved dramatically, albeit with remaining challenges of failure and access, and therapeutic options to prevent graft infection during liver transplantation are emerging. Developments in directed use of new direct-acting antiviral agents (DAAs) to eliminate circulating HCV before or after transplantation in the past 5 years provide renewed hope for prevention and treatment of liver graft infection. Identification of the ideal regimen and use of DAAs reveals new ways to treat this specific population of patients. Complementing DAAs, viral entry inhibitors have been shown to prevent liver graft infection in animal models and delay graft infection in clinical trials, which shows their potential for use concomitant to transplantation. We review the challenges and pathology associated with HCV liver graft infection, highlight current and future strategies of DAA treatment timing, and discuss the potential role of entry inhibitors that might be used synergistically with DAAs to prevent or treat graft infection. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. [Electrical failure with nerve stimulation: cases report and check list for prevention].

    PubMed

    Choquet, O; Feugeas, J-L; Capdevila, X; Manelli, J-C

    2007-03-01

    Functionality of the nerve stimulator and integrity of the electrical circuit should be verified and confirmed before performing peripheral nerve blockade. The clinical cases reported here demonstrate that electrical disconnection or malfunction during nerve localization can unpredictably occur and a checklist is described to prevent the unknown electrical circuit failure.

  19. Human papillomavirus infections: new perspectives for prevention and treatment.

    PubMed

    Menzo, Stefano; Marinelli, Katia; Bagnarelli, Patrizia; Rolla, Serena; Clementi, Massimo

    2007-07-01

    Human papillomaviruses (HPVs) have been recognized as the main etiologic agent of cervical cancer and other anogenital neoplasms, and a leading cause of death from cancer worldwide. In the last twenty years, extensive research has contributed to document the molecular mechanisms of virus persistence and malignant transformation, confirming a direct role of viral proteins in these processes. A clear understanding of the molecular epidemiology of HPVs and the availability of powerful molecular diagnostic techniques have provided the background for prevention strategies of HPV-related carcinomas. Since these viruses are highly prevalent in the general population, strict screening programs are still necessary. Recently, major breakthroughs have emerged from immunological studies. Indeed, these studies have paved the way for medical treatment of HPV infections and provided the first highly effective preventive vaccines. For these principal reasons, the time has come for a great effort towards the eradication of these important human pathogens. The present review summarizes the main aspects of the virology, molecular epidemiology and molecular biology of HPV infection and highlights the recent perspectives of prevention and treatment of the HPV-related disease.

  20. Intralipid prevents and rescues fatal pulmonary arterial hypertension and right ventricular failure in rats.

    PubMed

    Umar, Soban; Nadadur, Rangarajan D; Li, Jingyuan; Maltese, Federica; Partownavid, Parisa; van der Laarse, Arnoud; Eghbali, Mansoureh

    2011-09-01

    Pulmonary arterial hypertension (PAH) is characterized by pulmonary vascular remodeling leading to right ventricular (RV) hypertrophy and failure. Intralipid (ILP), a source of parenteral nutrition for patients, contains γ-linolenic acid and soy-derived phytoestrogens that are protective for lungs and heart. We, therefore, investigated the therapeutic potential of ILP in preventing and rescuing monocrotaline-induced PAH and RV dysfunction. PAH was induced in male rats with monocrotaline (60 mg/kg). Rats then received daily ILP (1 mL of 20% ILP per day IP) from day 1 to day 30 for prevention protocol or from day 21 to day 30 for rescue protocol. Other monocrotaline-injected rats were left untreated to develop severe PAH by day 21 or RV failure by approximately day 30. Saline or ILP-treated rats served as controls. Significant increase in RV pressure and decrease in RV ejection fraction in the RV failure group resulted in high mortality. Therapy with ILP resulted in 100% survival and prevented PAH-induced RV failure by preserving RV pressure and RV ejection fraction and preventing RV hypertrophy and lung remodeling. In preexisting severe PAH, ILP attenuated most lung and RV abnormalities. The beneficial effects of ILP in PAH seem to result from the interplay of various factors, among which preservation and/or stimulation of angiogenesis, suppression and/or reversal of inflammation, fibrosis and hypertrophy, in both lung and RV, appear to be major contributors. In conclusion, ILP not only prevents the development of PAH and RV failure but also rescues preexisting severe PAH.

  1. Regulatory perspective for prevention of groundwater pollution. [Monograph

    SciTech Connect

    Dotson, L.J.

    1982-01-01

    This paper attempts to establish a regulatory perspective for preventing groundwater pollution, which is a serious problem in many regions of the country. Historically, pollution-control regulations have been haphazard and uncoordinated. Few have been designed to consider the problems unique to this source. The paper outlines important hydrologic factors to establish a basis for an improved regulatory program for groundwater quality protection. Significant factors include the hydrologic role of ground water, the uses and regional importance of groundwater, and groundwater contamination pathways. A review of past and present trends in regulatory protection includes two regulatory approaches that are generally superior and a listing of key factors that planners should consider when designing land-use regulations. The paper concludes with a discussion of some possible problems of implementing an improved regulatory program, such as limits on our technical or enforcement capabilities. 52 references, 7 figures.

  2. Design and Rationale of the PREVENT III Clinical Trial: Edifoligide for the Prevention of Infrainguinal Vein Graft Failure

    PubMed Central

    Conte, Michael S.; Lorenz, Todd J.; Bandyk, Dennis F.; Clowes, Alexander W.; Moneta, Gregory L.; Seely, B. Lynn

    2006-01-01

    Surgical bypass of peripheral arterial occlusive disease with autologous vein grafts provides an effective means of restoring blood flow to the lower extremity, and has been a standard therapy for patients with disabling claudication or critical limb ischemia (CLI). However, failure rates may run as high as 50% within 5 years. These graft failures occur as a result of neointimal hyperplasia, a ubiquitous biologic response of blood vessel walls to injury, which is characterized by the migration and proliferation of smooth muscle cells (SMC). The E2F family of transcription factors regulates the expression of genes controlling SMC proliferation. Edifoligide (E2F Decoy) is a novel therapy that inhibits E2F function, thus attenuating neointimal hyperplasia. Its use in conjunction with a patented drug delivery pressurization chamber is under investigation. Using this system, edifoligide is administered to vein grafts in a single, ex vivo treatment following vein harvest and before implantation, resulting in minimal systemic drug exposure and excellent patient compliance. This Phase 3, randomized, double-blind, multicenter clinical trial is designed to evaluate the safety and efficacy of edifoligide in a population of approximately 1400 patients with CLI undergoing infrainguinal bypass for peripheral arterial disease (PAD). The primary outcome measure will be the time to occurrence of non-technical graft failure resulting in either graft revision or major amputation at 12 months after enrollment. A governing Clinical Events Classification committee (CEC) will adjudicate each graft failure to determine its etiology. The PREVENT III trial is the largest multicenter trial ever performed in patients receiving autologous vein bypass grafts for CLI. This landmark study will determine if edifoligide is safe and effective at preventing vein graft failure in patients undergoing lower extremity bypass, but it also provides a unique opportunity to observe current treatment

  3. Prediction and prevention of failure: an early intervention to assist at-risk medical students.

    PubMed

    Winston, Kalman A; van der Vleuten, Cees P M; Scherpbier, Albert J J A

    2014-01-01

    Consistent identification and prevention of failure for at-risk medical students is challenging, failing courses is costly to all stakeholders, and there is need for further research into duration, timing and structure of interventions to help students in difficulty. To verify the value of a new exam two weeks into medical school as a predictor of failure, and explore the requirements for a preventative intervention. Students who failed the two-week exam were invited to a series of large-group workshops and small-group follow-up meetings. Participants' subsequent exam performance was compared with non-participants. About 71% of students who performed poorly in the new exam subsequently failed a course. Attendance at the workshops made no difference to short- or long-term pass rates. Attendance at more than three follow-up small group sessions significantly improved pass rates two semesters later, and was influenced by teacher experience. Close similarity between predictor task and target task is important for accurate prediction of failure. Consideration should be given to dose effect and class size in the prevention of failure of at-risk students, and we recommend a systemic approach to intervention/remediation programmes, involving a whole semester of mandatory, weekly small group meetings with experienced teachers.

  4. Predictors of Prevention Failure in College Students Participating in Two Indicated Depression Prevention Programs

    PubMed Central

    Blanco, Vanessa; Rohde, Paul; Vázquez, Fernando L.; Otero, Patricia

    2014-01-01

    The purpose of this study was to identify subgroups of university students with the highest likelihood of remaining at elevated levels of depressive symptoms six months following the receipt of a depressive prevention intervention on the basis of known risk factors and participation in one of two depression prevention programs. Data from a randomized controlled trial evaluating depression prevention among 133 college students with elevated depressive symptoms were analyzed. Participants were randomized to a cognitive-behavioral or relaxation training group preventive intervention. Classification tree analysis showed that older age was the strongest risk factor for persistently elevated depression. Additional risk factors were: (1) for younger students, fewer daily pleasant activities; (2) for those with higher level of pleasant activities, higher level of stressful events; and (3) for those with higher level of stressful events, lower assertiveness. Results offer directions for prevention foci, identify specific subgroups of college students to target for depression prevention efforts, and suggest that research aim to help older, non-traditional students or graduating students manage the transition from college to the work force. PMID:24714056

  5. Predictors of prevention failure in college students participating in two indicated depression prevention programs.

    PubMed

    Blanco, Vanessa; Rohde, Paul; Vázquez, Fernando L; Otero, Patricia

    2014-04-04

    The purpose of this study was to identify subgroups of university students with the highest likelihood of remaining at elevated levels of depressive symptoms six months following the receipt of a depressive prevention intervention on the basis of known risk factors and participation in one of two depression prevention programs. Data from a randomized controlled trial evaluating depression prevention among 133 college students with elevated depressive symptoms were analyzed. Participants were randomized to a cognitive-behavioral or relaxation training group preventive intervention. Classification tree analysis showed that older age was the strongest risk factor for persistently elevated depression. Additional risk factors were: (1) for younger students, fewer daily pleasant activities; (2) for those with higher level of pleasant activities, higher level of stressful events; and (3) for those with higher level of stressful events, lower assertiveness. Results offer directions for prevention foci, identify specific subgroups of college students to target for depression prevention efforts, and suggest that research aim to help older, non-traditional students or graduating students manage the transition from college to the work force.

  6. Core competencies and the prevention of school failure and early school leaving.

    PubMed

    Bradshaw, Catherine P; O'Brennan, Lindsey M; McNeely, Clea A

    2008-01-01

    There is an increasing awareness that school failure and early school leaving are processes, rather than discrete events, that often co-occur and can have lasting negative effects on children's development. Most of the literature has focused on risk factors for failure and dropout rather than on the promotion of competencies that can increase youths' likelihood of successfully completing high school. This chapter applies the core competencies framework to the promotion of youths' success within the school environment. We conclude with a brief review of evidence-based prevention strategies that address the five competencies and identify avenues for future research.

  7. The role of pharmacotherapy in the prevention of sudden cardiac death in patients with heart failure.

    PubMed

    Weeks, Phillip A; Sieg, Adam; Gass, Jennifer Ann; Rajapreyar, Indranee

    2016-07-01

    Sudden cardiac death remains a significant threat to the survival of patients with heart failure. Long-term cardiac remodeling predisposes these patients to develop malignant ventricular arrhythmias. Permanent implantable and temporary external defibrillators remain a mainstay for the prevention of sudden cardiac death in this population. For decades, researchers have attempted to identify reliable drug therapies to avoid such arrhythmias; however, to date, success has been inconsistent. This review aims to explore the evidence defining the role of drug therapies for direct and indirect suppression of arrhythmias that may cause sudden cardiac death in patients with heart failure.

  8. Perspectives on the Tertiary Prevention Strategy for Alzheimer’s Disease

    PubMed Central

    Bua, Xian-Le; Jiaoa, Shu-Sheng; Lianb, Yan; Wanga, Yan-Jiang

    2016-01-01

    Amyloid-beta (Aβ) plays a pivotal role in Alzheimer’s disease (AD) pathogenesis, and is the most promising disease-modifying target for AD. A succession of failures in Aβ-targeting clinical trials, however, has prompted questions on whether Aβ is the true cause of AD and a valid therapeutic target. Therefore, current therapeutic targets and intervention strategies must be reconsidered. In addition to Aβ, multiple pathological events such as tau hyperphosphorylation, oxidative stress and neuroinflammation are involved in the disease pathogenesis and cause cross-talk between these pathological pathways, which synergistically drive disease progression. Increasing evidence also reveals that the pathogenesis varies at different stages of the disease. Therefore, targeting Aβ alone at all stages of the disease would not be sufficient to halt or reverse disease progression. In the light of the pathophysiologic similarities between the development of ischemic stroke and AD, we can formulate management strategies for AD from the successful practice of ischemic stroke management, namely the tertiary prevention strategy. These new perspectives of tertiary prevention target both Aβ and different pathological pathways of AD pathogenesis at different stages of the disease, and may represent a promising avenue for the effective prevention and treatment of AD. PMID:26667888

  9. A Perspective on Progress and Gaps in HIV Prevention Science

    PubMed Central

    Mesquita, Pedro M.M.; Herold, Betsy C.

    2012-01-01

    Abstract In the past few years, the transdisciplinary field of HIV prevention has reached several milestones. Topically applied tenofovir gel provided significant protection from sexual transmission of HIV in a large-scale clinical trial and oral Truvada (emtricitabine/tenofovir disoproxil fumarate) was recently approved for preexposure prophylaxis (PrEP) following two successful clinical trials in men and women. These achievements are tempered by the disappointing results of other clinical trials, which highlight the complexities of prevention research. In this perspective, we discuss scientific and developmental gaps for topical chemoprophylaxis of the sexual transmission of HIV, which depends on the complex interactions between the pharmacokinetics and pharmacodynamics of drugs, formulation and delivery systems, anatomic site of transmission, and host mucosal immune defenses. Despite the considerable time and resources devoted to unraveling the initial steps in sexual transmission of HIV, current knowledge is based on animal models and human explanted tissue, which may not fully recapitulate what happens clinically. Understanding these events, including the role that sex hormones, semen, and mucosal secretions play in transmission, and the interplay between innate immunity, the mucosal environment, and drug efficacy is paramount. This drives some of the most pressing questions in the field. PMID:22966871

  10. Statistical failure models for water distribution pipes - A review from a unified perspective.

    PubMed

    Scheidegger, Andreas; Leitão, João P; Scholten, Lisa

    2015-10-15

    This review describes and compares statistical failure models for water distribution pipes in a systematic way and from a unified perspective. The way the comparison is structured provides the information needed by scientists and practitioners to choose a suitable failure model for their specific needs. The models are presented in a novel framework consisting of: 1) Clarification of model assumptions. The models originally formulated in different mathematical forms are all presented as failure rate. This enables to see differences and similarities across the models. Furthermore, we present a new conceptual failure rate that an optimal model would represent and to which the failure rate of each model can be compared. 2) Specification of the detailed data assumptions required for unbiased model calibration covering the structure and completeness of the data. 3) Presentation of the different types of probabilistic predictions available for each model. Nine different models and their variations or further developments are presented in this review. For every model an overview of its applications published in scientific journals and the available software implementations is provided. The unified view provides guidance to model selection. Furthermore, the model comparison presented herein enables to identify areas where further research is needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Preventing Instrumentation Failure in Three-Column Spinal Osteotomy: Biomechanical Analysis of Rod Configuration.

    PubMed

    Jager, Zachary S; İnceoğlu, Serkan; Palmer, Daniel; Akpolat, Yusuf T; Cheng, Wayne K

    2016-01-01

    Biomechanical analysis. To show the role of additional rods and long-term fatigue strength to prevent the instrumentation failure on three-column osteotomies. Three-column osteotomy such as pedicle subtraction osteotomy (PSO) and vertebral column resections are surgical correction options for fixed spinal deformity. Posterior fixation for the PSO involves pedicle screw-and rod-based instrumentation, with the rods being contoured to accommodate the accentuated lordosis. Pseudarthrosis and instrumentation failure are known complications of PSO. Unilateral pedicle screw and rod constructs were mounted in ultra-high-molecular-weight polyethylene blocks using a vertebrectomy model with the rods contoured to simulate posterior fixation of a PSO. Each construct was cycled under a 200 N load at 5 Hz in simulated flexion and extension to rod failure. Three configurations (n = 5) of titanium alloy rods were tested: single rod (control), double rod, and bridging rod. Outcomes were total cycles to failure and location of rod failure. Double-rod and bridging-rod constructs had a significantly higher number of cycles to failure compared with the single-rod construct (p < .05). Single-rod constructs failed at or near the rod bend apex, whereas the majority of double-rod and bridging-rod constructs failed at the screw-rod or rod-connector junction. Double-rod and bridging-rod constructs are more resistant to fatigue failure compared with single-rod constructs in PSO instrumentation and could be considered to mitigate the risk of instrumentation failure. Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

  12. The patient perspective: Quality of life in advanced heart failure with frequent hospitalisations.

    PubMed

    Nieminen, Markku S; Dickstein, Kenneth; Fonseca, Cândida; Serrano, Jose Magaña; Parissis, John; Fedele, Francesco; Wikström, Gerhard; Agostoni, Piergiuseppe; Atar, Shaul; Baholli, Loant; Brito, Dulce; Colet, Josep Comín; Édes, István; Gómez Mesa, Juan E; Gorjup, Vojka; Garza, Eduardo Herrera; González Juanatey, José R; Karanovic, Nenad; Karavidas, Apostolos; Katsytadze, Igor; Kivikko, Matti; Matskeplishvili, Simon; Merkely, Béla; Morandi, Fabrizio; Novoa, Angel; Oliva, Fabrizio; Ostadal, Petr; Pereira-Barretto, Antonio; Pollesello, Piero; Rudiger, Alain; Schwinger, Robert H G; Wieser, Manfred; Yavelov, Igor; Zymliński, Robert

    2015-07-15

    End of life is an unfortunate but inevitable phase of the heart failure patients' journey. It is often preceded by a stage in the progression of heart failure defined as advanced heart failure, and characterised by poor quality of life and frequent hospitalisations. In clinical practice, the efficacy of treatments for advanced heart failure is often assessed by parameters such as clinical status, haemodynamics, neurohormonal status, and echo/MRI indices. From the patients' perspective, however, quality-of-life-related parameters, such as functional capacity, exercise performance, psychological status, and frequency of re-hospitalisations, are more significant. The effects of therapies and interventions on these parameters are, however, underrepresented in clinical trials targeted to assess advanced heart failure treatment efficacy, and data are overall scarce. This is possibly due to a non-universal definition of the quality-of-life-related endpoints, and to the difficult standardisation of the data collection. These uncertainties also lead to difficulties in handling trade-off decisions between quality of life and survival by patients, families and healthcare providers. A panel of 34 experts in the field of cardiology and intensive cardiac care from 21 countries around the world convened for reviewing the existing data on quality-of-life in patients with advanced heart failure, discussing and reaching a consensus on the validity and significance of quality-of-life assessment methods. Gaps in routine care and research, which should be addressed, were identified. Finally, published data on the effects of current i.v. vasoactive therapies such as inotropes, inodilators, and vasodilators on quality-of-life in advanced heart failure patients were analysed.

  13. Lack of prevention of heart failure by serial electrical cardioversion in patients with persistent atrial fibrillation

    PubMed Central

    Tuinenburg, A; Van Gelder, I C; Den Berg, M P V.; Brugemann, J; De Kam, P J; Crijns, H

    1999-01-01

    OBJECTIVE—To investigate the occurrence of heart failure complications, and to identify variables that predict heart failure in patients with (recurrent) persistent atrial fibrillation, treated aggressively with serial electrical cardioversion and antiarrhythmic drugs to maintain sinus rhythm.
DESIGN—Non-randomised controlled trial; cohort; case series; mean (SD) follow up duration 3.4 (1.6) years.
SETTING—Tertiary care centre.
SUBJECTS—Consecutive sampling of 342 patients with persistent atrial fibrillation (defined as > 24 hours duration) considered eligible for electrical cardioversion.
INTERVENTIONS—Serial electrical cardioversions and serial antiarrhythmic drug treatment, after identification and treatment of underlying cardiovascular disease.
MAIN OUTCOME MEASURES—heart failure complications: development or progression of heart failure requiring the institution or addition of drug treatment, hospital admission, or death from heart failure.
RESULTS—Development or progression of heart failure occurred in 38 patients (11%), and 22 patients (6%) died from heart failure. These complications were related to the presence of coronary artery disease (p < 0.001, risk ratio 3.2, 95% confidence interval (CI) 1.6 to 6.5), rheumatic heart disease (p < 0.001, risk ratio 5.0, 95% CI 2.4 to 10.2), cardiomyopathy (p < 0.001, risk ratio 5.0, 95% CI 2.0 to 12.4), atrial fibrillation for < 3 months (p = 0.04, risk ratio 2.0, 95% CI 1.0 to 3.7), and poor exercise tolerance (New York Heart Association class III at inclusion, p < 0.001, risk ratio 3.5, 95% CI 1.9 to 6.7). No heart failure complications were observed in patients with lone atrial fibrillation.
CONCLUSIONS—Aggressive serial electrical cardioversion does not prevent heart failure complications in patients with persistent atrial fibrillation. These complications are predominantly observed in patients with more severe underlying cardiovascular disease. Randomised

  14. [Prevention and treatment of energy failure in neonates with hypoxic-ischemic encephalopathy].

    PubMed

    Zou, Rong; Mu, De-Zhi

    2016-09-01

    Hypoxic-ischemic encephalopathy (HIE) in neonates is the brain injury caused by perinatal asphyxia or hypoxia and is a major cause of death in neonates and nervous system dysfunction in infants and young children. Although to a certain degree, mild hypothermia therapy reduces the mortality of infants with moderate to severe HIE, it cannot achieve the expected improvements in nervous system dysfunction. Hence, it is of vital importance to search for effective therapeutic methods for HIE. The search for more therapies and better preventive measures based on the pathogenesis of HIE has resulted in much research. As an important link in the course of HIE, energy failure greatly affects the development and progression of HIE. This article reviews the research advances in the treatment and prevention of energy failure in the course of HIE.

  15. Liver resection for cancer: New developments in prediction, prevention and management of postresectional liver failure.

    PubMed

    van Mierlo, Kim M C; Schaap, Frank G; Dejong, Cornelis H C; Olde Damink, Steven W M

    2016-12-01

    Hepatic failure is a feared complication that accounts for up to 75% of mortality after extensive liver resection. Despite improved perioperative care, the increasing complexity and extensiveness of surgical interventions, in combination with an expanding number of resections in patients with compromised liver function, still results in an incidence of postresectional liver failure (PLF) of 1-9%. Preventive measures aim to enhance future remnant liver size and function. Numerous non-invasive techniques to assess liver function and predict remnant liver volume are being developed, along with introduction of novel surgical strategies that augment growth of the future remnant liver. Detection of PLF is often too late and treatment is primarily symptomatic. Current therapeutic research focuses on ([bio]artificial) liver function support and regenerative medicine. In this review we discuss the current state and new developments in prediction, prevention and management of PLF, in light of novel insights into the aetiology of this complex syndrome.

  16. Prevention and Treatment of Intestinal Failure-Associated Liver Disease in Children

    PubMed Central

    Raphael, Bram P.; Duggan, Christopher

    2016-01-01

    Intestinal failure-associated liver disease (IFALD), a serious complication occurring in infants, children and adults exposed to long-term parenteral nutrition (PN), causes a wide-spectrum of disease, ranging from cholestasis and steatosis to fibrosis and eventually cirrhosis. Known host risk factors for IFALD include low birth weight, prematurity, short bowel syndrome and recurrent sepsis. The literature suggests that components of PN may also play a part of the multifactorial pathophysiology. Because some intravenous lipid emulsions (ILE) may contribute to inflammation and interfere with bile excretion, treatment with ILE minimization and/or ILEs composed primarily of omega-3 fatty acids can be helpful but requires careful monitoring for growth failure and essential fatty acid deficiency (EFAD). Data from randomized controlled trials are awaited to support widespread use of these approaches. Other IFALD treatments include cycling PN, ursodeoxycholic acid, sepsis prevention, photoprotection and polyvinylchloride-free tubing. Management and prevention of IFALD remains a clinical challenge. PMID:23397535

  17. Perspectives of Fijian Policymakers on the Obesity Prevention Policy Landscape

    PubMed Central

    Hendriks, Anna-Marie; Delai, Mere Y.; Thow, Anne-Marie; Gubbels, Jessica S.; De Vries, Nanne K.; Kremers, Stef P. J.; Jansen, Maria W. J.

    2015-01-01

    In Fiji and other Pacific Island countries, obesity has rapidly increased in the past decade. Therefore, several obesity prevention policies have been developed. Studies show that their development has been hampered by factors within Fiji's policy landscape such as pressure from industry. Since policymakers in the Fijian national government are primarily responsible for the development of obesity policies, it is important to understand their perspectives; we therefore interviewed 15 policymakers from nine Fijian ministries. By applying the “attractor landscape” metaphor from dynamic systems theory, we captured perceived barriers and facilitators in the policy landscape. A poor economic situation, low food self-sufficiency, power inequalities, inappropriate framing of obesity, limited policy evidence, and limited resource sharing hamper obesity policy developments in Fiji. Facilitators include policy entrepreneurs and policy brokers who were active when a window of opportunity opened and who strengthened intersectoral collaboration. Fiji's policy landscape can become more conducive to obesity policies if power inequalities are reduced. In Fiji and other Pacific Island countries, this may be achievable through increased food self-sufficiency, strengthened intersectoral collaboration, and the establishment of an explicit functional focal unit within government to monitor and forecast the health impact of policy changes in non-health sectors. PMID:26380307

  18. Liver targeting of catalase by cationization for prevention of acute liver failure in mice.

    PubMed

    Ma, Shen-Feng; Nishikawa, Makiya; Katsumi, Hidemasa; Yamashita, Fumiyoshi; Hashida, Mitsuru

    2006-01-10

    To achieve hepatic delivery of CAT for the prevention of CCl4-induced acute liver failure in mice, two types of cationized CAT derivatives, HMD- and ED-conjugated CAT, were developed. Slight structural changes occurred during cationization and the number of increased free amino groups was 3.1 in HMD-CAT and 13.6 in ED-CAT. 111In-cationized CAT derivatives showed an increased binding to HepG2 cells, and were rapidly taken up by the liver. H2O2-induced cytotoxicity in HepG2 cells was significantly prevented by preincubation of the cells with cationized CAT derivatives. A bolus intravenous injection of the cationized CAT derivatives reduced the hepatotoxicity induced by CCl4 in mice. The ED-CAT, which showed more rapid and greater binding to the liver than the HMD-CAT, exhibited more beneficial effects as far as all the parameters examined (serum GOT, GPT, LDH and hepatic GSH) were concerned, suggesting that a high degree of cationization is effective in delivering CAT to the liver to prevent CCl4-induced hepatotoxicity. These results suggest that cationized CAT derivatives are effective in preventing acute liver failure, and ED-based cationization is a suitable method for developing liver-targetable cationized CAT derivatives, because it provides CAT with a high degree of cationization and a high remaining enzymatic activity.

  19. Implementing telemonitoring in heart failure care: barriers from the perspectives of patients, healthcare professionals and healthcare organizations.

    PubMed

    Boyne, Josiane J J; Vrijhoef, Hubertus J M

    2013-09-01

    The increasing prevalence of chronic diseases, such as heart failure, presents a substantial challenge to healthcare systems. Telemonitoring is believed to be a useful instrument in the delivery of heart failure care. However, a widespread use of telemonitoring is currently failing for various reasons. This article provides an overview of the barriers for the implementation of telemonitoring in heart failure patients from the perspectives of its users: patients, healthcare professionals and healthcare organisations. In doing so, identified barriers are grouped according to the perceived attributes of innovation by Rogers. Recommendations are provided as to how research can improve the implementation of telemonitoring in heart failure.

  20. Parental perspectives on adolescent hearing loss risk and prevention.

    PubMed

    Sekhar, Deepa L; Clark, Sarah J; Davis, Matthew M; Singer, Dianne C; Paul, Ian M

    2014-01-01

    Data indicate that 1 in 6 adolescents has high-frequency hearing loss, which is typically noise related and preventable. Parental participation improves the success of adolescent behavioral interventions, yet little is known about parental perspectives regarding adolescent noise-induced hearing loss. To perform a survey to determine parental knowledge of adolescent hearing loss and willingness to promote hearing conservation to discern information that is critical to design adolescent hearing loss prevention programs. A cross-sectional, Internet-based survey of a nationally representative online sample of parents of 13- to 17-year-olds. A survey conducted with the C.S. Mott Children's Hospital National Poll on Children's Health, a recurring online survey. Parental knowledge of adolescent hearing loss and willingness to promote hearing conservation. Of 716 eligible respondents, 96.3% of parents reported that their adolescent was slightly or not at all at risk of hearing problems from excessive noise, and 69.0% had not spoken with their adolescent about noise exposure, mainly because of the perceived low risk. Nonetheless, to protect their adolescents' hearing, more than 65.0% of parents are either willing or very willing to consider limiting time listening to music, limiting access to excessively noisy situations, or insisting on the use of hearing protection (earplugs or earmuffs). Higher parental education increased the odds of promoting hearing-protective strategies. Parents were less likely to insist on hearing protection for older adolescents. Parents who understood that both volume and time of exposure affect hearing damage were more likely to have discussed hearing loss with their adolescent (odds ratio [OR], 1.98; 95% CI, 1.29-3.03). The odds of discussing hearing loss were also increased for those who were willing or very willing to limit time listening to music (OR, 1.88; 95% CI, 1.19-2.26) and to insist on hearing protection (OR, 1.92; 95% CI, 1

  1. Ubiquitous protective effects of cyclosporine A in preventing cardiac arrest-induced multiple organ failure.

    PubMed

    Cour, Martin; Abrial, Maryline; Jahandiez, Vincent; Loufouat, Joseph; Belaïdi, Elise; Gharib, Abdallah; Varennes, Annie; Monneret, Guillaume; Thibault, Hélène; Ovize, Michel; Argaud, Laurent

    2014-10-15

    Opening of the mitochondrial permeability transition pore (mPTP) appears to be a pivotal event in myocardial ischemia-reperfusion (I/R) injury. Resuscitated cardiac arrest (CA) leads to the post-CA syndrome that encompasses, not only myocardial dysfunction, but also brain injury, failure of other organs (kidney, liver, or lung), and systemic response to I/R. We aimed to determine whether cyclosporine A (CsA) might prevent multiple organ failure following CA through a ubiquitous mPTP inhibition in each distant vital organ. Anesthetized New Zealand White rabbits were subjected to 15 min of CA and 120 min of reperfusion. At the onset of resuscitation, the rabbits received CsA, its non-immunosuppressive derivative NIM811, or vehicle (controls). Survival, hemodynamics, brain damage, organ injuries, and systemic I/R response were analyzed. Fresh mitochondria were isolated from the brain, heart, kidney, liver, and lung to assess both oxidative phosphorylation and permeability transition. CsA analogs significantly improved short-term survival and prevented multiple organ failure, including brain damage and myocardial dysfunction (P < 0.05 vs. controls). Susceptibility of mPTP opening was significantly increased in heart, brain, kidney, and liver mitochondria isolated from controls, while mitochondrial respiration was impaired (P < 0.05 vs. sham). CsA analogs prevented these mitochondrial dysfunctions (P < 0.05 vs. controls). These results suggest that CsA and NIM811 can prevent the post-CA syndrome through a ubiquitous mitochondrial protective effect at the level of each major distant organ. Copyright © 2014 the American Physiological Society.

  2. [Current perspectives in telemonitoring and devices in chronic heart failure patients: lights and shadows].

    PubMed

    Mortara, Andrea; Oliva, Fabrizio; Di Lenarda, Andrea

    2010-05-01

    The complexity of an integrated approach, mandatory for chronic diseases such as heart failure, might be simplified by the availability of new technologies for remote data transmission at relatively low costs. Home telemonitoring for complex patients opens new perspectives for the safe discharge of chronically severe patients and intensive surveillance for unstable subjects, and shows potential benefits on patients' quality of life and cost containment. Systematic reviews and meta-analyses document a 30-35% decrease in mortality and a 15-20% reduction in hospital admissions. Critical issues remain the presence of health facilities and professionals both in hospital and in the community adequately prepared for patient management through the telemonitoring tool, the selection of patients who may benefit most from it, and financial reimbursement of remote monitoring. The main indication to telemonitoring is the patient at high risk of short-term hemodynamic deterioration, but psychosocial issues should also be considered. New perspectives for tailored management of heart failure patients come from the recent availability of implantable devices able to record hemodynamic parameters. Current evidence is, however, insufficient to affirm their reliability, efficacy, cost-effectiveness, and management changes that may derive from their use.

  3. The significance of informal caregivers in information management from the perspective of heart failure patients.

    PubMed

    Hellesø, Ragnhild; Eines, Johannes; Fagermoen, May Solveig

    2012-02-01

    To explore patients' perspectives on the significance of informal carers in their information management. Being well informed is considered a prerequisite for the ability of heart failure patients to manage their lives at home. Developing knowledge about the informal caregiver's role in patient information management is important, that is, accurate information adapted to the individual level of comprehension. A qualitative approach using in-depth semi-structured interviews conducted with patients was used. Eight women and six men suffering from heart failure and with a mean age of 79·6 were interviewed. Data were collected one week after their discharge. A content analysis was performed. The informal carer's role in information management from the patient's perspective represents two different phenomena. The first, variation in involvement, [corrected] is related to the background of the informal carer. From what patients experienced, the process of information involvement throughout their hospital stay was affected by whether or not their informal carer had a health care background. The second phenomenon, information ambivalence, is related to the relationship between the patient and the informal carer with regard to information management at home. The informal carers were of great importance in the information management process because the patients relied on them so as to be able to devote their energy to managing their daily life. Relevance to clinical practice.  Patients should be assessed with regard to their information management problems and to the role of their informal carers in this process. © 2011 Blackwell Publishing Ltd.

  4. Preventing cerebral oedema in acute liver failure: the case for quadruple-H therapy.

    PubMed

    Warrillow, S J; Bellomo, R

    2014-01-01

    Severe cerebral oedema is a life-threatening complication of acute liver failure. Hyperammonaemia and cerebral hyperaemia are major contributing factors. A multimodal approach, which incorporates hyperventilation, haemodiafiltration, hypernatraemia and hypothermia (quadruple-H therapy), may prevent or attenuate severe cerebral oedema. This approach is readily administered by critical care clinicians and is likely to be more effective than the use of single therapies. Targeting of PaCO2 in the mild hyperventilation range, as seen in acute liver failure patients before intubation, aims to minimise hyperaemic cerebral oedema. Haemodiafiltration aims to achieve the rapid control of elevated blood ammonia concentrations by its removal and to reduce production via the lowering of core temperature. The administration of concentrated saline increases serum tonicity and further reduces cerebral swelling. In addition, the pathologically increased cerebral blood-flow is further attenuated by therapeutic hypothermia. The combination of all four treatments in a multimodal approach may be a safe and effective means of attenuating or treating the cerebral oedema of acute liver failure and preventing death from neurological complications.

  5. Late renal failure due to prostatic outflow obstruction: a preventable disease.

    PubMed Central

    Sacks, S. H.; Aparicio, S. A.; Bevan, A.; Oliver, D. O.; Will, E. J.; Davison, A. M.

    1989-01-01

    Nineteen patients presenting with late renal failure due to prostatic outflow obstruction (mean age 68.7 years; mean serum creatinine concentration 1158 mumol/l) were identified from the admission records of two renal units. As late renal failure secondary to prostatic enlargement is preventable case records were analysed retrospectively in an attempt to identify aspects of management in which preventive efforts might be of value. Delays in referral were common, with a mean of 2.8 years between the onset of prostatic symptoms and time of referral, six patients being referred who had had symptoms for more than three years. Four of five patients who had had a prostatectomy were known to be in renal failure at the time of operation but were not referred until 2-13 years later, when prostatic symptoms had recurred and there was evidence of progressive nephropathy with dilatation of the upper urinary tract. Two patients died on admission and eight (47% of survivors) required long term dialysis, most patients (80%) requiring some dialysis support during the initial period. These findings suggest that progressive nephropathy caused by prostatic outflow obstruction might, in part, be averted by more adequate screening of renal function in men with untreated prostatism and closer follow up of patients with uraemia at the time of prostatectomy. PMID:2466506

  6. Late renal failure due to prostatic outflow obstruction: a preventable disease.

    PubMed

    Sacks, S H; Aparicio, S A; Bevan, A; Oliver, D O; Will, E J; Davison, A M

    1989-01-21

    Nineteen patients presenting with late renal failure due to prostatic outflow obstruction (mean age 68.7 years; mean serum creatinine concentration 1158 mumol/l) were identified from the admission records of two renal units. As late renal failure secondary to prostatic enlargement is preventable case records were analysed retrospectively in an attempt to identify aspects of management in which preventive efforts might be of value. Delays in referral were common, with a mean of 2.8 years between the onset of prostatic symptoms and time of referral, six patients being referred who had had symptoms for more than three years. Four of five patients who had had a prostatectomy were known to be in renal failure at the time of operation but were not referred until 2-13 years later, when prostatic symptoms had recurred and there was evidence of progressive nephropathy with dilatation of the upper urinary tract. Two patients died on admission and eight (47% of survivors) required long term dialysis, most patients (80%) requiring some dialysis support during the initial period. These findings suggest that progressive nephropathy caused by prostatic outflow obstruction might, in part, be averted by more adequate screening of renal function in men with untreated prostatism and closer follow up of patients with uraemia at the time of prostatectomy.

  7. Traditional heart failure medications and sudden cardiac death prevention: a review.

    PubMed

    Al Chekakie, M Obadah

    2013-09-01

    Sudden cardiac death (SCD) is still a major public health issue with an estimated annual incidence ranging from 184,000 to > 400,000 per year. The ACC/AHA/ESC 2006 guidelines define SCD as "death from an unexpected circulatory arrest, usually due to a cardiac arrhythmia occurring within an hour of the onset of symptoms". A recent study of sudden cardiac death using multiple sources of ascertainment found that coronary artery disease was present in more than 50% of patients older than 35 years who died suddenly and underwent autopsy. Antiarrhythmic drugs have failed to show any mortality benefit even when compared to placebo or implantable cardiovertor defibrillators (ICDs). While patients with systolic heart failure are at higher risk of dying suddenly, most of the patients experiencing sudden cardiac death have left ventricular ejection fraction (LVEF) > 50%. β-blockers, Angiotensin enzymes (ACE) inhibitors as well as aldosterone antagonists prevent ischemia and remodelling in the left ventricle especially in post myocardial infarction (MI) patients and in patients with systolic heart failure. This article will review the data on the effects of traditional heart failure medications, especially β-blockers, Renin Angiotensin system blockers, as well as Statin therapy on sudden cardiac death in post MI patients and in patients with systolic heart failure.

  8. Prevention of corrosion-related failures in condensers and feedwater heaters

    SciTech Connect

    Beavers, J.A.; Agrawal, A.K.; Berry, W.E.

    1982-12-01

    The common alloys used for tubing in power plant feedwater heaters and condensers are identified and the major corrosion problems encountered in these components are described. The frequency of failure and failure modes in both components are shown to be alloy specific. Some corrosion problems are shown to be controllable through minor design modifications in the equipment and others through judicious selection of alloys. In condensers, alloy selection is most effective when based on tube location. In feedwater heaters, strict control of water quality is shown to be necessary with most alloys to minimize corrosion problems. Benefits of some auxiliary techniques for preventing corrosion attack include coating and cathodic protection of the tube sheet and cooling water intake screens.

  9. A Novel Role of Three Dimensional Graphene Foam to Prevent Heater Failure during Boiling

    PubMed Central

    Ahn, Ho Seon; Kim, Ji Min; Park, Chibeom; Jang, Ji-Wook; Lee, Jae Sung; Kim, Hyungdae; Kaviany, Massoud; Kim, Moo Hwan

    2013-01-01

    We report a novel boiling heat transfer (NBHT) in reduced graphene oxide (RGO) suspended in water (RGO colloid) near critical heat flux (CHF), which is traditionally the dangerous limitation of nucleate boiling heat transfer because of heater failure. When the heat flux reaches the maximum value (CHF) in RGO colloid pool boiling, the wall temperature increases gradually and slowly with an almost constant heat flux, contrary to the rapid wall temperature increase found during water pool boiling. The gained time by NBHT would provide the safer margin of the heat transfer and the amazing impact on the thermal system as the first report of graphene application. In addition, the CHF and boiling heat transfer performance also increase. This novel boiling phenomenon can effectively prevent heater failure because of the role played by the self-assembled three-dimensional foam-like graphene network (SFG). PMID:23743619

  10. A novel role of three dimensional graphene foam to prevent heater failure during boiling.

    PubMed

    Ahn, Ho Seon; Kim, Ji Min; Park, Chibeom; Jang, Ji-Wook; Lee, Jae Sung; Kim, Hyungdae; Kaviany, Massoud; Kim, Moo Hwan

    2013-01-01

    We report a novel boiling heat transfer (NBHT) in reduced graphene oxide (RGO) suspended in water (RGO colloid) near critical heat flux (CHF), which is traditionally the dangerous limitation of nucleate boiling heat transfer because of heater failure. When the heat flux reaches the maximum value (CHF) in RGO colloid pool boiling, the wall temperature increases gradually and slowly with an almost constant heat flux, contrary to the rapid wall temperature increase found during water pool boiling. The gained time by NBHT would provide the safer margin of the heat transfer and the amazing impact on the thermal system as the first report of graphene application. In addition, the CHF and boiling heat transfer performance also increase. This novel boiling phenomenon can effectively prevent heater failure because of the role played by the self-assembled three-dimensional foam-like graphene network (SFG).

  11. Bone cement augmentation in the prevention of adjacent segment failure after multilevel adult deformity fusion.

    PubMed

    Lattig, Friederike

    2009-08-01

    Prospective case report series and detailed description of technique. To describe a surgical procedure designed to prevent fracture and cutting-through and pullout of screws in the adjacent segment after multilevel deformity correction in adults. Surgery of adult deformities has a high complication rate. One of the potential late complications is the development of fracture at the first mobile segment above a multilevel lumbar or thoracolumbar spinal fusion that necessitates further surgical intervention with extension of the instrumentation. Augmentation with bone cement of the last instrumented vertebra and the first mobile vertebra has the potential to prevent this pathology. Three patients with degenerative thoracolumbar kyphoscoliosis and 3 with adjacent segment failure after correction surgery were treated. Cannulated and perforated pedicle screws were placed in the uppermost-instrumented vertebra. A vertebroplasty tube was inserted from 1 side at the center of the first mobile vertebra. Under C-arm control, vertebroplasty was performed in both vertebrae. Intraoperatively, there were no cement-related complications. Follow-ups at 6 and 12 (+/-2) months revealed there was no loss of correction, fracture or screw loosening in the augmented vertebrae. Bone cement augmentation of the uppermost screws and the first mobile vertebra in multilevel adult deformity and revision surgery seems to be a safe and potentially effective method of preventing adjacent segment failure.

  12. Failure Prevention For Nuclear Power Plants Through Proactive Management of Materials Degradation (PMMD)

    SciTech Connect

    Bond, Leonard J.; Doctor, Steven R.; Bruemmer, Stephen M.; Cumblidge, Stephen E.; Hull, Amy; Malik, Shah

    2009-05-01

    Failure prevention is central to the operation of nuclear power plants. To meet this goal there is growing interest in new and improved philosophies and methodologies for plant life management (PLiM), which include the migration from reliance on periodic inservice inspection to include condition-based maintenance. A further step in the development of plant management is the move from reactive responses based on ISI to become proactive, through the investigation of the potential for implementation of a proactive management of materials degradation (PMMD) program and its potential impact on the management of LWRs.

  13. A systematic review of discontinued trials suggested that most reasons for recruitment failure were preventable.

    PubMed

    Briel, Matthias; Olu, Kelechi Kalu; von Elm, Erik; Kasenda, Benjamin; Alturki, Reem; Agarwal, Arnav; Bhatnagar, Neera; Schandelmaier, Stefan

    2016-12-01

    To collect and classify reported reasons for recruitment failure in discontinued randomized controlled trials (RCTs) and to assess reporting quality. We systematically searched MEDLINE and EMBASE (2010-2014) and a previous cohort of RCTs for published RCTs reporting trial discontinuation due to poor recruitment. Teams of two investigators selected eligible RCTs working independently and extracted information using standardized forms. We used an iterative approach to classify reasons for poor recruitment. We included 172 RCTs discontinued due to poor recruitment (including 26 conference abstracts and 63 industry-funded RCTs). Of those, 131 (76%) reported one or more reasons for discontinuation due to poor recruitment. We identified 28 different reasons for recruitment failure; most frequently mentioned were overestimation of prevalence of eligible participants and prejudiced views of recruiters and participants on trial interventions. Few RCTs reported relevant details about the recruitment process such as how eligible participants were identified, the number of patients assessed for eligibility, and who actually recruited participants. Our classification could serve as a checklist to assist investigators in the planning of RCTs. Most reasons for recruitment failure seem preventable with a pilot study that applies the planned informed consent procedure. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Teacher Perceptions of High School Student Failure in the Classroom: Identifying Preventive Practices of Failure Using Critical Incident Technique

    ERIC Educational Resources Information Center

    Kalahar, Kory G.

    2011-01-01

    Student failure is a prominent issue in many comprehensive secondary schools nationwide. Researchers studying error, reliability, and performance in organizations have developed and employed a method known as critical incident technique (CIT) for investigating failure. Adopting an action research model, this study involved gathering and analyzing…

  15. Emerging drugs for prevention of graft failure after allogeneic hematopoietic stem cell transplantation.

    PubMed

    Servais, Sophie; Beguin, Yves; Baron, Frédéric

    2013-06-01

    Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the treatment of choice for many patients suffering from hematological malignancies, severe hemoglobinopathies, bone marrow failures or severe primary immunodeficiencies. Graft rejection/failure (GF) is a life-threatening complication following allo-HSCT that is most commonly caused by the reactivity of recipient T cells, natural killer (NK) cells or antibodies against donor grafted hematopoietic cells. The increasing use of allo-HSCT following reduced-intensity conditioning (RIC) and the increasing use of alternative donors (unrelated cord blood and human leukocyte antigen (HLA)-mismatched donor) have resulted in higher frequency of GF. This review describes the pathogenesis and current prevention and treatment of GF as well as agents in development for GF prevention or treatment. The risk of GF may be reduced in the future by optimizing the conditioning regimens and post-grafting immunosuppression, increasing the number of hematopoietic stem cells (HSCs) and/or immune cells transplanted, optimizing HSC homing and better detecting patients at high risk of GF by searching for pre-transplant donor-specific anti-HLA antibodies in patients given grafts from HLA-mismatched donors, or by closely monitoring donor T- and/or NK-cell chimerism after allo-HSCT following RIC.

  16. New Graduate Nurses' Preparation for Recognition and Prevention of Failure to Rescue: A Qualitative Study.

    PubMed

    Herron, Elizabeth K

    2017-08-17

    To explore new graduate nurses' experiences with recognition and prevention of failure to rescue. Failure to rescue is recognized as a quality of care indicator, a core measure of nursing care in hospitals, and a determinant for staffing in acute care facilities. Clinical reasoning is an essential component in preventing failure to rescue and should be emphasized in nursing education and new graduate orientation. Many nurses graduate without the ability to use clinical reasoning in providing patient care which can lead to adverse patient outcomes. A descriptive phenomenological design was used. A purposive sample of 14 new graduate nurses from a nursing program in the Southeastern United States, in practice for no more than eighteen months, was recruited. Individual one on one interviews were conducted from January to June 2016 and audio recorded for accuracy. Data were evaluated using the consolidated criteria for reporting qualitative research (COREQ) guidelines. Recordings were professionally transcribed and reviewed. Using Giorgi's methods for data analysis, five main themes were discerned in the data: clinical preparation in school; experience with emergent situations; development of clinical reasoning; low confidence as a new graduate; and responding to emergencies. Within each theme, subthemes emerged. The words of the participants provided rich detail into the preparation of new graduate nurses and how nurse educators, managers, and preceptors can better focus learning opportunities to prepare them for practice. Experiential learning combined with collaboration among education stakeholders will lead to a better prepared and more confident nursing work force. Better preparation and continued support of new graduate nurses leads to positive patient outcomes and more satisfaction with their choice of nursing as a profession. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  17. Arteriogenic therapy by intramyocardial sustained delivery of a novel growth factor combination prevents chronic heart failure.

    PubMed

    Banquet, Sébastien; Gomez, Elodie; Nicol, Lionel; Edwards-Lévy, Florence; Henry, Jean-Paul; Cao, Renhai; Schapman, Damien; Dautreaux, Brigitte; Lallemand, Francoise; Bauer, Fabrice; Cao, Yihai; Thuillez, Christian; Mulder, Paul; Richard, Vincent; Brakenhielm, Ebba

    2011-08-30

    Therapeutic angiogenesis is a promising approach for the treatment of cardiovascular diseases, including myocardial infarction and chronic heart failure. We aimed to improve proangiogenic therapies by identifying novel arteriogenic growth factor combinations, developing injectable delivery systems for spatiotemporally controlled growth factor release, and evaluating functional consequences of targeted intramyocardial growth factor delivery in chronic heart failure. First, we observed that fibroblast growth factor and hepatocyte growth factor synergistically stimulate vascular cell migration and proliferation in vitro. Using 2 in vivo angiogenesis assays (n=5 mice per group), we found that the growth factor combination results in a more potent and durable angiogenic response than either growth factor used alone. Furthermore, we determined that the molecular mechanisms involve potentiation of Akt and mitogen-activated protein kinase signal transduction pathways, as well as upregulation of angiogenic growth factor receptors. Next, we developed crosslinked albumin-alginate microcapsules that sequentially release fibroblast growth factor-2 and hepatocyte growth factor. Finally, in a rat model of chronic heart failure induced by coronary ligation (n=14 to 15 rats per group), we found that intramyocardial slow release of fibroblast growth factor-2 with hepatocyte growth factor potently stimulates angiogenesis and arteriogenesis and prevents cardiac hypertrophy and fibrosis, as determined by immunohistochemistry, leading to improved cardiac perfusion after 3 months, as shown by magnetic resonance imaging. These multiple beneficial effects resulted in reduced adverse cardiac remodeling and improved left ventricular function, as revealed by echocardiography. Our data showing the selective advantage of using fibroblast growth factor-2 together with hepatocyte growth factor suggest that this growth factor combination may constitute an efficient novel treatment for chronic

  18. Suicide Prevention Programs in the Schools: A Review and Public Health Perspective

    ERIC Educational Resources Information Center

    Miller, David N.; Eckert, Tanya L.; Mazza, James J.

    2009-01-01

    The purpose of this article is to provide a comprehensive review of school-based suicide prevention programs from a public health perspective. A literature review of empirical studies examining school-based suicide prevention programs was conducted. Studies were required to contain information pertaining to the implementation and outcomes of a…

  19. Youth and Adult Perspectives on Violence Prevention Strategies: A Community-Based Participatory Study

    ERIC Educational Resources Information Center

    Dodington, James; Mollen, Cynthia; Woodlock, Joseph; Hausman, Alice; Richmond, Therese S.; Fein, Joel A.

    2012-01-01

    This project explores the beliefs and perspectives of urban adults and youth regarding community violence prevention strategies and identifies points of overlap and differences of opinion that can contribute to the development of successful youth violence prevention programs. We coded transcript data from adults and 10-16-year-old youth from the…

  20. Youth and Adult Perspectives on Violence Prevention Strategies: A Community-Based Participatory Study

    ERIC Educational Resources Information Center

    Dodington, James; Mollen, Cynthia; Woodlock, Joseph; Hausman, Alice; Richmond, Therese S.; Fein, Joel A.

    2012-01-01

    This project explores the beliefs and perspectives of urban adults and youth regarding community violence prevention strategies and identifies points of overlap and differences of opinion that can contribute to the development of successful youth violence prevention programs. We coded transcript data from adults and 10-16-year-old youth from the…

  1. Suicide Prevention Programs in the Schools: A Review and Public Health Perspective

    ERIC Educational Resources Information Center

    Miller, David N.; Eckert, Tanya L.; Mazza, James J.

    2009-01-01

    The purpose of this article is to provide a comprehensive review of school-based suicide prevention programs from a public health perspective. A literature review of empirical studies examining school-based suicide prevention programs was conducted. Studies were required to contain information pertaining to the implementation and outcomes of a…

  2. Present status and perspective of the development of a bioartificial kidney for chronic renal failure patients.

    PubMed

    Saito, Akira; Aung, Tun; Sekiguchi, Koji; Sato, Yoshinobu

    2006-08-01

    A bioartificial tubule device was applied for the treatment of 10 acute renal failure and multiple organ failure patients by Humes et al. A bioartificial kidney for chronic renal failure patients, however, has never been applied. In order to develop a bioartificial kidney for preventing and treating long-term complications of maintenance dialysis patients, we have to overcome difficulties such as antithrombogenic issue of hemofilters and development of long functioning tubule devices in the context of economical and easy treatment. Continuous hemofilters should modify with an antithrombogenic material on the inner surfaces of membranes to get more hemocompatible characteristics. We are developing an antithrombogenic continuous hemofilter coating with methacryloyloxyethyl phosphorylcholine polymer which will mimic phospholipid layers of human cell membrane on the inner surface of a hemofilter. The transportability of H2O, Na+, and glucose of bioartificial tubule devices using polysulfone hollow fiber modules and porcine proximal tubular epithelial cells LLC-PK1 were evaluated using two kinds of circuits of different medium inside and outside of the cell-attached hollow fiber membrane. Transport of H2O, Na+, and glucose were significantly increased when 2.5 g/dL of albumin was added, and plateaued on the eight day and then decreased thereafter until the 13th day. Transfection of a specific gene into human tubular epithelial cells might be required to keep contact inhibition in order to maintain a confluent monolayer for longer duration.

  3. Pulmonary Hypertension in Heart Failure: Pathophysiology, Pathobiology, and Emerging Clinical Perspectives.

    PubMed

    Guazzi, Marco; Naeije, Robert

    2017-04-04

    Pulmonary hypertension is a common hemodynamic complication of heart failure. Interest in left-sided pulmonary hypertension has increased remarkably in recent years because its development and consequences for the right heart are now seen as mainstay abnormalities that begin in the early stages of the disease and bear unfavorable prognostic insights. However, some knowledge gaps limit our ability to influence this complex condition. Accordingly, attention is now focused on: 1) establishing a definitive consensus for a hemodynamic definition, perhaps incorporating exercise and fluid challenge; 2) implementing the limited data available on the pathobiology of lung capillaries and small arteries; 3) developing standard methods for assessing right ventricular function and, hopefully, its coupling to pulmonary circulation; and 4) searching for effective therapies that may benefit lung vessels and the remodeled right ventricle. The authors review the pathophysiology, pathobiology, and emerging clinical perspectives on pulmonary hypertension across the broad spectrum of heart failure stages. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  4. Finding common ground: perspectives on community-based childhood obesity prevention.

    PubMed

    Porter, Christine M; Pelletier, David L

    2012-11-01

    To support successful and inclusive community organizing for childhood obesity prevention, this research identified stakeholder perspectives on what communities should do to prevent childhood obesity. It employed factor analysis on statement sorts (Q methodology) conducted by 95 people in an upstate New York community. These participants sorted 36 statements about the issue by how much he or she agreed or disagreed with each. Participants were recruited through strategic snowball sampling to sample a variety of perspectives. The four resulting factors, or perspectives, were interpreted in the context of presort demographic surveys and postsort interviews. This research found one stance that fits the environmental perspective common in public health. The other three factors indicate important variations among perspectives centered on individual responsibility, ranging from libertarian to technocratic views. However, overall, results revealed a substantial degree of agreement among the four perspectives, including on providing access to family activities and on making fruits and vegetables more available and affordable, for example, through subsidies. This article points to common ground for community action on childhood obesity prevention, highlights areas likely to generate considerable contention, and shows whose views are not being accounted for in, at least, this community's childhood obesity prevention project.

  5. Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers.

    PubMed

    Barr, Ronald G

    2012-10-16

    Head trauma from abuse, including shaken baby syndrome, is a devastating and potentially lethal form of infant physical abuse first recognized in the early 1970s. What has been less recognized is the role of the early increase in crying in otherwise normal infants in the first few months of life as a trigger for the abuse. In part, this is because infant crying, especially prolonged unsoothable crying, has been interpreted clinically as something wrong with the infant, the infant's caregiver, or the interactions between them. Here, we review an alternative developmental interpretation, namely, that the early increase in crying is a typical behavioral development in normal infants and usually does not reflect anything wrong or abnormal. We also review evidence indicating that this normal crying pattern is the most common trigger for abusive head trauma (AHT). Together, these findings point to a conceptualization of AHT as the consequence of a failure in an otherwise common, iterative, and developmentally normal infant-caregiver interaction. They also imply that there is a window of opportunity for prevention of AHT, and potentially other forms of infant abuse, through a public health primary universal prevention strategy aimed at changing knowledge and behaviors of caregivers and society in general concerning normal development of infants and the significance of early increased infant crying. If effective, there may be important implications for prevention of infant abuse nationally and internationally.

  6. Prevention and treatment of renal osteodystrophy in children on chronic renal failure: European guidelines

    PubMed Central

    Watson, A.; Edefonti, A.; Fischbach, M.; Rönnholm, K.; Schaefer, F.; Simkova, E.; Stefanidis, C. J.; Strazdins, V.; Vande Walle, J.; Schröder, C.; Zurowska, A.; Ekim, M.

    2005-01-01

    Childhood renal osteodystrophy (ROD) is the consequence of disturbances of the calcium-regulating hormones vitamin D and parathyroid hormone (PTH) as well as of the somatotroph hormone axis associated with local modulation of bone and growth cartilage function. The resulting growth retardation and the potentially rapid onset of ROD in children are different from ROD in adults. The biochemical changes of ROD as well as its prevention and treatment affect calcium and phosphorus homeostasis and are directly associated with the development of cardiovascular disease in pediatric renal patients. The aims of the clinical and biochemical surveillance of pediatric patients with CRF or on dialysis are prevention of hyperphosphatemia, avoidance of hypercalcemia and keeping the calcium phosphorus product below 5 mmol2/l2. The PTH levels should be within the normal range in chronic renal failure (CRF) and up to 2–3 times the upper limit of normal levels in dialysed children. Prevention of ROD is expected to result in improved growth and less vascular calcification. PMID:16247644

  7. Exogenous midkine administration prevents cardiac remodeling in pacing-induced congestive heart failure of rabbits.

    PubMed

    Harada, Masahide; Hojo, Mayumi; Kamiya, Kaichiro; Kadomatsu, Kenji; Murohara, Toyoaki; Kodama, Itsuo; Horiba, Mitsuru

    2016-01-01

    Midkine (MK), a heparin-binding growth factor, has been shown to prevent cardiac remodeling after ischemic injury through its anti-apoptotic effect. Cell apoptosis is central to the pathophysiology of cardiac remodeling in congestive heart failure (CHF) of ischemic as well as non-ischemic origin. We hypothesized that MK exerts the anti-apoptotic cardioprotective effect in CHF of non-ischemic etiology. MK protein or vehicle (normal saline) was subcutaneously administered in tachycardia-induced CHF rabbits (right ventricular pacing, 350 beats/min, 4 weeks). The vehicle-treated rabbits (n = 19, control) demonstrated severe CHF and high mortality rate, whereas MK (n = 16) demonstrated a well-compensated state and a lower mortality rate. In echocardiography, left ventricular (LV) end-diastolic dimension decreased in MK versus control, whereas LV systolic function increased. In histological analysis (picrosirius red staining), MK decreased collagen deposition area compared with control. TUNEL staining showed that MK prevented cell apoptosis and minimized myocyte loss in the CHF rabbit ventricle, associated with activation of PI3-K/Akt signaling, producing a parallel decrease of Bax/Bcl-2 ratio. MK prevented progression of cardiac remodeling in the CHF rabbit, likely by activation of anti-apoptotic signaling. Exogenous MK application might be a novel therapeutic strategy for CHF due to non-ischemic origin.

  8. Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers

    PubMed Central

    Barr, Ronald G.

    2012-01-01

    Head trauma from abuse, including shaken baby syndrome, is a devastating and potentially lethal form of infant physical abuse first recognized in the early 1970s. What has been less recognized is the role of the early increase in crying in otherwise normal infants in the first few months of life as a trigger for the abuse. In part, this is because infant crying, especially prolonged unsoothable crying, has been interpreted clinically as something wrong with the infant, the infant’s caregiver, or the interactions between them. Here, we review an alternative developmental interpretation, namely, that the early increase in crying is a typical behavioral development in normal infants and usually does not reflect anything wrong or abnormal. We also review evidence indicating that this normal crying pattern is the most common trigger for abusive head trauma (AHT). Together, these findings point to a conceptualization of AHT as the consequence of a failure in an otherwise common, iterative, and developmentally normal infant–caregiver interaction. They also imply that there is a window of opportunity for prevention of AHT, and potentially other forms of infant abuse, through a public health primary universal prevention strategy aimed at changing knowledge and behaviors of caregivers and society in general concerning normal development of infants and the significance of early increased infant crying. If effective, there may be important implications for prevention of infant abuse nationally and internationally. PMID:23045677

  9. Engaging local businesses in HIV prevention efforts: the consumer perspective.

    PubMed

    Phillips-Guzman, Christina M; Martinez-Donate, Ana P; Hovell, Melbourne F; Blumberg, Elaine J; Sipan, Carol L; Rovniak, Liza S; Kelley, Norma J

    2011-07-01

    Participation of different community sectors, including the private business sector, is necessary to fight the HIV/AIDS epidemic. Local businesses may be reluctant to participate in HIV prevention because of fear of negative customer reactions and loss of revenue. This study examines the extent to which residents of two communities in San Diego, California, would support HIV prevention initiatives in local businesses. A population-based household survey (N = 200) is conducted in two communities with higher versus lower risk for HIV. The survey includes questions regarding the acceptability of HIV prevention activities, such as condom and brochure distribution in businesses, and history of exposure to HIV prevention activities in local businesses. Most residents agree that (a) business involvement in prevention activities would reduce HIV (92%), (b) free or low-cost condoms available in businesses could prevent the spread of HIV (90.9%) and increase condom accessibility (87%), and (c) they would prefer to shop at businesses that supported HIV prevention versus those that did not (87.4%). These findings suggest that HIV prevention in local businesses would be supported by residents and would be unlikely to adversely affect business profits. This information could be used to design interventions to engage local businesses in HIV-prevention efforts.

  10. Prevention strategies for cardioembolic stroke: present and future perspectives.

    PubMed

    Giacalone, Giacomo; Abbas, Mohammed Abballa; Corea, Francesco

    2010-06-15

    Atrial fibrillation (AF) is the most common cause of cardioembolism. An update on secondary prevention strategies, used to protect patients from the risk of stroke in many common cardiac conditions, is presented in the paper. The main line of actions of stroke prevention in cardioembolism is mostly connected with antithrombotic drugs, but also other, more invasive, techniques are quickly emerging. Also the classic pharmacological prevention with coumarins may soon be overcome by new generation anticoagulants. Is an aggressive treatment of Patent Foramen Ovale (PFO) always recommended? One of the main challenges of the future years will be to understand competitiveness between old and new preventive strategies.

  11. Expectations and high school change: teacher-researcher collaboration to prevent school failure.

    PubMed

    Weinstein, R S; Soulé, C R; Collins, F; Cone, J; Mehlhorn, M; Simontacchi, K

    1991-06-01

    Describes the multilevel outcomes of a collaborative preventive intervention for ninth-graders at risk for school failure using qualitative and quasi-experimental methods. Teachers, administrators, and researchers implemented innovative practices communicating positive expectations for low-achieving adolescents in their transition to high school. Changes were made in the practices of curriculum, grouping, evaluation, motivation, student responsibility, and relationships (in the classroom, with parents, and in the school). Both implementation and evaluation evolved as a function of collaboration. Change was promising but not uniform. Project teachers became more positive about students and colleagues, expanded their roles, and changed school tracking policies. The 158 project students, in contrast to the 154 comparison students showed improved grades and disciplinary referrals post-intervention and increased retention in school 1 year later, but their absences rose and improved performance was not maintained. The implications of this analysis for school-based interventions and its evaluation are discussed.

  12. Hepatocyte Growth Factor Prevents Acute Renal Failure of Accelerates Renal Regeneration in mice

    NASA Astrophysics Data System (ADS)

    Kawaida, Kouichi; Matsumoto, Kunio; Shimazu, Hisaaki; Nakamura, Toshikazu

    1994-05-01

    Although acute renal failure is encountered with administration of nephrotoxic drugs, ischemia, or unilateral nephrectomy, there has been no effective drug which can be used in case of acute renal failure. Hepatocyte growth factor (HGF) is a potent hepatotropic factor for liver regeneration and is known to have mitogenic, motogenic, and morphogenic activities for various epithelial cells, including renal tubular cells. Intravenous injection of recombinant human HGF into mice remarkably suppressed increases in blood urea nitrogen and serum creatinine caused by administration of cisplatin, a widely used antitumor drug, or HgCl_2, thereby indicating that HGF strongly prevented the onset of acute renal dysfunction. Moreover, exogenous HGF stimulated DNA synthesis of renal tubular cells after renal injuries caused by HgCl_2 administration and unilateral nephrectomy and induced reconstruction of the normal renal tissue structure in vivo. Taken together with our previous finding that expression of HGF was rapidly induced after renal injuries, these results allow us to conclude that HGF may be the long-sought renotropic factor for renal regeneration and may prove to be effective treatment for patients with renal dysfunction, especially that caused by cisplatin.

  13. Family Roles in Refugee Youth Resettlement from a Prevention Perspective

    PubMed Central

    Weine, Stevan

    2008-01-01

    Synopsis The families of refugee youth in resettlement bear both strains and strengths that impact their children’s adjustment and coping. Preventive interventions aimed at helping youth through helping their families should be developed. Given that many refugee youth struggle in school and may have inadequate involvement of their parents, one area in need of preventive intervention is parental involvement in refugee youths’ education. The design, implementation, and evaluation of family-focused preventive interventions should be informed by research findings, family resilience theory, a community based participatory research approach, and a focus on engagement. PMID:18558310

  14. Liver failure induces a systemic inflammatory response. Prevention by recombinant N-terminal bactericidal/permeability-increasing protein.

    PubMed Central

    Boermeester, M. A.; Houdijk, A. P.; Meyer, S.; Cuesta, M. A.; Appelmelk, B. J.; Wesdorp, R. I.; Hack, C. E.; Van Leeuwen, P. A.

    1995-01-01

    The observed increased susceptibility of patients with fulminant hepatic failure for local and systemic infections has been hypothesized to be due to a failure for the hepatic clearance function and subsequent leaking of endogenous endotoxins into the systemic circulation. However, experimental evidence for such a systemic inflammation during liver failure due to endogenous endotoxemia is lacking. Therefore, we designed a study to clarify whether circulating endotoxins due to liver failure could lead to the development of systemic inflammations. In a rat model for liver failure induced by a two-thirds partial hepatectomy, we evaluated the course of circulating tumor necrosis factor and interleukin-6, changes in blood chemistry and hemodynamics, and histopathological changes in the lungs. Partially hepatectomized animals, but not sham-operated animals, demonstrated cardiac failure, increased levels of creatinin and urea, metabolic acidosis, high plasma levels of tumor necrosis factor and interleukin-6, and an influx of PMNs in the lungs-together indicating the development of a systemic inflammatory response. Continuous infusion of recombinant N-terminal bactericidal/permeability-increasing protein (rBPI23), a well described endotoxin-neutralizing protein, prevented these inflammatory reactions. Ex vivo experiments with rat plasma samples confirmed the presence of circulating endotoxins in partially hepatectomized rats as opposed to those treated with rBPI23. Thus, our results indicate that the early phase of liver failure induces a systemic inflammatory response triggered by circulating endotoxins, which can be prevented by perioperative infusion of rBPI23. Images Figure 2 PMID:7485405

  15. New perspectives on the transition between discrete fracture, fragmentation, and pulverization during brittle failure of rocks

    NASA Astrophysics Data System (ADS)

    Griffith, W. A.; Ghaffari, H.; Barber, T. J.; Borjas, C.

    2015-12-01

    The motions of Earth's tectonic plates are typically measured in millimeters to tens of centimeters per year, seemingly confirming the generally-held view that tectonic processes are slow, and have been throughout Earth's history. In line with this perspective, the vast majority of laboratory rock mechanics research focused on failure in the brittle regime has been limited to experiments utilizing slow loading rates. On the other hand, many natural processes that pose significant risk for humans (e.g., earthquakes and extraterrestrial impacts), as well as risks associated with human activities (blow-outs, explosions, mining and mine failures, projectile penetration), occur at rates that are hundreds to thousands of times faster than those typically simulated in the laboratory. Little experimental data exists to confirm or calibrate theoretical models explaining the connection between these dramatic events and the pulverized rocks found in fault zones, impacts, or explosions; however the experimental data that does exist is thought-provoking: At the earth's surface, the process of brittle fracture passes through a critical transition in rocks at high strain rates (101-103s-1) between regimes of discrete fracture and distributed fragmentation, accompanied by a dramatic increase in strength. Previous experimental works on this topic have focused on key thresholds (e.g., peak stress, peak strain, average strain rate) that define this transition, but more recent work suggests that this transition is more fundamentally dependent on characteristics (e.g., shape) of the loading pulse and related microcrack dynamics, perhaps explaining why for different lithologies different thresholds more effectively define the pulverization transition. In this presentation we summarize some of our work focused on this transition, including the evolution of individual defects at the microscopic, microsecond scale and the energy budget associated with the brittle fragmentation process as a

  16. Darbepoetin-α prevents progressive left ventricular dysfunction and remodeling in nonanemic dogs with heart failure

    PubMed Central

    Rastogi, Sharad; Imai, Makoto; Sharov, Victor G.; Mishra, Sudhish; Sabbah, Hani N.

    2008-01-01

    In anemic patients with heart failure (HF), erythropoietin-type drugs can elicit clinical improvement. This study examined the effects of chronic monotherapy with darbepoetin-α (DARB) on left ventricular (LV) function and remodeling in nonanemic dogs with advanced HF. HF [LV ejection fraction (EF) ∼25%] was produced in 14 dogs by intracoronary microembolizations. Dogs were randomized to once a week subcutaneous injection of DARB (1.0 μg/kg, n = 7) or to no therapy (HF, n = 7). All procedures were performed during cardiac catheterization under general anesthesia and under sterile conditions. LV end-diastolic volume (EDV), end-systolic volume (ESV), and EF were measured before the initiation of therapy and at the end of 3 mo of therapy. mRNA and protein expression of caspase-3, hypoxia inducible factor-1α, and the bone marrow-derived stem cell marker c-Kit were determined in LV tissue. In HF dogs, EDV and ESV increased and EF decreased after 3 mo of followup. Treatment with DARB prevented the increase in EDV, decreased ESV, and increased EF. DARB therapy also normalized the expression of HIF-1α and active caspase-3 and enhanced the expression of c-Kit. We conclude that chronic monotherapy with DARB prevents progressive LV dysfunction and dilation in nonanemic dogs with advanced HF. These results suggest that DARB elicits beneficial effects in HF that are independent of the presence of anemia. PMID:18952719

  17. Shockwaves prevent from heart failure after acute myocardial ischaemia via RNA/protein complexes.

    PubMed

    Tepeköylü, Can; Primessnig, Uwe; Pölzl, Leo; Graber, Michael; Lobenwein, Daniela; Nägele, Felix; Kirchmair, Elke; Pechriggl, Elisabeth; Grimm, Michael; Holfeld, Johannes

    2017-04-01

    Shock wave treatment (SWT) was shown to induce regeneration of ischaemic myocardium via Toll-like receptor 3 (TLR3). The antimicrobial peptide LL37 gets released by mechanical stress and is known to form complexes with nucleic acids thus activating Toll-like receptors. We suggested that SWT in the acute setting prevents from the development of heart failure via RNA/protein release. Myocardial infarction in mice was induced followed by subsequent SWT. Heart function was assessed 4 weeks later via transthoracic echocardiography and pressure-volume measurements. Human umbilical vein endothelial cells (HUVECs) were treated with SWT in the presence of RNase and proteinase and analysed for proliferation, tube formation and LL37 expression. RNA release and uptake after SWT was evaluated. We found significantly improved cardiac function after SWT. SWT resulted in significantly higher numbers of capillaries and arterioles and less left ventricular fibrosis. Supernatants of treated cells activated TLR3 reporter cells. Analysis of the supernatant revealed increased RNA levels. The effect could not be abolished by pre-treatment of the supernatant with RNase, but only by a sequential digestion with proteinase and RNase hinting strongly towards the involvement of RNA/protein complexes. Indeed, LL37 expression as well as cellular RNA uptake were significantly increased after SWT. We show for the first time that SWT prevents from left ventricular remodelling and cardiac dysfunction via RNA/protein complex release and subsequent induction of angiogenesis. It might therefore develop a potent regenerative treatment alternative for ischaemic heart disease.

  18. Prevention strategies for gastric cancer: a global perspective.

    PubMed

    Park, Jin Young; von Karsa, Lawrence; Herrero, Rolando

    2014-11-01

    Despite the substantial burden of gastric cancer worldwide, population strategies for primary prevention have not been introduced in any country. Recognizing the causal role of Helicobacter pylori infection, there is increasing interest in population-based programs to eradicate the infection to prevent gastric cancer. Nonetheless, the paucity of available evidence on feasibility and effectiveness has prevented implementation of this approach. There are very few secondary prevention programs based on screening with endoscopy or radiography, notably in the Republic of Korea and Japan, two of the countries with the highest incidence rates of gastric cancer. In Korea, where the organized screening program is in place, survival rate of gastric cancer is as high as 67%. More research is needed to quantify the specific contribution of the screening program to observed declines in mortality rates. Gastric cancer screening is unlikely to be feasible in many Low-Middle Income Countries where the gastric cancer burden is high. Prevention strategies are still under development and the optimal approach may differ depending on local conditions and societal values. The present review gives an overview of the etiology and burden of the disease, and possible prevention strategies for countries and regions confronted with a significant burden of disease.

  19. Pegloticase failure and a possible solution: Immunosuppression to prevent intolerance and inefficacy in patients with gout.

    PubMed

    Berhanu, Adey A; Krasnokutsky, Svetlana; Keenan, Robert T; Pillinger, Michael H

    2017-06-01

    Pegloticase is a highly effective therapy for patients with refractory and/or tophaceous gout, but has a high discontinuation rate (30-50%) due to development of anti-drug antibodies causing loss of efficacy and risk of infusion reactions. To describe the use of azathioprine or other immunosuppressive therapies as a pegloticase adjunct to prevent pegloticase immunogenicity when treating gout. Case report of azathioprine use in a patient receiving pegloticase therapy for refractory tophaceous gout, and review of the literature for the impact of immunosuppressive agents on development of anti-drug antibodies. A 56-year-old man with severe refractory tophaceous gouty arthritis was placed on low-dose azathioprine (50mg daily) in combination with pegloticase, with successful treatment after 98 weeks illustrated by significant improvement of caliper-measured tophi (77% decrease), resolution of gouty attacks, maintenance of low serum urate (sUA) level, absence of infusion reactions, and good toleration of the treatment by the patient. Two transient increases in sUA (maximal sUA 1.0 and 6.2mg/dL, respectively), were associated with azathioprine non-compliance and resolved with azathioprine reinstitution. Literature review confirmed successful use of DMARDs for prevention of anti-drug antibodies to anti-TNF-α therapies in RA, spondyloarthropathies, and inflammatory bowel disease. Additionally, one open-label trial of pegloticase for refractory tophaceous gout included 7 organ transplant recipients on immunosuppressive medications (mycophenolate mofetil, cyclosporine, azathioprine, and/or tacrolimus), only one of whom (14%) was noted to experience treatment failure (anti-pegloticase antibodies and loss of urate-lowering efficacy without infusion reaction), versus 52% (n =12) of non-immunosuppressed subjects (n = 23). Low doses of oral immunosuppressive therapy may provide a safe, cost-effective adjunct to prevent the development of anti-drug antibodies associated with

  20. AAV-mediated liver-specific MPV17 expression restores mtDNA levels and prevents diet-induced liver failure.

    PubMed

    Bottani, Emanuela; Giordano, Carla; Civiletto, Gabriele; Di Meo, Ivano; Auricchio, Alberto; Ciusani, Emilio; Marchet, Silvia; Lamperti, Costanza; d'Amati, Giulia; Viscomi, Carlo; Zeviani, Massimo

    2014-01-01

    Mutations in human MPV17 cause a hepatocerebral form of mitochondrial DNA depletion syndrome (MDS) hallmarked by early-onset liver failure, leading to premature death. Liver transplantation and frequent feeding using slow-release carbohydrates are the only available therapies, although surviving patients eventually develop slowly progressive peripheral and central neuropathy. The physiological role of Mpv17, including its functional link to mitochondrial DNA (mtDNA) maintenance, is still unclear. We show here that Mpv17 is part of a high molecular weight complex of unknown composition, which is essential for mtDNA maintenance in critical tissues, i.e. liver, of a Mpv17 knockout mouse model. On a standard diet, Mpv17-/- mouse shows hardly any symptom of liver dysfunction, but a ketogenic diet (KD) leads these animals to liver cirrhosis and failure. However, when expression of human MPV17 is carried out by adeno-associated virus (AAV)-mediated gene replacement, the Mpv17 knockout mice are able to reconstitute the Mpv17-containing supramolecular complex, restore liver mtDNA copy number and oxidative phosphorylation (OXPHOS) proficiency, and prevent liver failure induced by the KD. These results open new therapeutic perspectives for the treatment of MPV17-related liver-specific MDS.

  1. An analysis of influenza prevention measures from air travellers' perspective.

    PubMed

    Chou, P-F

    2014-09-01

    The influenza A virus is easily transmitted through airborne saliva droplets disseminated by unprotected coughing or sneezing, particularly in a crowded, enclosed space. The purpose of this study was to analyse the knowledge, attitudes and practices of air travellers regarding influenza A preventive measures and to examine any significant differences in perceptions among different types of traveller groups. This study used a 5-point Likert scale questionnaire and surveyed 1684 passengers at Taoyuan International Airport in Taiwan. The frequencies, mean score and ranking of descriptive analyses were used to evaluate respondents' demographic profiles. t-Test, one-way analysis of variance and Scheffe post hoc analyses were used to evaluate the relationship among knowledge, attitudes and practices, and respondents' characteristics. There were significant differences in the knowledge, attitudes and practices measures among groups with different types of trip purposes and among occupation groups. Most passengers expressed common knowledge regarding influenza A; however, their attitudes and their degree of perception were not consistent with their prevention practices. This research is limited because it only examined surveyed air travellers in Taiwan. Air travellers could benefit greatly if the government and airlines were to implement a health policy that includes education on the importance of influenza prevention measures, such as frequent hand washing, to citizens. Nurses could be involved in this important health promotion activity. Schools should implement a health education policy to communicate the importance of prevention measures. Nurses can consider how they can be involved in emphasizing the importance of prevention and health promotion regarding this. Airlines should also include basic preventive measures as a component of flight attendant training. © 2014 International Council of Nurses.

  2. Teachers' Perspectives on Preventing Suicide in Children and Adolescents in Schools: A Qualitative Study.

    PubMed

    Ross, Victoria; Kõlves, Kairi; De Leo, Diego

    2016-08-31

    Given the important role teachers play as gatekeepers in school suicide prevention, this study explored teachers' perspectives on what should be done to improve current suicide prevention efforts. The study, in Queensland, Australia, was part of a large-scale survey examining teachers' knowledge, attitudes and experience of suicidality. One hundred and fifteen teachers responded to an online survey question regarding their views on the requirements for school suicide prevention. Qualitative analysis identified five themes from teachers' responses: awareness and stigma reduction, support services for students, education and training, bullying and the role of social media. The results of this study provide some profound insights into teachers' perspectives on suicide and highlight the critical need for improved suicide prevention efforts in schools.

  3. Cardiac nuclear high mobility group box 1 prevents the development of cardiac hypertrophy and heart failure.

    PubMed

    Funayama, Akira; Shishido, Tetsuro; Netsu, Shunsuke; Narumi, Taro; Kadowaki, Shinpei; Takahashi, Hiroki; Miyamoto, Takuya; Watanabe, Tetsu; Woo, Chang-Hoon; Abe, Jun-ichi; Kuwahara, Koichiro; Nakao, Kazuwa; Takeishi, Yasuchika; Kubota, Isao

    2013-09-01

    High mobility group box 1 (HMGB1) is an abundant and ubiquitous nuclear DNA-binding protein that has multiple functions dependent on its cellular location. HMGB1 binds to DNA, facilitating numerous nuclear functions including maintenance of genome stability, transcription, and repair. However, little is known about the effects of nuclear HMGB1 on cardiac hypertrophy and heart failure. The aim of this study was to examine whether nuclear HMGB1 plays a role in the development of cardiac hypertrophy induced by pressure overload. Analysis of human biopsy samples by immunohistochemistry showed decreased nuclear HMGB1 expression in failing hearts compared with normal hearts. Nuclear HMGB1 decreased in response to both endothelin-1 (ET-1) and angiotensin II (Ang II) stimulation in neonatal rat cardiomyocytes, where nuclear HMGB1 was acetylated and translocated to the cytoplasm. Overexpression of nuclear HMGB1 attenuated ET-1 induced cardiomyocyte hypertrophy. Thoracic transverse aortic constriction (TAC) was performed in transgenic mice with cardiac-specific overexpression of HMGB1 (HMGB1-Tg) and wild-type (WT) mice. Cardiac hypertrophy after TAC was attenuated in HMGB1-Tg mice and the survival rate after TAC was higher in HMGB1-Tg mice than in WT mice. Induction of foetal cardiac genes was decreased in HMGB1-Tg mice compared with WT mice. Nuclear HMGB1 expression was preserved in HMGB1-Tg mice compared with WT mice and significantly attenuated DNA damage after TAC was attenuated in HMGB1-TG mice. These results suggest that the maintenance of stable nuclear HMGB1 levels prevents hypertrophy and heart failure by inhibiting DNA damage.

  4. New Prevention Perspectives in Nutrition Services for Children.

    ERIC Educational Resources Information Center

    Weaver, Nancy

    Presentations concerning a variety of special programs operating within the framework of a large comprehensive child care program were discussed. A description is given of how a specialist from a certain discipline functions in the many varied programs aimed at prevention. The specialty is nutrition. Each presentation discussed has opportunities…

  5. Theoretical Perspectives on Fishing Vessel Accidents and Their Prevention.

    ERIC Educational Resources Information Center

    Boshier, Roger

    Fishing vessel accidents occur because of complex interactions of human, technical, and environmental factors. Although they usually occur because of human actions, thoughts, or behavior, investigators and prevention educators are preoccupied with technical matters and equipment. Equipment, machinery, weather, and other objective facts are…

  6. Suicide and Suicide Prevention: Greek versus Biblical Perspectives.

    ERIC Educational Resources Information Center

    Kaplan, Kalman J.

    1992-01-01

    Compares suicide in Greek tragedy and Hebrew Bible, concentrating on life situations portrayed in two sets of narratives promoting or preventing suicide. Notes frequency of suicides in Greek tragedy and infrequency of suicides in Bible. Compares stories of Narcissus and Jonah in attempt to pinpoint what is suicide-promoting in Greek narratives and…

  7. Suicide and Suicide Prevention: Greek versus Biblical Perspectives.

    ERIC Educational Resources Information Center

    Kaplan, Kalman J.

    1992-01-01

    Compares suicide in Greek tragedy and Hebrew Bible, concentrating on life situations portrayed in two sets of narratives promoting or preventing suicide. Notes frequency of suicides in Greek tragedy and infrequency of suicides in Bible. Compares stories of Narcissus and Jonah in attempt to pinpoint what is suicide-promoting in Greek narratives and…

  8. A Perspective on Primary Prevention in the Earliest Years.

    ERIC Educational Resources Information Center

    Richmond, Julius B.

    The decade of the 70's has seen significant improvements in child health and dramatic insights into the biological, psychological, and social factors influencing children's growth and development. Four of the six major gains in health status listed in the Surgeon General's Report on Health Promotion and Disease Prevention relate to improvements in…

  9. Physical activity and Alzheimer's disease: from prevention to therapeutic perspectives.

    PubMed

    Rolland, Yves; Abellan van Kan, Gabor; Vellas, Bruno

    2008-07-01

    A number of factors, including physical activity, may contribute to prevention of cognitive decline and delay the onset of dementia. In addition to its convincing multiple benefits, an increasing body of evidence suggests that an active life has a protective effect on brain functioning in elders. Physical activity may also slow down the course of Alzheimer's disease. These hypotheses have led to increasing research in this specific area during the past decade. This review systematically analyzes the current literature on Alzheimer's disease and the effect of physical activity. Epidemiological studies, short-term randomized controlled trials (RCTs) in nondemented participants, and biological research suggest that physical activity improves cognitive function in older subjects. The limitations of these works are discussed. No RCTs have yet demonstrated that regular physical activity prevents dementia. Additional challenging clinical interventional studies are needed to demonstrate this relationship, but accumulating evidence from biological research is available. Defining the optimal preventive and therapeutic strategies in terms of type, duration, and intensity of physical activity remain an open question. In the future, the prevention of Alzheimer's disease may be based on rules governing lifestyle habits such as diet, cognitive activity, and physical activity.

  10. A Perspective on Primary Prevention in the Earliest Years.

    ERIC Educational Resources Information Center

    Richmond, Julius B.

    The decade of the 70's has seen significant improvements in child health and dramatic insights into the biological, psychological, and social factors influencing children's growth and development. Four of the six major gains in health status listed in the Surgeon General's Report on Health Promotion and Disease Prevention relate to improvements in…

  11. A Network Perspective on Dropout Prevention in Two Cities

    ERIC Educational Resources Information Center

    Wells, Rebecca; Gifford, Elizabeth; Bai, Yu; Corra, Ashley

    2015-01-01

    Purpose: This exploratory case study examines how school systems and other local organizations have been working within two major U.S. cities to improve high school graduation rates. Systematically assessing active interorganizational dropout prevention networks may reveal characteristics affecting communities' capacity to support school…

  12. USPSTF perspective on evidence-based preventive recommendations for children.

    PubMed

    Melnyk, Bernadette Mazurek; Grossman, David C; Chou, Roger; Mabry-Hernandez, Iris; Nicholson, Wanda; DeWitt, Thomas G; Cantu, Adelita G; Flores, Glenn

    2012-08-01

    The development and use of evidence-based recommendations for preventive care by primary care providers caring for children is an ongoing challenge. This issue is further complicated by the fact that a higher proportion of recommendations by the US Preventive Services Task Force (USPSTF) for pediatric preventive services in comparison with adult services have insufficient evidence to recommend for or against the service. One important root cause for this problem is the relative lack of high quality screening and counseling studies in pediatric primary care settings. The paucity of studies limits the development of additional evidence-based guidelines to enhance best practices for pediatric and adolescent conditions. In this article, we describe the following: (1) evidence-based primary care preventive services as a strategy for addressing important pediatric morbidities, (2) the process of making evidence-based screening recommendations by the USPSTF, (3) the current library of USPSTF recommendations for children and adolescents, and (4) factors influencing the use of USPSTF recommendations and other evidence-based guidelines by clinicians. Strategies to accelerate the implementation of evidence-based services and areas of need for future research to fill key gaps in evidence-based recommendations and guidelines are highlighted.

  13. A Network Perspective on Dropout Prevention in Two Cities

    ERIC Educational Resources Information Center

    Wells, Rebecca; Gifford, Elizabeth; Bai, Yu; Corra, Ashley

    2015-01-01

    Purpose: This exploratory case study examines how school systems and other local organizations have been working within two major U.S. cities to improve high school graduation rates. Systematically assessing active interorganizational dropout prevention networks may reveal characteristics affecting communities' capacity to support school…

  14. Self-Regulation, Cooperative Learning, and Academic Self-Efficacy: Interactions to Prevent School Failure

    PubMed Central

    Fernandez-Rio, Javier; Cecchini, Jose A.; Méndez-Gimenez, Antonio; Mendez-Alonso, David; Prieto, Jose A.

    2017-01-01

    Learning to learn and learning to cooperate are two important goals for individuals. Moreover, self regulation has been identified as fundamental to prevent school failure. The goal of the present study was to assess the interactions between self-regulated learning, cooperative learning and academic self-efficacy in secondary education students experiencing cooperative learning as the main pedagogical approach for at least one school year. 2.513 secondary education students (1.308 males, 1.205 females), 12–17 years old (M = 13.85, SD = 1.29), enrolled in 17 different schools belonging to the National Network of Schools on Cooperative Learning in Spain agreed to participate. They all had experienced this pedagogical approach a minimum of one school year. Participants were asked to complete the cooperative learning questionnaire, the strategies to control the study questionnaire and the global academic self-efficacy questionnaire. Participants were grouped based on their perceptions on cooperative learning and self-regulated learning in their classes. A combination of hierarchical and κ-means cluster analyses was used. Results revealed a four-cluster solution: cluster one included students with low levels of cooperative learning, self-regulated learning and academic self-efficacy, cluster two included students with high levels of cooperative learning, self-regulated learning and academic self-efficacy, cluster three included students with high levels of cooperative learning, low levels of self-regulated learning and intermediate-low levels of academic self-efficacy, and, finally, cluster four included students with high levels of self-regulated learning, low levels of cooperative learning, and intermediate-high levels of academic self-efficacy. Self-regulated learning was found more influential than cooperative learning on students’ academic self-efficacy. In cooperative learning contexts students interact through different types of regulations: self, co, and

  15. Self-Regulation, Cooperative Learning, and Academic Self-Efficacy: Interactions to Prevent School Failure.

    PubMed

    Fernandez-Rio, Javier; Cecchini, Jose A; Méndez-Gimenez, Antonio; Mendez-Alonso, David; Prieto, Jose A

    2017-01-01

    Learning to learn and learning to cooperate are two important goals for individuals. Moreover, self regulation has been identified as fundamental to prevent school failure. The goal of the present study was to assess the interactions between self-regulated learning, cooperative learning and academic self-efficacy in secondary education students experiencing cooperative learning as the main pedagogical approach for at least one school year. 2.513 secondary education students (1.308 males, 1.205 females), 12-17 years old (M = 13.85, SD = 1.29), enrolled in 17 different schools belonging to the National Network of Schools on Cooperative Learning in Spain agreed to participate. They all had experienced this pedagogical approach a minimum of one school year. Participants were asked to complete the cooperative learning questionnaire, the strategies to control the study questionnaire and the global academic self-efficacy questionnaire. Participants were grouped based on their perceptions on cooperative learning and self-regulated learning in their classes. A combination of hierarchical and κ-means cluster analyses was used. Results revealed a four-cluster solution: cluster one included students with low levels of cooperative learning, self-regulated learning and academic self-efficacy, cluster two included students with high levels of cooperative learning, self-regulated learning and academic self-efficacy, cluster three included students with high levels of cooperative learning, low levels of self-regulated learning and intermediate-low levels of academic self-efficacy, and, finally, cluster four included students with high levels of self-regulated learning, low levels of cooperative learning, and intermediate-high levels of academic self-efficacy. Self-regulated learning was found more influential than cooperative learning on students' academic self-efficacy. In cooperative learning contexts students interact through different types of regulations: self, co, and shared

  16. Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes: Insights From the PREVENT IV Trial

    PubMed Central

    Harskamp, Ralf E.; Alexander, John H.; Ferguson, T. Bruce; Hager, Rebecca; Mack, Michael J.; Englum, Brian; Wojdyla, Daniel; Schulte, Phillip J.; Kouchoukos, Nicholas T.; de Winter, Robbert J.; Gibson, C. Michael; Peterson, Eric D.; Harrington, Robert A.; Smith, Peter K.; Lopes, Renato D.

    2015-01-01

    Background The internal mammary artery (IMA) is the preferred conduit for bypassing the left anterior descending (LAD) artery in patients undergoing coronary artery bypass grafting (CABG). Systematic evaluation of the frequency and predictors of IMA failure and long-term outcomes is lacking. Methods and Results PREVENT IV trial participants who underwent IMA-LAD revascularization and had 12–18-month angiographic follow-up (n=1539) were included. Logistic regression with fast false selection rate methods was used to identify characteristics associated with IMA failure (≥75% stenosis). The relationship between IMA failure and long-term outcomes including death, myocardial infarction, and repeat revascularization was assessed using Cox regression. IMA failure occurred in 132 participants (8.6%). Predictors of IMA graft failure were LAD stenosis <75% (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.19–2.59), additional bypass graft to diagonal branch (OR, 1.92; 95% CI, 1.33–2.76), and not having diabetes (OR, 1.82; 95% CI, 1.20–2.78). LAD stenosis and additional diagonal graft remained predictive of IMA failure in an alternative model that included angiographic failure or death before angiography as the outcome. IMA failure was associated with a significantly higher incidence of subsequent acute (<14 days of angiography) clinical events, mostly due to a higher rate of repeat revascularization. Conclusions IMA failure was common and associated with higher rates of repeat revascularization, and patients with intermediate LAD stenosis or with an additional bypass graft to the diagonal branch had increased risk for IMA failure. These findings raise concerns regarding competitive flow and the benefit of CABG in intermediate LAD stenosis without functional evidence of ischemia. Clinical Trial Registration Information ClinicalTrials.gov. Identifier: NCT00042081. PMID:26647082

  17. Tobacco Prevention Education in Schools for the Deaf: The Faculty Perspective

    ERIC Educational Resources Information Center

    Berman, Barbara A.; Guthmann, Debra S.; Liu, Weiqing; Streja, Leanne

    2011-01-01

    We report results of a survey of tobacco education practices and perspectives among faculty at four Schools for the Deaf participating in the trial of a tailored tobacco prevention curriculum. Few faculty (20.4%) included tobacco use among the three most important health problems facing their students, although 88.8% considered tobacco education…

  18. Tobacco Prevention Education in Schools for the Deaf: The Faculty Perspective

    ERIC Educational Resources Information Center

    Berman, Barbara A.; Guthmann, Debra S.; Liu, Weiqing; Streja, Leanne

    2011-01-01

    We report results of a survey of tobacco education practices and perspectives among faculty at four Schools for the Deaf participating in the trial of a tailored tobacco prevention curriculum. Few faculty (20.4%) included tobacco use among the three most important health problems facing their students, although 88.8% considered tobacco education…

  19. Adolescent Dating Violence Prevention and Intervention in a Community Setting: Perspectives of Young Adults and Professionals

    ERIC Educational Resources Information Center

    Martsolf, Donna S.; Colbert, Crystal; Draucker, Claire B.

    2012-01-01

    Adolescent dating violence (ADV) is a significant community problem. In this study, we examine the perspectives of two groups (young adults who experienced ADV as teens and professionals who work with teens) on ADV prevention/intervention in a community context. We interviewed 88 young adults and 20 professionals. Our research team used Thorne's…

  20. Programs and Policies that Promote Positive Youth Development and Prevent Risky Behaviors: An International Perspective

    ERIC Educational Resources Information Center

    Naudeau, Sophie; Cunningham, Wendy; Lundberg, Mattias K. A.; McGinnis, Linda

    2008-01-01

    This chapter provides an international perspective on the promotion of positive development and the prevention of risky behavior among youth. We discuss some of the specific challenges that youth face in low- and middle-income countries and identify six key evidence-based policies and programs that aim to promote positive youth development and…

  1. Stretching and injury prevention in football: current perspectives.

    PubMed

    Stojanovic, Marko D; Ostojic, Sergej M

    2011-04-01

    Stretching exercises are regularly recommended as a part of football-training sessions and in preparation for competition. There is little sound empirical evidence, however, to substantiate the role of stretching exercises and consequently increased flexibility on injury prevention in football. Furthermore, in the last decade or so, fundamental research has shed some light on the biomechanical adaptation of the muscle-tendon unit following different stretching protocols, improving knowledge about the topic and enabling better understanding of the stretching-injury relationship. The purpose of this review is to examine the literature on the role of stretching and/or increased flexibility on injury prevention in football, with presented results analyzed in the context of the up-to-date basic science research evidence.

  2. Cardiac Implantable Electronic Device Infection: From an Infection Prevention Perspective

    PubMed Central

    Sastry, Sangeeta; Rahman, Riaz; Yassin, Mohamed H.

    2015-01-01

    A cardiac implantable electronic device (CIED) is indicated for patients with severely reduced ejection fraction or with life-threatening cardiac arrhythmias. Infection related to a CIED is one of the most feared complications of this life-saving device. The rate of CIED infection has been estimated to be between 2 and 25; though evidence shows that this rate continues to rise with increasing expenditure to the patient as well as healthcare systems. Multiple risk factors have been attributed to the increased rates of CIED infection and host comorbidities as well as procedure related risks. Infection prevention efforts are being developed as defined bundles in numerous hospitals around the country given the increased morbidity and mortality from CIED related infections. This paper aims at reviewing the various infection prevention measures employed at hospitals and also highlights the areas that have relatively less established evidence for efficacy. PMID:26550494

  3. Food Policy Approaches to Obesity Prevention: An International Perspective.

    PubMed

    Zhang, Qi; Liu, Shiyong; Liu, Ruicui; Xue, Hong; Wang, Youfa

    2014-06-01

    This paper provides a comprehensive overview of the recent obesity prevention-related food policies initiated in countries worldwide. We searched and reviewed relevant research papers and government documents, focusing on those related to dietary guidelines, food labeling, regulation of food marketing, and policies affecting food prices. We also commented on the effects and challenges of some of the related policy options. There are large variations regarding what, when, and how policies have been implemented across countries. Clearly, developed countries are leading the effort, and developing countries are starting to develop some related policies. The encouraging message is that many countries have been adopting policies that might help prevent obesity and that the support for more related initiatives is strong and continues to grow. Communicating information about these practices will help researchers, public health professionals, and policy makers around the world to take action to fight the growing epidemic of obesity and other nutrition-related diseases.

  4. Calorie restriction and cancer prevention: a mechanistic perspective

    PubMed Central

    2013-01-01

    Calorie restriction (CR) is one of the most potent broadly acting dietary interventions for inducing weight loss and for inhibiting cancer in experimental models. Translation of the mechanistic lessons learned from research on CR to cancer prevention strategies in human beings is important given the high prevalence of excess energy intake, obesity, and metabolic syndrome in many parts of the world and the established links between obesity-associated metabolic perturbations and increased risk or progression of many types of cancer. This review synthesizes findings on the biological mechanisms underlying many of the anticancer effects of CR, with emphasis on the impact of CR on growth factor signaling pathways, inflammation, cellular and systemic energy homeostasis pathways, vascular perturbations, and the tumor microenvironment. These CR-responsive pathways and processes represent targets for translating CR research into effective cancer prevention strategies in human beings. PMID:24280167

  5. Maltreatment in Infancy: A Developmental Perspective on Prevention and Intervention.

    PubMed

    Harden, Brenda Jones; Buhler, Andrea; Parra, Laura Jimenez

    2016-10-01

    Burgeoning research has documented high rates of maltreatment during the first 3 years of life. Early exposure to maltreatment is related to a host of negative physical, developmental, and mental health outcomes in childhood and adulthood. Scientists have documented the "biological embedding" of maltreatment, including alterations in the structures and processes of the young brain. Maltreatment is a complex phenomenon, which manifests in contexts of family poverty, inadequate parental knowledge and skill regarding child development and caregiving, social isolation of parents, disruptions in parent-child relationships, compromised parental psychological functioning, and concrete issues that affect parenting. Capitalizing on research on young child maltreatment, interventions have been designed to ameliorate infant/toddler maltreatment, buffer young children against the effects of maltreatment, and promote the well-being of maltreated young children. There is a growing empirical base on interventions to address early maltreatment within the context of a public health prevention framework. Primary prevention programs aim to reduce the incidence of maltreatment and related outcomes for infants, toddlers, and their families through the implementation of population-based programs, such as home visiting and early care and education programs. Secondary prevention models target families with specific risk factors associated with maltreatment, such as maternal depression. Tertiary programs generally entail involuntary services, designed to prevent maltreatment recurrence and to improve parenting skills through therapeutic approaches targeting the parent-child dyad. Empirical knowledge about maltreated young children and their families and interventions to support them can inform the design and delivery of child welfare services. © The Author(s) 2016.

  6. Diabetes prevention: global health policy and perspectives from the ground

    PubMed Central

    Bergman, Michael; Buysschaert, Martin; Schwarz, Peter EH; Albright, Ann; Narayan, KM Venkat; Yach, Derek

    2015-01-01

    SUMMARY Type 2 diabetes and other noncommunicable diseases are a growing public health challenge globally. An estimated 285 million people, corresponding to 6.4% of the world’s adult population, has diabetes, which is expected to reach 552 million by the International Diabetes Federation in 2030. A much larger segment of the world’s population, approximating 79 million individuals in the USA alone, has prediabetes. Globally, a relatively small percentage of those with diabetes or prediabetes are diagnosed with the potential for developing chronic complications. To address this epidemic, governments, in concert with the private sector, need to set policies that promote healthy nutritional and agricultural policies, favor modifications in the environment that encourage greater physical activity and make prevention affordable for all citizens at high risk. The public health sector has the charge of translating evidence-based findings into practical, accessible and cost-effective programs and monitoring the process to continuously improve prevention initiatives. The clinical sector has the formidable challenge of screening and identifying those at high risk and referring them to accredited intervention programs. There is a need to explore additional cost-effective interventions that are customized to meet individual needs that can be offered at the community and clinical levels. Thus, all three sectors, government, public health and clinical, each have a critical role in this process and by working in a partnership, ought to create the necessary synergies essential for making substantial forays in the prevention of Type 2 diabetes. PMID:26339296

  7. Teenage Pregnancy from a Black Perspective: Some Reflections on Its Prevention. Occasional Paper No. 24.

    ERIC Educational Resources Information Center

    Hendricks, Leo E.; Montgomery, Teresa A.

    This paper focuses on the causes, consequences and prevention of the alarming number of pregnancies among black teenagers. Teenage pregnancy is a symptom of the failure to have one's basic spiritual, intellectual/emotional, and physical needs met. Unmet infantile needs cause adolescents to search for romantic relationships in which they can…

  8. Metformin prevents the development of chronic heart failure in the SHHF rat model.

    PubMed

    Cittadini, Antonio; Napoli, Raffaele; Monti, Maria Gaia; Rea, Domenica; Longobardi, Salvatore; Netti, Paolo Antonio; Walser, Marion; Samà, Mariateresa; Aimaretti, Gianluca; Isgaard, Jörgen; Saccà, Luigi

    2012-04-01

    Insulin resistance is a recently identified mechanism involved in the pathophysiology of chronic heart failure (CHF). We investigated the effects of two insulin-sensitizing drugs (metformin and rosiglitazone) in a genetic model of spontaneously hypertensive, insulin-resistant rats (SHHF). Thirty SHHF rats were randomized into three treatment groups as follows: 1) metformin (100 mg/kg per day), 2) rosiglitazone (2 mg/kg per day), and 3) no drug. Ten Sprague-Dawley rats served as normal controls. At the end of the treatment period (12 months), the cardiac phenotype was characterized by histology, echocardiography, and isolated perfused heart studies. Metformin attenuated left ventricular (LV) remodeling, as shown by reduced LV volumes, wall stress, perivascular fibrosis, and cardiac lipid accumulation. Metformin improved both systolic and diastolic indices as well as myocardial mechanical efficiency, as shown by improved ability to convert metabolic energy into mechanical work. Metformin induced a marked activation of AMP-activated protein kinase, endothelial nitric oxide synthase, and vascular endothelial growth factor and reduced tumor necrosis factor-α expression and myocyte apoptosis. Rosiglitazone did not affect LV remodeling, increased perivascular fibrosis, and promoted further cardiac lipid accumulation. In conclusion, long-term treatment with metformin, but not with rosiglitazone, prevents the development of severe CHF in the SHHF model by a wide-spectrum interaction that involves molecular, structural, functional, and metabolic-energetic mechanisms.

  9. Future Issues and Approaches to Health Monitoring and Failure Prevention for Oil-Free Gas Turbines

    NASA Technical Reports Server (NTRS)

    DellaCorte, Christopher

    2004-01-01

    Recent technology advances in foil air bearings, high temperature solid lubricants and computer based modeling has enabled the development of small Oil-Free gas turbines. These turbomachines are currently commercialized as small (<100 kW) microturbine generators and larger machines are being developed. Based upon these successes and the high potential payoffs offered by Oil-Free systems, NASA, industry, and other government entities are anticipating Oil-Free gas turbine propulsion systems to proliferate future markets. Since an Oil-Free engine has no oil system, traditional approaches to health monitoring and diagnostics, such as chip detection, oil analysis, and possibly vibration signature analyses (e.g., ball pass frequency) will be unavailable. As such, new approaches will need to be considered. These could include shaft orbit analyses, foil bearing temperature measurements, embedded wear sensors and start-up/coast down speed analysis. In addition, novel, as yet undeveloped techniques may emerge based upon concurrent developments in MEMS technology. This paper introduces Oil-Free technology, reviews the current state of the art and potential for future turbomachinery applications and discusses possible approaches to health monitoring, diagnostics and failure prevention.

  10. Application of woven tires waste as soft clay subgrade reinforcement for preventing highway structural failure

    NASA Astrophysics Data System (ADS)

    Apriyono, Arwan; Sumiyanto, Gusmawan, Dadan Deri

    2017-03-01

    This study presents the application of woven waste tires as soft clay subgrade reinforcement for preventing highway structural failure, reducing construction cost and minimizing environmental hazards associated with the increasingly large amount of waste tires in Indonesia. To his end, we performed experiments using five stripe distance variations of woven tires - i.e. 2, 2.5, 3, 3.5 and 4 cm. Five soft clay samples were made and each was reinforced using each of these woven tires. The California Bearing Ratio (CBR) test was conducted on each softclay sample and the CBR value was determined from the stress on the displacement of 0.10 and 0.20 inch. The correlation between CBR value and strip distance was used to infer the optimum woven tires strip distance, indicated by the largest CBR value. The result suggests that the strip distance of 3 cm is optimum with corresponding CBR value of ˜20%, which is 115% increase compared to softclay without reinforcement.

  11. Netrin-1 prevents the development of cardiac hypertrophy and heart failure.

    PubMed

    Wang, Nan; Cao, Yunshan; Zhu, Yan

    2016-03-01

    The aim of the present study was to examine whether netrin-1 is involved in the development of cardiac hypertrophy, induced by pressure overload. For this investigation, thoracic transverse aortic constriction (TAC) was performed in mice. A total of 18 mice were divided into three groups (n=6 per group): Sham, TAC and TAC + recombinant netrin-1. Neonatal rat cardiomyocytes were stimulated with endothelin-1 (ET-1), and samples were collected to examine the expression levels of netrin‑1 by western blot analysis and the mRNA expression of A‑type natriuretic peptide by reverse transcription‑quantitative polymerase chain reaction. It was found that the expression of netrin‑1 was decreased in the TAC mice and in the neonatal rat cardiomyocytes in response to ET‑1 stimulation. Netrin‑1 eliminated ventricular remodeling, cardiac dysfunction and DNA damage during pressure overload. Furthermore, analysis of the signaling events indicated that netrin‑1‑mediated protection against cardiac hypertrophy was attributed to interruption of the activation of mitogen‑activated protein kinase kinase (MEK) kinase‑1 (K1)‑dependent MEK‑extracellular signal‑regulated protein kinase 1/2 (ERK1/2) and c‑Jun N‑terminal kinase 1/2 (JNK1/2). Therefore, netrin‑1 prevented cardiac hypertrophy and heart failure through the negative regulation of the MEKK1-dependent MEK‑ERK1/2 and JNK1/2 signaling pathways.

  12. Reduced cardiac remodelling and prevention of glutathione deficiency after omega-3 supplementation in chronic heart failure.

    PubMed

    Fang, Yuehua; Favre, Julie; Vercauteren, Magalie; Laillet, Brigitte; Remy-Jouet, Isabelle; Skiba, Mohamed; Lallemand, Françoise; Dehaudt, Cathy; Monteil, Christelle; Thuillez, Christian; Mulder, Paul

    2011-06-01

    n-3 polyunsaturated fatty acids (omega-3) supplementation is associated with reduced cardiovascular mortality and post-infarction death. However, the impact of omega-3 supplementation in congestive heart failure (CHF) is still unknown. This study assesses the effects of omega-3 supplementation on left ventricular (LV) function and remodelling. We assessed, in rats with CHF induced by left coronary ligation, the effects of a 1-week and a 12-week supplementation with omega-3 (450 mg/kg per day) on LV hemodynamics, function and structure. Chronic omega-3 reduces total peripheral resistance due to an increase in cardiac output without modification of arterial pressure. Only chronic omega-3 reduces LV end-diastolic pressure and LV relaxation constant. Moreover, chronic omega-3 decreases LV systolic and diastolic diameters, LV weight and collagen density. Acute and chronic omega-3 increase LV γ-glutamyl-cysteine synthetase and oppose glutathione deficiency resulting in a reduction of myocardial oxidized glutathione. In experimental CHF, long-term omega-3 supplementation improves LV hemodynamics and function and prevents LV remodelling and glutathione deficiency. The latter might be one of the mechanisms involved, but whether other mechanism, independent of myocardial redox 'status', such as reduced inflammation, are implicated remains to be confirmed.

  13. Restriction of food intake prevents postinfarction heart failure by enhancing autophagy in the surviving cardiomyocytes.

    PubMed

    Watanabe, Takatomo; Takemura, Genzou; Kanamori, Hiromitsu; Goto, Kazuko; Tsujimoto, Akiko; Okada, Hideshi; Kawamura, Itta; Ogino, Atsushi; Takeyama, Toshiaki; Kawaguchi, Tomonori; Morishita, Kentaro; Ushikoshi, Hiroaki; Kawasaki, Masanori; Mikami, Atsushi; Fujiwara, Takako; Fujiwara, Hisayoshi; Minatoguchi, Shinya

    2014-05-01

    We investigated the effect of restriction of food intake, a potent inducer of autophagy, on postinfarction cardiac remodeling and dysfunction. Myocardial infarction was induced in mice by left coronary artery ligation. At 1 week after infarction, mice were randomly divided into four groups: the control group was fed ad libitum (100%); the food restriction (FR) groups were fed 80%, 60%, or 40% of the mean amount of food consumed by the control mice. After 2 weeks on the respective diets, left ventricular dilatation and hypofunction were apparent in the control group, but both parameters were significantly mitigated in the FR groups, with the 60% FR group showing the strongest therapeutic effect. Cardiomyocyte autophagy was strongly activated in the FR groups, as indicated by up-regulation of microtubule-associated protein 1 light chain 3-II, autophagosome formation, and myocardial ATP content. Chloroquine, an autophagy inhibitor, completely canceled the therapeutic effect of FR. This negative effect was associated with reduced activation of AMP-activated protein kinase and of ULK1 (a homolog of yeast Atg1), both of which were enhanced in hearts from the FR group. In vitro, the AMP-activated protein kinase inhibitor compound C suppressed glucose depletion-induced autophagy in cardiomyocytes, but did not influence activity of chloroquine. Our findings imply that a dietary protocol with FR could be a preventive strategy against postinfarction heart failure. Copyright © 2014 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

  14. Constructing an effective prevention mechanism for MSW lifecycle using failure mode and effects analysis.

    PubMed

    Chen, Ying-Chu; Wu, Wen-Fang

    2015-12-01

    Municipal solid waste in Taiwan is a valuable source of renewable energy. Phases of municipal solid waste lifecycle (classification, disposal, storage, collection and transportation) before incineration or landfilled face various potential failures. Applying a proper technique to eliminate or decrease potential failures is desirable and needed. Failure Modes and Effects Analysis to municipal solid waste lifecycle was found in literature. This study utilized the Failure Modes and Effects Analysis as a convenient technique for determining, classifying and analyzing common failures in the municipal solid waste lifecycle. As a result, an appropriate risk scoring of severity, occurrence, and detection of failure modes and computing the Risk Priority Number for identifying the high potential failure modes were made. Nineteen failure modes were identified, and nine of them were ranked as the priority items for improvement. Recommended actions for all failure modes were suggested. Occurrences of failures were remarkably reduced after implementing the procedure for six months. The results of this study have minimized potential failures and brought continuous improvement, thus achieving a better protection of the environment. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Battered women: intervention and prevention. A psychosociocultural perspective, Part 2.

    PubMed

    Hoff, L A

    1993-01-01

    Building on the foundation of understanding and comprehensive assessment of battered women, this article addresses service planning and intervention. Strategies are approached within the framework of a Crisis Paradigm developed from field research with battered women and their families. They include mechanisms such as support groups which link crisis service to the long-term needs of battered women, and systematic approaches to removing the obstacles which keep women victimized. An Assessment and Service Planning Guide (ASPG) is proposed for inclusion in routine health care of abused women. The article concludes with strategies for preventing violence at interpersonal and societal levels.

  16. Preventive Intervention for Early Childhood Behavioral Problems: An Ecological Perspective

    PubMed Central

    Shepard, Stephanie A.; Dickstein, Susan

    2009-01-01

    The purpose of this paper is to highlight the importance of preventive interventions targeting parents when addressing early childhood behavior problems. We briefly review evidence-based parent management training programs (PMT), focusing on one particular program, the Incredible Years Series (IY). Next, we discuss the barriers to embedding evidence-based practice like IY in community contexts, and demonstrate how early childhood mental health consultation can be used to enhance community capacity to adopt evidence-based practice and improve outcomes for the large number of young children and their families in need. PMID:19486845

  17. Psychosocial Perspectives and the Issue of Prevention in Childhood Obesity

    PubMed Central

    Stein, Daniel; Weinberger-Litman, Sarah L.; Latzer, Yael

    2014-01-01

    A dramatic increase in childhood overweight/obesity has been recognized globally over the past 50 years. This observed increase may reflect genetic, as well as psychological, environmental, and socio-cultural influences. In the first part of this review, we present an updated summary of the psychosocial factors associated with this change and discuss possible ways in which they operate. Among these factors, lower socio economic status (in both industrialized and non-industrialized countries), being female, belonging to a minority group, and being exposed to adverse life events may all be associated with a greater risk of childhood overweight/obesity. These influences may be mediated via a variety of mechanisms, in particular above-average food intake of low nutritional quality and reduction in physical activity. Other important psychosocial mediators include the influence of the family and peer environment, and exposure to the media. In the second part of the review, we discuss the potential of psychosocial prevention programs to intervene in the processes involved in the rise of childhood overweight/obesity. Two points are emphasized. First, prevention programs should be multidisciplinary, combining the knowledge of experts from different professions, and taking into consideration the important role of the family environment and relevant influential social organizations, particularly school. Second, effective change is unlikely to occur without large-scale programs carried out on a public policy level. PMID:25133140

  18. Youth Sports: A Pediatrician's Perspective on Coaching and Injury Prevention.

    PubMed

    Koester, M C

    2000-10-01

    My objective is to review the factors that influence youth participation in sports, to discuss the role coaches may play in youth sports injuries, and to call on athletic trainers and other health professionals to become involved in youth sports in an effort to limit injury risk. Millions of American youths participate in team sports. Their primary motivation to participate is to have fun. Unfortunately, large numbers of participants have sustained correspondingly large numbers of injuries. Many injuries can be attributed to improper technique and conditioning methods taught by volunteer coaches. Although not the only contributors to injuries, these may be the most amenable to preventive measures, such as formal instruction for coaches in the areas of proper biomechanics and player-coach communication. I provide an overview of the reasons why children participate in sports, discuss participation motivation, and review the literature on coaches' communication methods that have been proved effective in maximizing learning and enjoyment for young athletes. This article provides certified athletic trainers with the background knowledge needed to take an active role in youth sports injury prevention at the community level.

  19. Youth Sports: A Pediatrician's Perspective on Coaching and Injury Prevention

    PubMed Central

    Koester, Michael C.

    2000-01-01

    Objective: My objective is to review the factors that influence youth participation in sports, to discuss the role coaches may play in youth sports injuries, and to call on athletic trainers and other health professionals to become involved in youth sports in an effort to limit injury risk. Background: Millions of American youths participate in team sports. Their primary motivation to participate is to have fun. Unfortunately, large numbers of participants have sustained correspondingly large numbers of injuries. Many injuries can be attributed to improper technique and conditioning methods taught by volunteer coaches. Although not the only contributors to injuries, these may be the most amenable to preventive measures, such as formal instruction for coaches in the areas of proper biomechanics and player-coach communication. Description: I provide an overview of the reasons why children participate in sports, discuss participation motivation, and review the literature on coaches' communication methods that have been proved effective in maximizing learning and enjoyment for young athletes. Clinical Advantages: This article provides certified athletic trainers with the background knowledge needed to take an active role in youth sports injury prevention at the community level. PMID:16558664

  20. Perspective: Physician education: a promising strategy to prevent adolescent suicide.

    PubMed

    Taliaferro, Lindsay A; Borowsky, Iris Wagman

    2011-03-01

    Many young people who present to primary care providers (PCPs) have high levels of emotional distress and/or suicidal ideation. Therefore, PCPs are in an ideal position to recognize and respond to early symptoms and distress signals that accompany suicide warning signs, yet they underrecognize mood disorders and suicidality among youth. Medical school and residency programs typically provide inadequate training on pediatric mental health and adolescent suicide prevention. Thus, PCPs lack complete knowledge of risk factors and feel unprepared to handle mental health problems among youth. In this article, the authors provide an overview of the epidemiology of adolescent suicide and describe risk factors, protective factors, and warning signs. They propose that physician education represents a promising strategy to prevent adolescent suicide, and they establish the need for improved educational opportunities that would provide PCPs with the necessary skills and supports to identify and respond to psychosocial concerns that may increase suicide risk among youth. They recommend strategies, methods, and content areas for addressing educational gaps, as well as organizational approaches to support enhanced physician education. They also suggest areas for future research.

  1. Psychosocial perspectives and the issue of prevention in childhood obesity.

    PubMed

    Stein, Daniel; Weinberger-Litman, Sarah L; Latzer, Yael

    2014-01-01

    A dramatic increase in childhood overweight/obesity has been recognized globally over the past 50 years. This observed increase may reflect genetic, as well as psychological, environmental, and socio-cultural influences. In the first part of this review, we present an updated summary of the psychosocial factors associated with this change and discuss possible ways in which they operate. Among these factors, lower socio economic status (in both industrialized and non-industrialized countries), being female, belonging to a minority group, and being exposed to adverse life events may all be associated with a greater risk of childhood overweight/obesity. These influences may be mediated via a variety of mechanisms, in particular above-average food intake of low nutritional quality and reduction in physical activity. Other important psychosocial mediators include the influence of the family and peer environment, and exposure to the media. In the second part of the review, we discuss the potential of psychosocial prevention programs to intervene in the processes involved in the rise of childhood overweight/obesity. Two points are emphasized. First, prevention programs should be multidisciplinary, combining the knowledge of experts from different professions, and taking into consideration the important role of the family environment and relevant influential social organizations, particularly school. Second, effective change is unlikely to occur without large-scale programs carried out on a public policy level.

  2. A preventive maintenance policy for a standby system subject to internal failures and external shocks with loss of units

    NASA Astrophysics Data System (ADS)

    Eloy Ruiz-Castro, Juan

    2015-07-01

    In many situations, serious damage and considerable financial losses are caused by non-repairable failures of a system. Redundant systems and maintenance policies are commonly employed to improve reliability. This paper is focused on the modelling of a complex cold standby system by analysing the effectiveness and costs of preventive maintenance, always in an algorithmic form. The online unit of the system is subject to wear failures and external shocks. The online unit can go through an indeterminate number of degradation levels before failure. This one is observed when inspections occur. Inspections are performed at random intervals, and when one takes place, the unit is taken to the preventive maintenance facility if it is necessary. The preventive maintenance time and cost is different depending on the degradation level observed. If only one unit is performing, a minimal maintenance policy is adopted in order to optimise system behaviour. Reliability measures such as the conditional probability of failure are worked out in a well-structured and algebraic form in transient and stationary regimes by using algorithmic methods. The stationary distribution is calculated using matrix analytic methods, and rewards are included in the model. An optimisation example shows the versatility of the model presented.

  3. An early warning scoring system for the prevention of acute heart failure.

    PubMed

    Bian, Yuan; Xu, Feng; Lv, Rui-juan; Wang, Jia-li; Cao, Li-jun; Xue, Li; Zheng, Wen; Qiao, Yan-xiang; Yan, Xian-liang; Liu, Zhen-fang; Zhang, Yun; Chen, Yu-guo

    2015-03-15

    Early prediction and identification of the onset of acute heart failure (AHF) in high-risk patients are of great significance for preemptive treatment and a better prognosis. We sought to find a scoring system to predict the onset of AHF in patients in the acute heart failure unit (AHFU). Data for 433 patients at of AHF in the AHFU were analyzed. We recorded sex, age, history of coronary artery disease, hypertension, diabetes, and primary percutaneous coronary intervention. We also reviewed temperature, pulse, SpO₂, respiratory rate, urine volume, and emotional state every hour before the onset of AHF. All admission and follow-up data were retrieved from hospital charts. Factors were analyzed using a binary logistic regression model to create the SUPER (SpO₂, urine volume, pulse, emotional state, and respiratory rate) scoring model. We divided the scoring system into four levels: low-, intermediate-, high-, and extremely high-risk. Patients fitting the four risk levels were followed up for 6 to 24 months. SpO₂, hourly urine volume, pulse, emotional state and respiratory rates were associated with an independent increased risk for the onset of AHF. The SUPER score for the patients in the AHFU predicted the onset of AHF 3.90 ± 1.94 h (1-17 h) earlier. The areas under the ROC curve for the SUPER score and the modified early warning score were 0.811 and 0.662 (p<0.05), indicating that the SUPER score provided a better warning of the AHF. A low-, intermediate-, high-, and very high-risk SUPER predicted the likelihood of AHF at 17.3%, 61.3%, 84.4%, and 94.0%, respectively. The differences in mortality rates between the four levels were statistically significant (p<0.05). In patients at high risk of AHF, the SUPER scoring system could predict the onset of AHF 2 to 6h earlier. Preemptive treatment according to the SUPER score may prevent or delay AHF occurrence to improve quality of life and reduce mortality. Copyright © 2015 Elsevier Ireland Ltd. All rights

  4. Hazard report. Shift checks and semiannual preventive maintenance are important in detecting critical failures in Zoll M series defibrillators.

    PubMed

    2009-05-01

    The manufacturer-recommended shift check for Zoll M Series defibrillators cannot detect some critical failures that could inhibit defibrillation or pacing. To improve detection of these failures and to limit their impact on patient care, hospitals should perform not only the routine perform not only the routine shift check, but also the twice-annual preventive maintenance procedure recommended by Zoll. Additionally, units exhibiting an error code--even one that appears to resolve itself--should be immediately removed from service and evaluated by the clinical engineering department.

  5. Best practices for preventing musculoskeletal disorders in masonry: stakeholder perspectives.

    PubMed

    Entzel, Pamela; Albers, Jim; Welch, Laura

    2007-09-01

    Brick masons and mason tenders report a high prevalence of work-related musculoskeletal disorders (WMSDs), many of which can be prevented with changes in materials, work equipment or work practices. To explore the use of "best practices" in the masonry industry, NIOSH organized a 2-day meeting of masonry stakeholders. Attendees included 30 industry representatives, 5 health and safety researchers, 4 health/safety specialists, 2 ergonomic consultants, and 2 representatives of state workers' compensation programs. Small groups discussed ergonomic interventions currently utilized in the masonry industry, including factors affecting intervention implementation and ways to promote diffusion of interventions. Meeting participants also identified various barriers to intervention implementation, including business considerations, quality concerns, design issues, supply problems, jobsite conditions and management practices that can slow or limit intervention diffusion. To be successful, future diffusion efforts must not only raise awareness of available solutions but also address these practical concerns.

  6. Food Policy Approaches to Obesity Prevention: An International Perspective

    PubMed Central

    Zhang, Qi; Liu, Shiyong; Liu, Ruicui; Xue, Hong

    2015-01-01

    This paper provides a comprehensive overview of the recent obesity prevention–related food policies initiated in countries worldwide. We searched and reviewed relevant research papers and government documents, focusing on those related to dietary guidelines, food labeling, regulation of food marketing, and policies affecting food prices. We also commented on the effects and challenges of some of the related policy options. There are large variations regarding what, when, and how policies have been implemented across countries. Clearly, developed countries are leading the effort, and developing countries are starting to develop some related policies. The encouraging message is that many countries have been adopting policies that might help prevent obesity and that the support for more related initiatives is strong and continues to grow. Communicating information about these practices will help researchers, public health professionals, and policy makers around the world to take action to fight the growing epidemic of obesity and other nutrition-related diseases. PMID:25705571

  7. Client and provider perspectives on new HIV prevention tools for MSM in the Americas.

    PubMed

    Lippman, Sheri A; Koester, Kimberly A; Amico, K Rivet; Lama, Javier R; Martinez Fernandes, Nilo; Gonzales, Pedro; Grinsztejn, Beatriz; Liu, Al; Buchbinder, Susan; Koblin, Beryl A

    2015-01-01

    Men who have sex with men (MSM) in the Americas require targeted, combination HIV prevention approaches. We solicited client and provider perspectives on emerging prevention interventions including HIV pre-exposure prophylaxis (PrEP) and HIV self-tests through focus groups and in-depth interviews with 130 MSM and 41 providers across four sites: New York, San Francisco, Lima, and Rio de Janeiro. Among the MSM participants, we identified three prevention typologies: non-condom users, inconsistent condom users, and consistent condom users. Northern and Southern MSM differed in the variety of harm reduction strategies utilized: where U.S. MSM relied on condom use as well as disclosure and seroadaptive behaviors for prevention, condom use without disclosure or serostatus discussions was the norm in South America. Interest in new prevention technologies was shaped by the social context. U.S. MSM preferences differed by typology, such that non-condom users were interested in taking PrEP and using home HIV tests. MSM in Brazil, regardless of typology, were interested in exploring new prevention options. MSM in Peru demonstrated moderate interest but were less comfortable with adopting new strategies. MSM and providers' opinions differed substantially with respect to new prevention options. Across sites, most providers were reticent to engage with new prevention options, though some NGO-based providers were more supportive of exploring new prevention tools. Both clients and providers will need to be engaged in developing integrated prevention strategies for MSM.

  8. Client and Provider Perspectives on New HIV Prevention Tools for MSM in the Americas

    PubMed Central

    Lippman, Sheri A.; Koester, Kimberly A.; Amico, K. Rivet; Lama, Javier R.; Martinez Fernandes, Nilo; Gonzales, Pedro; Grinsztejn, Beatriz; Liu, Al; Buchbinder, Susan; Koblin, Beryl A.

    2015-01-01

    Men who have sex with men (MSM) in the Americas require targeted, combination HIV prevention approaches. We solicited client and provider perspectives on emerging prevention interventions including HIV pre-exposure prophylaxis (PrEP) and HIV self-tests through focus groups and in-depth interviews with 130 MSM and 41 providers across four sites: New York, San Francisco, Lima, and Rio de Janeiro. Among the MSM participants, we identified three prevention typologies: non-condom users, inconsistent condom users, and consistent condom users. Northern and Southern MSM differed in the variety of harm reduction strategies utilized: where U.S. MSM relied on condom use as well as disclosure and seroadaptive behaviors for prevention, condom use without disclosure or serostatus discussions was the norm in South America. Interest in new prevention technologies was shaped by the social context. U.S. MSM preferences differed by typology, such that non-condom users were interested in taking PrEP and using home HIV tests. MSM in Brazil, regardless of typology, were interested in exploring new prevention options. MSM in Peru demonstrated moderate interest but were less comfortable with adopting new strategies. MSM and providers’ opinions differed substantially with respect to new prevention options. Across sites, most providers were reticent to engage with new prevention options, though some NGO-based providers were more supportive of exploring new prevention tools. Both clients and providers will need to be engaged in developing integrated prevention strategies for MSM. PMID:25826246

  9. Epidemiology and prevention of chronic arsenicosis: an Indian perspective.

    PubMed

    Ghosh, Pramit; Roy, Chinmoyi; Das, Nilay Kanti; Sengupta, Sujit Ranjan

    2008-01-01

    Arsenicosis is a global problem but the recent data reveals that Asian countries, India and Bangladesh in particular, are the worst sufferers. In India, the state of West Bengal bears the major brunt of the problem, with almost 12 districts presently in the grip of this deadly disease. Recent reports suggest that other states in the Ganga/Brahmaputra plains are also showing alarming levels of arsenic in ground water. In West Bengal, the majority of registered cases are from the district of Nadia, and the maximum number of deaths due to arsenicosis is from the district of South 24 Paraganas. The reason behind the problem in India is thought to be mainly geogenic, though there are instances of reported anthropogenic contamination of arsenic from industrial sources. The reason for leaching of arsenic in ground water is attributed to various factors, including excessive withdrawal of ground water for the purpose of irrigation, use of bio-control agents and phosphate fertilizers. It remains a mystery why all those who are exposed to arsenic-contaminated water do not develop the full-blown disease. Various host factors, such as nutritional status, socioeconomic status, and genetic polymorphism, are thought to make a person vulnerable to the disease. The approach to arsenicosis mitigation needs be holistic, sustainable, and multidisciplinary, with the 2 main pillars being health education and provision of 'arsenic-free water.' In the state of West Bengal, the drive for arsenic mitigation has been divided into 3 phases using various methods, including new hand pumps/tube wells at alternative deep aquifers, dug wells, arsenic removal plants, arsenic treatment units, as well as piped and surface water supply schemes. The methods have their own limitations, so it is intended that a pragmatic approach be followed in the arsenicosis prevention drive. It is also intended that the preventive measures be operationally and economically feasible for the people living in the affected

  10. Premature ageing prevention: limitations and perspectives of pharmacological interventions.

    PubMed

    Anisimov, Vladimir N

    2006-11-01

    A significant increase of the elderly in populations of developed countries is followed by increase morbidity and mortality from main age-related diseases--cardiovascular and neuro-degenerative, cancer, diabetes mellitus, declining in a resistance to infections. Obviously, the development of means of the prevention of the premature ageing and these diseases in humans are crucial at present. However, data on such type means rather scarce, contradictory and often not reliable from the points of view of the adequacy of the experiments to current scientific requirements, as well as the interpretation of the results and safety. Available data on the life span extension and adverse effects of chemical compounds and drugs suggested as geroprotectors are critically analyzed: antidiabetic drugs, growth and thyroid hormones, glucocorticoids, DHEA, sex steroids and contraceptives, melatonin and peptide preparations modulating the pineal gland, antioxidants, chelate agents and lathyrogens, adaptogens and herbs, neurotropic drugs, inhibitors of monoamine oxidase, immunomodulators and some other. Most of the results could not convincingly evidence the life span extension and safety of the suggested geroprotectors. We believe that it is necessary to establish an international program for the expert evaluation of the life span extension potential of pharmacological interventions for humans. The scope of the program should be to evaluate chemical, immunological, dietary and behavioural interventions that may lead to life span extension or retard premature ageing and the objective--preparation of critical reviews and evaluations on evidence of the life span extending properties of a wide range of potential geroprotectors and strategies by international groups of working experts. The program may assist national and international authorities in devising programs of health promotion and premature ageing prevention.

  11. Environmental vascular risk factors: new perspectives for stroke prevention.

    PubMed

    Bernal-Pacheco, Oscar; Román, Gustavo C

    2007-11-15

    Despite intensive evaluation of acute stroke patients, perhaps only half of the attributable stroke risk is usually identified. In addition to traditional and non-traditional vascular risk factors-including most recently homocysteine, inflammation, and alterations of coagulation-a number of environmental risk factors for stroke have been identified in the last decade. In this update we review the following: lower education and poor socioeconomic status (probable surrogates for exposure to traditional high-risk behaviors such as smoking, poor nutrition, lack of prenatal control, absence of preventive medical and dental care, and non-compliance of treatment of conditions such as hypertension); depression, stress and affective disorders; obstructive sleep apnea; passive smoking and environmental pollution; infections, in particular periodontal diseases that increase C-reactive protein (CRP); raised body mass index (obesity); exercise, and diet. The possible role of high-fructose corn syrup in the epidemic of obesity in the USA is reviewed. Protective diets include higher consumption of fish, olive oil, grains, fruits and vegetables (Mediterranean diet), as well as probiotic bacteria in yogurt and dairy products. Careful attention should be given to the patient's environment looking for modifiable factors. The effects of clean environmental air and water, adequate diet and appropriate nutrition, healthy teeth, exercise, and refreshing sleep in the prevention of stroke and cardiovascular disease appear to be quite compelling. Although some of these modifiable risk factors lack evidence-based information, judicious clinical sense should be used to counteract the potentially damaging effects of adverse environmental vascular risk factors.

  12. [Prevention of mother-to-child transmission of toxoplasmosis: perspectives].

    PubMed

    Mandelbrot, L

    2012-10-01

    In France, screening for toxoplasmosis is mandatory during pregnancy, whereas it is not performed in most other countries. The rationale for prenatal screening is to allow for several levels of intervention: primary prevention by health education; in case of seroconversion, prophylactic therapy; prenatal diagnosis using amniocentesis; the possibility of termination of pregnancy (TOP) in case of severe cerebral lesions at ultrasound; in most cases of fetal infection, antiparasitic therapy prenatally as well as postnatally. The French Health Authority (Haute Autorité de santé [HAS]) called into question the screening policy, but maintained it for 5 years pending randomized clinical trials. Recent data is available to answer some of the questions, but not the place of prenatal therapy. The sensitivity of prenatal diagnosis has progressed, while the place of TOP has decreased. The incidence of toxoplasmosis in the French population has fallen. Some studies have shown evidence in favor of prenatal therapy for infected fetuses. However, studies of prophylactic therapy are disappointing. These studies are purely observational and concern mostly spiramycine. For the first time, a multicenter randomized clinical trial of prevention of mother-to-child transmission of Toxoplasma gondii is underway (the TOXOGEST study). The HAS guidelines are that any suspected toxoplasmosis seroconversion should be confirmed in a reference laboratory, and that patients should be referred to expert centers without delay. It is not recommeded to start therapy before such expert consultation. The reference centers should provide counseling and access to prenatal diagnosis and therapy options. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  13. Advanced composites: Design and application. Proceedings of the meeting of the Mechanical Failures Prevention Group

    NASA Technical Reports Server (NTRS)

    Shives, T. R.; Willard, W. A.

    1979-01-01

    The design and application of advanced composites is discussed with emphasis on aerospace, aircraft, automotive, marine, and industrial applications. Failure modes in advanced composites are also discussed.

  14. Genistein, a soy phytoestrogen, reverses severe pulmonary hypertension and prevents right heart failure in rats.

    PubMed

    Matori, Humann; Umar, Soban; Nadadur, Rangarajan D; Sharma, Salil; Partow-Navid, Rod; Afkhami, Michelle; Amjedi, Marjan; Eghbali, Mansoureh

    2012-08-01

    Pretreatment with a phytoestrogen genistein has been shown to attenuate the development of pulmonary hypertension (PH). Because PH is not always diagnosed early, we examined whether genistein could also reverse preexisting established PH and prevent associated right heart failure (RHF). PH was induced in male rats by 60 mg/kg of monocrotaline. After 21 days, when PH was well established, rats received daily injection of genistein (1 mg/kg per day) for 10 days or were left untreated to develop RHF by day 30. Effects of genistein on human pulmonary artery smooth muscle cell and endothelial cell proliferation and neonatal rat ventricular myocyte hypertrophy were assessed in vitro. Severe PH was evident 21 days after monocrotaline, as peak systolic right ventricular pressure increased to 66.35±1.03 mm Hg and right ventricular ejection fraction reduced to 41.99±1.27%. PH progressed to RHF by day 30 (right ventricular pressure, 72.41±1.87 mm Hg; RV ejection fraction, 29.25±0.88%), and mortality was ≈75% in RHF rats. Genistein therapy resulted in significant improvement in lung and heart function as right ventricular pressure was significantly reduced to 43.34±4.08 mm Hg and right ventricular ejection fraction was fully restored to 65.67±1.08% similar to control. Genistein reversed PH-induced pulmonary vascular remodeling in vivo and inhibited human pulmonary artery smooth muscle cell proliferation by ≈50% in vitro likely through estrogen receptor-β. Genistein also reversed right ventricular hypertrophy (right ventricular hypertrophy index, 0.35±0.029 versus 0.70±0.080 in RHF), inhibited neonatal rat ventricular myocyte hypertrophy, and restored PH-induced loss of capillaries in the right ventricle. These improvements in cardiopulmonary function and structure resulted in 100% survival by day 30. Genistein restored PH-induced downregulation of estrogen receptor-β expression in the right ventricle and lung. In conclusion, genistein therapy not only rescues

  15. Genistein, a Soy Phytoestrogen, Reverses Severe Pulmonary Hypertension and Prevents Right Heart Failure in Rats

    PubMed Central

    Matori, Humann; Umar, Soban; Nadadur, Rangarajan D.; Sharma, Salil; Partow-Navid, Rod; Afkhami, Michelle; Amjedi, Marjan; Eghbali, Mansoureh

    2014-01-01

    Pretreatment with a phytoestrogen genistein has been shown to attenuate the development of pulmonary hypertension (PH). Because PH is not always diagnosed early, we examined whether genistein could also reverse preexisting established PH and prevent associated right heart failure (RHF). PH was induced in male rats by 60 mg/kg of monocrotaline. After 21 days, when PH was well established, rats received daily injection of genistein (1 mg/kg per day) for 10 days or were left untreated to develop RHF by day 30. Effects of genistein on human pulmonary artery smooth muscle cell and endothelial cell proliferation and neonatal rat ventricular myocyte hypertrophy were assessed in vitro. Severe PH was evident 21 days after monocrotaline, as peak systolic right ventricular pressure increased to 66.35±1.03 mm Hg and right ventricular ejection fraction reduced to 41.99±1.27%. PH progressed to RHF by day 30 (right ventricular pressure, 72.41 ± 1.87 mm Hg; RV ejection fraction, 29.25 ± 0.88%), and mortality was ≈75% in RHF rats. Genistein therapy resulted in significant improvement in lung and heart function as right ventricular pressure was significantly reduced to 43.34±4.08 mm Hg and right ventricular ejection fraction was fully restored to 65.67 ± 1.08% similar to control. Genistein reversed PH-induced pulmonary vascular remodeling in vivo and inhibited human pulmonary artery smooth muscle cell proliferation by ≈50% in vitro likely through estrogen receptor-β. Genistein also reversed right ventricular hypertrophy (right ventricular hypertrophy index, 0.35±0.029 versus 0.70±0.080 in RHF), inhibited neonatal rat ventricular myocyte hypertrophy, and restored PH-induced loss of capillaries in the right ventricle. These improvements in cardiopulmonary function and structure resulted in 100% survival by day 30. Genistein restored PH-induced downregulation of estrogen receptor-β expression in the right ventricle and lung. In conclusion, genistein therapy not only

  16. Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy.

    PubMed

    Lorente-Poch, Leyre; Sancho, Juan; Muñoz, Jose Luis; Gallego-Otaegui, Lander; Martínez-Ruiz, Carlos; Sitges-Serra, Antonio

    2017-03-01

    Parathyroid autotransplantation during total thyroidectomy leads to higher rates of postoperative hypocalcaemia. It has been argued, however, that it prevents permanent hypoparathyroidism. The impact of autografted normal parathyroid gland fragments on long-term parathyroid status has not been assessed properly. To clarify this, the short- and long-term parathyroid function was assessed in patients with three glands remaining in situ after total thyroidectomy, in whom the fourth gland was either autotransplanted (Tx) or accidentally resected (AR). Consecutive patients (n = 669) undergoing first-time total thyroidectomy were prospectively studied recording the number of parathyroid glands remaining in situ: PGRIS =4-(glands autografted + glands in the specimen). The study was focused on the subgroup of 186 patients with three parathyroid glands remaining in situ as a result of either accidental resection (AR, n = 76) or autotransplantation into the sternocleidomastoid muscle (Tx, n = 110). Prevalence of postoperative hypocalcaemia, protracted, and permanent hypoparathyroidism were compared between the two groups. Demographic, disease-related, laboratory, and surgical variables were recorded. All patients were followed for at least 1 year. Both groups were comparable in terms of disease and extent of surgery. Mean postoperative serum calcium was the same (AR: 1.97 ± 0.2 vs Tx: 1.97 ± 0.22 mmol/L). Rates of protracted (AR: 24% vs Tx: 25.5%) and permanent hypoparathyroidism (AR: 5.3% vs Tx: 7.3%) were similar in both groups. The prevalence of parathyroid failure syndromes after total thyroidectomy was similar whether a parathyroid gland was inadvertently excised or autotransplanted. Autotransplantation did not influence the permanent hypoparathyroidism rate.

  17. Condensin and the spindle midzone prevent cytokinesis failure induced by chromatin bridges in C. elegans embryos.

    PubMed

    Bembenek, Joshua N; Verbrugghe, Koen J C; Khanikar, Jayshree; Csankovszki, Györgyi; Chan, Raymond C

    2013-06-03

    During cell division, chromosomes must clear the path of the cleavage furrow before the onset of cytokinesis. The abscission checkpoint in mammalian cells stabilizes the cleavage furrow in the presence of a chromatin obstruction. This provides time to resolve the obstruction before the cleavage furrow regresses or breaks the chromosomes, preventing aneuploidy or DNA damage. Two unanswered questions in the proposed mechanistic pathway of the abscission checkpoint concern factors involved in (1) resolving the obstructions and (2) coordinating obstruction resolution with the delay in cytokinesis. We found that the one-cell and two-cell C. elegans embryos suppress furrow regression following depletion of essential chromosome-segregation factors: topoisomerase II(TOP-2), CENP-A(HCP-3), cohesin, and to a lesser degree, condensin. Chromatin obstructions activated Aurora B(AIR-2) at the spindle midzone, which is needed for the abscission checkpoint in other systems. Condensin I, but not condensin II, localizes to the spindle midzone in anaphase and to the midbody during normal cytokinesis. Interestingly, condensin I is enriched on chromatin bridges and near the midzone/midbody in an AIR-2-dependent manner. Disruption of AIR-2, the spindle midzone, or condensin leads to cytokinesis failure in a chromatin-obstruction-dependent manner. Examination of the condensin-deficient embryos uncovered defects in both the resolution of the chromatin obstructions and the maintenance of the stable cleavage furrow. We postulate that condensin I is recruited by Aurora B(AIR-2) to aid in the resolution of chromatin obstructions and also helps generate a signal to maintain the delay in cytokinesis. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Inhibition of Apoptosis-Regulated Signaling Kinase-1 and Prevention of Congestive Heart Failure by Estrogen

    PubMed Central

    Satoh, Minoru; Matter, Christian M.; Ogita, Hisakazu; Takeshita, Kyosuke; Wang, Chao-Yung; Dorn, Gerald W.; Liao, James K.

    2008-01-01

    Background Epidemiological studies have shown gender differences in the incidence of congestive heart failure (CHF); however, the role of estrogen in CHF is not known. We hypothesize that estrogen prevents cardiomyocyte apoptosis and the development of CHF. Methods and Results 17β-Estradiol (E2, 0.5 mg/60-day release) or placebo pellet was implanted subcutaneously into male Gαq transgenic (Gq) mice. After 8 weeks, E2 treatment decreased the extent of cardiac hypertrophy and dilation and improved contractility in Gq mice. E2 treatment also attenuated nicotinamide adenine dinucleotide phosphate oxidase activity and superoxide anion production via downregulation of Rac1. This correlated with reduced apoptosis in cardiomyocytes of Gq mice. The antioxidative properties of E2 were also associated with increased expression of thioredoxin (Trx), Trx reductases, and Trx reductase activity in the hearts of Gq mice. Furthermore, the activation of apoptosis signal-regulating kinase 1 and its downstream effectors, c-Jun N-terminal kinase and p38 mitogen-activated protein kinase, in the hearts of Gq mice was reduced by long-term E2 treatment. Indeed, E2 (10 nmol/L)-treated cardiomyocytes were much more resistant to angiotensin II–induced apoptosis. These antiapoptotic and cardioprotective effects of E2 were blocked by an estrogen receptor antagonist (ICI 182,780) and by a Trx reductase inhibitor (azelaic acid). Conclusions These findings indicate that long-term E2 treatment improves CHF by antioxidative mechanisms that involve the upregulation of Trx and inhibition of Rac1-mediated attenuated nicotinamide adenine dinucleotide phosphate oxidase activity and apoptosis signal-regulating kinase 1 /c-Jun N-terminal kinase/p38 mitogen-activated protein kinase–mediated apoptosis. These results suggest that estrogen may be a useful adjunctive therapy for patients with CHF. PMID:17562954

  19. Condensin and the spindle midzone prevent cytokinesis failure induced by chromatin bridges in C. elegans embryos

    PubMed Central

    Bembenek, Joshua N.; Verbrugghe, Koen J.C.; Khanikar, Jayshree; Csankovszki, Györgyi; Chan, Raymond C.

    2013-01-01

    Summary Background During cell division, chromosomes must clear the path of the cleavage furrow before the onset of cytokinesis. The abscission checkpoint in mammalian cells stabilizes the cleavage furrow in the presence of a chromatin obstruction. This provides time to resolve the obstruction before the cleavage furrow regresses or breaks the chromosomes, preventing aneuploidy or DNA damage. Two unanswered questions in the proposed mechanistic pathway of the abscission checkpoint concern factors involved in 1) resolving the obstructions, and 2) coordinating obstruction resolution with the delay in cytokinesis. Results We found that the 1-cell and 2-cell C. elegans embryos suppress furrow regression following depletion of essential chromosome segregation factors: topoisomerase IITOP-2, CENP-AHCP-3, cohesin, and to a lesser degree, condensin. Chromatin obstructions activated Aurora BAIR-2 at the spindle midzone, which is needed for the abscission checkpoint in other systems. Condensin I, but not condensin II, localizes to the spindle midzone in anaphase and to the midbody during normal cytokinesis. Interestingly, condensin I is enriched on chromatin bridges and near the midzone/midbody in an AIR-2 dependent manner. Disruption of AIR-2, the spindle midzone or condensin leads to cytokinesis failure in a chromatin-obstruction-dependent manner. Examination of the condensin-deficient embryos uncovered defects in both the resolution of the chromatin obstructions and the maintenance of the stable cleavage furrow. Conclusions We postulate that condensin I is recruited by Aurora BAIR-2 to aid in the resolution of chromatin obstructions and also helps generate a signal to maintain the delay in cytokinesis. PMID:23684975

  20. Fragility Fracture Prevention: Review from a Japanese Perspective

    PubMed Central

    Hagino, Hiroshi

    2012-01-01

    Osteoporosis has been named 舠the silent disease舡 because there are no symptoms until a fragility fracture occurs. With the rapid rise in the elderly population, the number of patients with osteoporosis and fragility fractures has increased in most developed countries. Fragility fractures increase societal burdens in terms of mortality and quality of life, as well as economic costs. Fragility fractures of the hip have the most impact on the ambulatory status of the elderly and its incidence is reported to be lower among Asians or Africans than Caucasians. Increases in the age-specific and gender-specific incidence of hip fracture with time have been reported in Asian countries, including Japan; however, studies in North America, Europe and Oceania have reported decreases in the incidence. A new fragility fracture increases fracture risk, resulting in possible recurrence or other new fractures. The most important strategy for preventing such fractures is a systematic approach to educating and following patients in the immediate postoperative period after the initial fragility fracture. PMID:24031136

  1. Men's perspectives on cancer prevention behaviors associated with HPV.

    PubMed

    FitzGerald, Serena; Cornally, Nicola; Hegarty, Josephine

    2017-07-28

    The human papillomavirus (HPV) is associated with the diagnosis of anal, penile, and oropharyngeal cancers in men. Evidence indicates that correct condom use in addition to obtaining the HPV vaccine provides the greatest protection from HPV infections. To explore young men's beliefs and behavioral intention in relation to receiving the HPV vaccine and using a condom correctly and consistently for sexual contact. A cross-sectional study underpinned by the theory of planned behavior (TPB) was conducted with male participants (n = 359, 18-28 years) who completed an online survey. Descriptive, correlational, and hierarchical regression analyses were performed on both status variables and variables of the TPB. Subjective norms (β = 0.519, P < .001) was identified as the most influential predictor in relation to men's intention to receive the HPV vaccine, while relationship status (β = -0.215, P < .001) and attitudes (β = 0.394, P < .001) presented as the most significant predictors of intention to use a condom. Summarily, 51% of the variance in intention to receive the HPV vaccine and 44% in intention to use a condom were explained by the TPB model. Results from this study will impact on future sexual health research, education programs, and interventions for both HPV preventative behaviors towards the elimination of HPV-related cancers in men. Copyright © 2017 John Wiley & Sons, Ltd.

  2. Stroke prevention in atrial fibrillation--an Asian stroke perspective.

    PubMed

    Tse, Hung-Fat; Wang, Yong-Jun; Ahmed Ai-Abdullah, Moheeb; Pizarro-Borromeo, Annette B; Chiang, Chern-En; Krittayaphong, Rungroj; Singh, Balbir; Vora, Amit; Wang, Chun-Xue; Zubaid, Mohammad; Clemens, Andreas; Lim, Paul; Hu, Dayi

    2013-07-01

    Despite relatively lower prevalence of atrial fibrillation (AF) in Asians (~1%) than in Caucasians (~2%), Asia has a much higher overall disease burden because of its proportionally larger aged population. For example, on the basis of reported age-adjusted prevalence rates and projected population figures in China, there will be an estimated 5.2 million men and 3.1 million women with AF older than 60 years by year 2050. Stroke is a disabling complication of AF that is of increasing cause for concern in Asians patients. Implementing consensus expert recommendations for managing stroke risk in patients with AF can considerably reduce stroke rates. However, caution is necessary when aligning management of Asian patients with AF to that of their Caucasian counterparts. Current international guidelines and risk stratification tools for AF management are based on findings in predominantly Caucasian populations and may therefore have limited relevance, in certain respects, to Asian patients. Oral anticoagulants play an important role in preventing AF-related stroke. The vitamin K antagonist warfarin is recommended for reducing the risk of stroke and thromboembolism in high-risk patients with nonvalvular AF; however, warfarin interacts with many drugs and food ingredients, which may pose significant challenges in administration and monitoring among Asian patients. Further research is needed to inform specific guidance on the implications of different stroke and bleeding profiles in Asians vs Caucasians. Moreover, there is scope to improve physician perceptions and patient knowledge, as well as considering alternative new oral anticoagulants, for example, direct thrombin inhibitors or factor Xa inhibitors. Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  3. Supporting Vulnerable Learners in the Primary Grades: Strategies To Prevent Early School Failure.

    ERIC Educational Resources Information Center

    Stormont, Melissa; Espinosa, Linda; Knipping, Nancy; McCathren, Rebecca

    2003-01-01

    This article provides early elementary school teachers with specific strategies to support the diverse needs of children who are vulnerable for failure in school. Children who are vulnerable include those who have an increased risk for failure because of specific characteristics that have been found to predict problems in school, such as poverty.…

  4. Core Competencies and the Prevention of School Failure and Early School Leaving

    ERIC Educational Resources Information Center

    Bradshaw, Catherine P.; O'Brennan, Lindsey M.; McNeely, Clea A.

    2008-01-01

    There is an increasing awareness that school failure and early school leaving are processes, rather than discrete events, that often co-occur and can have lasting negative effects on children's development. Most of the literature has focused on risk factors for failure and dropout rather than on the promotion of competencies that can increase…

  5. Core Competencies and the Prevention of School Failure and Early School Leaving

    ERIC Educational Resources Information Center

    Bradshaw, Catherine P.; O'Brennan, Lindsey M.; McNeely, Clea A.

    2008-01-01

    There is an increasing awareness that school failure and early school leaving are processes, rather than discrete events, that often co-occur and can have lasting negative effects on children's development. Most of the literature has focused on risk factors for failure and dropout rather than on the promotion of competencies that can increase…

  6. Seminar Proceedings: Prevention of Condenser Failures--The State of the Art

    SciTech Connect

    1985-12-01

    The 21 presentations summarized in this report offer up-to-date guidance to design engineers, plant engineers and chemists, condenser vendors, and others interested in minimizing failures in power plant condensers. Among the highlights are case histories of condenser failures and their countermeasures from Scandinavia, Great Britain, and the United States.

  7. Caregiver perspectives for the prevention, diagnosis and treatment of childhood giardiasis in Havana City, Cuba. A qualitative study.

    PubMed

    Escobedo, Angel A; Almirall, Pedro; Alfonso, Maydel; Avila, Ivonne; Cimerman, Sérgio; Salazar, Yohana; Dawkins, Isabel V; García, Rosa M

    2011-08-01

    Although long considered a non-pathogenic protozoan, Giardia lamblia is now a well recognized cause of abdominal discomfort, diarrhoea and failure-to-thrive in children. The overall prevalence of this infection in Cuban population is about 7.2%; however, higher prevalences have been found among young children attending day-care centres and primary school in the country. Anecdotally, clinical giardiasis is generally considered to place a large burden on both diagnostic and treatment services in Cuba. In order to gain insight into caregivers' perspectives with respect to this infection in children, a qualitative study was carried out in a paediatric hospital in Cuba. Focus group discussions were conducted to gather information about the awareness of the giardiasis, their mode of transmission and symptoms, diagnosis process, treatment seeking behaviour, possible ways of prevention, and barriers for not adopting preventive behaviours, the source and channels of information about this disease. Caregivers have knowledge of giardiasis, although there were myths and misconceptions regarding giardiasis. Manifestations like diarrhoea, abdominal pain and nausea were cited; however, asymptomatic forms of these infections are hardly accepted. Boiling water and washing hands before eating and after defecation and washing vegetables were mentioned among the principal ways of preventing this infection. The most commonly mentioned reasons for not adopting preventive behaviours included lack of time due to outdoor activities and limitation of combustible distribution. Treatment-seeking behaviour when giardiasis suspected mainly included visiting the nearby family doctor. The findings of this study reveal the need for a health education intervention in areas of misperceptions and confusion.

  8. Nurses' perspectives on nurse-coordinated prevention programmes in secondary prevention of cardiovascular disease: a pilot survey

    PubMed Central

    Jorstad, H.T.; Chan, Y.K.; Scholte op Reimer, W.J.M.; Doornenbal, J.; Tijssen, J.G.P.; Peters, R.J.G.

    2015-01-01

    Background: Secondary prevention of coronary artery disease (CAD) is increasingly provided by nurse-coordinated prevention programs (NCPP). Little is known about nurses’ perspectives on these programs. Aim: To investigate nurses’ perspectives/experiences in NCPPs in acute coronary syndrome patients. Methods: Thirteen nurses from NCPPs in 11 medical centers in the RESPONSE trial completed an online survey containing 45 items evaluating 3 outcome categories: (1) conducting NCPP visits; (2) effects of NCPP interventions on risk profiles and (3) process of care. Results: Nurses felt confident in counseling/motivating patients to reduce CAD risk. Interventions targeting LDL, blood pressure and medication adherence were reported as successful, corresponding with significant improvements of these risk factors. Improving weight, smoking and physical activity was reported as less effective. Screening for anxiety/depression was suggested as an improvement. Conclusions: Nurses acknowledge the importance and effectiveness of NCPPs, and correctly identify which components of the program are the most successful. Our study provides a basis for implementation and quality improvement for NCCPs. PMID:26572788

  9. The causes and prevention of cancer: gaining perspective.

    PubMed Central

    Ames, B N; Gold, L S

    1997-01-01

    Epidemiological studies have identified several factors that are likely to have a major effect on reducing rates of cancer: reduction of smoking, increased consumption of fruits and vegetables, and control of infections. Other factors include avoidance of intense sun exposure, increased physical activity, and reduced consumption of alcohol and possibly red meat. Risks of many types of cancer can already be reduced, and the potential for further reductions is great. In the United States, cancer death rates for all cancers combined are decreasing, if lung cancer (90% of which is due to smoking), is excluded from the analysis. We review the research on causes of cancer and show why much cancer is preventable. The idea that traces of synthetic chemicals, such as DDT, are major contributors to human cancer is not supported by the evidence, yet public concern and resource allocation for reduction of chemical pollution are very high, in part because standard risk assessment uses linear extrapolation from limited data in high-dose animal cancer tests. These tests are done at the maximum tolerated dose (MTD) and are typically misinterpreted to mean that low doses of synthetic chemicals and industrial pollutants are relevant to human cancer. About half the chemicals tested, whether synthetic or natural, are carcinogenic to rodents at such high doses. Almost all chemicals in the human diet are natural. For example, 99.99% of the pesticides we eat are naturally present in plants to ward off insects and other predators. Half of the natural pesticides that have been tested at the MTD are rodent carcinogens. Cooking food produces large numbers of natural dietary chemicals. Roasted coffee, for example, contains more than 1000 chemicals: of 27 tested, 19 are rodent carcinogens. Increasing evidence supports the idea that the high frequency of positive results in rodent bioassays is due to testing at the MTD, which frequently can cause chronic cell killing and consequent cell

  10. Prevention preferable to treatment: 3 case reports of patients experiencing right-sided heart failure after Ebstein anomaly correction

    PubMed Central

    Luo, Ming; Lin, Jing; Qin, Zhen; Du, Lei

    2017-01-01

    Abstract Rationale: Ebstein anomaly is a common congenital heart disease that may induce severe tricuspid regurgitation and dilation of the “atrialized” portion of the right ventricle. Patients who undergo surgery to correct Ebstein anomaly are at high risk of postoperative right-sided heart failure, yet little is known about what pre-, peri-, or postoperative procedures may help reduce this risk. Patient concerns: Here, we describe 3 cases of adults with Ebstein anomaly who underwent corrective surgery and in whom right-sided heart failure occurred with severe tricuspid regurgitation detected by transesophageal echocardiography. Diagnoses: Ebstein anomaly. Intervention: Various approaches were applied to prevent right heart failure: perioperative control of atrial and ventricle arrhythmia, protection of myocardium, reduction of right-side cardiac workload after cardiopulmonary bypass, and mechanical support for right heart. Outcomes: One of the 3 patients died, another experienced kidney failure despite postoperative support on extracorporeal membrane oxygenation, and the third patient survived without complications. Lessons: Our case series suggests that surgical prognosis can be improved through aggressive preoperative treatment, vasoactive and anti-arrhythmia medications, and comprehensive measures designed to reduce myocardial injury, prevent myocardial edema, and reduce pre- and afterload on the right ventricle. PMID:28072699

  11. Role of the family in suicide prevention: an attachment and family systems perspective.

    PubMed

    Lobo Prabhu, Sheila; Molinari, Victor; Bowers, Theron; Lomax, James

    2010-01-01

    Suicide can be an act of despair, anger, or escape from intolerable pain associated with prior bonding disturbances within the family system, interpersonal loss, and current perceived lack of social support. Using a variety of online databases, the authors examined the research on the family's role in preventing suicide from an attachment and family systems perspective. They found relevant articles describing how to make use of family support in suicide prevention. From a study of the literature, the authors outline three new family concepts in suicide prevention: family cohesion, family adhesion, and formation of a new family. Therapists should use every familial resource to avoid premature closure and to expand perception of support options. The authors suggest specific practice recommendations to successfully involve families in suicide prevention based on the outlined family conceptual framework, and they recommend research investigation to determine empirical validation of these tentative formulations.

  12. Aligning product development and user perspectives: social-behavioural dimensions of multipurpose prevention technologies.

    PubMed

    Brady, M; Tolley, E

    2014-10-01

    Multipurpose prevention technologies provide a compelling response to the multiple and reinforcing sexual and reproductive health risks faced by women globally. To ensure that this potential is realised, product-specific characteristics and their social-behavioural correlates must be considered early in the product development process. This paper provides an overview of the key user-related social and behavioural dimensions of three broad categories of multipurpose prevention technologies: 1) sustained release vaginal rings, 2) pericoital vaginal products, and 3) co-formulated or co-administered injectables. The authors build upon the broad parameters of Target Product Profiles for such products, aligning them with user perspective considerations.

  13. Economic Statistical Design of Integrated X-bar-S Control Chart with Preventive Maintenance and General Failure Distribution

    PubMed Central

    Caballero Morales, Santiago Omar

    2013-01-01

    The application of Preventive Maintenance (PM) and Statistical Process Control (SPC) are important practices to achieve high product quality, small frequency of failures, and cost reduction in a production process. However there are some points that have not been explored in depth about its joint application. First, most SPC is performed with the X-bar control chart which does not fully consider the variability of the production process. Second, many studies of design of control charts consider just the economic aspect while statistical restrictions must be considered to achieve charts with low probabilities of false detection of failures. Third, the effect of PM on processes with different failure probability distributions has not been studied. Hence, this paper covers these points, presenting the Economic Statistical Design (ESD) of joint X-bar-S control charts with a cost model that integrates PM with general failure distribution. Experiments showed statistically significant reductions in costs when PM is performed on processes with high failure rates and reductions in the sampling frequency of units for testing under SPC. PMID:23527082

  14. Economic Statistical Design of integrated X-bar-S control chart with Preventive Maintenance and general failure distribution.

    PubMed

    Caballero Morales, Santiago Omar

    2013-01-01

    The application of Preventive Maintenance (PM) and Statistical Process Control (SPC) are important practices to achieve high product quality, small frequency of failures, and cost reduction in a production process. However there are some points that have not been explored in depth about its joint application. First, most SPC is performed with the X-bar control chart which does not fully consider the variability of the production process. Second, many studies of design of control charts consider just the economic aspect while statistical restrictions must be considered to achieve charts with low probabilities of false detection of failures. Third, the effect of PM on processes with different failure probability distributions has not been studied. Hence, this paper covers these points, presenting the Economic Statistical Design (ESD) of joint X-bar-S control charts with a cost model that integrates PM with general failure distribution. Experiments showed statistically significant reductions in costs when PM is performed on processes with high failure rates and reductions in the sampling frequency of units for testing under SPC.

  15. Prevention and management of treatment failure to new oral hepatitis C drugs.

    PubMed

    Benítez-Gutiérrez, Laura; Barreiro, Pablo; Labarga, Pablo; de Mendoza, Carmen; Fernandez-Montero, José V; Arias, Ana; Peña, José M; Soriano, Vicente

    2016-06-01

    Chronic hepatitis C virus (HCV) infection has become a curable disease. Sustained virologic response rates above 90% have been achieved with recommended direct-acting antiviral (DAA) combinations in most registration trials. However, outcomes in real-world patients are lower. In patients experiencing DAA failure, resistance-associated variants (RAVs) are almost universally selected. At this time it is unclear when and how to re-treat hepatitis C in patients with prior DAA failure. The rate of DAA failure and predictors of lack of treatment response using distinct DAA combinations are analyzed. We discuss the management of HCV treatment failure and the impact of RAVs on re-treatment strategies. Failure to DAA combinations occurs more often in chronic hepatitis C patients with baseline predictors of poor response, such as those with RAVs, genotypes 3 or 1a, advanced liver cirrhosis, elevated serum HCV-RNA and perhaps HIV coinfection. Impaired antiviral efficacy is more frequent when multiple factors are present. On-treatment predictors of DAA failure are poor drug adherence and development of side effects. Extending the length of therapy, adding ribavirin and/or using DAA from other drug families may allow successful re-treatment of most prior DAA failures.

  16. Policy and Prevention Approaches for Disordered and Hazardous Gaming and Internet Use: an International Perspective.

    PubMed

    King, Daniel L; Delfabbro, Paul H; Doh, Young Yim; Wu, Anise M S; Kuss, Daria J; Pallesen, Ståle; Mentzoni, Rune; Carragher, Natacha; Sakuma, Hiroshi

    2017-07-04

    Problems related to high levels of gaming and Internet usage are increasingly recognized as a potential public health burden across the developed world. The aim of this review was to present an international perspective on prevention strategies for Internet gaming disorder and related health conditions (e.g., Internet addiction), as well as hazardous gaming and Internet use. A systematic review of quantitative research evidence was conducted, followed by a search of governmental reports, policy and position statements, and health guidelines in the last decade. The regional scope included the USA, UK, Australia, China, Germany, Japan, and South Korea. Prevention studies have mainly involved school-based programs to train healthier Internet use habits in adolescents. The efficacy of selective prevention is promising but warrants further empirical attention. On an international scale, the formal recognition of gaming or Internet use as a disorder or as having quantifiable harms at certain levels of usage has been foundational to developing structured prevention responses. The South Korean model, in particular, is an exemplar of a coordinated response to a public health threat, with extensive government initiatives and long-term strategic plans at all three levels of prevention (i.e., universal, selective, and indicated). Western regions, by comparison, are dominated by prevention approaches led by non-profit organizations and private enterprise. The future of prevention of gaming and Internet problems ultimately relies upon all stakeholders working collaboratively in the public interest, confronting the reality of the evidence base and developing practical, ethical, and sustainable countermeasures.

  17. A marketing perspective on disseminating evidence-based approaches to disease prevention and health promotion.

    PubMed

    Maibach, Edward W; Van Duyn, Mary Ann S; Bloodgood, Bonny

    2006-07-01

    Evidence-based disease prevention practice guidelines can provide a rationale for health programming decisions, which should, in turn, lead to improved public health outcomes. This logic has stimulated the creation of a growing number of evidence-based prevention practice guidelines, including the Guide to Community Preventive Services. Few systematic efforts have been made to document the degree of adoption and implementation of these approaches, although the evidence on translation of research into practice in other health fields indicates that the adoption and implementation rate is low. Drawing on the marketing literature, we suggest three approaches to enhance the adoption and implementation of evidence-based approaches: 1) conducting consumer research with prospective adopters to identify their perspectives on how evidence-based prevention programs can advance their organization's mission, 2) building sustainable distribution channels to promote and deliver evidence-based programs to prospective adopters, and 3) improving access to easily implemented programs that are consistent with evidence-based guidelines. Newly emerging paradigms of prevention research (e.g., RE-AIM) that are more attuned to the needs of the marketplace will likely yield a new generation of evidence-based preventive approaches that can be more effectively disseminated. We suggest that the public health community prioritize the dissemination of evidence-based prevention approaches, because doing so is a potent environmental change strategy for enhancing health.

  18. Predicting and preventing peripheral intravenous cannula insertion failure in the emergency department: Clinician 'gestalt' wins again.

    PubMed

    Rippey, James Cr; Carr, Peter J; Cooke, Marie; Higgins, Niall; Rickard, Claire M

    2016-12-01

    Failed attempts at peripheral i.v. cannula (PIVC) insertion in the ED are common. The psychological, physical and economic impact of these failures is significant. We sought to explore whether clinicians of differing experience levels can predict their own likelihood (clinician 'gestalt') of first-time cannula insertion success on any given patient. Data analyses from a prospective self-reported study assessing risk factors for first-time insertion success in a tertiary adult ED. We constructed and compared two simple theoretical clinical decision algorithms in an attempt to improve first-time PIVC insertion success rates. This best algorithm identified a subgroup of 18% of the total PIVC population at higher risk of failure. This 18% comprised 57% of all PIVC failures, and implementation would result in a relative risk reduction of PIVC failure by 31%. When applied to our sample population, an algorithm relying on clinician gestalt to identify patients at high risk of PIVC failure had the greatest potential impact. These patients would be referred to expert PIVC inserters prior to, rather than after, failed attempts. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  19. Perspectives on preventive health care and barriers to breast cancer screening among Iraqi women refugees.

    PubMed

    Saadi, Altaf; Bond, Barbara; Percac-Lima, Sanja

    2012-08-01

    Since the Iraq war began in 2003, over 4 million Iraqis have been displaced. Little is known about preventive cancer care in this population, but stark disparities have been documented. The purpose of this study was to assess the perspectives of Iraqi women refugees on preventive care and perceived barriers to breast cancer screening. Interviews were conducted in Arabic with twenty Iraqi refugee women by a bilingual (English/Arabic) medical student, transcribed, translated and coded according to established qualitative content and thematic analysis procedures. Psychosocial barriers, culturally mediated beliefs, and health consequences of war were identified as major themes, ultimately showing what factors, alone and collectively, have impeded Iraqi refugee women's ability and motivation to obtain breast cancer screening. To improve cancer prevention and decrease disparities in care in this most vulnerable population, culturally appropriate health education and outreach programs, as well as further community-level targeted studies, are needed.

  20. Resident dendritic cells prevent postischemic acute renal failure by help of single Ig IL-1 receptor-related protein.

    PubMed

    Lech, Maciej; Avila-Ferrufino, Alejandro; Allam, Ramanjaneyulu; Segerer, Stephan; Khandoga, Alexander; Krombach, Fritz; Garlanda, Cecilia; Mantovani, Alberto; Anders, Hans-Joachim

    2009-09-15

    Ischemia-reperfusion (IR) triggers tissue injury by activating innate immunity, for example, via TLR2 and TLR4. Surprisingly, TLR signaling in intrinsic renal cells predominates in comparison to intrarenal myeloid cells in the postischemic kidney. We hypothesized that immune cell activation is specifically suppressed in the postischemic kidney, for example, by single Ig IL-1-related receptor (SIGIRR). SIGIRR deficiency aggravated postischemic acute renal failure in association with increased renal CXCL2/MIP2, CCL2/MCP-1, and IL-6 mRNA expression 24 h after IR. Consistent with this finding interstitial neutrophil and macrophage counts were increased and tubular cell necrosis was aggravated in Sigirr-deficient vs wild-type IR kidneys. In vivo microscopy revealed increased leukocyte transmigration in the postischemic microvasculature of Sigirr-deficient mice. IL-6 and CXCL2/MIP2 release was much higher in Sigirr-deficient renal myeloid cells but not in Sigirr-deficient tubular epithelial cells after transient hypoxic culture conditions. Renal IR studies with chimeric mice confirmed this finding, as lack of SIGIRR in myeloid cells largely reproduced the phenotype of renal IR injury seen in Sigirr(-/-) mice. Additionally, clodronate depletion of dendritic cells prevented the aggravated renal failure in Sigirr(-/-) mice. Thus, loss of function mutations in the SIGIRR gene predispose to acute renal failure because SIGIRR prevents overshooting tissue injury by suppressing the postischemic activation of intrarenal myeloid cells.

  1. ISS Ammonia Pump Failure, Recovery, and Lesson Learned A Hydrodynamic Bearing Perspective

    NASA Technical Reports Server (NTRS)

    Bruckner, Robert J.; Manco, Richard A., II

    2014-01-01

    The design, development, and operation of long duration spaceflight hardware has become an evolutionary process in which meticulous attention to details and lessons learned from previous experiences play a critical role. Invaluable to this process is the ability to retrieve and examine spaceflight hardware that has experienced a premature failure. While these situations are rare and unfortunate, the failure investigation and recovery from the event serve a valuable purpose in advancing future space mechanism development. Such a scenario began on July 31, 2010 with the premature failure of an ammonia pump on the external active thermal control system of the International Space Station. The ground-based inspections of the returned pump and ensuing failure investigation revealed five potential bearing forces that were un-accounted for in the design phase and qualification testing of the pump. These forces could combine in a number of random orientations to overload the pump bearings leading to solid-surface contact, wear, and premature failure. The recovery plan identified one of these five forces as being related to the square of the operating speed of the pump and this fact was used to recover design life through a change in flight rules for the operation of the pump module. Through the course of the failure investigation, recovery, and follow-on assessment of pump wear life, design guidance has been developed to improve the life of future mechanically pumped thermal control systems for both human and robotic exploration missions.

  2. F 16915 prevents heart failure-induced atrial fibrillation: a promising new drug as upstream therapy.

    PubMed

    Le Grand, Bruno; Letienne, Robert; Dupont-Passelaigue, Elisabeth; Lantoine-Adam, Frédérique; Longo, Frédéric; David-Dufilho, Monique; Michael, Georghia; Nishida, Kunihiro; Catheline, Daniel; Legrand, Philippe; Hatem, Stéphane; Nattel, Stanley

    2014-07-01

    Atrial fibrillation (AF) is a common complication of heart failure. The aim of the present study was to investigate the effects of a new pure docosahexaenoic acid derivative called F 16915 in experimental models of heart failure-induced atria dysfunction. The atrial dysfunction-induced AF was investigated (1) in a dog model of tachypacing-induced congestive heart failure and (2) in a rat model of heart failure induced by occlusion of left descending coronary artery and 2 months reperfusion. F 16915 (5 g/day for 4 weeks) significantly reduced the mean duration of AF induced by burst pacing in the dog model (989 ± 111 s in the vehicle group to 79 ± 59 s with F 16915, P < 0.01). This dose of F 16915 also significantly reduced the incidence of sustained AF (5/5 dogs in the vehicle group versus 1/5 with F 16915, P < 0.05). In the rat model, the percentage of shortening fraction in the F 16915 group (100 mg/kg p.o. daily) was significantly restored after 2 months (32.6 ± 7.4 %, n = 9 vs 17.6 ± 3.4 %, n = 9 in the vehicle group, P < 0.01). F 16915 also reduced the de-phosphorylation of connexin43 from atria tissue. The present results show that treatment with F 16915 reduced the heart dilation, resynchronized the gap junction activity, and reduced the AF duration in models of heart failure. Thus, F 16915 constitutes a promising new drug as upstream therapy for the treatment of AF in patients with heart failure.

  3. Effect of fluid therapy on prevention of acute renal failure in Bam earthquake crush victims.

    PubMed

    Sagheb, Mohammad Mahdi; Sharifian, Maryam; Roozbeh, Jamshid; Moini, Maryam; Gholami, Khodakaram; Sadeghi, Hossein

    2008-01-01

    At 5:28 a.m. (local time) on December 26, 2003, an earthquake measuring 6.51 on the Richter scale struck the city of Bam in the Kerman Province in southeastern Iran. Among the most important morbid events in survivors were acute renal problems. Clinical findings, laboratory data, and management of the renal victims, all of whom were transferred to Shiraz Hospitals, have been the subject of this analysis. Medical records of twenty patients with acute renal failure admitted to three university hospitals and one community hospital were reviewed. Overall, 801 patients were transferred to Shiraz hospitals, of whom 20 (mean age 36.2 +/- 14.8 years, 15 males) developed acute renal failure with mean duration of 14.5 +/- 9.6 days. Total mortality was 21 (2.6%) and acute renal failure mortality was 3 (15%). Seven patients received standard fluid therapy and 13 patients received variable volume treatment. In total, 79 dialysis sessions were performed in 15 patients (mean 5.2, 3.3 +/- 1 sessions per patients). There was a positive correlation between time spent under rubble and peak serum CK (creatine phosphokinase) level (p = 0.035), acute renal failure duration (p = 0.047), and admission potassium levels (p = 0.033). Serum CK level was positively correlated with acute renal failure duration (p = 0.008). Patients who had received standard treatment had significantly shorter duration of acute renal failure (7.1 versus 9.4 days, p = 0.008) and less need for dialysis (1 versus 6, p = 0.007) than patients who were treated variably. In victims of earthquake, time spent under rubble and peak serum CK level can serve to estimate morbidity, and early standard treatment may decrease renal morbidity.

  4. Compliance with infection prevention and control in oral health-care facilities: a global perspective.

    PubMed

    Oosthuysen, Jeanné; Potgieter, Elsa; Fossey, Annabel

    2014-12-01

    Many publications are available on the topic of compliance with infection prevention and control in oral health-care facilities all over the world. The approaches of developing and developed countries show wide variation, but the principles of infection prevention and control are the same globally. This study is a systematic review and global perspective of the available literature on infection prevention and control in oral health-care facilities. Nine focus areas on compliance with infection-control measures were investigated: knowledge of infectious occupational hazards; personal hygiene and care of hands; correct application of personal protective equipment; use of environmental barriers and disposable items; sterilisation (recirculation) of instruments and handpieces; disinfection (surfaces) and housekeeping; management of waste disposal; quality control of dental unit waterlines, biofilms and water; and some special considerations. Various international studies from developed countries have reported highly scientific evidence-based information. In developed countries, the resources for infection prevention and control are freely available, which is not the case in developing countries. The studies in developing countries also indicate serious shortcomings with regard to infection prevention and control knowledge and education in oral health-care facilities. This review highlights the fact that availability of resources will always be a challenge, but more so in developing countries. This presents unique challenges and the opportunity for innovative thinking to promote infection prevention and control.

  5. Aircraft Loss-of-Control Accident Prevention: Switching Control of the GTM Aircraft with Elevator Jam Failures

    NASA Technical Reports Server (NTRS)

    Chang, Bor-Chin; Kwatny, Harry G.; Belcastro, Christine; Belcastro, Celeste

    2008-01-01

    Switching control, servomechanism, and H2 control theory are used to provide a practical and easy-to-implement solution for the actuator jam problem. A jammed actuator not only causes a reduction of control authority, but also creates a persistent disturbance with uncertain amplitude. The longitudinal dynamics model of the NASA GTM UAV is employed to demonstrate that a single fixed reconfigured controller design based on the proposed approach is capable of accommodating an elevator jam failure with arbitrary jam position as long as the thrust control has enough control authority. This paper is a first step towards solving a more comprehensive in-flight loss-of-control accident prevention problem that involves multiple actuator failures, structure damages, unanticipated faults, and nonlinear upset regime recovery, etc.

  6. Primary Prevention of Reading Failure: Effect of Universal Peer Tutoring in the Early Grades

    ERIC Educational Resources Information Center

    Jones, Giavana; Ostojic, Dragana; Menard, Jessica; Picard, Erin; Miller, Carlin J.

    2017-01-01

    Reading is typically considered a survival skill in our technology- and literacy-bound culture. Individuals who struggle with learning to read are at significantly elevated risk for a number of negative outcomes, including school failure, under- and unemployment, and special education placement. Thus, those who do not learn to read fluently will…

  7. High saturated fat feeding prevents left ventricular dysfunction and enhances mitochondrial function in heart failure

    USDA-ARS?s Scientific Manuscript database

    Accumulation of lipids in the heart is associated with contractile dysfunction, and has been proposed to be a causative factor in mitochondrial dysfunction. We have previously shown that administration of a high saturated fat diet in heart failure (HF) increased mitochondrial respiration and ETC com...

  8. Primary Prevention of Reading Failure: Effect of Universal Peer Tutoring in the Early Grades

    ERIC Educational Resources Information Center

    Jones, Giavana; Ostojic, Dragana; Menard, Jessica; Picard, Erin; Miller, Carlin J.

    2017-01-01

    Reading is typically considered a survival skill in our technology- and literacy-bound culture. Individuals who struggle with learning to read are at significantly elevated risk for a number of negative outcomes, including school failure, under- and unemployment, and special education placement. Thus, those who do not learn to read fluently will…

  9. CONSIDERATIONS FOR FAILURE PREVENTION IN AEROSPACEELECTRICAL POWER SYSTEMS UTILIZING HIGHER VOLTAGES

    DTIC Science & Technology

    2017-07-01

    relatively low in terms of those found on land -based power systems, moving to higher voltage thresholds introduces an increased likelihood of... pollution on a coated surface can lead to tracking damage. Thermo-mechanical stressing due to large rapid temperature cycle changes can fatigue...coatings, increasing the chance of cracking, pollution ingress, and subsequent failure, particularly at lower temperatures where material glass

  10. Genetic deletion of myostatin from the heart prevents skeletal muscle atrophy in heart failure

    PubMed Central

    Heineke, Joerg; Auger-Messier, Mannix; Xu, Jian; Sargent, Michelle; York, Allen; Welle, Stephen; Molkentin, Jeffery D.

    2010-01-01

    Background Cardiac cachexia is characterized by an exaggerated loss of skeletal muscle, weakness, and exercise intolerance, although the etiology of these effects remains unknown. Here we hypothesized that the heart functions as an endocrine organ in promoting systemic cachexia by secreting peptide factors such as myostatin. Myostatin is a cytokine of the transforming growth factor β(TGFβ) superfamily that is known to control muscle wasting. Methods and Results We used a Cre/loxP system to ablate myostatin (Mstn gene) expression in a celltype-specific manner. As expected, elimination of Mstn selectively in skeletal muscle with a myosin light chain 1f (MLC1f)-cre allele induced robust hypertrophy in all skeletal muscle. However, heart-specific deletion of Mstn with a Nkx2.5-cre allele did not alter baseline heart size or secondarily affect skeletal muscle size, but the characteristic wasting and atrophy of skeletal muscle that typifies heart failure was not observed in these heart-specific null mice, indicating that myocardial myostatin expression controls muscle atrophy in heart failure. Indeed, myostatin levels in the plasma were significantly increased in wildtype mice subjected to pressure overload-induced cardiac hypertrophy, but not in Mstn heart-specific deleted mice. Moreover, cardiac-specific overexpression of myostatin, which increased circulating levels of myostatin by 3–4-fold, caused a reduction in weight of the quadriceps, gastrocnemius, soleus, and even the heart itself. Lastly, to investigate myostatin as a potential therapeutic target for the treatment of muscle wasting in heart failure, we infused a myostatin blocking antibody (JA-16), which promoted greater maintenance of muscle mass in heart failure. Conclusions Myostatin released from cardiomyocytes induces skeletal muscle wasting in heart failure. Targeted inhibition of myostatin in cardiac cachexia might be a therapeutic option in the future. PMID:20065166

  11. Genetic deletion of myostatin from the heart prevents skeletal muscle atrophy in heart failure.

    PubMed

    Heineke, Joerg; Auger-Messier, Mannix; Xu, Jian; Sargent, Michelle; York, Allen; Welle, Stephen; Molkentin, Jeffery D

    2010-01-26

    Cardiac cachexia is characterized by an exaggerated loss of skeletal muscle, weakness, and exercise intolerance, although the cause of these effects remains unknown. Here, we hypothesized that the heart functions as an endocrine organ in promoting systemic cachexia by secreting peptide factors such as myostatin. Myostatin is a cytokine of the transforming growth factor-beta superfamily that is known to control muscle wasting. We used a Cre/loxP system to ablate myostatin (Mstn gene) expression in a cell type-specific manner. As expected, elimination of Mstn selectively in skeletal muscle with a myosin light chain 1f (MLC1f)-cre allele induced robust hypertrophy in all skeletal muscle. However, heart-specific deletion of Mstn with an Nkx2.5-cre allele did not alter baseline heart size or secondarily affect skeletal muscle size, but the characteristic wasting and atrophy of skeletal muscle that typify heart failure were not observed in these heart-specific null mice, indicating that myocardial myostatin expression controls muscle atrophy in heart failure. Indeed, myostatin levels in the plasma were significantly increased in wild-type mice subjected to pressure overload-induced cardiac hypertrophy but not in Mstn heart-specific deleted mice. Moreover, cardiac-specific overexpression of myostatin, which increased circulating levels of myostatin by 3- to 4-fold, caused a reduction in weight of the quadriceps, gastrocnemius, soleus, and even the heart itself. Finally, to investigate myostatin as a potential therapeutic target for the treatment of muscle wasting in heart failure, we infused a myostatin blocking antibody (JA-16), which promoted greater maintenance of muscle mass in heart failure. Myostatin released from cardiomyocytes induces skeletal muscle wasting in heart failure. Targeted inhibition of myostatin in cardiac cachexia might be a therapeutic option in the future.

  12. Psychosis Prevention: A Modified Clinical High Risk Perspective From the Recognition and Prevention (RAP) Program

    PubMed Central

    Cornblatt, Barbara A.; Carrión, Ricardo E.; Auther, Andrea; McLaughlin, Danielle; Olsen, Ruth H.; John, Majnu; Correll, Christoph U.

    2016-01-01

    Objective Early intervention and prevention of psychosis remain a major challenge. Prediction would be greatly advanced with improved ability to identify individuals at true risk, which, at present, is moderate at best. The authors tested a modified strategy to improve prediction by selecting a more homogeneous high-risk sample (attenuated positive symptom criteria only, age range of mid-teens to early 20s) than is currently standard, combined with a systematic selection of neurodevelopmental deficits. Method A sample of 101 treatment-seeking adolescents (mean age, 15.9 years) at clinical high risk for psychosis were followed clinically for up to 5 years (mean follow-up time, 3.0 years, SD=1.6). Adolescents were included only if they exhibited one or more attenuated positive symptoms at moderate to severe, but not psychotic, severity levels. Cox regression was used to derive a risk index. Results The overall conversion rate to psychosis was 28.3%. The final predictor model, with a positive predictive validity of 81.8%, consisted of four variables: disorganized communication, suspiciousness, verbal memory deficits, and decline in social functioning during follow-up. Significant effects also suggest narrowing the risk age range to 15–22 years. Conclusions Clinical high risk criteria that emphasize disorganized communication and suspiciousness while also including compromised verbal memory and declining social functioning have the potential to improve predictive accuracy compared with attenuated positive symptoms used alone. On the resulting risk index (a weighted combination of the predictors), low scores were interpreted as signifying minimal risk, with little treatment necessary, high scores as suggesting aggressive intervention, and intermediate scores, although less informative, as supporting psychosocial treatment. PMID:26046336

  13. EPA, not DHA, prevents fibrosis in pressure overload-induced heart failure: potential role of free fatty acid receptor 4.

    PubMed

    Eclov, Julie A; Qian, Qingwen; Redetzke, Rebecca; Chen, Quanhai; Wu, Steven C; Healy, Chastity L; Ortmeier, Steven B; Harmon, Erin; Shearer, Gregory C; O'Connell, Timothy D

    2015-12-01

    Heart failure with preserved ejection fraction (HFpEF) is half of all HF, but standard HF therapies are ineffective. Diastolic dysfunction, often secondary to interstitial fibrosis, is common in HFpEF. Previously, we found that supra-physiologic levels of ω3-PUFAs produced by 12 weeks of ω3-dietary supplementation prevented fibrosis and contractile dysfunction following pressure overload [transverse aortic constriction (TAC)], a model that resembles aspects of remodeling in HFpEF. This raised several questions regarding ω3-concentration-dependent cardioprotection, the specific role of EPA and DHA, and the relationship between prevention of fibrosis and contractile dysfunction. To achieve more clinically relevant ω3-levels and test individual ω3-PUFAs, we shortened the ω3-diet regimen and used EPA- and DHA-specific diets to examine remodeling following TAC. The shorter diet regimen produced ω3-PUFA levels closer to Western clinics. Further, EPA, but not DHA, prevented fibrosis following TAC. However, neither ω3-PUFA prevented contractile dysfunction, perhaps due to reduced uptake of ω3-PUFA. Interestingly, EPA did not accumulate in cardiac fibroblasts. However, FFA receptor 4, a G protein-coupled receptor for ω3-PUFAs, was sufficient and required to block transforming growth factor β1-fibrotic signaling in cultured cardiac fibroblasts, suggesting a novel mechanism for EPA. In summary, EPA-mediated prevention of fibrosis could represent a novel therapy for HFpEF.

  14. A perspective on sympathetic renal denervation in chronic congestive heart failure.

    PubMed

    Madanieh, Raef; El-Hunjul, Mohammed; Alkhawam, Hassan; Kosmas, Constantine E; Madanieh, Abed; Vittorio, Timothy J

    2016-01-01

    Medical therapy has indisputably been the mainstay of management for chronic congestive heart failure. However, a significant percentage of patients continue to experience worsening heart failure (HF) symptoms despite treatment with multiple therapeutic agents. Recently, catheter-based interventional strategies that interrupt the renal sympathetic nervous system have shown promising results in providing better symptom control in patients with HF. In this article, we will review the pathophysiology of HF for better understanding of the interplay between the cardiovascular system and the kidney. Subsequently, we will briefly discuss pivotal renal denervation (RDN) therapy trials in patients with resistant hypertension and then present the available evidence on the role of RDN in HF therapy.

  15. Patterns of perspectives on fall-prevention beliefs by community-dwelling older adults: a Q method investigation.

    PubMed

    Chen, Shueh-Fen; Huang, Su-Fei; Lu, Li-Ting; Wang, Mei-Chuen; Liao, Jung-Yu; Guo, Jong-Long

    2016-07-07

    Falling has high incidence and reoccurrence rates and is an essential factor contributing to accidental injury or death for older adults. Enhancing the participation of community-dwelling older adults in fall-prevention programs is crucial. Understanding fall-prevention beliefs will be beneficial for developing a community-based fall-prevention program. The aim of the present study was to identify the distinct types of subjective views on the fall-prevention beliefs of community-dwelling older adults aged 80 years and older by applying the Q method. The Q method was adopted to investigate the pattern of perception on fall-prevention beliefs. Forty-two older adults aged 80 - 92 years from a community care center in Northern Taiwan were recruited and requested to complete a Q-sorting. A series of Q-sorts was performed by the participants to rank 30 statements into a normal distribution Q-sort grid. The Q-sorts were subjected to principal component analysis by using PQMethod software Version 2.35. Four statistically independent perspectives were derived from the analysis and reflected distinct viewpoints on beliefs related to fall prevention. Participants in the Considerate perspective believed that health problems caused by falling were serious and fall prevention could decrease the burden they place on their family. Participants in the Promising perspective believed that existing health problems could cause a fall and that fall prevention contributed to their well-being. Participants in the Adaptable perspective perceived low barriers to execute fall prevention and displayed self-confidence and independence in preventing falls. Participants in the Ignorance perspective believed that they could not prevent falls and perceived barriers to fall prevention. By combining theoretical constructs and the Q methodology approach, this study identified four distinct perspectives on fall prevention among community-dwelling older adults. Critical reflection on older adult

  16. Preventing Filipino Mental Health Disparities: Perspectives from Adolescents, Caregivers, Providers, and Advocates.

    PubMed

    Javier, Joyce R; Supan, Jocelyn; Lansang, Anjelica; Beyer, William; Kubicek, Katrina; Palinkas, Lawrence A

    2014-12-01

    Filipino Americans are the second largest immigrant population and second largest Asian ethnic group in the U.S. Disparities in youth behavioral health problems and the receipt of mental health services among Filipino youth have been documented previously. However, few studies have elicited perspectives from community stakeholders regarding how to prevent mental health disparities among Filipino youth. The purpose of the current study is to identify intervention strategies for implementing mental health prevention programs among Filipino youth. We conducted semi-structured interviews (n=33) with adolescents, caregivers, advocates, and providers and focus groups (n=18) with adolescents and caregivers. Interviews were audio taped and transcribed verbatim. Transcripts were analyzed using a methodology of "coding consensus, co-occurrence, and comparison" and was rooted in grounded theory. Four recommendations were identified when developing mental health prevention strategies among Filipino populations: address the intergenerational gap between Filipino parents and children, provide evidence-based parenting programs, collaborate with churches in order to overcome stigma associated with mental health, and address mental health needs of parents. Findings highlight the implementation of evidence-based preventive parenting programs in faith settings as a community-identified and culturally appropriate strategy to prevent Filipino youth behavioral health disparities.

  17. Perspectives on biomedical HIV prevention options among women who inject drugs in Kenya.

    PubMed

    Bazzi, Angela Robertson; Yotebieng, Kelly A; Agot, Kawango; Rota, Grace; Syvertsen, Jennifer L

    2017-08-05

    Due to heightened vulnerability to HIV from frequent engagement in sex work and overlapping drug-using and sexual networks, women who inject drugs should be a high priority population for pre-exposure prophylaxis (PrEP) and other biomedical HIV prevention tools. Kenya is one of the first African countries to approve oral PrEP for HIV prevention among "key populations," including people who inject drugs and sex workers. The objective of this study was to explore preferences and perceived challenges to PrEP adoption among women who inject drugs in Kisumu, Kenya. We conducted qualitative interviews with nine HIV-uninfected women who inject drugs to assess their perceptions of biomedical HIV interventions, including oral PrEP, microbicide gels, and intravaginal rings. Despite their high risk and multiple biomedical studies in the region, only two women had ever heard of any of these methods. All women were interested in trying at least one biomedical prevention method, primarily to protect themselves from partners who were believed to have multiple other sexual partners. Although women shared concerns about side effects and product efficacy, they did not perceive drug use as a significant deterrent to adopting or adhering to biomedical prevention methods. Beginning immediately and continuing throughout Kenya's planned PrEP rollout, efforts are urgently needed to include the perspectives of high risk women who use drugs in biomedical HIV prevention research and programing.

  18. Success, Failure, and Unfinished Business of Education, Prevention, Policy, and Intervention Programs on Substance Misuse in Brazilian Sport.

    PubMed

    Santos, Azenildo M

    2015-01-01

    The current Brazilian situation is such that it is difficult to obtain a worldwide evaluation of failure in education, intervention, or prevention programs. How fragile Brazil's anti-doping system is, its appropriateness as well as its relevance, with needed policy infrastructures for achieving the selected goals, and how wide the gap is between education and prevention program effectiveness between high-performance athletes and recreational practitioners who just want to look good. An additional concern, and ever present flaw regarding Brazil's "common sportsman" in day-to-day society is their not receiving known and necessary "sports education," enabling the development of an "at-risk" population for self-harm. Reflections on public health policy are noted.

  19. Plasmodium vivax infections in U.S. Army troops: failure of primaquine to prevent relapse in studies from Somalia.

    PubMed

    Smoak, B L; DeFraites, R F; Magill, A J; Kain, K C; Wellde, B T

    1997-02-01

    Different strains of Plasmodium vivax vary in their sensitivity to primaquine, the only drug that prevents relapses. Described are the clinical data and relapse pattern for 75 soldiers treated for vivax malaria since returning from Somalia. Following their initial attack of malaria, 60 of the 75 cases received a standard course of primaquine (15 mg base daily for 14 days). Twenty-six of the 60 soldiers subsequently relapsed for a failure rate of 43%. Eight soldiers had a second relapse following primaquine therapy after both the primary attack and first relapse. Three of these soldiers had received a higher dosage of primaquine (30 mg base daily for 14 days) after their second attack. The apparent ineffectiveness of primaquine therapy in preventing relapses suggests the presence of primaquine-resistant P. vivax strains in Somalia.

  20. Academic Failure, Alienation, the Threat of Extinction: A Global Perspective on Children at Risk.

    ERIC Educational Resources Information Center

    Flake, Carol L.

    1990-01-01

    Discusses common and critical global problems related to children who are at risk. Section on academic failure examines programs for preschool children, education for disadvantaged children at the elementary school level, and an ecological approach to the problem. Other sections explore issues of youth alienation, the future of the human species,…

  1. Reducing risk of Anthracycline-related heart failure after childhood cancer | Division of Cancer Prevention

    Cancer.gov

    DESCRIPTION (provided by applicant): Childhood cancer survivors are at a 15-fold risk of developing heart failure (HF) compared to age-matched controls. There is a strong dose-dependent association between anthracyclines and risk of HF;the incidence approaches 20% at cumulative doses between 300-600 mg/m2, and exceeds 30% for doses >600 mg/m2. Outcome following HF is poor;5-year survival rate is |

  2. Inhibition of class I histone deacetylase with an apicidin derivative prevents cardiac hypertrophy and failure.

    PubMed

    Gallo, Pasquale; Latronico, Michael V G; Gallo, Paolo; Grimaldi, Serena; Borgia, Francesco; Todaro, Matilde; Jones, Philip; Gallinari, Paola; De Francesco, Raffaele; Ciliberto, Gennaro; Steinkühler, Christian; Esposito, Giovanni; Condorelli, Gianluigi

    2008-12-01

    Recent studies have demonstrated the importance of chromatin remodelling via histone acetylation/deacetylation for the control of cardiac gene expression. Specific histone deacetylases (HDACs) can, in fact, play a positive or negative role in determining cardiac myocyte (CM) size. Here, we report on the effect on hypertrophy development of three inhibitors (HDACi) of class I HDACs. The compounds were first analysed in vitro by scoring hypertrophy, expression of foetal genes, and apoptosis of neonatal rat CMs stimulated with phenylephrine, an alpha1-adrenergic agonist. This initial screening indicated that a truncated derivative of apicidin with class I HDAC specificity, denoted API-D, had the highest efficacy to toxicity ratio, and was thus selected for further analysis in vivo. Administration of this drug significantly decreased myocardial hypertrophy and foetal gene expression after 1 week of pressure overload induced by thoracic aortic constriction (TAC) in mice. After 9 weeks of TAC, when manifest heart failure is encountered, mice treated with API-D presented with significantly improved echocardiographic and haemodynamic parameters of cardiac function when compared with untreated TAC-operated mice. The apicidin derivative, API-D, is capable of reducing hypertrophy and, consequently, the transition to heart failure in mice subjected to TAC. Treatment with this substance, therefore, holds promise as an important therapeutic option for heart failure.

  3. Prevent boiler tube failures--Part 1: Fire-side mechanisms

    SciTech Connect

    Colannino, J.

    1993-10-01

    A boiler tube fails when the structural integrity of the tube is compromised. For boilers that have been previously operating, some change must occur to effect tube failure. Usually this change is wrought through some combination of corrosion and erosion acting on the boiler tube to weaken it. Boiler tubes depend on a complex metal oxide layer for protection from the hot furnace environment. Fire-side corrosion and erosion remove or alter the oxide layer, rendering the tube vulnerable to attack. Corrosion and erosion are destructive mechanisms that ravage boiler tubes. They are distinguished by the cause of the destruction--corrosion is caused by chemical or electrochemical attack, whereas erosion is caused by abrasive action of a moving fluid or solid. Both mechanisms can and often do operate simultaneously. This article focuses on the fire side of the tube. It explains the major mechanisms responsible for fire-side boiler tube failures, how to recognize the underlying cause of the failure, and how to avoid such problems. Fuel oil, coal, and municipal solid waste boilers are discussed.

  4. Cardiac-resynchronization therapy for the prevention of heart-failure events.

    PubMed

    Moss, Arthur J; Hall, W Jackson; Cannom, David S; Klein, Helmut; Brown, Mary W; Daubert, James P; Estes, N A Mark; Foster, Elyse; Greenberg, Henry; Higgins, Steven L; Pfeffer, Marc A; Solomon, Scott D; Wilber, David; Zareba, Wojciech

    2009-10-01

    This trial was designed to determine whether cardiac-resynchronization therapy (CRT) with biventricular pacing would reduce the risk of death or heart-failure events in patients with mild cardiac symptoms, a reduced ejection fraction, and a wide QRS complex. During a 4.5-year period, we enrolled and followed 1820 patients with ischemic or nonischemic cardiomyopathy, an ejection fraction of 30% or less, a QRS duration of 130 msec or more, and New York Heart Association class I or II symptoms. Patients were randomly assigned in a 3:2 ratio to receive CRT plus an implantable cardioverter-defibrillator (ICD) (1089 patients) or an ICD alone (731 patients). The primary end point was death from any cause or a nonfatal heart-failure event (whichever came first). Heart-failure events were diagnosed by physicians who were aware of the treatment assignments, but they were adjudicated by a committee that was unaware of assignments. During an average follow-up of 2.4 years, the primary end point occurred in 187 of 1089 patients in the CRT-ICD group (17.2%) and 185 of 731 patients in the ICD-only group (25.3%) (hazard ratio in the CRT-ICD group, 0.66; 95% confidence interval [CI], 0.52 to 0.84; P=0.001). The benefit did not differ significantly between patients with ischemic cardiomyopathy and those with nonischemic cardiomyopathy. The superiority of CRT was driven by a 41% reduction in the risk of heart-failure events, a finding that was evident primarily in a prespecified subgroup of patients with a QRS duration of 150 msec or more. CRT was associated with a significant reduction in left ventricular volumes and improvement in the ejection fraction. There was no significant difference between the two groups in the overall risk of death, with a 3% annual mortality rate in each treatment group. Serious adverse events were infrequent in the two groups. CRT combined with ICD decreased the risk of heart-failure events in relatively asymptomatic patients with a low ejection fraction

  5. Differential Effects of Prevention and Reversal Treatment with Lisinopril on Left Ventricular Remodelling in a Rat Model of Heart Failure

    PubMed Central

    Brower, Gregory L.; Levick, Scott P.; Janicki, Joseph S.

    2015-01-01

    Background Angiotensin converting enzyme (ACE) inhibitors such as lisinopril, represent the front line pharmacological treatment for heart failure, which is characterised by marked left ventricular (LV) dilatation and hypertrophy. This study sought to determine whether initiating treatment with ACE inhibitors at different stages in the remodelling process would alter the efficacy of treatment. Methods To this end, LV size and function were determined in the aortocaval (AV) fistula model of volume overload-induced heart failure. Sprague-Dawley rats were assigned to sham, untreated AV fistula (21 weeks), AV fistula treated with lisinopril (21 weeks), or AV fistula treated with lisinopril from six to 21 weeks post-fistula groups. Results Administration of lisinopril for the entire 21-week period prevented LV dilatation, attenuated myocardial hypertrophy and prevented changes in myocardial compliance and contractility, whereas delaying initiation of treatment until six weeks post-fistula attenuated LV dilatation and hypertrophy, however, the delayed onset of treatment had no beneficial effect on ventricular compliance or systolic function. Conclusions The results demonstrate differential effects that can occur with ACE inhibitors depending on the stage during the remodelling process at which treatment is administered. PMID:25837018

  6. Differential Effects of Prevention and Reversal Treatment with Lisinopril on Left Ventricular Remodelling in a Rat Model of Heart Failure.

    PubMed

    Brower, Gregory L; Levick, Scott P; Janicki, Joseph S

    2015-09-01

    Angiotensin converting enzyme (ACE) inhibitors such as lisinopril, represent the front line pharmacological treatment for heart failure, which is characterised by marked left ventricular (LV) dilatation and hypertrophy. This study sought to determine whether initiating treatment with ACE inhibitors at different stages in the remodelling process would alter the efficacy of treatment. To this end, LV size and function were determined in the aortocaval (AV) fistula model of volume overload-induced heart failure. Sprague-Dawley rats were assigned to sham, untreated AV fistula (21 weeks), AV fistula treated with lisinopril (21 weeks), or AV fistula treated with lisinopril from six to 21 weeks post-fistula groups. Administration of lisinopril for the entire 21-week period prevented LV dilatation, attenuated myocardial hypertrophy and prevented changes in myocardial compliance and contractility, whereas delaying initiation of treatment until six weeks post-fistula attenuated LV dilatation and hypertrophy, however, the delayed onset of treatment had no beneficial effect on ventricular compliance or systolic function. The results demonstrate differential effects that can occur with ACE inhibitors depending on the stage during the remodelling process at which treatment is administered. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  7. Financial implications of a model heart failure disease management program for providers, hospital, healthcare systems, and payer perspectives.

    PubMed

    Whellan, David J; Reed, Shelby D; Liao, Lawrence; Gould, Stuart D; O'connor, Christopher M; Schulman, Kevin A

    2007-01-15

    Although heart failure disease management (HFDM) programs improve patient outcomes, the implementation of these programs has been limited because of financial barriers. We undertook the present study to understand the economic incentives and disincentives for adoption of disease management strategies from the perspectives of a physician (group), a hospital, an integrated health system, and a third-party payer. Using the combined results of a group of randomized controlled trials and a set of financial assumptions from a single academic medical center, a financial model was developed to compute the expected costs before and after the implementation of a HFDM program by 3 provider types (physicians, hospitals, and health systems), as well as the costs incurred from a payer perspective. The base-case model showed that implementation of HFDM results in a net financial loss to all potential providers of HFDM. Implementation of HFDM as described in our base-case analysis would create a net loss of US dollars 179,549 in the first year for a physician practice, US dollars 464,132 for an integrated health system, and US dollars 652,643 in the first year for a hospital. Third-party payers would be able to save US dollars 713,661 annually for the care of 350 patients with heart failure in a HFDM program. In conclusion, although HFDM programs may provide patients with improved clinical outcomes and decreased hospitalizations that save third-party payers money, limited financial incentives are currently in place for healthcare providers and hospitals to initiate these programs.

  8. Ethanol-lock therapy for the prevention of central venous access device infections in pediatric patients with intestinal failure.

    PubMed

    Cober, M Petrea; Kovacevich, Debra S; Teitelbaum, Daniel H

    2011-01-01

    Central venous access device (CVAD) infections are a major complication in pediatric patients receiving long-term parenteral nutrition (PN) and are particularly prevalent in patients with intestinal failure. This study evaluated the outcomes of outpatient ethanol-lock therapy (ELT) for the prevention of CVAD infections in children with intestinal failure. In this retrospective analysis, the primary outcome measure was the rate of bloodstream infection (BSI) due to CVAD infections per 1,000 catheter days, and secondary measures included type of organisms cultured and complications of ELT. Over the course of 2 years, 15 patients received outpatient ELT. Sixty-seven percent were male; patients had a mean ± standard deviation age at enrollment of 5.6 ± 6.9 years and body weight of 19.9 ± 15.4 kg. Mean duration of ELT was 263 ± 190 days. Mean BSI rate per 1,000 catheter days significantly decreased from 8.0 before ELT to 1.3 after ELT (P < .01). Seventy-three percent of patients remained infection free throughout the entire study period. Adverse events potentially related to ELT included thrombosis (n = 1), difficulty withdrawing blood from the CVAD, requiring thrombolytic administration (n = 3), and repair of the CVAD for leakage/tear (n = 20). The rate of CVAD repair for leakage/tear with ELT was compared to prior rates per 1,000 catheter days and was found to be elevated after initiation of ELT (6.4 ± 10.0 vs 3.1 ± 5.2; P = .20). No signs and symptoms of ethanol intoxication were observed. ELT for the prevention of CVAD infections in pediatric intestinal failure patients significantly decreased BSI rates and may be used for extended periods of time in an outpatient setting.

  9. Celastrol prevents circulatory failure via induction of heme oxygenase-1 and heat shock protein 70 in endotoxemic rats.

    PubMed

    Wang, Yi-Li; Lam, Kwok-Keung; Cheng, Pao-Yun; Lee, Yen-Mei

    2015-03-13

    Celastrol, a quinone methide extracted from the root of Tripterygium wilfordii Hook, possesses anti-oxidant and anti-inflammatory effects. Tripterygium wilfordii Hook is officially listed in the Chinese Pharmacopoeia and is used traditionally against rheumatoid arthritis, ankylosing spondylitis, and cancer. Furthermore, the circulatory protective effect of celastrol on an in vivo animal model of sepsis was investigated. Sepsis is a systemic inflammatory disorder that increases tissue oxidative stress and leads to multiple organ injury. We evaluated the beneficial effects of celastrol on multiple organ failure induced by lipopolysaccharide (LPS) in rats. Celastrol (0.5 and 1.0 mg/kg, i.v.) was administered to anaesthetized rats 2 h before and 30 min after LPS challenge (10 mg/kg, i.v.). Eight hours later, cardiac and aortic protein expressions related to inflammatory responses, superoxide anion production, and reduced glutathione (GSH) level were measured. Treatment with celastrol prevented circulatory failure (bradycardia and hypotension) 8h after LPS challenge. The plasma levels of ALT, LDH, TNF-α, and nitric oxide metabolites increased markedly during sepsis, which significantly reduced after celastrol treatments. Celastrol attenuated iNOS, TNF-α, NF-κB phospho-p65 expression, superoxide anion production, and caspase 3 activity in the cardiovascular system, all of which were markedly elevated after LPS challenge. Furthermore, celastrol induced HO-1 and HSP70 expressions increase in nuclear levels of Nrf2 and HSF-1, respectively, and increase cardiac GSH level 8h after LPS challenge. Anti-inflammatory and anti-oxidant effects of celastrol contribute to prevent circulatory failure in sepsis. Induction of HO-1 and HSP70 by celastrol participates in these beneficial effects. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Inhibition of leukotriene B4 synthesis does not prevent development of acute renal failure following storage and transplantation.

    PubMed

    Lane, N J; Thorniley, M S; Manek, S; Fuller, B J; Green, C J

    1994-12-27

    Compound BW B70C, a selective 5-lipoxygenase inhibitor was tested for its ability to reduce inflammatory damage in an in vivo rabbit model of renal storage and transplantation. Kidneys were stored at 0-2 degrees C for 48 hr prior to autografting. In controls, renal vein LTB4 levels rose significantly after 30 min reperfusion but fell after 2 hr to baseline. TxB2 levels remained at baseline for the 6 hr measured. 6-k-PGF1 alpha levels rose significantly after 1 hr of reperfusion and remained elevated thereafter. Histology after 6 hr reperfusion showed moderate-to-severe cortical edema and mild congestion. Infused colloidal carbon was retained in the perivascular area in a narrow band at the corticomedullary junction, indicating a zone of vascular permeability. At 3 days after transplant, kidneys exhibited widespread tubular necrosis and calcification but little inflammation. Serum creatinine and urea peaked between days 3 and 5. 3/6 rabbits showed no symptoms of renal failure after 3 weeks. Pretreatment with BW B70C prevented the increase in LTB4 but had little effect on TxB2 and 6-k-PGF1 alpha levels. Histology showed no amelioration of cortical edema at 6 hr and congestion and hemorrhage were exacerbated. BW B70C had no effect on either colloidal carbon retention or distribution but did significantly reduce tubular necrosis and calcification at day 3. There was very little inflammatory infiltrate. BW B70C treatment did not improve the long-term viability of transplanted kidneys: 2/6 rabbits showed no symptoms of renal failure after 3 weeks. These data indicate that inhibition of LTB4 synthesis by BW B70C does not prevent the development of acute renal failure following 48 hr hypothermic storage and transplantation.

  11. Failure of a novel silicone–polyurethane copolymer (Optim™) to prevent implantable cardioverter-defibrillator lead insulation abrasions

    PubMed Central

    Hauser, Robert G.; Abdelhadi, Raed H.; McGriff, Deepa M.; Kallinen Retel, Linda

    2013-01-01

    Aim The purpose of this study was to determine if Optim™, a unique copolymer of silicone and polyurethane, protects Riata ST Optim and Durata implantable cardioverter-defibrillator (ICD) leads (SJM, St Jude Medical Inc., Sylmar, CA, USA) from abrasions that cause lead failure. Methods and results We searched the US Food and Drug Administration's (FDA's) Manufacturers and User Device Experience (MAUDE) database on 13 April 2012 using the simple search terms ‘Riata ST Optim™ abrasion analysis’ and ‘Durata abrasion analysis’. Lead implant time was estimated by subtracting 3 months from the reported lead age. The MAUDE search returned 15 reports for Riata ST Optim™ and 37 reports for Durata leads, which were submitted by SJM based on its analyses of returned leads for clinical events that occurred between December 2007 and January 2012. Riata ST Optim™ leads had been implanted 29.1 ± 11.7 months. Eight of 15 leads had can abrasions and three abrasions were caused by friction with another device, most likely another lead. Four of these abrasions resulted in high-voltage failures and one death. One failure was caused by an internal insulation defect. Durata leads had been implanted 22.2 ± 10.6 months. Twelve Durata leads had can abrasions, and six leads had abrasions caused by friction with another device. Of these 18 can and other device abrasions, 13 (72%) had electrical abnormalities. Low impedances identified three internal insulation abrasions. Conclusions Riata ST Optim™ and Durata ICD leads have failed due to insulation abrasions. Optim™ did not prevent these abrasions, which developed ≤4 years after implant. Studies are needed to determine the incidence of these failures and their clinical implications. PMID:22915789

  12. Adult venovenous extracorporeal membrane oxygenation for severe respiratory failure: Current status and future perspectives

    PubMed Central

    Sen, Ayan; Callisen, Hannelisa E.; Alwardt, Cory M.; Larson, Joel S.; Lowell, Amelia A.; Libricz, Stacy L.; Tarwade, Pritee; Patel, Bhavesh M.; Ramakrishna, Harish

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure was proposed more than 40 years ago. Despite the publication of the ARDSNet study and adoption of lung protective ventilation, the mortality for acute respiratory failure due to acute respiratory distress syndrome has continued to remain high. This technology has evolved over the past couple of decades and has been noted to be safe and successful, especially during the worldwide H1N1 influenza pandemic with good survival rates. The primary indications for ECMO in acute respiratory failure include severe refractory hypoxemic and hypercarbic respiratory failure in spite of maximum lung protective ventilatory support. Various triage criteria have been described and published. Contraindications exist when application of ECMO may be futile or technically impossible. Knowledge and appreciation of the circuit, cannulae, and the physiology of gas exchange with ECMO are necessary to ensure lung rest, efficiency of oxygenation, and ventilation as well as troubleshooting problems. Anticoagulation is a major concern with ECMO, and the evidence is evolving with respect to diagnostic testing and use of anticoagulants. Clinical management of the patient includes comprehensive critical care addressing sedation and neurologic issues, ensuring lung recruitment, diuresis, early enteral nutrition, treatment and surveillance of infections, and multisystem organ support. Newer technology that delinks oxygenation and ventilation by extracorporeal carbon dioxide removal may lead to ultra-lung protective ventilation, avoidance of endotracheal intubation in some situations, and ambulatory therapies as a bridge to lung transplantation. Risks, complications, and long-term outcomes and resources need to be considered and weighed in before widespread application. Ethical challenges are a reality and a multidisciplinary approach that should be adopted for every case in consideration. PMID:26750681

  13. Adult venovenous extracorporeal membrane oxygenation for severe respiratory failure: Current status and future perspectives.

    PubMed

    Sen, Ayan; Callisen, Hannelisa E; Alwardt, Cory M; Larson, Joel S; Lowell, Amelia A; Libricz, Stacy L; Tarwade, Pritee; Patel, Bhavesh M; Ramakrishna, Harish

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure was proposed more than 40 years ago. Despite the publication of the ARDSNet study and adoption of lung protective ventilation, the mortality for acute respiratory failure due to acute respiratory distress syndrome has continued to remain high. This technology has evolved over the past couple of decades and has been noted to be safe and successful, especially during the worldwide H1N1 influenza pandemic with good survival rates. The primary indications for ECMO in acute respiratory failure include severe refractory hypoxemic and hypercarbic respiratory failure in spite of maximum lung protective ventilatory support. Various triage criteria have been described and published. Contraindications exist when application of ECMO may be futile or technically impossible. Knowledge and appreciation of the circuit, cannulae, and the physiology of gas exchange with ECMO are necessary to ensure lung rest, efficiency of oxygenation, and ventilation as well as troubleshooting problems. Anticoagulation is a major concern with ECMO, and the evidence is evolving with respect to diagnostic testing and use of anticoagulants. Clinical management of the patient includes comprehensive critical care addressing sedation and neurologic issues, ensuring lung recruitment, diuresis, early enteral nutrition, treatment and surveillance of infections, and multisystem organ support. Newer technology that delinks oxygenation and ventilation by extracorporeal carbon dioxide removal may lead to ultra-lung protective ventilation, avoidance of endotracheal intubation in some situations, and ambulatory therapies as a bridge to lung transplantation. Risks, complications, and long-term outcomes and resources need to be considered and weighed in before widespread application. Ethical challenges are a reality and a multidisciplinary approach that should be adopted for every case in consideration.

  14. [Women's preventive healthcare and health policy from the gender mainstreaming perspective].

    PubMed

    Wang, Hsiu-Hung

    2009-12-01

    Feminist and gender mainstreaming perspectives can help expand consideration of women's health and preventive healthcare beyond maternal and reproductive care to encompass the multiple roles and life span experiences of women. Such a shift may encourage the adoption by nursing professionals of broader viewpoints that address contemporary women's health priorities and facilitate the delivery of more appropriate preventive healthcare. This article discusses the World Health Organization's gender mainstreaming and women's health policies, gender mainstreaming women's health policies in Taiwan, and the roles of nurses in women's preventive healthcare. Based on the Women's Health Policy White Paper proposed by Taiwan's Department of Health, when working with female clients, nurses should play multiple roles that include healthcare provider, information provider, educator, advocate, consultant and researcher. Strategies that may be employed to achieve these roles include: (1) Adjusting perceptions toward traditional reproduction; (2) Providing correct and sufficient medical information; (3) Considering possible adverse effects of medical interventions on women; (4) Considering the healthcare system as a probable stressor for women; (5) Considering women's medical environment and space; (6) Exploring the relationship between socio-culture and women's preventive healthcare and (7) Recruiting women as major subjects in healthcare research.

  15. Exploring primary school headteachers' perspectives on the barriers and facilitators of preventing childhood obesity.

    PubMed

    Howard-Drake, E J; Halliday, V

    2016-03-01

    Headteachers of primary schools in England are a crucial partner for childhood obesity prevention. Understanding how this works in practice is limited by their views being underrepresented or missing from the evidence base. The aim of this study was to explore primary school headteachers' perspectives on childhood obesity and the perceived barriers and facilitators of prevention. A qualitative study with a purposive sample of 14 primary school headteachers from the Yorkshire and Humber region of England was conducted. Semi-structured interviews were audio-taped, transcribed and analysed using an inductive thematic approach. An extensive range of barriers and facilitators emerged within four key themes; understanding childhood obesity, primary school setting, the role of parents and external partners. A lack of knowledge, awareness and skills to deal with the sensitivity and complexity of childhood obesity across all school stakeholders presents the most significant barrier to effective action. Headteachers recognize primary schools are a crucial setting for childhood obesity prevention; however their school's often do not have the capability, capacity and confidence to make a meaningful and sustainable impact. To increase headteachers' ability and desire to prevent childhood obesity, schools require specialist and tailored training, resources and support from external partners such as public health teams and school nursing services. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. Community Perspectives on Communication Strategies for Alcohol Abuse Prevention in Rural Central Kenya.

    PubMed

    Muturi, Nancy

    2016-01-01

    The current study explores community perspectives on alcohol abuse prevention strategies in rural Kenya. Data from focus group discussions with members of community organizations and in-depth interviews with a snowball sample of key informants revealed that rural communities view national alcohol abuse prevention interventions as ineffective and messages as unpersuasive in changing this high-risk behavior. The use of ethnic languages, stronger fear appeals, and visual aids were recommended for alcohol prevention messages aimed at communities with low literacy. Community members favored narratives and entertainment-education strategies, which are more engaging, and print media for their educational value. Health activism, although common, was viewed as less effective in motivating individuals to change drinking behavior but more effective in advocacy campaigns to pressure the government to enforce alcohol regulations. This study suggests further empirical research to inform evidence-based prevention campaigns and to understand how to communicate about alcohol-related health risks within communities that embrace alcohol consumption as a cultural norm.

  17. Improving access to and utilization of adolescent preventive health care: the perspectives of adolescents and parents.

    PubMed

    Coker, Tumaini R; Sareen, Harvinder G; Chung, Paul J; Kennedy, David P; Weidmer, Beverly A; Schuster, Mark A

    2010-08-01

    To examine the perspectives of publicly insured adolescents and their parents on ways to encourage adolescent utilization of preventive health services. We conducted eight focus groups with 77 adolescents enrolled in a large Medicaid managed care plan in Los Angeles County, California, and two focus groups with 21 of their parents. Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Adolescents and parents reported that the most effective way to encourage preventive care utilization among teens was to directly address provider-level barriers related to the timeliness, privacy, confidentiality, comprehensiveness, and continuity of their preventive care. They reported that incentives (e.g., cash, movie tickets, gift cards) might also be an effective way to increase preventive care utilization. To improve adolescent receipt of surveillance and guidance on sensitive health-related topics, most adolescents suggested that the best way to encourage clinician-adolescent discussion was to increase private face-to-face discussions with a clinician with whom they had a continuous and confidential relationship. Adolescents reported that the use of text messaging, e-mail, and Internet for providing information and counseling on various sensitive health-related topics would also encourage adolescent utilization of preventive health services. Parents, however, more often preferred that their teen receive these services through in-office discussions and clinician-provided brochures. State agencies, health plans, clinics, and individual providers may consider focusing their efforts to improve adolescents' utilization of preventive services on basic structural and quality of care issues related to the clinician-patient relationship, access to services, and confidentiality. (c) 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  18. Ventricular assist devices in heart failure: how to support the heart but prevent atrophy?

    PubMed

    Pokorný, M; Cervenka, L; Netuka, I; Pirk, J; Koňařík, M; Malý, J

    2014-01-01

    Ventricular assist devices (VAD) have recently established themselves as an irreplaceable therapeutic modality of terminal heart failure. Because of the worldwide shortage of donors, ventricular assist devices play a key role in modern heart failure therapy. Some clinical data have revealed the possibility of cardiac recovery during VAD application. On the other hand, both clinical and experimental studies indicate the risk of the cardiac atrophy development, especially after prolonged mechanical unloading. Little is known about the specific mechanisms governing the unloading-induced cardiac atrophy and about the exact ultrastructural changes in cardiomyocytes, and even less is known about the ways in which possible therapeutical interventions may affect heart atrophy. One aim of this review was to present important aspects of the development of VAD-related cardiac atrophy in humans and we also review the most significant observations linking clinical data and those derived from studies using experimental models. The focus of this article was to review current methods applied to alleviate cardiac atrophy which follows mechanical unloading of the heart. Out of many pharmacological agents studied, only the selective beta2 agonist clenbuterol has been proved to have a significantly beneficial effect on unloading-induced atrophy. Mechanical means of atrophy alleviation also seem to be effective and promising.

  19. The Relevance of the Primary Prevention Criteria for Implantable Cardioverter Defibrillator Implantation in Korean Symptomatic Severe Heart Failure Patients

    PubMed Central

    Kim, JiYeong; Lee, Min-Ho; Kang, Do-Yoon; Sung, Young-Jun; Lee, Dong-Won; Oh, Ilyoung; Choi, Yun-Shik; Oh, Seil

    2012-01-01

    Background and Objectives Implantable cardioverter defibrillator (ICD) therapy is recommended as the primary tool for prevention of sudden cardiac death (SCD) in symptomatic patients with severe left ventricular dysfunction. There is a paucity of information on whether this recommendation is appropriate for the Korean population with severe heart failure. Subjects and Methods The study group consisted of 275 consecutive patients (mean age 65 years, 71% male) who met the ICD implantation criteria for primary prevention (left ventricular ejection fraction ≤30% and New York Heart Association functional class II or III). We analyzed the clinical characteristics and outcomes of an ischemic cardiomyopathy (ICMP) group (n=131) and a non-ischemic cardiomyopathy (NICMP) group (n=144). The outcomes of these 2 groups were compared with the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) conventional and Defibrillators in the Non-ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) standard therapy groups, respectively. Results Eighty patients (29%) died during a follow-up period of 40±17 months. The NICMP group had better all-cause mortality rates than the ICMP group (19% vs. 40%, p<0.001), however both groups had a similar incidence of SCD (7% vs. 10%, p=0.272). The 2-year all-cause mortality and SCD for the ICMP group were similar to those of the MADIT-II conventional therapy group (20% vs. 20%, 7% vs. 10%, respectively, all p>0.05). All-cause mortality and the incidence of SCD in the NICMP group were comparable to those of the DEFINITE standard therapy group (13% vs. 17%, 6% vs. 6%, respectively, all p>0.05). Conclusion Korean patients with severe heart failure in both the ICMP and NICMP groups had all-caused mortality and risk of SCD comparable to patients in the MADIT-II and DEFINITE standard therapy groups. Therefore, the primary prevention criteria for ICD implantation would be appropriate in both Korean ICMP and NICMP patients. PMID:22493612

  20. [Efforts to prevent adverse events in the United States--health care risk management and a fresh perspective on adverse events prevention].

    PubMed

    Ayuzawa, J

    2001-03-01

    Not causing adverse events is never-ceasing issue in the health care field. However, the advances and greater specialization of medical technologies and the increasing number of elderly people, are all factors in the occurrence of adverse events. At the same time, greater efficiency is now demanded in the health care field, and the problem of preventing adverse events has become tougher than ever before. Given the situation, a fresh perspective on attempts to prevent adverse events may be important. One hint for such a new perspective is the health care risk management that is widely practiced in the health care field in the United States. This was introduced in the mid-1970s to counter the disputes and lawsuits at the time, but over the years the focus has shifted to the importance of prevention, and is now recognized as a means to work toward the assurance of quality of health care. Hints are also found in the suggestions related to adverse events prevention. In "To Err Is Human," published in November 1999 in the United States, includes proposals to "respect human limits in process design" and "promote effective team functioning," which are just the approaches we should adopt for a new perspective. I would also like to draw attention to the idea that there should be investigations into "developing effective mechanisms for identifying and dealing with unsafe practitioners" and the importance of "protecting voluntary reporting systems" that is mentioned. Adopting American methods unchanged to the health care system in Japan may not be appropriate, but the way of thinking and know-how from health care risk management, as well as the suggestions for adverse events prevention will provide us new perspectives on adverse events prevention, from which we should work toward a system of more efficient, and high-quality adverse events prevention.

  1. Gaps and Resemblances in Current Heart Failure Guidelines: A Clinical Perspective.

    PubMed

    Bulnes, Juan F; Jalil, Jorge E

    2015-10-01

    The newly available clinical guidelines in heart failure (HF) from Europe (2012), the United States (2010 and 2013), and Canada (2015) were compared, focusing on the systems for grading the evidence and classifying the recommendations, HF definitions, pharmacologic treatment, and devices used in HF. Some gaps were evident in the methodology for assessing evidence or in HF definitions. Pharmacologic treatments and recommendations for cardiac resynchronization therapy and implantable cardioverter-defibrillators are similar but some differences need to be considered by the practicing clinician. Guideline recommendations regarding new emergent treatments are becoming available. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Rehabilitation practice patterns for patients with heart failure: the Asian perspective.

    PubMed

    Sun, Xing-Guo

    2015-01-01

    More countries around world have begun to use cardiac rehabilitation in patients diagnosed with chronic heart failure (HF). Asia is the largest continent in the world and, depending on its economy, culture, and beliefs, a given Asian country differs from Western countries as well as others in Asia. The cardiac rehabilitation practice patterns for patients with HF are somewhat different in Asia. In addition to the formal pattern of Western practice, it also includes special techniques and skills, such as Taiji, Qigong, and Yoga. This article describes cardiac rehabilitation patterns for patients with HF in most Asian countries and areas.

  3. The redefinition of failure to thrive from a case study perspective.

    PubMed

    Locklin, Maryanne

    2005-01-01

    Explaining failure to thrive (FTT) in dichotomous terms--organic versus non-organic --no longer applies in the context of modern pediatric nursing. FTT has turned out to be much more multifaceted. One infant's story illustrates the complexities and long-term ramifications of a pediatric feeding disorder and the challenges faced by health care professionals and families in their care. The story illustrates how physiologic, sensorimotor, and behavioral issues can all impact a child's inability to gain weight as expected. With greater understanding, pediatric nurses can appreciate their role as members of a multidisciplinary pediatric feeding disorder team.

  4. Assessing Risk and Preventing 30-Day Readmissions in Decompensated Heart Failure: Opportunity to Intervene?

    PubMed

    Dunbar-Yaffe, Richard; Stitt, Audra; Lee, Joseph J; Mohamed, Shanas; Lee, Douglas S

    2015-10-01

    Heart failure (HF) patients are at high risk of hospital readmission, which contributes to substantial health care costs. There is great interest in strategies to reduce rehospitalization for HF. However, many readmissions occur within 30 days of initial hospital discharge, presenting a challenge for interventions to be instituted in a short time frame. Potential strategies to reduce readmissions for HF can be classified into three different forms. First, patients who are at high risk of readmission can be identified even before their initial index hospital discharge. Second, ambulatory remote monitoring strategies may be instituted to identify early warning signs before acute decompensation of HF occurs. Finally, strategies may be employed in the emergency department to identify low-risk patients who may not need hospital readmission. If symptoms improve with initial therapy, low-risk patients could be referred to specialized, rapid outpatient follow-up care where investigations and therapy can occur in an outpatient setting.

  5. Immunotherapeutics to prevent the replication of Brucella in a treatment failure mouse model.

    PubMed

    Jain-Gupta, N; Contreras-Rodriguez, A; Smith, G P; Garg, V K; Witonsky, S G; Isloor, S; Vemulapalli, R; Boyle, S M; Sriranganathan, N

    2014-02-12

    Outer membrane vesicles (OMVs) from Brucella melitensis and irradiated Brucella neotomae have been shown to be effective vaccines against a B. melitensis challenge in a mouse model. The present study evaluates the efficacy of these two vaccines as immuno-therapeutics in combination with conventional antibiotics against a B. melitensis infection. BALB/c mice chronically infected with B. melitensis were treated for 4 weeks with doxycycline and gentamicin and vaccinated twice during the course of therapy. Antibiotics in sub-therapeutic concentrations were chosen in such a way that the treatment would result in a therapeutic failure in mice. Although no additive effect of vaccines and antibiotics was seen on the clearance of B. melitensis, mice receiving vaccines along with antibiotics exhibited no Brucella replication post-treatment compared to mice treated only with antibiotics. Administration of irradiated B. neotomae along with antibiotics led to higher production of IFN-γ ex vivo by splenocytes upon stimulation with heat inactivated B. melitensis while no such effect was seen by splenocytes from mice vaccinated with OMVs. OMV vaccinated mice developed significantly higher anti-Brucella IgG antibody titers at the end of the treatment compared to the mice that received only antibiotics. The mice that received only vaccines did not show any significant clearance of Brucella from spleens and livers compared to non-treated control mice. This study suggests that incorporating OMVs or irradiated B. neotomae along with conventional antibiotics might be able to improve therapeutic efficacy and control the progression of disease in treatment failure cases.

  6. Failure of propranolol to prevent tilt-evoked systemic vasodilatation, adrenaline release and neurocardiogenic syncope.

    PubMed

    Eldadah, Basil A; Pechnik, Sandra L; Holmes, Courtney S; Moak, Jeffrey P; Saleem, Ahmed M; Goldstein, David S

    2006-09-01

    In patients with neurocardiogenic syncope, head-up tilt often evokes acute loss of consciousness accompanied by vasodilatation, increased plasma adrenaline and systemic hypotension. Since hypotension increases adrenaline levels and adrenaline can produce skeletal muscle vasodilatation by activating beta2 receptors, adrenaline might induce a positive feedback loop precipitating circulatory collapse. We hypothesized that propranolol, a non-selective beta-blocker, would prevent adrenaline-induced vasodilatation and thereby prevent syncope. Eight subjects with recurrent neurocardiogenic syncope and previously documented tilt-induced syncope with elevated plasma adrenaline levels participated in the present study. Subjects underwent tilt table testing after receiving oral propranolol or placebo in a double-blind randomized crossover fashion. Haemodynamic and neurochemical variables were measured using intra-arterial monitoring, impedance cardiography, arterial blood sampling and tracer kinetics of simultaneously infused [3H]noradrenaline and [3H]adrenaline. The occurrence of tilt-induced neurally mediated hypotension and syncope, duration of tilt tolerance, extent of the decrease in SVRI (systemic vascular resistance index) and magnitude of plasma adrenaline increases did not differ between the propranolol and placebo treatment phases. SVRI was inversely associated with fractional increase in plasma adrenaline during both phases. One subject did not faint when on propranolol; this subject's response is discussed in the context of central effects of propranolol. In this small, but tightly controlled, study, propranolol did not prevent tilt-induced vasodilatation, syncope or elevated plasma adrenaline.

  7. Failure of Synbiotic 2000 to prevent postoperative recurrence of Crohn's disease.

    PubMed

    Chermesh, Irit; Tamir, Ada; Reshef, Ron; Chowers, Yehuda; Suissa, Alain; Katz, Dalia; Gelber, Moshe; Halpern, Zamir; Bengmark, Stig; Eliakim, Rami

    2007-02-01

    Complications of Crohn's disease (CD) lead to surgery in about 70-90% of patients. The majority of patients suffer from relapse of the disease. Colonic bacteria are essential to the development of CD. Therefore, a rationale exists in trying to prevent relapse by manipulation of gut microflora. This is feasible by treatment with probiotics or antibiotics. Synbiotic 2000 is a cocktail containing 4 probiotic species and 4 prebiotics. It is rational to pursue that it could be effective in preventing postoperative disease. We sought to check weather treatment with Synbiotic 2000 could prevent postoperative recurrence in patients with CD. This was a prospective multicenter, randomized study. Patients were randomized to active treatment or placebo in a 2:1 ratio. Follow-up consisted of endoscopic, clinical, and laboratory parameters. Thirty patients were enrolled. No differences were found between the 2 treatment groups regarding gender, age at diagnosis, age at surgery, weight, smoking status, type of disease, length of the resected segment, or medical treatment prior to surgery. No difference in either endoscopic or clinical relapse rate was found between patients treated with once daily dose of Synbiotic 2000 or placebo. In our small study, Synbiotic 2000 had no effect on postoperative recurrence of patients with CD. Larger studies in patients with the inflammatory type of CD undergoing surgery, using higher doses of probiotics cocktail might prove effective.

  8. Cross-border reproductive care: market forces in action or market failure? An economic perspective.

    PubMed

    Connolly, Mark

    2011-12-01

    From an economist's perspective, cross-border reproductive care (CBRC) reflects a global market economy bringing together the needs of patients and skills of doctors at an agreed price. From this perspective CBRC is neither wrong nor right, rather it reflects rational economic behaviour of couples to maximize their wellbeing. The major economic criticism of CBRC relates to the costs and risks of multiple pregnancies, as couples paying out-of-pocket may have more embryos transferred than is desirable to optimize their chances of having a live birth. This criticism is valid, suggesting a need to communicate the hidden costs of failing to adequately fund fertility services. However, under some circumstances health authorities may be willing to bear these additional costs if the savings from not providing fertility services are sufficiently large enough to warrant a no-funding policy. Because infertility is often viewed as a low health priority, the likelihood of CBRC persisting is real, particularly as many health services adjust to the challenges of ageing populations and decreased public financing. To counter funding challenges, there is a need to communicate the medical benefits of assisted reproduction and the economic benefits that these children will offer in an era of austerity and ageing populations.

  9. GPs’ perspectives on secondary cardiovascular prevention in older age: a focus group study in the Netherlands

    PubMed Central

    van Peet, Petra G; Drewes, Yvonne M; Gussekloo, Jacobijn; de Ruijter, Wouter

    2015-01-01

    Background Although guidelines recommend secondary cardiovascular prevention irrespective of age, in older age the uptake of treatment is lower than in younger age groups. Aim To explore the dilemmas GPs in the Netherlands encounter when implementing guidelines for secondary cardiovascular prevention in older age. Design and setting Qualitative study in four focus groups consisting of GPs (n = 23, from the northern part of the province South Holland) and a fifth focus group consisting of GP trainees (n = 4, from the Leiden University Medical Center). Method Focus group discussions were organised to elicit perspectives on the implementation of secondary cardiovascular prevention for older people. The 14 theoretical domains of the refined Theoretical Domains Framework (TDF) were used for (deductive) coding of the focus group discussions. The coded texts were analysed, content was discussed, and barriers and facilitators were identified for each domain of the TDF. Results The main theme that emerged was ‘uncertainty’. Identified barriers were guideline-related, patient-related, and organisation-related. Identified facilitators were doctor-related, patient-related, and organisation-related. The main aim of secondary preventive treatment was improvement in quality of life. Conclusion GPs in the Netherlands are uncertain about many aspects of secondary cardiovascular prevention in older age; the guidelines themselves, their own role, patient factors, and the organisation of care. In view of this uncertainty, GPs consciously weigh all aspects of the situation in close dialogue with the individual patient, with the ultimate aim of improving quality of life. This highly-individualised care may largely explain the reduced prescription rates. PMID:26500321

  10. Noninvasive Mechanical Ventilation in Acute Respiratory Failure Patients: A Respiratory Therapist Perspective.

    PubMed

    Hidalgo, V; Giugliano-Jaramillo, C; Pérez, R; Cerpa, F; Budini, H; Cáceres, D; Gutiérrez, T; Molina, J; Keymer, J; Romero-Dapueto, C

    2015-01-01

    Physiotherapist in Chile and Respiratory Therapist worldwide are the professionals who are experts in respiratory care, in mechanical ventilation (MV), pathophysiology and connection and disconnection criteria. They should be experts in every aspect of the acute respiratory failure and its management, they and are the ones who in medical units are able to resolve doubts about ventilation and the setting of the ventilator. Noninvasive mechanical ventilation should be the first-line of treatment in acute respiratory failure, and the standard of care in severe exacerbations of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema, and in immunosuppressed patients with high levels of evidence that support the work of physiotherapist. Exist other considerations where most of the time, physicians and other professionals in the critical units do not take into account when checking the patient ventilator synchrony, such as the appropriate patient selection, ventilator selection, mask selection, mode selection, and the selection of a trained team in NIMV. The physiotherapist needs to evaluate bedside; if patients are properly connected to the ventilator and in a synchronously manner. In Chile, since 2004, the physioterapist are included in the guidelines as a professional resource in the ICU organization, with the same skills and obligations as those described in the literature for respiratory therapists.

  11. Perioperative management of left ventricular diastolic dysfunction and heart failure: an anesthesiologist's perspective

    PubMed Central

    2017-01-01

    Anesthesiologists frequently see asymptomatic patients with diastolic dysfunction or heart failure for various surgeries. These patients typically show normal systolic function but abnormal diastolic parameters in their preoperative echocardiographic evaluations. The symptoms that are sometimes seen are similar to those of chronic obstructive pulmonary disease. Patients with diastolic dysfunction, and even with diastolic heart failure, have the potential to develop a hypertensive crisis or pulmonary congestion. Thus, in addition to conventional perioperative risk quantification, it may be important to consider the results of diastolic assessment for predicting the postoperative outcome and making better decisions. If anesthesiologists see female patients older than 70 years of age who have hypertension, diabetes, chronic renal disease, recent weight gain, or exercise intolerance, they should focus on the patient's diastologic echocardiography indicators such as left atrial enlargement or left ventricular hypertrophy. In addition, there is a need for perioperative strategies to mitigate diastolic dysfunction-related morbidity. Specifically, hypertension should be controlled, keeping pulse pressure below diastolic blood pressure, maintaining a sinus rhythm and normovolemia, and avoiding tachycardia and myocardial ischemia. There is no need to classify these diastolic dysfunction, but it is important to manage this condition to avoid worsening outcomes. PMID:28184260

  12. Perioperative management of left ventricular diastolic dysfunction and heart failure: an anesthesiologist's perspective.

    PubMed

    Ryu, Taeha; Song, Seok-Young

    2017-02-01

    Anesthesiologists frequently see asymptomatic patients with diastolic dysfunction or heart failure for various surgeries. These patients typically show normal systolic function but abnormal diastolic parameters in their preoperative echocardiographic evaluations. The symptoms that are sometimes seen are similar to those of chronic obstructive pulmonary disease. Patients with diastolic dysfunction, and even with diastolic heart failure, have the potential to develop a hypertensive crisis or pulmonary congestion. Thus, in addition to conventional perioperative risk quantification, it may be important to consider the results of diastolic assessment for predicting the postoperative outcome and making better decisions. If anesthesiologists see female patients older than 70 years of age who have hypertension, diabetes, chronic renal disease, recent weight gain, or exercise intolerance, they should focus on the patient's diastologic echocardiography indicators such as left atrial enlargement or left ventricular hypertrophy. In addition, there is a need for perioperative strategies to mitigate diastolic dysfunction-related morbidity. Specifically, hypertension should be controlled, keeping pulse pressure below diastolic blood pressure, maintaining a sinus rhythm and normovolemia, and avoiding tachycardia and myocardial ischemia. There is no need to classify these diastolic dysfunction, but it is important to manage this condition to avoid worsening outcomes.

  13. Noninvasive Mechanical Ventilation in Acute Respiratory Failure Patients: A Respiratory Therapist Perspective

    PubMed Central

    Hidalgo, V; Giugliano-Jaramillo, C; Pérez, R; Cerpa, F; Budini, H; Cáceres, D; Gutiérrez, T; Molina, J; Keymer, J; Romero-Dapueto, C

    2015-01-01

    Physiotherapist in Chile and Respiratory Therapist worldwide are the professionals who are experts in respiratory care, in mechanical ventilation (MV), pathophysiology and connection and disconnection criteria. They should be experts in every aspect of the acute respiratory failure and its management, they and are the ones who in medical units are able to resolve doubts about ventilation and the setting of the ventilator. Noninvasive mechanical ventilation should be the first-line of treatment in acute respiratory failure, and the standard of care in severe exacerbations of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema, and in immunosuppressed patients with high levels of evidence that support the work of physiotherapist. Exist other considerations where most of the time, physicians and other professionals in the critical units do not take into account when checking the patient ventilator synchrony, such as the appropriate patient selection, ventilator selection, mask selection, mode selection, and the selection of a trained team in NIMV. The physiotherapist needs to evaluate bedside; if patients are properly connected to the ventilator and in a synchronously manner. In Chile, since 2004, the physioterapist are included in the guidelines as a professional resource in the ICU organization, with the same skills and obligations as those described in the literature for respiratory therapists. PMID:26312104

  14. Flap Failure and Wound Complications in Autologous Breast Reconstruction: A National Perspective.

    PubMed

    Massenburg, Benjamin B; Sanati-Mehrizy, Paymon; Ingargiola, Michael J; Rosa, Jonatan Hernandez; Taub, Peter J

    2015-12-01

    There are many options for breast reconstruction following a mastectomy, and data on outcomes are greatly needed for both the patient and the care provider. This study aims to identify the prevalence and predictors of adverse outcomes in autologous breast reconstruction in order to better inform patients and surgeons when choosing a surgical technique. This study retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and identified each autologous breast reconstruction performed between 2005 and 2012. Of the 6855 autologous breast reconstructions, there were 2085 latissimus dorsi (LD) flap procedures, 2464 pedicled transverse rectus abdominis myocutaneous (TRAM) flap procedures, and 2306 free flap procedures that met the inclusion criteria. The prevalence of complications in each of the three procedures was calculated and compared using χ(2) analysis for binomial categorical variables. Univariate and multivariate logistic regression analyses identified independent risk factors for adverse outcomes in autologous reconstruction as a whole. The prevalence of general complications was 10.8% in LD flaps, 20.6% in TRAM flaps, and 26.1% in free flaps for autologous breast reconstruction (p < 0.001). The prevalence of wound complications was 4.3% in LD flaps, 8.1% in TRAM flaps, and 6.2% in free flaps for autologous breast reconstruction (p < 0.001). The prevalence of flap failure was 1.1 % in LD flaps, 2.7% in TRAM flaps, and 2.4% in free flaps for autologous breast reconstruction (p < 0.001). Multivariate regression analysis showed that obesity [odds ratio (OR) 1.495, p = 0.024], hypertension (OR 1.633, p = 0.008), recent surgery (OR 3.431, p < 0.001), and prolonged operative times (OR 1.944, p < 0.001) were independently associated with flap failure in autologous breast reconstruction procedures. When controlling for confounding variables, TRAM flaps were twice as likely (OR 2.279, p = 0.001) and free flaps

  15. Prevention of perinatal group B streptococcal infections: a review with an Indian perspective.

    PubMed

    Narava, S; Rajaram, G; Ramadevi, A; Prakash, G V; Mackenzie, S

    2014-01-01

    Group B Streptococcus (GBS) is an important cause of maternal and neonatal morbidity and mortality in many parts of the world. Asymptomatic colonisation of the vagina and rectum with Group B streptococci is common in pregnancy. Maternal colonisation of GBS can vary depending on ethnicity and geographical distribution. Vertical transmission of this organism from mother to foetus may lead to neonatal GBS disease. Intra-partum use of antibiotics in these women has led to a decrease in the rate of early onset but not late onset GBS disease. Identification of women with GBS is the key factor in the prevention of perinatal GBS disease. There are different screening strategies available to identify women at risk of perinatal GBS disease. Clinicians continue to face the challenge of choosing between preventive strategies to reduce the impact of perinatal GBS disease. Controversy exists regarding the ideal preventive strategy. In India, the mortality and morbidity associated with the GBS disease remains largely a under-recognised problem. This comprehensive review summarises the salient features of GBS disease and discusses the epidemiology, risk factors, screening strategies, intra-partum antibiotic prophylaxis with an Indian perspective and how it compares with the Western nations.

  16. Civil society perspectives on negative biomedical HIV prevention trial results and implications for future trials.

    PubMed

    Essack, Zaynab; Koen, Jennifer; Slack, Catherine; Lindegger, Graham; Newman, Peter A

    2012-01-01

    Community engagement is crucial to ongoing development and testing of sorely needed new biomedical HIV prevention technologies. Yet, negative trial results raise significant challenges for community engagement in HIV prevention trials, including the early termination of the Cellulose Sulfate microbicide trial and two Phase IIb HIV vaccine trials (STEP and Phambili). The present study aimed to explore the perspectives and experiences of civil society organization (CSO) representatives regarding negative HIV prevention trial results and perceived implications for future trials. We conducted in-depth interviews with 14 respondents from a broad range of South African and international CSOs, and analyzed data using thematic analysis. CSO representatives reported disappointment in response to negative trial results, but acknowledged such outcomes as inherent to clinical research. Respondents indicated that in theory negative trial results seem likely to impact on willingness to participate in future trials, but that in practice people in South Africa have continued to volunteer. Negative trial results were described as having contributed to improving ethical standards, and to a re-evaluation of the scientific agenda. Such negative results were identified as potentially impacting on funding for trials and engagement activities. Our findings indicate that trial closures may be used constructively to support opportunities for reflection and renewed vigilance in strategies for stakeholder engagement, communicating trial outcomes, and building research literacy among communities; however, these strategies require sustained resources for community engagement and capacity-building.

  17. Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

    PubMed Central

    Arnold, J Malcolm O; Howlett, Jonathan G; Dorian, Paul; Ducharme, Anique; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Ignaszewski, Andrew; Isaac, Debra; Jong, Philip; Liu, Peter; Mann, Elizabeth; McKelvie, Robert S; Moe, Gordon W; Parker, John D; Svendsen, Anna M; Tsuyuki, Ross T; O’Halloran, Kelly; Ross, Heather J; Rao, Vivek; Sequeira, Errol J; White, Michel

    2007-01-01

    Heart failure is common, yet it is difficult to treat. It presents in many different guises and circumstances in which therapy needs to be individualized. The Canadian Cardiovascular Society published a comprehensive set of recommendations in January 2006 on the diagnosis and management of heart failure, and the present update builds on those core recommendations. Based on feedback obtained through a national program of heart failure workshops during 2006, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. Specific recommendations and practical tips were written for the prevention of heart failure, the management of heart failure during intercurrent illness, the treatment of acute heart failure, and the current and future roles of biomarkers in heart failure care. Specific clinical questions that are addressed include: which patients should be identified as being at high risk of developing heart failure and which interventions should be used? What complications can occur in heart failure patients during an intercurrent illness, how should these patients be monitored and which medications may require a dose adjustment or discontinuation? What are the best therapeutic, both drug and nondrug, strategies for patients with acute heart failure? How can new biomarkers help in the treatment of heart failure, and when and how should BNP be measured in heart failure patients? The goals of the present update are to translate best evidence into practice, to apply clinical wisdom where evidence for specific strategies is weaker, and to aid physicians and other health care providers to optimally treat heart failure patients to result in a measurable impact on patient health and clinical outcomes in Canada. PMID:17245481

  18. Electrochemical stabilization as a means of preventing ground failure in railroads

    USGS Publications Warehouse

    Solntzev, D.I.; Sorkov, V.S.; Sokoloff, V.P.

    1947-01-01

    Laboratory and field data on electrochemical stabilization of clays, by three Russian authors, are here presented in translation. Abstracts of the Russian papers were published in May 1947 issue of the Engineering News Record (pp. 100-101). There exists also a small body of literature, in German and English, dealing with the electrochemical stabilization and related subjects. Elements of the electrochemical process were patented by Casagrande in Germany, shortly before the last war. Results of the Russians and of others, including the German patent, appear to be sound and interesting accordingly. Mechanism of the electrochemical stabilization, however, appears to be surmised rather than established. Unless the mechanism of such stabilization is understood in detail, little progress may be expected in field applications of the electrochemical method. Electroosmosis, a poorly reversible coagulation of the soil colloids, and introduction of exchangeable aluminum into the clay complex have been given credit for the ground-stabilizing effects of direct electrical current. Much remains to be done, as the reader may see, in developing further the theory of the method. A critical study is indicated, in this connection, by agencies or individuals qualified and equipped for basic research in soil physics. Optimum schedules for field treatments need be ascertained with particular care, to suit any given kind of material and environment. A wide range of variation in such schedules, is most certainly to be encountered in dealing with materials as diverse in their composition and properties as are clays. Any generalization on relationships between soil, electrolytes, moisture, and current could be premature if based on the Russian work alone. Stabilization of ground is a major engineering geologic problem of national interest. Needless to say, perhaps, that failures are to be expected, in laboratory and in the field, in this as well as in any other kind of research. To minimize

  19. The use of failure mode and effects analysis to construct an effective disposal and prevention mechanism for infectious hospital waste

    SciTech Connect

    Ho, Chao Chung; Liao, Ching-Jong

    2011-12-15

    Highlights: > This study is based on a real case in a regional teaching hospital in Taiwan. > We use Failure mode and effects analysis (FMEA) as the evaluation method. > We successfully identify the risk factors of infectious waste disposal. > We propose plans for the detection of exceptional cases of infectious waste. - Abstract: In recent times, the quality of medical care has been continuously improving in medical institutions wherein patient-centred care has been emphasized. Failure mode and effects analysis (FMEA) has also been promoted as a method of basic risk management and as part of total quality management (TQM) for improving the quality of medical care and preventing mistakes. Therefore, a study was conducted using FMEA to evaluate the potential risk causes in the process of infectious medical waste disposal, devise standard procedures concerning the waste, and propose feasible plans for facilitating the detection of exceptional cases of infectious waste. The analysis revealed the following results regarding medical institutions: (a) FMEA can be used to identify the risk factors of infectious waste disposal. (b) During the infectious waste disposal process, six items were scored over 100 in the assessment of uncontrolled risks: erroneous discarding of infectious waste by patients and their families, erroneous discarding by nursing staff, erroneous discarding by medical staff, cleaning drivers pierced by sharp articles, cleaning staff pierced by sharp articles, and unmarked output units. Therefore, the study concluded that it was necessary to (1) provide education and training about waste classification to the medical staff, patients and their families, nursing staff, and cleaning staff; (2) clarify the signs of caution; and (3) evaluate the failure mode and strengthen the effects.

  20. Cancer Therapy-Related Cardiac Dysfunction and Heart Failure: Part 2: Prevention, Treatment, Guidelines, and Future Directions.

    PubMed

    Hamo, Carine E; Bloom, Michelle W; Cardinale, Daniela; Ky, Bonnie; Nohria, Anju; Baer, Lea; Skopicki, Hal; Lenihan, Daniel J; Gheorghiade, Mihai; Lyon, Alexander R; Butler, Javed

    2016-02-01

    Success with oncologic treatment has allowed cancer patients to experience longer cancer-free survival gains. Unfortunately, this success has been tempered by unintended and often devastating cardiac complications affecting overall patient outcomes. Cardiac toxicity, specifically the association of several cancer therapy agents with the development of left ventricular dysfunction and cardiomyopathy, is an issue of growing concern. Although the pathophysiologic mechanisms behind cardiac toxicity have been characterized, there is currently no evidence-based approach for monitoring and management of these patients. In the first of a 2-part review, we discuss the epidemiologic, pathophysiologic, risk factors, and imaging aspects of cancer therapy-related cardiac dysfunction and heart failure. In this second part, we discuss the prevention and treatment aspects in these patients and conclude with highlighting the evidence gaps and future directions for research in this area.

  1. [Twenty-five years of the amyloid hypothesis of alzheimer disease: advances, failures and new perspectives].

    PubMed

    Levin, O S; Vasenina, E E

    2016-01-01

    Amyloid hypothesis of Alzheimer's disease (AD) has been long the primary one. During the 25-year history the concept has been dramatically changed. Accumulation of β-amyloid is associated not only with the disruption of its synthesis (as it seemed after the discovery of genetic mechanisms of some familial cases of AD) but rather with the disruption of its clearance and elimination from the brain tissue via the microcirculatory system. It has been recognized that soluble oligomers of β-amyloid, but not senile plaques that consisted of insoluble conjugates described by A. Alzheimer 100 years ago, play a key pathogenic role in the brain. Interrelation of vascular and degenerative processes is confirmed by common risk factors, clinical, neuroimaging, pathomorphological and experimental data. Insulin-resistance is also one of the links between AD degenerative and vascular processes. Based on the current state of the amyloid hypothesis, perspectives of new multimodal treatment strategies are discussed.

  2. [Twenty-five years of the amyloid hypothesis of alzheimer disease: advances, failures and new perspectives].

    PubMed

    Levin, O S; Vasenina, E E

    Amyloid hypothesis of Alzheimer's disease (AD) has been long the primary one. During the 25-year history the concept has been dramatically changed. Accumulation of β-amyloid is associated not only with the disruption of its synthesis (as it seemed after the discovery of genetic mechanisms of some familial cases of AD) but rather with the disruption of its clearance and elimination from the brain tissue via the microcirculatory system. It has been recognized that soluble oligomers of β-amyloid, but not senile plaques that consisted of insoluble conjugates described by A. Alzheimer 100 years ago, play a key pathogenic role in the brain. Interrelation of vascular and degenerative processes is confirmed by common risk factors, clinical, neuroimaging, pathomorphological and experimental data. Insulin-resistance is also one of the links between AD degenerative and vascular processes. Based on the current state of the amyloid hypothesis, perspectives of new multimodal treatment strategies are discussed.

  3. Roof Deformation, Failure Characteristics, and Preventive Techniques of Gob-Side Entry Driving Heading Adjacent to the Advancing Working Face

    NASA Astrophysics Data System (ADS)

    Bai, Jian-biao; Shen, Wen-long; Guo, Guan-long; Wang, Xiang-yu; Yu, Yang

    2015-11-01

    In mining excavation, the roof bending subsidence of gob-side entry driving heading adjacent to the advancing working face (HAWF) can be considerable. Influenced by the original rock pressure, the front and lateral abutment pressure of the adjacent working face, and the front abutment pressure of the current working face, the support body can easily fail, leading to serious instability of the rock mass surrounding the tunnel. To study the stress state and the deformation failure mechanism of the HAWF roof structure, we use on-site survey data, numerical simulation, and theoretical calculations to fit the spatial distribution law of mining abutment pressure piecewise, and establish a dynamic mechanical model of the roof structure. We then propose a roof failure criterion and examine the roof flexure deformation behavioral pattern. We found that the central part of the roof is the main point that controls the surrounding rock. To prevent the deformation and collapse of the roof and rock surrounding the tunnel, we propose techniques that can be applied to HAWF gob-side entry driving, including setting the coal pillar width, the driving stop and restart timing, and other control concepts.

  4. Durable mechanical circulatory support in advanced heart failure: a critical care cardiology perspective.

    PubMed

    Lala, Anuradha; Mehra, Mandeep R

    2013-11-01

    Though cardiac transplantation for advanced heart disease patients remains definitive therapy for patients with advanced heart failure, it is challenged by inadequate donor supply, causing durable mechanical circulatory support (MCS) to slowly become a new primary standard. Selecting appropriate patients for MCS involves meeting a number of prespecifications as is required in evaluation for cardiac transplant candidacy. As technology evolves to bring forth more durable smaller devices, selection criteria for appropriate MCS recipients will likely expand to encompass a broader, less sick population. The "Holy Grail" for MCS will be a focus on clinical recovery and explantation of devices rather than the currently more narrowly defined indications of bridge to transplantation or lifetime device therapy. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Prevention of liver cancer cachexia-induced cardiac wasting and heart failure

    PubMed Central

    Springer, Jochen; Tschirner, Anika; Haghikia, Arash; von Haehling, Stephan; Lal, Hind; Grzesiak, Aleksandra; Kaschina, Elena; Palus, Sandra; Pötsch, Mareike; von Websky, Karoline; Hocher, Berthold; Latouche, Celine; Jaisser, Frederic; Morawietz, Lars; Coats, Andrew J.S.; Beadle, John; Argiles, Josep M.; Thum, Thomas; Földes, Gabor; Doehner, Wolfram; Hilfiker-Kleiner, Denise; Force, Thomas; Anker, Stefan D.

    2014-01-01

    Aims Symptoms of cancer cachexia (CC) include fatigue, shortness of breath, and impaired exercise capacity, which are also hallmark symptoms of heart failure (HF). Herein, we evaluate the effects of drugs commonly used to treat HF (bisoprolol, imidapril, spironolactone) on development of cardiac wasting, HF, and death in the rat hepatoma CC model (AH-130). Methods and results Tumour-bearing rats showed a progressive loss of body weight and left-ventricular (LV) mass that was associated with a progressive deterioration in cardiac function. Strikingly, bisoprolol and spironolactone significantly reduced wasting of LV mass, attenuated cardiac dysfunction, and improved survival. In contrast, imidapril had no beneficial effect. Several key anabolic and catabolic pathways were dysregulated in the cachectic hearts and, in addition, we found enhanced fibrosis that was corrected by treatment with spironolactone. Finally, we found cardiac wasting and fibrotic remodelling in patients who died as a result of CC. In living cancer patients, with and without cachexia, serum levels of brain natriuretic peptide and aldosterone were elevated. Conclusion Systemic effects of tumours lead not only to CC but also to cardiac wasting, associated with LV-dysfunction, fibrotic remodelling, and increased mortality. These adverse effects of the tumour on the heart and on survival can be mitigated by treatment with either the β-blocker bisoprolol or the aldosterone antagonist spironolactone. We suggest that clinical trials employing these agents be considered to attempt to limit this devastating complication of cancer. PMID:23990596

  6. Preventive effects of eastern medication (Kampo) on the progression of chronic renal failure.

    PubMed

    Mitsuma, T

    1996-01-01

    Twenty-two patients with chronic renal failure (CRF) were investigated. The patients were mainly administered decoctions of rhubarb (symbol in text) for 4 weeks. After that, traditional Chinese (Kampo) prescriptions, most of them involving Wen-Pi-Tang were given for another 4 weeks. Following administration of these prescriptions, the levels of serum methylguanidine (MG), blood urea nitrogen and serum inorganic phosphorus improved significantly, although the values of serum creatinine (Cr) were not changed remarkably. The fact that the serum MG/Cr ratio was reduced after the therapy suggested that rhubarb possessed the potential to scavenge hydroxyl radicals by which MG was produced from Cr through creatol, as reported recently. The serum Cr concentration was determined over an observation period of more than 40 weeks in each of the 7 cases. Evaluation of the progression rate of CRF was made from the slopes of the regression lines. After analysis, 5 of the 7 cases showed significant retardation of progression after the administration of Kampo prescriptions during 106 ± 32 (mean ± SD) weeks. Of the 5 cases, 2 were prescribed Wen-Pi-Tang, another 2 cases were treated with Wen-Pi-Tang and Bu-Zhong-Yi-Qi-Tang and the last was treated with Ba-Wei-Di-Huang-Wan. This study demonstrated that the traditional Chinese prescriptions, most of them comprising Wen-Pi-Tang and/or Bu-Zhong-Yi-Qi-Tang, retarded the progression of CRF.

  7. Passive ALWR requirements to prevent containment failure. Advanced Reactor Severe Accident Program

    SciTech Connect

    Additon, S.L.; Blanchard, D.P.; Leaver, D.E.; Persinko, D. |

    1991-12-01

    The purpose of this report is to document a systematic evaluation of the Passive Advanced Light Water Reactor (ALWR) design requirements which address severe accident mitigation. This evaluation was performed concurrent with completion of the ALWR Requirements Document to assure the adequacy of these mitigation requirements. The passive plant approach to containment integrity assurance reflects an expansion of the approach established earlier for evolutionary ALWRs. The report identifies containment challenges that might occur coincident with or result from a core damage event, compiles the set of passive ALWR design requirements which addresses each challenge, and evaluates each set of requirements on an integrated basis to confirm that the requirements provide substantial assurance that coincident core damage and containment failure are precluded. Based on past PRAs, a review of pertinent safety functions, severe accident analyses, current regulatory requirements, and reviews by ALWR design personnel, twenty-three (23) potential containment challenges were identified. The report concludes that the relevant ALWR requirements severe to limit the likelihood and magnitude of the challenges, and to assure the capability of the containment to accommodate all challenges which remain potentially risk-significant.

  8. Passive ALWR requirements to prevent containment failure. [Advanced light water reactors

    SciTech Connect

    Additon, S.L.; Blanchard, D.P.; Leaver, D.E.; Persinko, D. TENERA, L.P., Bethesda, MD )

    1991-12-01

    The purpose of this report is to document a systematic evaluation of the Passive Advanced Light Water Reactor (ALWR) design requirements which address severe accident mitigation. This evaluation was performed concurrent with completion of the ALWR Requirements Document to assure the adequacy of these mitigation requirements. The passive plant approach to containment integrity assurance reflects an expansion of the approach established earlier for evolutionary ALWRs. The report identifies containment challenges that might occur coincident with or result from a core damage event, compiles the set of passive ALWR design requirements which addresses each challenge, and evaluates each set of requirements on an integrated basis to confirm that the requirements provide substantial assurance that coincident core damage and containment failure are precluded. Based on past PRAs, a review of pertinent safety functions, severe accident analyses, current regulatory requirements, and reviews by ALWR design personnel, twenty-three (23) potential containment challenges were identified. The report concludes that the relevant ALWR requirements severe to limit the likelihood and magnitude of the challenges, and to assure the capability of the containment to accommodate all challenges which remain potentially risk-significant.

  9. Increase in parasympathetic tone by pyridostigmine prevents ventricular dysfunction during the onset of heart failure.

    PubMed

    Lataro, Renata M; Silva, Carlos A A; Fazan, Rubens; Rossi, Marcos A; Prado, Cibele M; Godinho, Rosely O; Salgado, Helio C

    2013-10-15

    Heart failure (HF) is characterized by elevated sympathetic activity and reduced parasympathetic control of the heart. Experimental evidence suggests that the increase in parasympathetic function can be a therapeutic alternative to slow HF evolution. The parasympathetic neurotransmission can be improved by acetylcholinesterase inhibition. We investigated the long-term (4 wk) effects of the acetylcholinesterase inhibitor pyridostigmine on sympathovagal balance, cardiac remodeling, and cardiac function in the onset of HF following myocardial infarction. Myocardial infarction was elicited in adult male Wistar rats. After 4 wk of pyridostigmine administration, per os, methylatropine and propranolol were used to evaluate the cardiac sympathovagal balance. The tachycardic response caused by methylatropine was considered to be the vagal tone, whereas the bradycardic response caused by propranolol was considered to be the sympathetic tone. In conscious HF rats, pyridostigmine reduced the basal heart rate, increased vagal, and reduced sympathetic control of heart rate. Pyridostigmine reduced the myocyte diameter and collagen density of the surviving left ventricle. Pyridostigmine also increased vascular endothelial growth factor protein in the left ventricle, suggesting myocardial angiogenesis. Cardiac function was assessed by means of the pressure-volume conductance catheter system. HF rats treated with pyridostigmine exhibited a higher stroke volume, ejection fraction, cardiac output, and contractility of the left ventricle. It was demonstrated that the long-term administration of pyridostigmine started right after coronary artery ligation augmented cardiac vagal and reduced sympathetic tone, attenuating cardiac remodeling and left ventricular dysfunction during the progression of HF in rats.

  10. Octreotide prevents liver failure through upregulating 5'-methylthioadenosine in extended hepatectomized rats.

    PubMed

    Du, Zhenggui; Zhou, Yongjie; Lu, Xufeng; Li, Lei; Lu, Changli; Li, Li; Li, Bo; Bu, Hong; Yang, Jiayin; Shi, Yujun

    2016-02-01

    Insufficient liver regeneration and hepatocyte injury caused by excessive portal perfusion are considered to be responsible for post-hepatectomy liver failure (PLF) or small-for-size syndrome in living-donor liver transplantation. Somatostatin can decrease portal vein pressure (PVP) but simultaneously inhibits liver regeneration. This interesting paradox motivated us to investigate the outcome of PLF in response to somatostatin treatment. Rats receiving extended partial hepatectomy (90% PH) were treated with octreotide, a somatostatin analogue, or placebo. Animal survival, serum parameters and hepatic histology were evaluated. Metabolomic analysis was performed to investigate the effect of octreotide on hepatocyte metabolism. Despite significantly inhibiting early regeneration, octreotide application noticeably improved the hepatic histology, liver function and survival after PH but did not decrease the PVP level. Metabolomic analysis exhibited that octreotide profoundly and exclusively altered the levels of five metabolites that participate in or closely associate with the methionine cycle, a biochemical reaction that uniquely produces S-adenosylmethionine (SAMe), an active methyl residual donor for methyltransferase reactions. Among these metabolites, 5'-methylthioadenosine (MTA), a derivate of SAMe, increased three-fold and was found independently improve the hepatic histology and reduce inflammatory cytokines in hepatectomized rats. Octreotide exclusively regulates the methionine cycle reaction and augments the MTA level in hepatocytes. MTA prominently protects hepatocytes against shear stress injury and reduces the secondary inflammation, thereby protecting rats from PLF. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Metallic wear debris sensors: promising developments in failure prevention for wind turbine gearsets and similar components

    NASA Astrophysics Data System (ADS)

    Poley, Jack; Dines, Michael

    2011-04-01

    Wind turbines are frequently located in remote, hard-to-reach locations, making it difficult to apply traditional oil analysis sampling of the machine's critical gearset at timely intervals. Metal detection sensors are excellent candidates for sensors designed to monitor machine condition in vivo. Remotely sited components, such as wind turbines, therefore, can be comfortably monitored from a distance. Online sensor technology has come of age with products now capable of identifying onset of wear in time to avoid or mitigate failure. Online oil analysis is now viable, and can be integrated with onsite testing to vet sensor alarms, as well as traditional oil analysis, as furnished by offsite laboratories. Controlled laboratory research data were gathered from tests conducted on a typical wind turbine gearbox, wherein total ferrous particle measurement and metallic particle counting were employed and monitored. The results were then compared with a physical inspection for wear experienced by the gearset. The efficacy of results discussed herein strongly suggests the viability of metallic wear debris sensors in today's wind turbine gearsets, as correlation between sensor data and machine trauma were very good. By extension, similar components and settings would also seem amenable to wear particle sensor monitoring. To our knowledge no experiments such as described herein, have previously been conducted and published.

  12. Becoming a first-class noticer. How to spot and prevent ethical failures in your organization.

    PubMed

    Bazerman, Max H

    2014-01-01

    We'd like to think that no smart, upstanding manager would ever overlook or turn a blind eye to threats or wrongdoing that ultimately imperil his or her business. Yet it happens all the time. We fall prey to obstacles that obscure or drown out important signals that things are amiss. Becoming a "first-class noticer," says Max H. Bazerman, a professor at Harvard Business School, requires conscious effort to fight ambiguity, motivated blindness, conflicts of interest, the slippery slope, and efforts of others to mislead us. As a manager, you can develop your noticing skills by acknowledging responsibility when things go wrong rather than blaming external forces beyond your control. Bazerman also advises taking an outsider's view to challenge the status quo. Given the string of ethical failures of corporations around the world in recent years--from BP to GM to JP Morgan Chase--it's clear that leaders not only need to act more responsibly themselves but also must develop keen noticing skills in their employees and across their organizations.

  13. Can intracytoplasmic sperm injection prevent total fertilization failure and enhance embryo quality in patients with non-male factor infertility?

    PubMed

    Kim, Ju Yeong; Kim, Jee Hyun; Jee, Byung Chul; Lee, Jung Ryeol; Suh, Chang Suk; Kim, Seok Hyun

    2014-07-01

    To determine whether intracytoplasmic sperm injection (ICSI) could prevent total fertilization failure (TFF) and enhance the embryo quality in patients with non-male factor infertility. A total of 296 in vitro fertilization (IVF) cycles performed in patients with non-male factor infertility between April 2009 and March 2013 were included in this retrospective study. During the period, ICSI and conventional IVF were performed in 142 and 154 cycles, respectively. The usual indications for ICSI were in the cycles of patients with (1) known low fertilization rate, (2) repetitive implantation failure, (3) advanced maternal age, (4) presence of endometrioma, (5) low oocyte yield (number of oocytes ≤3), or (6) poor quality oocytes. The rate of TFF, normal fertilization, abnormal pronuclei (PN) formation, embryo quality, and pregnancy outcomes between the patients treated with ICSI and conventional IVF cycles were compared. The patients treated with ICSI (ICSI group, n=142) presented fewer number of oocytes than patients treated with conventional IVF cycles (n=154). The TFF rate was not different (4.2% vs. 0.6%, P=0.059), but the ICSI group presented a significantly higher rate of normal fertilization (83.4% vs. 79.1%, P=0.04) and lower rate of abnormal PN formation (3.9% vs. 13.3%, P<0.01). The cleavage stage embryo quality was better in the ICSI group (grade A: 31.1% vs. 21.3%, P=0.001; grade A+B: 65.1% vs. 47.6%, P<0.001). The result of this study does not support the use of ICSI to prevent TFF in patients with non-male factor infertility. However, ICSI improved the fertilization rate and the embryo quality. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. A closer look at acute heart failure: Putting Portuguese and European data into perspective.

    PubMed

    Fonseca, Cândida; Araújo, Inês; Marques, Filipa; Brás, Daniel; Bettencourt, Paulo

    2016-05-01

    Acute heart failure (AHF) is a heterogeneous clinical syndrome requiring urgent therapy. The prognosis is poor after the index hospitalization, with a high risk for rehospitalization and early death. The costs of managing AHF are thus increasing rapidly. A literature review was performed to gather and compare data on prevalence and treatment and to identify gaps in AHF management, based on European and Portuguese studies. A literature search from 1995 to 2014 was conducted in selected databases (BIOSIS Previews, EMBASE and Ovid MEDLINE). Seven Portuguese and nine European studies were analyzed. The mean age of AHF patients was ≥65 years and 30-50% were women. Coronary artery disease (42.3% vs. 61.9%) and hypertension (53.3% vs. 76.7%) were identified as primary etiologies in Europe and in Portugal. Similar proportions of heart failure with preserved ejection fraction were found in the Portuguese (19.9-44.7%) and European (32.8-39.1%) studies. Overall, all-cause mortality rates were comparable (six months: 9.3-25.5% vs. 13.5-27.4%; one year: 15.9-31% vs. 17.4-46.5%), as was in-hospital mortality (5.5-14% vs. 3.8-12%) in Portuguese and European studies, respectively. Length of stay was comparable. The studies were performed in very different hospital settings and data on treatment were scarce. Gaps were identified in treatment and clinical pathways of patients with AHF. Based on the results of this review, collection and investigation of data on the disease and treatment solutions, training in disease management, and improved organization of healthcare should be the subject of further investment. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  15. Lay health mentors in community-based older adult disability prevention programs: provider perspectives.

    PubMed

    Dossa, Almas; Capitman, John A

    2011-04-01

    In this study, we explored provider perspectives on the benefits of and implementation challenges in using lay health mentor peers in a community-based replication of an efficacious 12-month older adult disability prevention program. In addition, we describe the association of the mentor program with site features and program completion. We conducted semi-structured telephone interviews with nurses, social workers, and site managers and obtained primary data on site features and secondary data on program completion. Major themes included the importance of the health mentor program and implementation challenges. Sites with mentor programs were more likely to have older adults complete the program compared with sites without mentor programs. Rural, small, and less diverse sites were more likely to have health mentor programs than urban, large, and more diverse sites. Implications include a need to fund more lay health mentor programs, obtain adequate staffing including minority staff for health mentor support, and implement strategies to improve program efficiency.

  16. Entry Inhibitors: A Perspective for Prevention of Hepatitis C Virus Infection in Organ Transplantation.

    PubMed

    Colpitts, Che C; Chung, Raymond T; Baumert, Thomas F

    2017-09-08

    Entry inhibitors are emerging as an attractive class of therapeutics for hepatitis C virus (HCV) infection. Entry inhibitors target either virion-associated factors or cellular factors necessary for infection. By blocking entry into cells, entry inhibitors prevent both the establishment of persistent reservoirs and the emergence of resistant variants during viral replication. Furthermore, entry inhibitors protect naïve cells from virus-induced alterations. Combining entry inhibitors with direct-acting antivirals (DAAs) may therefore improve treatment outcomes, particularly in the context of organ transplantation. The role of DAAs in transplantation, while still under clinical investigation, carries the risk of recipient infection and HCV-induced disease, since DAAs act only after infection is established. Thus, entry inhibitors provide a perspective to improve patient outcomes during organ transplantation. Applying this approach for transplant of organs from HCV-positive donors to HCV-negative recipients may also contribute to alleviate the medical burden of organ shortage.

  17. Getting into trouble: perspectives on stress and suicide prevention among Pacific Northwest Indian youth.

    PubMed

    Strickland, C June; Cooper, Michelle

    2011-07-01

    Suicide rates among Indian youth in the United States are two to three times the national average. Although researchers have identified related risk and protective factors, they have limited understanding of the perspectives of youth at risk. In this descriptive, ethnographic study in a Pacific Northwest tribe, the goal was to gain an understanding of the life experiences of the youth. Focus groups and observations were conducted with 30 Indian youth aged between 14 and 19 years in a Pacific Northwest tribe. Youth were asked to talk about their stressors, sense of family/community support, and hopes for the future. Youth reported major stress and noted that friends and family were both a support and also a source of stress. They hoped for strengthening of cultural values, economic development, and opportunities to give their talents to the tribe. These findings provide further insight about suicide risk among Indian youth and advance the understanding of suicide prevention in a transcultural setting.

  18. Current status and perspectives of Clonorchis sinensis and clonorchiasis: epidemiology, pathogenesis, omics, prevention and control.

    PubMed

    Tang, Ze-Li; Huang, Yan; Yu, Xin-Bing

    2016-07-06

    Clonorchiasis, caused by Clonorchis sinensis (C. sinensis), is an important food-borne parasitic disease and one of the most common zoonoses. Currently, it is estimated that more than 200 million people are at risk of C. sinensis infection, and over 15 million are infected worldwide. C. sinensis infection is closely related to cholangiocarcinoma (CCA), fibrosis and other human hepatobiliary diseases; thus, clonorchiasis is a serious public health problem in endemic areas. This article reviews the current knowledge regarding the epidemiology, disease burden and treatment of clonorchiasis as well as summarizes the techniques for detecting C. sinensis infection in humans and intermediate hosts and vaccine development against clonorchiasis. Newer data regarding the pathogenesis of clonorchiasis and the genome, transcriptome and secretome of C. sinensis are collected, thus providing perspectives for future studies. These advances in research will aid the development of innovative strategies for the prevention and control of clonorchiasis.

  19. Preventing seclusion in psychiatry: a care ethics perspective on the first five minutes at admission.

    PubMed

    Voskes, Yolande; Kemper, Martijn; Landeweer, Elleke G M; Widdershoven, Guy A M

    2014-11-01

    In this article, an intervention aimed at improving quality of care to prevent seclusion in psychiatry by focusing on the first five minutes at admission is analyzed from a care ethics perspective. Two cases are presented from an evaluation study in a psychiatric hospital. In both cases, the nurses follow the intervention protocol, but the outcome is different. In the first case, the patient ends up in the seclusion room. In the second case, this does not happen. Analyzing the cases from a care ethics perspective, we conclude that applying the intervention in the right way implies more than following the steps laid down in the protocol. It requires a new way of thinking and acting, resulting in new relationships between nurses and patients. Care ethics theory can help clarify what good care is actually about and keep in mind what is needed to apply the intervention. Thus, care ethics theory can be highly practical and helpful in changing and improving healthcare practice. © The Author(s) 2013.

  20. Cost Effectiveness of Apixaban versus Warfarin or Aspirin for Stroke Prevention in Patients with Atrial Fibrillation: A Greek Perspective.

    PubMed

    Athanasakis, Kostas; Boubouchairopoulou, Nadia; Karampli, Eleftheria; Tarantilis, Filippos; Savvari, Paraskevi; Bilitou, Aikaterini; Kyriopoulos, John

    2017-04-01

    Strokes attributed to atrial fibrillation (AF) represent a major cause of adult disability and a great burden to society and healthcare systems. Our objective was to assess the cost effectiveness of apixaban, a direct acting oral anticoagulant (DOAC), versus warfarin or aspirin for patients with AF in the Greek healthcare setting. We used a previously published Markov model to simulate clinical events for patients with AF treated with apixaban, the vitamin K antagonist (VKA) warfarin, or aspirin. Clinical events (ischemic and hemorrhagic stroke, intracranial hemorrhage, other major bleed, clinically relevant non-major bleed, myocardial infarction, and cardiovascular [CV] hospitalizations) were modeled using efficacy data from the ARISTOTLE and AVERROES clinical trials. The cohort's baseline characteristics also sourced from these trials. Among VKA-suitable patients, 64.7% were men with a mean age of 70 years and average CHADS2 (cardiac failure, hypertension, age, diabetes, stroke2) score of 2.1, whereas 58.5% of VKA-unsuitable patients were men with a mean age of 70 years and a CHADS2 score of 2.0. A panel of experts (cardiologists and internists) provided information on the resource use associated with the management of AF. Cost calculations reflect the local clinical setting and a third-party payer perspective (€, discounted at 3%). Based on a simulation of 1000 VKA-suitable patients over a lifetime horizon, the use of apixaban versus warfarin resulted in 26 fewer strokes and systemic embolisms in total, 65 fewer bleeds, 41 fewer myocardial infarctions, and 29 fewer CV-related deaths, with an incremental cost-effectiveness ratio (ICER) of €14,478/quality-adjusted life-year (QALY). For VKA-unsuitable patients, apixaban versus aspirin resulted in 72 fewer strokes and systemic embolisms and 57 fewer CV-related deaths, with an ICER of €7104/QALY. Sensitivity analyses indicated that results were robust. Based on the present analysis, apixaban represents a cost

  1. The performance efficiency of bioaugmentation to prevent anaerobic digestion failure from ammonia and propionate inhibition.

    PubMed

    Li, Ying; Zhang, Yue; Sun, Yongming; Wu, Shubiao; Kong, Xiaoying; Yuan, Zhenhong; Dong, Renjie

    2017-05-01

    This study aims to investigate the effect of bioaugmentation with enriched methanogenic propionate degrading microbial consortia on propionate fermentation under ammonia stress from total ammonia nitrogen concentration (TAN) of 3.0gNL(-1). Results demonstrated that bioaugmentation could prevent unstable digestion against further deterioration. After 45days of 1dosage (0.3g dry cell weight L(-1)d(-1), DCW L(-1)d(-1)) of bioaugmentation, the average volumetric methane production (VMP), methane recovery rate and propionic acid (HPr) degradation rate was enhanced by 70mLL(-1)d(-1), 21% and 51%, respectively. In contrast, the non-bioaugmentation reactor almost failed. Routine addition of a double dosage (0.6g DCW L(-1)d(-1)) of bioaugmentation culture was able to effectively recover the failing digester. The results of FISH suggested that the populations of Methanosaetaceae increased significantly, which could be a main contributor for the positive effect on methane production.

  2. Iron-regulatory proteins secure iron availability in cardiomyocytes to prevent heart failure.

    PubMed

    Haddad, Saba; Wang, Yong; Galy, Bruno; Korf-Klingebiel, Mortimer; Hirsch, Valentin; Baru, Abdul M; Rostami, Fatemeh; Reboll, Marc R; Heineke, Jörg; Flögel, Ulrich; Groos, Stephanie; Renner, André; Toischer, Karl; Zimmermann, Fabian; Engeli, Stefan; Jordan, Jens; Bauersachs, Johann; Hentze, Matthias W; Wollert, Kai C; Kempf, Tibor

    2017-02-01

    Iron deficiency (ID) is associated with adverse outcomes in heart failure (HF) but the underlying mechanisms are incompletely understood. Intracellular iron availability is secured by two mRNA-binding iron-regulatory proteins (IRPs), IRP1 and IRP2. We generated mice with a cardiomyocyte-targeted deletion of Irp1 and Irp2 to explore the functional implications of ID in the heart independent of systemic ID and anaemia. Iron content in cardiomyocytes was reduced in Irp-targeted mice. The animals were not anaemic and did not show a phenotype under baseline conditions. Irp-targeted mice, however, were unable to increase left ventricular (LV) systolic function in response to an acute dobutamine challenge. After myocardial infarction, Irp-targeted mice developed more severe LV dysfunction with increased HF mortality. Mechanistically, the activity of the iron-sulphur cluster-containing complex I of the mitochondrial electron transport chain was reduced in left ventricles from Irp-targeted mice. As demonstrated by extracellular flux analysis in vitro, mitochondrial respiration was preserved at baseline but failed to increase in response to dobutamine in Irp-targeted cardiomyocytes. As shown by 31P-magnetic resonance spectroscopy in vivo, LV phosphocreatine/ATP ratio declined during dobutamine stress in Irp-targeted mice but remained stable in control mice. Intravenous injection of ferric carboxymaltose replenished cardiac iron stores, restored mitochondrial respiratory capacity and inotropic reserve, and attenuated adverse remodelling after myocardial infarction in Irp-targeted mice but not in control mice. As shown by electrophoretic mobility shift assays, IRP activity was significantly reduced in LV tissue samples from patients with advanced HF and reduced LV tissue iron content. ID in cardiomyocytes impairs mitochondrial respiration and adaptation to acute and chronic increases in workload. Iron supplementation restores cardiac energy reserve and function in iron

  3. Neurocognitive monitors: toward the prevention of cognitive performance decrements and catastrophic failures in the operational environment.

    PubMed

    Thomas, Maria L; Russo, Michael B

    2007-05-01

    Network-centric doctrine and the proposed C41SR (command, control, communications, computers, intelligence, surveillance and reconnaissance) distributions to the individual warfighter require that the cognitive performance, judgment, and decision making of warfighters must be sustained and effectively managed in the forward operating environment, where various physiological and psychological stressors abound, in order to reduce human errors and catastrophic failures. The U.S. Army Medical Research and Materiel Command (USAMRMC) established the Cognitive Performance, Judgment, and Decision-Making Research Program (CPJDRP) in 2004 to direct research to this issue. A Neurophysiological Measures and Cognition Focus Team (NMFCT) was formed to work with augmented cognition investigators and to specifically address the development of neurophysiological measures as potential monitors of alertness-cognitive state in warfighters. The USAM-RMC approach complemented the Defense Advanced Research Projects Agency (DARPA) Augmented Cognition approach, which focused on the detection of workload-related impaired cognitive state, and subsequent modification of information flow through automation. In this preface, the premise for neurophysiological measures as neurocognitive monitors is explained using an example of a neurophysiological index: the oculomotor measure, saccadic velocity. The progress of the NMFCT on the development of a neurocognitive monitor is described, as well as the recommendations of a 2005 USAMRMC/Telemedicine and Advanced Technology Research Center (TATRC)-sponsored workshop. Awareness of neurocognitive monitoring is discussed, as are future endeavors related to operational testing and fieldability. Four papers are summarized in this Neurophysiological Monitoring and Augmented Cognition section involving technologies to enhance cognitive performance in the operational environment: one on dynamic cortical electroencephalography, two on oculometrics, and one on a

  4. Acute decompensated heart failure (ADHF): A comprehensive contemporary review on preventing early readmissions and postdischarge death.

    PubMed

    Rocha, Bruno M L; Menezes Falcão, Luiz

    2016-11-15

    Heart failure (HF) is an increasingly prevalent syndrome and a leading cause of both first hospitalization and readmissions. Strikingly, up to 25% of the patients are readmitted within 30 to 60-days, accounting for HF as the primary cause for readmission in the adult population. Given its poor prognosis, one could describe it as a "malignant condition". Acute decompensation is intrinsically related to increased right heart tele-diastolic pressures and often related to congestive symptoms. In-hospital strategies to adequately compensate and timely discharge patients are limited. Conversely, the fragile early postdischarge phase is a vulnerable period when one could potentially intervene cost-effectively to improve survival and to reduce morbidity. Promising transitional hospital-to-home programs may have a broader role in the near future, namely for selected higher risk patients. However, identifying patients at risk for hospital readmission has been challenging. Novel approaches, such as ferric carboxymaltose and valsartan/sacubitril, and reemerging drugs, particularly digoxin, may reduce hospitalizations. Despite this, optimizing the use of "older" therapies is still warranted. Right heart pressures monitoring may provide novel insights into promptly outpatient management. Unfortunately, randomized trials in the specific ADHF population are scarce. A novel paradigmatic approach is needed in order to suitably improve the currently poor prognosis of ADHF. Both improving survival and reducing hospitalizations are, therefore, primordial therapy goals. Lastly, no single drug has consistently proved to improve survival in HF with preserved ejection fraction (HFpEF); yet, some approaches may efficiently reduce hospitalizations. Awareness on HFpEF management beyond the failing heart is imperative.

  5. Long-term pharmacological activation of PPARgamma does not prevent left ventricular remodeling in dogs with advanced heart failure.

    PubMed

    Suzuki, George; Khanal, Sanjaya; Rastogi, Sharad; Morita, Hideaki; Mishima, Takayuki; Anagnostopoulos, Petros V; Nass, Omar; Sharov, Victor G; Tanhehco, Elaine J; Goldstein, Sidney; Sabbah, Hani N

    2007-02-01

    Peroxisome proliferator-activated receptor gamma (PPARgamma) activators affect the myocardium through inhibition of inflammatory cytokines and metabolic modulation but their effect in the progression of heart failure is unclear. In the present study, we examined the effects of the PPARgamma activator, GW347845 (GW), on the progression of heart failure. Heart failure was produced in 21 dogs by intracoronary microembolizations to LV ejection fraction (EF) less than 30% and randomized to 3 months of therapy with high-dose GW (10 mg/Kg daily, n = 7), low-dose GW (3 mg/Kg daily, n = 7), or no therapy (control, n = 7). In control dogs, EF significantly decreased (28 +/- 1 vs. 22 +/- 1%, p < 0.001) and end-diastolic volume (EDV) and end-systolic volume (ESV) increased during the 3 months of the follow-up period (64 +/- 4 vs. 76 +/- 5; p = 0.003, 46 +/- 3 vs. 59 +/- 4 ml, p = 0.002, respectively). In dogs treated with low-dose GW, EDV increased significantly (69 +/- 4 vs.81 +/- 5 ml, p = 0.01), whereas ESV remained statistically unchanged (50 +/- 3 vs. 54 +/- 3 ml, p = 0.10) resulting in modestly increased ejection fraction (27 +/- 1 vs. 32 +/- 3%, p = 0.05). In dogs treated with high-dose GW, both EDV and ESV increased (72 +/- 4 vs. 79 +/- 5 ml, p = 0.04; 53 +/- 3 vs. 62 +/- 5 ml, p = 0.04) and EF decreased (26 +/- 1 vs. 23 +/- 1%, p = 0.04) as with control dogs. There was significantly increased myocardial hypertrophy as evidenced by increased LV weight to body weight ratio and myocyte cross-section area in the GW treated animals compared to controls. Compared to control, treatment with GW had no effect on mRNA expression of PPARgamma, inflammatory cytokines, stretch response proteins, or transcription factors that may induce hypertrophy. Long-term PPARgamma activation with GW did not prevent progressive LV remodeling in dogs with advanced heart failure.

  6. The cost effectiveness of ivabradine in the treatment of chronic heart failure from the UK National Health Service perspective

    PubMed Central

    Griffiths, A; Paracha, N; Davies, A; Branscombe, N; Cowie, M R; Sculpher, M

    2014-01-01

    Objective Ivabradine, a specific heart rate lowering therapy, has been shown in a randomised placebo-controlled study, Systolic HF Treatment with the If Inhibitor Ivabradine Trial (SHIfT), to significantly reduce the composite end point of cardiovascular death and hospitalisation for worsening heart failure (HF) in patients with systolic HF who are in sinus rhythm and with a heart rate ≥70 bpm, when added to optimised medical therapy (HR: 0.82, 95% CI 0.75 to 0.90, p<0.0001). We assessed the cost effectiveness of ivabradine, from a UK National Health Service perspective, based on the results of SHIfT. Methods A Markov model estimated the cost effectiveness of ivabradine compared with standard care for two cohorts of patients with HF (heart rate ≥75 bpm in line with the EU labelled indication; and heart rate ≥70 bpm in line with the SHIfT study population). Modelled outcomes included death, hospitalisation, quality of life and New York Heart Association class. Total costs and quality adjusted life years (QALYs) for ivabradine and standard care were estimated over a lifetime horizon. Results The incremental cost per additional QALY for ivabradine plus standard care versus standard care has been estimated as £8498 for heart rate ≥75 bpm and £13 764 for heart rate ≥70 bpm. Ivabradine is expected to have a 95% chance of being cost-effective in the EU licensed population using the current National Institute for Health and Care Excellence cost effectiveness threshold of £20 000 per QALY. These results were robust in sensitivity analyses. Conclusions This economic evaluation suggests that the use of ivabradine is likely to be cost-effective in eligible patients with HF from a UK National Health Service perspective. PMID:24634022

  7. New perspectives on ACL injury: On the role of repetitive sub-maximal knee loading in causing ACL fatigue failure.

    PubMed

    Wojtys, Edward M; Beaulieu, Mélanie L; Ashton-Miller, James A

    2016-12-01

    In this paper, we review a series of studies that we initiated to examine mechanisms of anterior cruciate ligament (ACL) injury in the hope that these injuries, and their sequelae, can be better prevented. First, using the earliest in vitro model of a simulated single-leg jump landing or pivot cut with realistic knee loading rates and trans-knee muscle forces, we identified the worst-case dynamic knee loading that causes the greatest peak ACL strain: Combined knee compression, flexion, and internal tibial rotation. We also identified morphologic factors that help explain individual susceptibility to ACL injury. Second, using the above knee loading, we introduced a possible paradigm shift in ACL research by demonstrating that the human ACL can fail by a sudden rupture in response to repeated sub-maximal knee loading. If that load is repeated often enough over a short time interval, the failure tended to occur proximally, as observed clinically. Third, we emphasize the value of a physical exam of the hip by demonstrating how limited internal axial rotation at the hip both increases the susceptibility to ACL injury in professional athletes, and also increases peak ACL strain during simulated pivot landings, thereby further increasing the risk of ACL fatigue failure. When training at-risk athletes, particularly females with their smaller ACL cross-sections, rationing the number and intensity of worst-case knee loading cycles, such that ligament degradation is within the ACL's ability to remodel, should decrease the risk for ACL rupture due to ligament fatigue failure.© 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2059-2068, 2016.

  8. [Human hydatidosis in children: manifestation of failure in the control and prevention measures. Chile, 2001-2011].

    PubMed

    Martínez, Paulina

    2015-04-01

    Hydatidosis is mainly a slowly developing disease, so its appearance in children and adolescents means a relatively recent acquisition; its quantification at this age groups is an indirect mechanism for the evaluation of a prevention and control program. To characterize human hydatidosis in children aged 0 to 18 years in Chile. Data from the Disease Notification System (2001-2009), hospital discharges (2001-2008), Deaths (2001-2008) and Years of Potential Life Lost (2001-2008) were used. The incidence rate for the period was 4.4 cases per 100.000 inhabitants, male dominated. Hospital discharges rate for the period was 40.3 discharges per 100.000 inhabitants. The mortality rate for the period was 0.13 deaths per 100 000 inhabitants. The incidence rates of cases reported, hospital discharges and mortality tend to decrease. However, each new infection reflects the failure of prevention and control, which suggested to incorporate surveillance system tracking and monitoring of cases particularly children's domiciled contacts.

  9. Current Perspectives on Systemic Hypertension in Heart Failure with Preserved Ejection Fraction.

    PubMed

    Tam, Marty C; Lee, Ran; Cascino, Thomas M; Konerman, Matthew C; Hummel, Scott L

    2017-02-01

    Heart failure with preserved ejection fraction (HFpEF) is a prevalent but incompletely understood syndrome. Traditional models of HFpEF pathophysiology revolve around systemic HTN and other causes of increased left ventricular afterload leading to left ventricular hypertrophy (LVH) and diastolic dysfunction. However, emerging models attribute the development of HFpEF to systemic proinflammatory changes secondary to common comorbidities which include HTN. Alterations in passive ventricular stiffness, ventricular-arterial coupling, peripheral microvascular function, systolic reserve, and chronotropic response occur. As a result, HFpEF is heterogeneous in nature, making it difficult to prescribe uniform therapies to all patients. Nonetheless, treating systemic HTN remains a cornerstone of HFpEF management. Antihypertensive therapies have been linked to LVH regression and improvement in diastolic dysfunction. However, to date, no therapies have definitive mortality benefit in HFpEF. Non-pharmacologic management for HTN, including dietary modification, exercise, and treating sleep disordered breathing, may provide some morbidity benefit in the HFpEF population. Future research is need to identify effective treatments, perhaps in more specific subgroups, and focus may need to shift from reducing mortality to improving exercise capacity and symptoms. Tailoring antihypertensive therapies to specific phenotypes of HFpEF may be an important component of this strategy.

  10. Antiplatelet and anticoagulant agents in heart failure: current status and future perspectives.

    PubMed

    Gurbel, Paul A; Tantry, Udaya S

    2014-02-01

    There has been a 3-fold increase in hospital discharges for heart failure (HF) and also significantly increased mortality rate in HF patients in recent years. A major focus of HF research has been in the area of neurohormonal control and resynchronization therapy. There is a great urgency in better understanding the pathophysiology underlying the exceedingly high mortality and a need for exploration of therapeutic strategies beyond those that influence neurohormonal pathways. The decision to treat patients with HF with antiplatelet therapy remains largely influenced by the presence or absence of concomitant arterial disease. Antithrombotic therapy has been shown to be effective in many forms of cardiac disease, including patients with HF and atrial fibrillation. Although it is clear that platelet activation and hypercoagulability are present in HF, and there is evidence that stroke is reduced by warfarin therapy in the HF patient, the available data suggest that the risk of major bleeding overshadows the antithromboembolic benefit in HF patients in sinus rhythm. The utility of oral anticoagulant and/or antiplatelet therapy has never been evaluated in an adequately powered dedicated clinical trial of HF patients in sinus rhythm. In this state-of-the art paper we explore the evidence for targeting the inhibition of platelet function and coagulation to improve outcomes in the HF patient.

  11. Hydrogen in Ti and Zr alloys: industrial perspective, failure modes and mechanistic understanding

    NASA Astrophysics Data System (ADS)

    Chapman, T. P.; Dye, D.; Rugg, D.

    2017-06-01

    Titanium is widely used in demanding applications, such as in aerospace. Its strength-to-weight ratio and corrosion resistance make it well suited to highly stressed rotating components. Zirconium has a no less critical application where its low neutron capture cross section and good corrosion resistance in hot water and steam make it well suited to reactor core use, including fuel cladding and structures. The similar metallurgical behaviour of these alloy systems makes it alluring to compare and contrast their behaviour. This is rarely undertaken, mostly because the industrial and academic communities studying these alloys have little overlap. The similarities with respect to hydrogen are remarkable, albeit potentially unsurprising, and so this paper aims to provide an overview of the role hydrogen has to play through the material life cycle. This includes the relationship between alloy design and manufacturing process windows, the role of hydrogen in degradation and failure mechanisms and some of the underpinning metallurgy. The potential role of some advanced experimental and modelling techniques will also be explored to give a tentative view of potential for advances in this field in the next decade or so. This article is part of the themed issue 'The challenges of hydrogen and metals'.

  12. Perspectives on the failure of pharmaceutical and medical device industries to fully protect public health interests.

    PubMed

    Maron, Barry J; Hauser, Robert G

    2007-07-01

    This discussion raises a fundamental, yet simple, public health issue--failure by the pharmaceutical and device industries to institute proper informed consent and full disclosure of critical medical information to patients (through their physicians) and recognize the autonomous right of patients to participate in important medical decisions that may affect their well-being, including the risk of death or injury. In this discussion, 2 recent affairs with high public visibility were analyzed as models illustrating these issues involving Merck and Co. (Whitehouse Station, New Jersey; for Vioxx) and Guidant Corp. (Indianapolis, Indiana; for implantable defibrillators). These scenarios proved to be remarkably similar with regard to their themes and parallel pathways and the pitfalls they illustrate. In conclusion, the focus of this review emphasizes the lessons learned and the changes already underway that will promote improved communication between industry and the physician community (and their patients) so that ultimately patient trust in the medical establishment can be restored and maintained and the errors of the past not repeated.

  13. Intraportal mesenchymal stem cell transplantation prevents acute liver failure through promoting cell proliferation and inhibiting apoptosis.

    PubMed

    Sang, Jian-Feng; Shi, Xiao-Lei; Han, Bin; Huang, Tao; Huang, Xu; Ren, Hao-Zhen; Ding, Yi-Tao

    2016-12-01

    Transplantation of mesenchymal stem cells (MSCs) has been regarded as a potential treatment for acute liver failure (ALF), but the optimal route was unknown. The present study aimed to explore the most effective MSCs transplantation route in a swine ALF model. The swine ALF model induced by intravenous injection of D-Gal was treated by the transplantation of swine MSCs through four routes including intraportal injection (InP group), hepatic intra-arterial injection (AH group), peripheral intravenous injection (PV group) and intrahepatic injection (IH group). The living conditions and survival time were recorded. Blood samples before and after MSCs transplantation were collected for the analysis of hepatic function. The histology of liver injury was interpreted and scored in terminal samples. Hepatic apoptosis was detected by TUNEL assay. Apoptosis and proliferation related protein expressions including cleaved caspase-3, survivin, AKT, phospho-AKT (Ser473), ERK and phospho-ERK (Tyr204) were analyzed by Western blotting. The average survival time of each group was 10.7+/-1.6 days (InP), 6.0+/-0.9 days (AH), 4.7+/-1.4 days (PV), 4.3+/-0.8 days (IH), respectively, when compared with the average survival time of 3.8+/-0.8 days in the D-Gal group. The survival rates between the InP group and D-Gal group revealed a statistically significant difference (P<0.01). Pathological and biochemical analysis showed that liver damage was the worst in the D-Gal group, while less injury in the InP group. Histopathological scores revealed a significant decrease in the InP group (3.17+/-1.04, P<0.01) and AH group (8.17+/-0.76, P<0.05) as compared with that in the D-Gal group (11.50+/-1.32). The apoptosis rate in the InP group (25.0%+/-3.4%, P<0.01) and AH group (40.5%+/-1.0%, P<0.05) was lower than that in the D-Gal group (70.6%+/-8.5%). The expression of active caspase-3 was inhibited, while the expression of survivin, AKT, phospho-AKT (Ser473), ERK and phospho-ERK (Tyr204) was

  14. Asbestos contamination in feldspar extraction sites: a failure of prevention? Commentary.

    PubMed

    Cavariani, Fulvio

    2016-01-01

    Fibrous tremolite is a mineral species belonging to the amphibole group. It is present almost everywhere in the world as a natural contaminant of other minerals, like talc and vermiculite. It can be also found as a natural contaminant of the chrysotile form of asbestos. Tremolite asbestos exposures result in respiratory health consequences similar to the other forms of asbestos exposure, including lung cancer and mesothelioma. Although abundantly distributed on the earth's surface, tremolite is only rarely present in significant deposits and it has had little commercial use. Significant presence of amphibole asbestos fibers, characterized as tremolite, was identified in mineral powders coming from the milling of feldspar rocks extracted from a Sardinian mining site (Italy). This evidence raises several problems, in particular the prevention of carcinogenic risks for the workers. Feldspar is widespread all over the world and every year it is produced in large quantities and it is used for several productive processes in many manufacturing industries (over 21 million tons of feldspar mined and marketed every year). Until now the presence of tremolite asbestos in feldspar has not been described, nor has the possibility of such a health hazard for workers involved in mining, milling and handling of rocks from feldspar ores been appreciated. Therefore the need for a wider dissemination of knowledge of these problems among professionals, in particular mineralogists and industrial hygienists, must be emphasized. In fact both disciplines are necessary to plan appropriate environmental controls and adequate protections in order to achieve safe working conditions.

  15. Failure of vaccination to prevent outbreaks of foot-and-mouth disease.

    PubMed Central

    Woolhouse, M. E.; Haydon, D. T.; Pearson, A.; Kitching, R. P.

    1996-01-01

    Outbreaks of foot-and-mouth disease persist in dairy cattle herds in Saudi Arabia despite revaccination at intervals of 4-6 months. Vaccine trials provide data on antibody responses following vaccination. Using this information we developed a mathematical model of the decay of protective antibodies with which we estimated the fraction of susceptible animals at a given time after vaccination. The model describes the data well, suggesting over 95% take with an antibody half-life of 43 days. Farm records provided data on the time course of five outbreaks. We applied a 'SLIR' epidemiological model to these data, fitting a single parameter representing disease transmission rate. The analysis provides estimates of the basic reproduction number R(0), which may exceed 70 in some cases. We conclude that the critical intervaccination interval which would provide herd immunity against FMDV is unrealistically short, especially for heterologous challenge. We suggest that it may not be possible to prevent foot-and-mouth disease outbreaks on these farms using currently available vaccines. PMID:8666082

  16. Aripiprazole for relapse prevention and craving in alcohol use disorder: current evidence and future perspectives.

    PubMed

    Martinotti, Giovanni; Orsolini, Laura; Fornaro, Michele; Vecchiotti, Roberta; De Berardis, Domenico; Iasevoli, Felice; Torrens, Marta; Di Giannantonio, Massimo

    2016-06-01

    Among other approaches, the modulation of the dopaminergic pathway has been advocated in the therapeutic management of Alcohol Use Disorders (AUD). A potential avenue toward the modulation of the dopaminergic pathway across varying substance disorders seems to be provided by aripiprazole, a second-generation antipsychotic characterized by a peculiar pharmacodynamics signature. In this review, the authors provided a qualitative synthesis and a critical perspective on the efficacy of aripiprazole in relapse prevention and craving in AUD. A systematic search was carried out through MEDLINE/Embase/PsycINFO/Cochrane Library from inception until September 2015, combining free terms and MESH headings for the topics of AUD and aripiprazole as following: (((Alcohol use Disorder) OR (Alcohol use)) AND aripiprazole). Based both on a qualitative synthesis and a critical interpretation of the evidence, the authors submit that aripiprazole would promote alcohol abstinence and reduce the alcohol seeking behaviour possibly via dopaminergic and serotoninergic modulations at the fronto-subcortical circuits underpinning alcohol reward and craving, impulsive behaviour as well as reduce alcohol-related anxiety/low mood and anhedonia. However, due to the lack of published studies, a conclusive statement about any direct effect of aripiprazole in the prevention of craving and/or alcohol consumption is not possible.

  17. Controversies and unresolved issues in tuberculosis prevention and control: a low-burden-country perspective.

    PubMed

    Abubakar, Ibrahim; Stagg, Helen R; Cohen, Ted; Mangtani, Punam; Rodrigues, Laura C; Pimpin, Laura; Watson, John M; Squire, S Bertel; Zumla, Alimuddin

    2012-05-15

    Despite declining incidence in most high-income countries, tuberculosis shows no signs of disappearing in the near future. Although surveillance data from most Western European countries show relatively stable declines in the rate of tuberculosis over the past several decades, some have reported either an increasing rate or a decelerating pace of reduction in recent years. The burden of disease now disproportionately affects high-risk groups such as migrants, homeless persons, and prisoners. In view of the concentration of cases in urban areas and high-risk deprived groups, interventions that may not be efficient when applied to the general population may be highly cost effective when targeted at high-risk groups. In this article, we examine some controversial elements of tuberculosis prevention and control in low-burden countries and recommend issues for further research. In particular, we assess current evidence on the duration of protection by BCG vaccine, the screening of migrants and hard-to-reach groups, and the use of preventive therapy for contacts of cases of infectious multidrug-resistant tuberculosis. This analysis is presented from the perspective of low-tuberculosis-burden, high-income countries attempting to eliminate tuberculosis.

  18. Resveratrol in primary and secondary prevention of cardiovascular disease: a dietary and clinical perspective.

    PubMed

    Tomé-Carneiro, João; Gonzálvez, Manuel; Larrosa, Mar; Yáñez-Gascón, María J; García-Almagro, Francisco J; Ruiz-Ros, José A; Tomás-Barberán, Francisco A; García-Conesa, María T; Espín, Juan Carlos

    2013-07-01

    Primary prevention of cardiovascular disease (CVD) aims to avoid a first event in subjects that are at risk but have not yet been diagnosed with heart disease. Secondary prevention of CVD aims to avoid new events in patients with established heart disease. Both approaches involve clinical intervention and implementation of healthy lifestyles. The grape and wine polyphenol resveratrol (3,5,4'-trihydroxy-trans-stilbene) has shown cardioprotective benefits in humans. Most of these approaches deal with rather high doses and short follow-ups, and do not address the issue of long-term resveratrol consumption safety, especially in medicated individuals. Here, we review the trials conducted with resveratrol in patients at risk for or with established CVD, focusing on the two longest human clinical trials reported so far (1-year follow-up). We also discuss the expectations for resveratrol from a dietary and clinical perspective in relation to CVD. However, statistically significant changes in CVD-risk markers do not necessarily equal clinical significance in the daily care of patients.

  19. Aerobic exercise training prevents heart failure-induced skeletal muscle atrophy by anti-catabolic, but not anabolic actions.

    PubMed

    Souza, Rodrigo W A; Piedade, Warlen P; Soares, Luana C; Souza, Paula A T; Aguiar, Andreo F; Vechetti-Júnior, Ivan J; Campos, Dijon H S; Fernandes, Ana A H; Okoshi, Katashi; Carvalho, Robson F; Cicogna, Antonio C; Dal-Pai-Silva, Maeli

    2014-01-01

    Heart failure (HF) is associated with cachexia and consequent exercise intolerance. Given the beneficial effects of aerobic exercise training (ET) in HF, the aim of this study was to determine if the ET performed during the transition from cardiac dysfunction to HF would alter the expression of anabolic and catabolic factors, thus preventing skeletal muscle wasting. We employed ascending aortic stenosis (AS) inducing HF in Wistar male rats. Controls were sham-operated animals. At 18 weeks after surgery, rats with cardiac dysfunction were randomized to 10 weeks of aerobic ET (AS-ET) or to an untrained group (AS-UN). At 28 weeks, the AS-UN group presented HF signs in conjunction with high TNF-α serum levels; soleus and plantaris muscle atrophy; and an increase in the expression of TNF-α, NFκB (p65), MAFbx, MuRF1, FoxO1, and myostatin catabolic factors. However, in the AS-ET group, the deterioration of cardiac function was prevented, as well as muscle wasting, and the atrophy promoters were decreased. Interestingly, changes in anabolic factor expression (IGF-I, AKT, and mTOR) were not observed. Nevertheless, in the plantaris muscle, ET maintained high PGC1α levels. Thus, the ET capability to attenuate cardiac function during the transition from cardiac dysfunction to HF was accompanied by a prevention of skeletal muscle atrophy that did not occur via an increase in anabolic factors, but through anti-catabolic activity, presumably caused by PGC1α action. These findings indicate the therapeutic potential of aerobic ET to block HF-induced muscle atrophy by counteracting the increased catabolic state.

  20. Aerobic Exercise Training Prevents Heart Failure-Induced Skeletal Muscle Atrophy by Anti-Catabolic, but Not Anabolic Actions

    PubMed Central

    Souza, Rodrigo W. A.; Piedade, Warlen P.; Soares, Luana C.; Souza, Paula A. T.; Aguiar, Andreo F.; Vechetti-Júnior, Ivan J.; Campos, Dijon H. S.; Fernandes, Ana A. H.; Okoshi, Katashi; Carvalho, Robson F.; Cicogna, Antonio C.; Dal-Pai-Silva, Maeli

    2014-01-01

    Background Heart failure (HF) is associated with cachexia and consequent exercise intolerance. Given the beneficial effects of aerobic exercise training (ET) in HF, the aim of this study was to determine if the ET performed during the transition from cardiac dysfunction to HF would alter the expression of anabolic and catabolic factors, thus preventing skeletal muscle wasting. Methods and Results We employed ascending aortic stenosis (AS) inducing HF in Wistar male rats. Controls were sham-operated animals. At 18 weeks after surgery, rats with cardiac dysfunction were randomized to 10 weeks of aerobic ET (AS-ET) or to an untrained group (AS-UN). At 28 weeks, the AS-UN group presented HF signs in conjunction with high TNF-α serum levels; soleus and plantaris muscle atrophy; and an increase in the expression of TNF-α, NFκB (p65), MAFbx, MuRF1, FoxO1, and myostatin catabolic factors. However, in the AS-ET group, the deterioration of cardiac function was prevented, as well as muscle wasting, and the atrophy promoters were decreased. Interestingly, changes in anabolic factor expression (IGF-I, AKT, and mTOR) were not observed. Nevertheless, in the plantaris muscle, ET maintained high PGC1α levels. Conclusions Thus, the ET capability to attenuate cardiac function during the transition from cardiac dysfunction to HF was accompanied by a prevention of skeletal muscle atrophy that did not occur via an increase in anabolic factors, but through anti-catabolic activity, presumably caused by PGC1α action. These findings indicate the therapeutic potential of aerobic ET to block HF-induced muscle atrophy by counteracting the increased catabolic state. PMID:25330387

  1. Preventing low birth weight, child abuse, and school failure: the need for comprehensive, community-wide approaches.

    PubMed

    Chamberlin, R W

    1992-02-01

    Based on numerous examples from this country and abroad, we now have a reasonable idea of how we can reduce substantially the incidence of low-weight births, child abuse, adolescent pregnancy, school failure, and school dropout. The most effective long-term strategy appears to be the development of a comprehensive, coordinated, community-wide approach focused on preventing low- and medium-risk families from becoming high-risk as well as providing intensive services to those who already have reached a high-risk status. The best results can be obtained when all levels of government and the private sector work together. In this partnership, the best outcomes appear to result when the state and federal governments, private corporations, or both provide technical assistance, additional funding as needed, and help in setting program standards, and when the community maintains local control over establishing priorities and implementation strategies. However, to reach these goals and to maintain program support over the long time periods needed to show positive results (4 to 8 years), it is necessary to become skilled in social marketing techniques to turn program need into demand and to develop a strong local and statewide advocacy group to facilitate passage of needed legislation and prevent funding cutbacks. Pediatricians can modify their practices to make them more supportive to families and can work with other community leaders to bring about the changes in attitudes and about the changes in attitudes and funding priorities at the state and community levels that will be necessary to develop more effective preventive programs.

  2. Perspectives of survivors, families and researchers on key outcomes for research in acute respiratory failure.

    PubMed

    Dinglas, Victor D; Chessare, Caroline M; Davis, Wesley E; Parker, Ann; Friedman, Lisa Aronson; Colantuoni, Elizabeth; Bingham, Clifton O; Turnbull, Alison E; Needham, Dale M

    2017-07-29

    There is heterogeneity among the outcomes evaluated in studies of survivors of acute respiratory failure (ARF). To evaluate the importance of specific outcome domains to acute respiratory distress syndrome (ARDS) survivors, their family members and clinical researchers. Nineteen outcome domains were identified from the National Institutes of Health's Patient Reported Outcomes Measurement Information System; WHO's International Classification of Functioning, Disability, and Health; Society of Critical Care Medicine's Post-Intensive Care Syndrome (PICS); as well as patient, clinician and researcher input. We surveyed ARDS survivors, family members and critical care researchers, 279 respondents in total, using a 5-point scale (strongly disagree, disagree, neutral, agree and strongly agree) to rate the importance of measuring each domain in studies of ARF survivors' postdischarge outcomes. At least 80% of patients and family members supported (ie, rated 'agree' or 'strongly agree') that 15 of the 19 domains should be measured in all future studies. Among researchers, 6 of 19 domains were supported, with researchers less supportive for all domains, except survival (95% vs 72% support). Overall, four domains were supported by all groups: physical function, cognitive function, return to work or prior activities and mental health. Patient, family and researcher groups supported inclusion of outcome domains that fit within the PICS framework. Patients and family members also supported many additional domains, emphasising the importance of including patients/family, along with researchers, in consensus processes to select core outcome domains for future research studies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. The failure of selenium supplementation to prevent copper-induced liver damage in Fischer 344 rats.

    PubMed Central

    Aburto, E M; Cribb, A; Fuentealba, I C; Ikede, B O; Kibenge, F S; Markham, F

    2001-01-01

    This study evaluates the ability of selenium (Se) supplementation to prevent experimental copper (Cu)-induced hepatocellular damage. Weanling male Fischer 344 rats were randomly assigned to groups of 15, 3 groups (A,B,C) were fed Cu-loaded diets (containing 2000 microg/g copper, added as CuSO4) and different levels of Se (added as Na2SeO3 x 5H2O) as follows: A) Cu-loaded/Se adequate diet (0.4 microg/g Se, fed basis); B) Cu-loaded/Se-supplemented diet (2 microg/g Se); and C) Cu-loaded/Se-deficient diet (< 0.2 microg/g). Three additional groups (D,E,F) were fed diets containing adequate levels of Cu (14 microg/g Cu, fed basis) and different levels of Se as follows: D) Cu-adequate/Se-adequate diet; E) Cu-adequate/Se-supplemented diet (2 microg/g Se); and F) Cu-adequate/Se-deficient (< 0.2 microg/g) diet. After 4, 8, and 12 weeks on the experimental diets, liver samples were processed for histology, histochemistry, metal analysis, glutathione peroxidase (GSH-Px) measurement, and quantification of malondialdehyde (MDA). Morphologic changes characteristic of Cu-associated hepatitis, without an increase in hepatic MDA levels, were seen in all Cu-loaded rats in each sampling. Similar changes occurred in rats fed Se-adequate, Se-supplemented and Se-deficient diets. This study demonstrates that Fischer 344 rats fed 2000 microg/g Cu develop morphologic changes due to Cu toxicity without evidence of lipid peroxidation. Furthermore, Se supplementation does not result in protection against Cu-induced liver injury. Images Figure 3. Figure 4. Figure 5. Figure 6. PMID:11346254

  4. The failure of selenium supplementation to prevent copper-induced liver damage in Fischer 344 rats.

    PubMed

    Aburto, E M; Cribb, A; Fuentealba, I C; Ikede, B O; Kibenge, F S; Markham, F

    2001-04-01

    This study evaluates the ability of selenium (Se) supplementation to prevent experimental copper (Cu)-induced hepatocellular damage. Weanling male Fischer 344 rats were randomly assigned to groups of 15, 3 groups (A,B,C) were fed Cu-loaded diets (containing 2000 microg/g copper, added as CuSO4) and different levels of Se (added as Na2SeO3 x 5H2O) as follows: A) Cu-loaded/Se adequate diet (0.4 microg/g Se, fed basis); B) Cu-loaded/Se-supplemented diet (2 microg/g Se); and C) Cu-loaded/Se-deficient diet (< 0.2 microg/g). Three additional groups (D,E,F) were fed diets containing adequate levels of Cu (14 microg/g Cu, fed basis) and different levels of Se as follows: D) Cu-adequate/Se-adequate diet; E) Cu-adequate/Se-supplemented diet (2 microg/g Se); and F) Cu-adequate/Se-deficient (< 0.2 microg/g) diet. After 4, 8, and 12 weeks on the experimental diets, liver samples were processed for histology, histochemistry, metal analysis, glutathione peroxidase (GSH-Px) measurement, and quantification of malondialdehyde (MDA). Morphologic changes characteristic of Cu-associated hepatitis, without an increase in hepatic MDA levels, were seen in all Cu-loaded rats in each sampling. Similar changes occurred in rats fed Se-adequate, Se-supplemented and Se-deficient diets. This study demonstrates that Fischer 344 rats fed 2000 microg/g Cu develop morphologic changes due to Cu toxicity without evidence of lipid peroxidation. Furthermore, Se supplementation does not result in protection against Cu-induced liver injury.

  5. Preventability of Hospital Readmissions From Skilled Nursing Facilities: A Consumer Perspective.

    PubMed

    Jacobsen, J Mary Lou; Schnelle, John F; Saraf, Avantika A; Long, Emily A; Vasilevskis, Eduard E; Kripalani, Sunil; Simmons, Sandra F

    2016-12-07

    A structured interview was conducted with Medicare patients readmitted to a private, tertiary teaching hospital from skilled nursing facilities (SNFs) to assess their perspectives of readmission preventability and their role in the readmission. Data were collected at Vanderbilt University Medical Center using a 6-item interview administered at the bedside to Medicare beneficiaries with unplanned hospital readmissions from 23 SNFs within 60 days of a previous hospital discharge. Mixed analytical methods were applied, including a content analysis that evaluated factors contributing to hospital readmission as perceived by consumers. Among 208 attempted interviews, 156 were completed, of which 53 (34%) respondents rated their readmission as preventable. 28.3% of the 53 consumers attributed the readmission to hospital factors, 52.8% attributed it to the SNF, and 18.9% believed both sites could have prevented the readmission. The primary driver of the readmission was a family member/caregiver in 31 cases and the patient in 24 of the 156 cases, amounting to 55 (35.3%) consumer-driven readmissions. Contributing factors included: premature hospital discharge (16.3%); poor discharge planning (16.3%); a clinical issue not resolved in the hospital (14.3%); inadequate treatment at the SNF (69.4%); improper medication management at the SNF (20.4%); and poor decision-making regarding the transfer (14.3%). Interviewing readmitted patients provides information relevant to reducing readmissions that may otherwise be omitted from hospital and SNF records. Consumers identified quality issues at both the hospital and SNF and perceived themselves as initiating a significant number of readmissions. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Memantine prevents memory consolidation failure induced by soluble beta amyloid in rats

    PubMed Central

    Tucci, Paolo; Mhillaj, Emanuela; Morgese, Maria Grazia; Colaianna, Marilena; Zotti, Margherita; Schiavone, Stefania; Cicerale, Maria; Trezza, Viviana; Campolongo, Patrizia; Cuomo, Vincenzo; Trabace, Luigia

    2014-01-01

    It has been well documented that β-amyloid (Aβ) peptide accumulation and aggregation in the brain plays a crucial role in the pathophysiology of Alzheimer’s disease (AD). However, a new orientation of the amyloid cascade hypothesis has evidenced that soluble forms of the peptide (sAβ) are involved in Aβ-induced cognitive impairment and cause rapid disruption of the synaptic mechanisms underlying memory. The primary aim of this study was to elucidate the effects of sAβ, acutely injected intracerebrally (i.c.v., 4 μM), on the short term and long term memory of young adult male rats, by using the novel object recognition task. Glutamatergic receptors have been proposed as mediating the effect of Aβ on synaptic plasticity and memory. Thus, we also investigated the effects of sAβ on prefrontal cortex (PFC) glutamate release and the specific contribution of N-methyl-D-aspartate (NMDA) receptor modulation to the effects of sAβ administration on the cognitive parameters evaluated. We found that a single i.c.v. injection of sAβ 2 h before testing did not alter the ability of rats to differentiate between a familiar and a novel object, in a short term memory test, while it was able to negatively affect consolidation/retrieval of long term memory. Moreover, a significant increase of glutamate levels was found in PFC of rats treated with the peptide 2 h earlier. Interestingly, memory deficit induced by sAβ was reversed by a NMDA-receptor antagonist, memantine (5 mg/kg i.p), administered immediately after the familiarization trial (T1). On the contrary, memantine administered 30 min before T1 trial, was not able to rescue long term memory impairment. Taken together, our results suggest that an acute i.c.v. injection of sAβ peptide interferes with the consolidation/retrieval of long term memory. Moreover, such sAβ-induced effect indicates the involvement of glutamatergic system, proposing that NMDA receptor inhibition might prevent or lead to the recovery of early

  7. Focus on Mechanical Failures: Mechanisms and Detection. Proceedings of the Meeting (45th) of the Mechanical Failures Prevention Group Held in Annapolis, Maryland on April 9 - 11, 1999

    DTIC Science & Technology

    1991-04-04

    of the applied strain rate. Except in the unusual case of a continuous reduction of area to rupture, separation during ductile fracture occurs by void...procedure in industry. As a general rule , all rotating elements over 2,000 lbs. usually have casing or foundation effects associated with them. Therefore...Analysis 195 P. Stumpff and W. B. Pinnell FAILURES IN METALS Analysis of a Failure of a Cu-Ni Fitting Used in a Ship Hydraulic System Application 207 D

  8. Teneligliptin Prevents Cardiomyocyte Hypertrophy, Fibrosis, and Development of Hypertensive Heart Failure in Dahl Salt-Sensitive Rats.

    PubMed

    Yamamoto, Masayoshi; Ishizu, Tomoko; Seo, Yoshihiro; Suto, Yoshimi; Sai, Seika; Xu, Dongzhu; Murakoshi, Nobuyuki; Kimura, Taizo; Kawakami, Yasushi; Aonuma, Kazutaka

    2017-09-06

    We investigated the effects of the DPP4 inhibitor, teneligliptin, on cardiac function and hemodynamics during heart failure in hypertensive model rats. Fifty-five male Dahl salt-sensitive rats were divided into four groups: control group (0.3% NaCl chow, n=13), hypertension (HT) group (8% NaCl chow, n=20), HT-early TNL group (8% NaCl chow and teneligliptin from 6 weeks, n=10), and HT-late TNL group (8% NaCl chow and teneligliptin from 10 weeks, n=12). Hemodynamic measurement and tissue analyses were performed at 18 weeks. In the all HT groups, systolic blood pressures and similarly elevated (p=0.66) and heart weight similarly increased (p=0.36) with or without TNL administration. LV end-diastolic dimension was significantly enlarged only in the HT-early TNL groups compared with control group (p=0.025). Histological analysis showed less fibrosis (p=0.008) and cardiomyocyte widths (p=0.009) in the HT-early TNL group compare with HT group. On hemodynamic analysis, only HT group showed significant LV end-diastolic pressure elevation (p=0.049) and lung congestion (p<0.001) compare with control group. These results suggest teneligliptin prevents concentric LV hypertrophy, fibrosis, and development of congestive heart failure in Dahl salt-sensitive rats. Teneligliptin may inhibit pressure-overload hypertrophic adaption and result in LV eccentric hypertrophy with reduced LV ejection fraction. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Pioglitazone promotes survival and prevents hepatic regeneration failure after partial hepatectomy in obese and diabetic KK-A(y) mice.

    PubMed

    Aoyama, Tomonori; Ikejima, Kenichi; Kon, Kazuyoshi; Okumura, Kyoko; Arai, Kumiko; Watanabe, Sumio

    2009-05-01

    Pathogenesis of metabolic syndrome-related nonalcoholic steatohepatitis (NASH) involves abnormal tissue-repairing responses in the liver. We investigated the effect of pioglitazone, a thiazolidinedione derivative (TZD), on hepatic regenerative responses in obese, diabetic KK-A(y) mice. Male KK-A(y) mice 9 weeks after birth underwent two-thirds partial hepatectomy (PH) after repeated intragastric injections of pioglitazone (25 mg/kg) for 5 days. Almost half of the KK-A(y) mice died within 48 hours of PH;however, mortality was completely prevented in mice pretreated with pioglitazone. In KK-A(y) mice, bromodeoxyuridine (BrdU) incorporation to hepatocyte nuclei 48 hours after PH reached only 1%; however, pioglitazone pretreatment significantly increased BrdU-positive cells to 8%. Cyclin D1 was barely detectable in KK-A(y) mice within 48 hours after PH. In contrast, overt expression of cyclin D1 was observed 24 hours after PH in KK-A(y) mice pretreated with pioglitazone. Hepatic tumor necrosis factor alpha (TNF-alpha) messenger RNA (mRNA) was tremendously increased 1 hour after PH in KK-A(y) mice, the levels reaching ninefold over C57Bl/6 given PH, whereas pioglitazone blunted this increase by almost three-fourths. Pioglitazone normalized hypoadiponectinemia in KK-A(y) mice almost completely. Serum interleukin (IL)-6 and leptin levels were elevated extensively 24 hours after PH in KK-A(y) mice, whereas the levels were largely decreased in KK-A(y) mice given pioglitazone. Indeed, pioglitazone prevented aberrant increases in signal transducers and activators of transcription (STAT)3 phosphorylation and suppressor of cytokine signaling (SOCS)-3 mRNA in the liver in KK-A(y) mice. These findings indicated that pioglitazone improved hepatic regeneration failure in KK-A(y) mice. The mechanism underlying the effect of pioglitazone on regeneration failure most likely involves normalization of expression pattern of adipokines and subsequent cytokine responses during the early

  10. A Biochemical Approach to Understanding the Fanconi Anemia Pathway-Regulated Nucleases in Genome Maintenance for Preventing Bone Marrow Failure and Cancer

    DTIC Science & Technology

    2014-04-01

    the Fanconi Anemia Pathway- Regulated Nucleases in Genome Maintenance for Preventing Bone Marrow Failure and Cancer PRINCIPAL INVESTIGATOR...GRANT NUMBER 4. TITLE AND SUBTITLE A Biochemical Approach to Understanding the Fanconi Anemia Pathway-Regulated Nucleases in Genome Maintenance for...Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Fanconi anemia is the most prevalent inherited BMF syndromes, caused by mutations in

  11. Dynamic analysis method for prevention of failure in the first-stage low-pressure turbine blade with two-finger root

    NASA Astrophysics Data System (ADS)

    Park, Jung-Yong; Jung, Yong-Keun; Park, Jong-Jin; Kang, Yong-Ho

    2002-05-01

    Failures of turbine blades are identified as the leading causes of unplanned outages for steam turbine. Accidents of low-pressure turbine blade occupied more than 70 percent in turbine components. Therefore, the prevention of failures for low pressure turbine blades is certainly needed. The procedure is illustrated by the case study. This procedure is used to guide, and support the plant manager's decisions to avoid a costly, unplanned outage. In this study, we are trying to find factors of failures in LP turbine blade and to make three steps to approach the solution of blade failure. First step is to measure natural frequency in mockup test and to compare it with nozzle passing frequency. Second step is to use FEM and to calculate the natural frequencies of 7 blades and 10 blades per group in BLADE code. Third step is to find natural frequencies of grouped blade off the nozzle passing frequency.

  12. PA21, a new iron-based noncalcium phosphate binder, prevents vascular calcification in chronic renal failure rats.

    PubMed

    Phan, Olivier; Maillard, Marc; Peregaux, Christine; Mordasini, David; Stehle, Jean-Christophe; Funk, Felix; Burnier, Michel

    2013-08-01

    Chronic renal failure (CRF) is associated with the development of secondary hyperparathyroidism and vascular calcifications. We evaluated the efficacy of PA21, a new iron-based noncalcium phosphate binder, in controlling phosphocalcic disorders and preventing vascular calcifications in uremic rats. Rats with adenine-diet-induced CRF were randomized to receive either PA21 0.5, 1.5, or 5% or CaCO3 3% in the diet for 4 weeks, and were compared with uremic and nonuremic control groups. After 4 weeks of phosphate binder treatment, serum calcium, creatinine, and body weight were similar between all CRF groups. Serum phosphorus was reduced with CaCO3 3% (2.06 mM; P ≤ 0.001), PA21 1.5% (2.29 mM; P < 0.05), and PA21 5% (2.21 mM; P ≤ 0.001) versus CRF controls (2.91 mM). Intact parathyroid hormone was strongly reduced in the PA21 5% and CaCO3 3% CRF groups to a similar extent (1138 and 1299 pg/ml, respectively) versus CRF controls (3261 pg/ml; both P ≤ 0.001). A lower serum fibroblast growth factor 23 concentration was observed in the PA21 5%, compared with CaCO3 3% and CRF, control groups. PA21 5% CRF rats had a lower vascular calcification score compared with CaCO3 3% CRF rats and CRF controls. In conclusion, PA21 was as effective as CaCO3 at controlling phosphocalcic disorders but superior in preventing the development of vascular calcifications in uremic rats. Thus, PA21 represents a possible alternative to calcium-based phosphate binders in CRF patients.

  13. Effect of ivabradine on numbers needed to treat for the prevention of recurrent hospitalizations in heart failure patients.

    PubMed

    Rogers, Jennifer K; Kielhorn, Adrian; Borer, Jeffrey S; Ford, Ian; Pocock, Stuart J

    2015-01-01

    Ivabradine, a specific heart rate lowering agent, was shown in the SHIFT study to reduce time to first hospitalization for worsening heart failure (HF) in chronic systolic HF patients and also to reduce recurrent/total hospitalizations over the study interval. We assessed the effects of adding ivabradine in patients with systolic HF on the number needed to treat (NNT) to reduce recurrent hospitalizations. The SHIFT trial included 6505 patients with symptomatic HF (NYHA II-IV), left ventricular ejection fraction ≤35% and heart rate ≥70 bpm in sinus rhythm. Patients were randomized to either ivabradine or placebo in addition to guidelines-based drug therapy. The times to first hospitalization were analyzed using a univariate Cox proportional-hazards model; the associated NNT was calculated using Kaplan-Meier estimates of the time-to-event curves at 1 year in each treatment arm. Recurrent hospitalizations were analyzed using a negative binomial and the estimated annual event rates used to calculate the associated patient-time NNTs respectively. The estimated NNT (number needed to initiate treatment with ivabradine to prevent one first HF hospitalization within 1 year) was 27 (estimated hazard ratio: 0.75, P < 0.0001). For recurrent HF hospitalizations, one event would be prevented on average per 14 patient-years for any year of follow-up over the course of SHIFT (estimated rate ratio: 0.71, P < 0.0001). A key limitation of this analysis is that it did not account for a relationship between recurrent HF hospitalizations and subsequent mortality. In chronic systolic HF the effect of ivabradine on reducing recurrent HF hospitalizations results in a lower NNT compared to the effect on the time for first hospitalization. The effect of ivabradine on recurrent hospitalizations, in addition to first events, may be a more appropriate measure when considering the impact of a treatment with ivabradine on healthcare resource utilization.

  14. Exercise training prevents oxidative stress and ubiquitin-proteasome system overactivity and reverse skeletal muscle atrophy in heart failure.

    PubMed

    Cunha, Telma F; Bacurau, Aline V N; Moreira, Jose B N; Paixão, Nathalie A; Campos, Juliane C; Ferreira, Julio C B; Leal, Marcelo L; Negrão, Carlos E; Moriscot, Anselmo S; Wisløff, Ulrik; Brum, Patricia C

    2012-01-01

    Heart failure (HF) is known to lead to skeletal muscle atrophy and dysfunction. However, intracellular mechanisms underlying HF-induced myopathy are not fully understood. We hypothesized that HF would increase oxidative stress and ubiquitin-proteasome system (UPS) activation in skeletal muscle of sympathetic hyperactivity mouse model. We also tested the hypothesis that aerobic exercise training (AET) would reestablish UPS activation in mice and human HF. Time-course evaluation of plantaris muscle cross-sectional area, lipid hydroperoxidation, protein carbonylation and chymotrypsin-like proteasome activity was performed in a mouse model of sympathetic hyperactivity-induced HF. At the 7(th) month of age, HF mice displayed skeletal muscle atrophy, increased oxidative stress and UPS overactivation. Moderate-intensity AET restored lipid hydroperoxides and carbonylated protein levels paralleled by reduced E3 ligases mRNA levels, and reestablished chymotrypsin-like proteasome activity and plantaris trophicity. In human HF (patients randomized to sedentary or moderate-intensity AET protocol), skeletal muscle chymotrypsin-like proteasome activity was also increased and AET restored it to healthy control subjects' levels. Collectively, our data provide evidence that AET effectively counteracts redox imbalance and UPS overactivation, preventing skeletal myopathy and exercise intolerance in sympathetic hyperactivity-induced HF in mice. Of particular interest, AET attenuates skeletal muscle proteasome activity paralleled by improved aerobic capacity in HF patients, which is not achieved by drug treatment itself. Altogether these findings strengthen the clinical relevance of AET in the treatment of HF.

  15. Saying 'No' to PrEP research in Malawi: what constitutes 'failure' in offshored HIV prevention research?

    PubMed

    Peterson, Kristin; Folayan, Morenike Oluwatoyin; Chigwedere, Edward; Nthete, Evaristo

    2015-12-01

    Between 2004 and 2005, the first multi-sited clinical trial tested whether an existing, marketed antiretroviral drug, Tenofovir (TDF), could prevent HIV transmission. Referred to as pre-exposure prophylaxis (PrEP), most of these trial sites prematurely closed down. Two sites located in Cambodia and Cameroon received international media attention. But little attention was drawn to sites in Malawi and Nigeria, where university ethicists and research scientists extensively debated PrEP. This article focuses on events that took place in Malawi where there was a prolonged dispute over the scientific rationales of PrEP and not trial specific ethics referred to as 'bioethics'. Specifically, the article discusses debates pertaining to three PrEP trial protocols that were refused ethics approval in Malawi between 2004 and 2009. It is argued that HIV science debates in Malawi are embedded in postcolonial politics--geopolitical histories and state and household economic dispossessions that have created the structural possibilities for Malawi to become an offshore destination for HIV clinical research. As such, ethics in this case does not pertain to trial or bioethical 'failures'. Rather, ethics is located at the scale of imperial relations that give rise to multiple, often invisible, research concerns and constraints.

  16. Does Accidental Overcorrection of Symptomatic Hyponatremia in Chronic Heart Failure Require Specific Therapeutic Adjustments for Preventing Central Pontine Myelinolysis?

    PubMed Central

    De Vecchis, Renato; Noutsias, Michel; Ariano, Carmelina; Cesaro, Arturo; Cioppa, Carmela; Giasi, Anna; Maurea, Nicola

    2017-01-01

    This review aims at summarizing essential aspects of epidemiology and pathophysiology of hyponatremia in chronic heart failure (CHF), to set the ground for a practical as well as evidence-based approach to treatment. As a guide through the discussion of the available evidence, a clinical case of hyponatremia associated with CHF is presented. For this case, the severe neurological signs at presentation justified an emergency treatment with hypertonic saline plus furosemide, as indicated. Subsequently, as the neurological emergency began to subside, the reversion of the trend toward hyponatremia overcorrection was realized by continuous infusion of hypotonic solutions, and administration of desmopressin, so as to prevent the very feared risk of an osmotic demyelination syndrome. This very disabling complication of the hyponatremia correction is then briefly outlined. Moreover, the possible advantages related to systematic correction of the hyponatremia that occurs in the course of CHF are mentioned. Additionally, the case of tolvaptan, a vasopressin receptor antagonist, is concisely presented in order to underline the different views that have led to different norms in Europe with respect to the USA or Japan as regards the use of this drug as a therapeutic resource against the hyponatremia. PMID:28270885

  17. Baden-Powell on teeth: a centenary perspective of a pioneer of preventive dental health.

    PubMed

    Pearn, J

    2008-01-12

    In the era when dental care, particularly preventive dental health, did not enjoy a high public profile, Lieut-General (later Lord) Robert Baden-Powell (1857-1941) was an influential advocate for the care of the teeth. He was a pioneer in a targeted outreach to youth, specifically boys and young men, emphasising the importance of dental health as an essential part of total body health and fitness. In his book, Scouting for boys, first published on 1 May 1908, he described personal accounts of the consequences of the neglect of oral hygiene and presented advice on how to make an effective 'camp tooth-brush' in order that dental hygiene would not be compromised even under the exigencies of conditions away from home. Baden-Powell wrote explicitly that daily dental hygiene was the single most important 'one civilised thing [teenage youths] could do', irrespective of one's physical circumstances. Scouting for boys was for more than five decades the world's best seller in English, after the Bible. It has run to, and now surpasses, 60 million copies in 30 languages and has been published in 35 editions. It is believed that Baden-Powell's frank and direct exhortations to preserve the teeth, with simple and direct advice on food and what today would be called oral hygiene, have been read by 350 million people throughout the world. His advocacy reached out to boys and young men as it does today to youths of both sexes in that 'window of opportunity' when life-long habits of healthcare are being inculcated and when important components of secondary dentition are forming. This paper is a centenary perspective of Baden-Powell's pioneering advocacy of modern preventive dental health.

  18. Prevention of unintended pregnancy and HIV/STIs among Latinos in rural communities: perspectives of health care providers.

    PubMed

    Branch, Meredith; Harvey, S Marie; Zukoski, Ann P; Warren, Jocelyn

    2010-08-01

    Latino women in the United States are disproportionately at risk for unintended pregnancy, HIV, and sexually transmitted infections (STIs). We conducted nine focus groups with health care practitioners who provide reproductive health care to Latinos in rural areas of the Northwest. From the practitioner perspective, we explored barriers and facilitators to the acquisition and use of contraceptives and to the prevention of HIV/STIs among rural Latinos. Suggestions for improving reproductive health care included Spanish-language resources/materials and convenient contraceptive methods. Findings provide context to the complex issues related to unintended pregnancy and disease prevention among Latinos residing in rural communities.

  19. Yup’ik Culture and Context in Southwest Alaska: Community Member Perspectives of Tradition, Social Change, and Prevention

    PubMed Central

    Ayunerak, Paula; Alstrom, Deborah; Moses, Charles; Charlie, James

    2014-01-01

    This paper provides an introduction to key aspects of Yup’ik Inuit culture and context from both historical and contemporary community member perspectives. Its purpose is to provide a framework for understanding the development and implementation of a prevention initiative centered on youth in two communities in Southwest Alaska as part of collaboration with the University of Alaska Fairbanks and the National Institutes of Health. This paper is written from the perspective of elders and local prevention workers from each of the two prevention communities. The co-authors discuss their culture and their community from their own perspectives, drawing from direct experience and from ancestral knowledge gained through learning and living the Yuuyaraq or the Yup’ik way of life. The authors of this paper identity key aspects of traditional Yup’ik culture that once contributed to the adaptability and survivability of their ancestors, particularly through times of hardship and social disruption. These key processes and practices represent dimensions of culture in a Yup’ik context that contribute to personal and collective growth, protection and wellbeing. Intervention development in Yup’ik communities requires bridging historical cultural frames with contemporary contexts and shifting focus from reviving cultural activities to repairing and revitalizing cultural systems that structure community. PMID:24771075

  20. Yup'ik culture and context in Southwest Alaska: community member perspectives of tradition, social change, and prevention.

    PubMed

    Ayunerak, Paula; Alstrom, Deborah; Moses, Charles; Charlie, James; Rasmus, Stacy M

    2014-09-01

    This paper provides an introduction to key aspects of Yup'ik Inuit culture and context from both historical and contemporary community member perspectives. Its purpose is to provide a framework for understanding the development and implementation of a prevention initiative centered on youth in two communities in Southwest Alaska as part of collaboration with the University of Alaska Fairbanks and the National Institutes of Health. This paper is written from the perspective of elders and local prevention workers from each of the two prevention communities. The co-authors discuss their culture and their community from their own perspectives, drawing from direct experience and from ancestral knowledge gained through learning and living the Yuuyaraq or the Yup'ik way of life. The authors of this paper identity key aspects of traditional Yup'ik culture that once contributed to the adaptability and survivability of their ancestors, particularly through times of hardship and social disruption. These key processes and practices represent dimensions of culture in a Yup'ik context that contribute to personal and collective growth, protection and wellbeing. Intervention development in Yup'ik communities requires bridging historical cultural frames with contemporary contexts and shifting focus from reviving cultural activities to repairing and revitalizing cultural systems that structure community.

  1. Race, Gender, and Age Differences in Heart Failure-Related Hospitalizations in a Southern State: Implications for Prevention

    PubMed Central

    Husaini, Baqar A.; Mensah, George A.; Sawyer, Douglas; Cain, Van A.; Samad, Zahid; Hull, Pamela C.; Levine, Robert S.; Sampson, Uchechukwu K. A.

    2011-01-01

    Background Since heart failure (HF) is the final common pathway for most heart diseases, we examined its 10-year prevalence trend by race, gender, and age in Tennessee. Methods and Results HF hospitalization data from the Tennessee Hospital Discharge Data System were analyzed by race, gender and age. Rates were directly age-adjusted using the Year 2000 standard population. Adult (age 20+) in-patient hospitalization for primary diagnosis of HF (HFPD) increased from 4.2% in 1997 to 4.5% in 2006. Age-adjusted hospitalization for HF (per 10,000 population) rose by 11.3% (from 29.3 in 1997 to 32.6 in 2006). Parallel changes in secondary HF admissions were also noted. Age-adjusted rates were higher among blacks than whites and higher among men than women. The ratios of black to white by gender admitted with HFPD in 2006 were highest (9:1) among the youngest age categories (20-34 and 35-44 years). Furthermore, for each age category of black men below 65 years, there were higher HF admission rates than for white men in the immediate older age category. In 2006, the adjusted rate ratios for HFPD in black to white men aged 20-34 and 35-44 years were OR=4.75, CI (3.29-6.86) and OR 5.10, CI (4.15-6.25) respectively. Hypertension was the independent predictor of HF admissions in black men age 20-34 years. Conclusions The higher occurrence of HF among young adults in general, particularly among young black men, highlights the need for prevention by identifying modifiable biological and social determinants in order to reduce cardiovascular health disparities in this vulnerable group. PMID:21178017

  2. Endothelial p53 deletion improves angiogenesis and prevents cardiac fibrosis and heart failure induced by pressure overload in mice.

    PubMed

    Gogiraju, Rajinikanth; Xu, Xingbo; Bochenek, Magdalena L; Steinbrecher, Julia H; Lehnart, Stephan E; Wenzel, Philip; Kessel, Michael; Zeisberg, Elisabeth M; Dobbelstein, Matthias; Schäfer, Katrin

    2015-02-24

    Cardiac dysfunction developing in response to chronic pressure overload is associated with apoptotic cell death and myocardial vessel rarefaction. We examined whether deletion of tumor suppressor p53 in endothelial cells may prevent the transition from cardiac hypertrophy to heart failure. Mice with endothelial-specific deletion of p53 (End.p53-KO) were generated by crossing p53fl/fl mice with mice expressing Cre recombinase under control of an inducible Tie2 promoter. Cardiac hypertrophy was induced by transverse aortic constriction. Serial echocardiography measurements revealed improved cardiac function in End.p53-KO mice that also exhibited better survival. Cardiac hypertrophy was associated with increased p53 levels in End.p53-WT controls, whereas banded hearts of End.p53-KO mice exhibited lower numbers of apoptotic endothelial and non-endothelial cells and altered mRNA levels of genes regulating cell cycle progression (p21), apoptosis (Puma), or proliferation (Pcna). A higher cardiac capillary density and improved myocardial perfusion was observed, and pharmacological inhibition or genetic deletion of p53 also promoted endothelial sprouting in vitro and new vessel formation following hindlimb ischemia in vivo. Hearts of End.p53-KO mice exhibited markedly less fibrosis compared with End.p53-WT controls, and lower mRNA levels of p53-regulated genes involved in extracellular matrix production and turnover (eg, Bmp-7, Ctgf, or Pai-1), or of transcription factors involved in controlling mesenchymal differentiation were observed. Our analyses reveal that accumulation of p53 in endothelial cells contributes to blood vessel rarefaction and fibrosis during chronic cardiac pressure overload and suggest that endothelial cells may be a therapeutic target for preserving cardiac function during hypertrophy. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  3. Use of growth-hormone-releasing peptide-6 (GHRP-6) for the prevention of multiple organ failure.

    PubMed

    Cibrián, Danay; Ajamieh, Hussam; Berlanga, Jorge; León, Olga S; Alba, Jose S; Kim, Micheal J-T; Marchbank, Tania; Boyle, Joseph J; Freyre, Freya; Garcia Del Barco, Diana; Lopez-Saura, Pedro; Guillen, Gerardo; Ghosh, Subrata; Goodlad, Robert A; Playford, Raymond J

    2006-05-01

    Novel therapies for the treatment of MOF (multiple organ failure) are required. In the present study, we examined the effect of synthetic GHRP-6 (growth hormone-releasing peptide-6) on cell migration and proliferation using rat intestinal epithelial (IEC-6) and human colonic cancer (HT29) cells as in vitro models of injury. In addition, we examined its efficacy when given alone and in combination with the potent protective factor EGF (epidermal growth factor) in an in vivo model of MOF (using two hepatic vessel ischaemia/reperfusion protocols; 45 min of ischaemia and 45 min of reperfusion or 90 min of ischaemia and 120 min of reperfusion). In vitro studies showed that GHRP-6 directly influenced gut epithelial function as its addition caused a 3-fold increase in the rate of cell migration of IEC-6 and HT29 cells (P<0.01), but did not increase proliferation ([3H]thymidine incorporation). In vivo studies showed that, compared with baseline values, ischaemia/reperfusion caused marked hepatic and intestinal damage (histological scoring), neutrophilic infiltration (myeloperoxidase assay; 5-fold increase) and lipid peroxidation (malondialdehyde assay; 4-fold increase). Pre-treatment with GHRP-6 (120 microg/kg of body weight, intraperitoneally) alone truncated these effects by 50-85% (all P<0.05) and an additional benefit was seen when GHRP-6 was used in combination with EGF (1 mg/kg of body weight, intraperitoneally). Lung and renal injuries were also reduced by these pre-treatments. In conclusion, administration of GHRP-6, given alone or in combination with EGF to enhance its effects, may provide a novel simple approach for the prevention and treatment of MOF and other injuries of the gastrointestinal tract. In view of these findings, further studies appear justified.

  4. Endothelial p53 Deletion Improves Angiogenesis and Prevents Cardiac Fibrosis and Heart Failure Induced by Pressure Overload in Mice

    PubMed Central

    Gogiraju, Rajinikanth; Xu, Xingbo; Bochenek, Magdalena L.; Steinbrecher, Julia H.; Lehnart, Stephan E.; Wenzel, Philip; Kessel, Michael; Zeisberg, Elisabeth M.; Dobbelstein, Matthias; Schäfer, Katrin

    2015-01-01

    Background Cardiac dysfunction developing in response to chronic pressure overload is associated with apoptotic cell death and myocardial vessel rarefaction. We examined whether deletion of tumor suppressor p53 in endothelial cells may prevent the transition from cardiac hypertrophy to heart failure. Methods and Results Mice with endothelial‐specific deletion of p53 (End.p53‐KO) were generated by crossing p53fl/fl mice with mice expressing Cre recombinase under control of an inducible Tie2 promoter. Cardiac hypertrophy was induced by transverse aortic constriction. Serial echocardiography measurements revealed improved cardiac function in End.p53‐KO mice that also exhibited better survival. Cardiac hypertrophy was associated with increased p53 levels in End.p53‐WT controls, whereas banded hearts of End.p53‐KO mice exhibited lower numbers of apoptotic endothelial and non‐endothelial cells and altered mRNA levels of genes regulating cell cycle progression (p21), apoptosis (Puma), or proliferation (Pcna). A higher cardiac capillary density and improved myocardial perfusion was observed, and pharmacological inhibition or genetic deletion of p53 also promoted endothelial sprouting in vitro and new vessel formation following hindlimb ischemia in vivo. Hearts of End.p53‐KO mice exhibited markedly less fibrosis compared with End.p53‐WT controls, and lower mRNA levels of p53‐regulated genes involved in extracellular matrix production and turnover (eg, Bmp‐7, Ctgf, or Pai‐1), or of transcription factors involved in controlling mesenchymal differentiation were observed. Conclusions Our analyses reveal that accumulation of p53 in endothelial cells contributes to blood vessel rarefaction and fibrosis during chronic cardiac pressure overload and suggest that endothelial cells may be a therapeutic target for preserving cardiac function during hypertrophy. PMID:25713289

  5. Endovenous administration of bone-marrow-derived multipotent mesenchymal stromal cells prevents renal failure in diabetic mice.

    PubMed

    Ezquer, Fernando; Ezquer, Marcelo; Simon, Valeska; Pardo, Fabian; Yañez, Alejandro; Carpio, Daniel; Conget, Paulette

    2009-11-01

    Twenty-five to 40% of diabetic patients develop diabetic nephropathy, a clinical syndrome that comprises renal failure and increased risk of cardiovascular disease. It represents the major cause of chronic kidney disease and is associated with premature morbimortality of diabetic patients. Multipotent mesenchymal stromal cells (MSC) contribute to the regeneration of several organs, including acutely injured kidney. We sought to evaluate if MSC protect kidney function and structure when endovenously administered to mice with severe diabetes. A month after nonimmunologic diabetes induction by streptozotocin injection, C57BL/6 mice presented hyperglycemia, glycosuria, hypoinsulinemia, massive beta-pancreatic islet destruction, low albuminuria, but not renal histopathologic changes (DM mice). At this stage, one group of animals received the vehicle (untreated) and other group received 2 doses of 0.5 x 10(6) MSC/each (MSC-treated). Untreated DM mice gradually increased urinary albumin excretion and 4 months after diabetes onset, they reached values 15 times higher than normal animals. In contrast, MSC-treated DM mice maintained basal levels of albuminuria. Untreated DM mice had marked glomerular and tubular histopathologic changes (sclerosis, mesangial expansion, tubular dilatation, proteins cylinders, podocytes lost). However, MSC-treated mice showed only slight tubular dilatation. Observed renoprotection was not associated with an improvement in endocrine pancreas function in this animal model, because MSC-treated DM mice remained hyperglycemic and hypoinsulinemic, and maintained few remnant beta-pancreatic islets throughout the study period. To study MSC biodistribution, cells were isolated from isogenic mice that constitutively express GFP (MSC(GFP)) and endovenously administered to DM mice. Although at very low levels, donor cells were found in kidney of DM mice 3 month after transplantation. Presented preclinical results support MSC administration as a cell

  6. Prevention of hospital-acquired thrombosis from a primary care perspective: a qualitative study

    PubMed Central

    Litchfield, Ian; Fitzmaurice, David; Apenteng, Patricia; Harrison, Sian; Heneghan, Carl; Ward, Alison; Greenfield, Sheila

    2016-01-01

    Background Although there is considerable risk for patients from hospital-acquired thrombosis (HAT), current systems for reducing this risk appear inefficient and have focused predominantly on secondary care, leaving the role of primary care underexplored, despite the onset of HAT often occurring post-discharge. Aim To gain an understanding of the perspectives of primary care clinicians on their contribution to the prevention of HAT. Their current role, perceptions of patient awareness, the barriers to better care, and suggestions for how these may be overcome were discussed. Design and setting Qualitative study using semi-structured interviews in Oxfordshire and South Birmingham, England. Method Semi-structured telephone interviews with clinicians working at practices of a variety of size, socioeconomic status, and geographical location. Results A number of factors that influenced the management of HAT emerged, including patient characteristics, a lack of clarity of responsibility, limited communication and poor coordination, and the constraints of limited practice resources. Suggestions for improving the current system include a broader role for primary care supported by appropriate training and the requisite funding. Conclusion The role of primary care remains limited, despite being ideally positioned to either raise patient awareness before admission or support patient adherence to the thromboprophylaxis regimen prescribed in hospital. This situation may begin to be addressed by more robust lines of communication between secondary and primary care and by providing more consistent training for primary care staff. In turn, this relies on the allocation of appropriate funds to allow practices to meet the increased demand on their time and resources. PMID:27266864

  7. Expanding the uses of AHRQ's prevention quality indicators: validity from the clinician perspective.

    PubMed

    Davies, Sheryl; McDonald, Kathryn M; Schmidt, Eric; Schultz, Ellen; Geppert, Jeffrey; Romano, Patrick S

    2011-08-01

    The Agency for Healthcare Research and Quality's prevention quality indicators (PQIs) are used as a metric of area-level access to quality care. Recently, interest has expanded to using the measures at the level of payer or large physician groups, including public reporting or pay-for-performance programs. However, the validity of these expanded applications is unknown. We conducted a novel panel process to establish face validity of the 12 PQIs at 3 denominator levels: geographic area, payer, and large physician groups; and 3 uses: quality improvement, comparative reporting, and pay for performance. Sixty-four clinician panelists were split into Delphi and Nominal Groups. We aimed to capitalize on the reliability of the Delphi method and information sharing in the Nominal group method by applying these techniques simultaneously. We examined panelists' perceived usefulness of the indicators for specific uses using median scores and agreement within and between groups. Panelists showed stronger support of the usefulness of chronic disease indicators at the payer and large physician group levels than for acute disease indicators. Panelists fully supported the usefulness of 2 indicators for comparative reporting (asthma, congestive heart failure) and no indicators for pay-for-performance applications. Panelists expressed serious concerns about the usefulness of all new applications of 3 indicators (angina, perforated appendix, dehydration). Panelists rated age, current comorbidities, earlier hospitalization, and socioeconomic status as the most important risk-adjustment factors. Clinicians supported some expanded uses of the PQIs, but generally expressed reservations. Attention to denominator definitions and risk adjustment are essential for expanded use.

  8. Detection, Diagnosis and Prognosis: Contribution to the energy challenge: Proceedings of the Meeting of the Mechanical Failures Prevention Group

    NASA Astrophysics Data System (ADS)

    Shives, T. R.; Willard, W. A.

    1981-10-01

    The contribution of failure detection, diagnosis and prognosis to the energy challenge is discussed. Areas of special emphasis included energy management, techniques for failure detection in energy related systems, improved prognostic techniques for energy related systems and opportunities for detection, diagnosis and prognosis in the energy field.

  9. Detection, Diagnosis and Prognosis: Contribution to the energy challenge: Proceedings of the Meeting of the Mechanical Failures Prevention Group

    NASA Technical Reports Server (NTRS)

    Shives, T. R. (Editor); Willard, W. A. (Editor)

    1981-01-01

    The contribution of failure detection, diagnosis and prognosis to the energy challenge is discussed. Areas of special emphasis included energy management, techniques for failure detection in energy related systems, improved prognostic techniques for energy related systems and opportunities for detection, diagnosis and prognosis in the energy field.

  10. Emerging Ecological Approaches to Prevention, Health Promotion, and Public Health in the School Context: Next Steps from a Community Psychology Perspective

    ERIC Educational Resources Information Center

    Trickett, Edison J.; Rowe, Hillary L.

    2012-01-01

    In recent years, ecological perspectives have become more visible in prevention, health promotion, and public health within the school context. Individually based approaches to understanding and changing behavior have been increasingly challenged by these perspectives because of their appreciation for contextual influences on individual behavior.…

  11. Emerging Ecological Approaches to Prevention, Health Promotion, and Public Health in the School Context: Next Steps from a Community Psychology Perspective

    ERIC Educational Resources Information Center

    Trickett, Edison J.; Rowe, Hillary L.

    2012-01-01

    In recent years, ecological perspectives have become more visible in prevention, health promotion, and public health within the school context. Individually based approaches to understanding and changing behavior have been increasingly challenged by these perspectives because of their appreciation for contextual influences on individual behavior.…

  12. Effects of a catheter-associated urinary tract infection prevention campaign on infection rate, catheter utilization, and health care workers' perspective at a community safety net hospital.

    PubMed

    Gray, Dorinne; Nussle, Richard; Cruz, Abner; Kane, Gail; Toomey, Michael; Bay, Curtis; Ostovar, Gholamabbas Amin

    2016-01-01

    Preventing catheter-associated urinary tract infections is in the forefront of health care quality. However, nurse and physician engagement is a common barrier in infection prevention efforts. After implementation of a multidisciplinary catheter-associated urinary tract infection (CAUTI) prevention campaign, we studied the impact of our campaign and showed its association with reducing the CAUTI rate and catheter utilization and the positive effect on health care workers' engagement and perspectives. CAUTI prevention campaigns can lead to lower infection rates and change health care workers' perspective.

  13. Improvement of the safety of a clinical process using failure mode and effects analysis: Prevention of venous thromboembolic disease in critical patients.

    PubMed

    Viejo Moreno, R; Sánchez-Izquierdo Riera, J Á; Molano Álvarez, E; Barea Mendoza, J A; Temprano Vázquez, S; Díaz Castellano, L; Montejo González, J C

    2016-11-01

    To improve critical patient safety in the prevention of venous thromboembolic disease, using failure mode and effects analysis as safety tool. A contemporaneous cohort study covering the period January 2014-March 2015 was made in 4 phases: phase 1) prior to failure mode and effects analysis; phase 2) conduction of mode analysis and implementation of the detected improvements; phase 3) evaluation of outcomes, and phase 4) (post-checklist introduction impact. Patients admitted to the adult polyvalent ICU of a third-level hospital center. A total of 196 patients, older than 18 years, without thromboembolic disease upon admission to the ICU and with no prior anticoagulant treatment. A series of interventions were implemented following mode analysis: training, and introduction of a protocol and checklist to increase preventive measures in relation to thromboembolic disease. Indication and prescription of venous thrombosis prevention measures before and after introduction of the measures derived from the failure mode and effects analysis. A total of 59, 97 and 40 patients were included in phase 1, 3 and 4, respectively, with an analysis of the percentage of subjects who received thromboprophylaxis. The failure mode and effects analysis was used to detect potential errors associated to a lack of training and protocols referred to thromboembolic disease. An awareness-enhancing campaign was developed, with staff training and the adoption of a protocol for the prevention of venous thromboembolic disease. The prescription of preventive measures increased in the phase 3 group (91.7 vs. 71.2%, P=.001). In the post-checklist group, prophylaxis was prescribed in 97.5% of the patients, with an increase in the indication of dual prophylactic measures (4.7, 6.7 and 41%; P<.05). There were no differences in complications rate associated to the increase in prophylactic measures. The failure mode and effects analysis allowed us to identify improvements in the prevention of

  14. Alzheimer's disease and vascular dementia: one potentially preventable and modifiable disease? Part II: Management, prevention and future perspective.

    PubMed

    Davey, Dennis A

    2014-01-01

    The management of dementia and mild cognitive impairment (MCI) includes pharmacological, nonpharmacological and caregiver interventions. Acetyl-cholinesterase inhibitors and memantine have a small beneficial effect in mild-to-moderate dementia. Attention is increasingly focused on long-term measures that may prevent, delay or minimize MCI and dementia, including Mediterranean diet, exercise, early active treatment of hypercholesterolaemia hypertension, and diabetes starting in midlife and earlier. High cognitive activity and a high cognitive reserve may prevent or delay the onset of aging-related MCI and dementia. Although the numbers of the elderly with dementia are rapidly increasing worldwide, the incidence of dementia in some countries is decreasing attributable to higher educational levels, decreased vascular risk factors and healthier lifestyles. Prevention of dementia is feasible and reasonable.

  15. Validation of Heart Failure Events in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Participants Assigned to Doxazosin and Chlorthalidone

    PubMed Central

    Piller, Linda B; Davis, Barry R; Cutler, Jeffrey A; Cushman, William C; Wright, Jackson T; Williamson, Jeff D; Leenen, Frans HH; Einhorn, Paula T; Randall, Otelio S; Golden, John S; Haywood, L Julian

    2002-01-01

    Background The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a randomized, double-blind, active-controlled trial designed to compare the rate of coronary heart disease events in high-risk hypertensive participants initially randomized to a diuretic (chlorthalidone) versus each of three alternative antihypertensive drugs: alpha-adrenergic blocker (doxazosin), ACE-inhibitor (lisinopril), and calcium-channel blocker (amlodipine). Combined cardiovascular disease risk was significantly increased in the doxazosin arm compared to the chlorthalidone arm (RR 1.25; 95% CI, 1.17–1.33; P < .001), with a doubling of heart failure (fatal, hospitalized, or non-hospitalized but treated) (RR 2.04; 95% CI, 1.79–2.32; P < .001). Questions about heart failure diagnostic criteria led to steps to validate these events further. Methods and Results Baseline characteristics (age, race, sex, blood pressure) did not differ significantly between treatment groups (P < .05) for participants with heart failure events. Post-event pharmacologic management was similar in both groups and generally conformed to accepted heart failure therapy. Central review of a small sample of cases showed high adherence to ALLHAT heart failure criteria. Of 105 participants with quantitative ejection fraction measurements provided, (67% by echocardiogram, 31% by catheterization), 29/46 (63%) from the chlorthalidone group and 41/59 (70%) from the doxazosin group were at or below 40%. Two-year heart failure case-fatalities (22% and 19% in the doxazosin and chlorthalidone groups, respectively) were as expected and did not differ significantly (RR 0.96; 95% CI, 0.67–1.38; P = 0.83). Conclusion Results of the validation process supported findings of increased heart failure in the ALLHAT doxazosin treatment arm compared to the chlorthalidone treatment arm. PMID:12459039

  16. Prevention

    MedlinePlus

    ... Error processing SSI file About Heart Disease & Stroke Prevention Heart disease and stroke are an epidemic in ... secondhand smoke. Barriers to Effective Heart Disease & Stroke Prevention Many people with key risk factors for heart ...

  17. Cost-effectiveness of natriuretic peptide-based screening and collaborative care: a report from the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) study.

    PubMed

    Ledwidge, Mark T; O'Connell, Eoin; Gallagher, Joseph; Tilson, Lesley; James, Stephanie; Voon, Victor; Bermingham, Margaret; Tallon, Elaine; Watson, Chris; O'Hanlon, Rory; Barry, Michael; McDonald, Kenneth

    2015-07-01

    Prevention of cardiovascular disease and heart failure (HF) in a cost-effective manner is a public health goal. This work aims to assess the cost-effectiveness of the St Vincent's Screening TO Prevent Heart Failure (STOP-HF) intervention. This is a substudy of 1054 participants with cardiovascular risk factors [median age 65.8 years, interquartile range (IQR) 57.8:72.4, with 4.3 years, IQR 3.4:5.2, follow-up]. Annual natriuretic peptide-based screening was performed, with collaborative cardiovascular care between specialist physicians and general practitioners provided to patients with BNP levels >50 pg/mL. Analysis of cost per case prevented and cost-effectiveness per quality-adjusted life year (QALY) gained was performed. The primary clinical endpoint of LV dysfunction (LVD) with or without HF was reduced in intervention patients [odds ratio (OR) 0.60; 95% confidence interval (CI) 0.38-0.94; P = 0.026]. There were 157 deaths and/or emergency hospitalizations for major adverse cardiac events (MACE) in the control group vs. 102 in the intervention group (OR 0.68; 95% CI 0.49-0.93; P = 0.01). The cost per case of LVD/HF prevented was €9683 (sensitivity range -€843 to €20 210), whereas the cost per MACE prevented was €3471 (sensitivity range -€302 to €7245). Cardiovascular hospitalization savings offset increased outpatient and primary care costs. The cost per QALY gain was €1104 and the intervention has an 88% probability of being cost-effective at a willingness to pay threshold of €30 000. Among patients with cardiovascular risk factors, natriuretic peptide-based screening and collaborative care reduced LVD, HF, and MACE, and has a high probability of being cost-effective. NCT00921960. © 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.

  18. Ivabradine treatment prevents dobutamine-induced increase in heart rate in patients with acute decompensated heart failure.

    PubMed

    Cavusoglu, Yuksel; Mert, Ugur; Nadir, Aydin; Mutlu, Fezan; Morrad, Bektas; Ulus, Taner

    2015-09-01

    Ivabradine is a heart rate (HR)-lowering agent acting by inhibiting the If-channel. Dobutamine does increase the HR and has some deleterious effects on myocardium. So, we aimed to evaluate whether ivabradine treatment blunts a dobutamine-induced increase in HR. The main study population consisted of 58 acute decompensated heart failure patients requiring inotropic support with left-ventricular ejection fraction below 35%, who were randomized to ivabradine (n = 29) or control (n = 29). All patients underwent Holter recording for 6 h and then dobutamine was administered at incremental doses of 5, 10 and 15 μg/kg/min, with 6-h steps. Holter recording was continued during dobutamine infusion. Ivabradine 7.5 mg was given at the initiation of dobutamine and readministered at 12 h of infusion. Also, a nonrandomized beta-blocker group with 15 patients receiving beta-blocker was included in the analysis. Control and beta-blocker groups did not receive ivabradine. In the control group, mean HR gradually and significantly increased at each step of dobutamine infusion (81 ± 11, 90 ± 16, 97 ± 14 and 101 ± 16 b.p.m., respectively; P = 0.001), whereas no significant increase in HR was observed in the ivabradine group (82 ± 17, 82 ± 15, 85 ± 14 and 83 ± 12 b.p.m., respectively; P = 0.439). Mean HR was also found to significantly increase during dobutamine infusion in the beta-blocker group (75 ± 13, 82 ± 13, 86 ± 14 and 88 ± 13 b.p.m., respectively; P = 0.001). The median increase in HR from baseline was significantly higher in the control group compared to those in the ivabradine group (5 vs. 2 b.p.m.; P = 0.007 at first step, 13 vs. 5 b.p.m.; P = 0.001 at second step and 18 vs. 6 b.p.m.; P = 0.0001 at third step of dobutamine, respectively). Ivabradine treatment prevents dobutamine-induced increase in HR and may be useful in reducing HR-related adverse effects of

  19. Importance and satisfaction of preventive health strategies in institutions for people with intellectual disabilities: a perspective of institutional directors.

    PubMed

    Lin, Jin-Ding; Yen, Chia-Feng; Wu, Jia-Ling

    2005-01-01

    To explore the perceptions of institutional directors on the preventive health strategies for people with intellectual disabilities in institutions. A structured questionnaire was conducted by a cross-sectional postal survey in all registered institutions in Taiwan in 2002. A total of 157 questionnaires were mailed, of which 121 valid questionnaire were analyzed in this study. The respondents indicated important perception to the preventive health strategies across the 17 criteria, the mean score of importance in preventive health strategies was from 8.4 to 9.7 (score 1-10). But the analysis found that there were many gaps of 'importance' compared with 'satisfactory' to implementation of preventive health strategies, particularly in the issues of 'thyroid screening for intellectual disabilities (ID) with Down syndrome', 'prevention and treatment of osteoporosis', and 'diagnosis and treatment of mental disorders', these health issues need to be improved in institutions. The present study found that the size and ownership of institutions were not related to the perceptions of importance and satisfaction toward preventive health strategies. The institutions should explore the reasons of why the failure to carry through important health plans into practice to ensure quality of health services for people with ID who living in institutions.

  20. Efficacy of intraoperative, single-bolus corticosteroid administration to prevent postoperative acute respiratory failure after oesophageal cancer surgery.

    PubMed

    Park, Seong Yong; Lee, Hyun-Sung; Jang, Hee-Jin; Joo, Jungnam; Zo, Jae Ill

    2012-10-01

    Respiratory failure from acute lung injury (ALI), acute respiratory distress syndrome (ARDS) and pneumonia are the major cause of morbidity and mortality following an oesophagectomy for oesophageal cancer. This study was performed to investigate whether an intraoperative corticosteroid can attenuate postoperative respiratory failure. Between November 2005 and December 2008, 234 consecutive patients who underwent an oesophagectomy for oesophageal cancer were reviewed. A 125-mg dose of methylprednisolone was administered after performing the anastomosis. ALI, ARDS and pneumonia occurring before postoperative day (POD) 7 were regarded as acute respiratory failure. The mean age was 64.2 ± 8.7 years. One hundred and fifty-one patients were in the control group and 83 patients in the steroid group. Patients' characteristics were comparable. The incidence of acute respiratory failure was lower in the steroid group (P = 0.037). The incidences of anastomotic leakage and wound dehiscence were not different (P = 0.57 and P = 1.0). The C-reactive protein level on POD 2 was lower in the steroid group (P < 0.005). Multivariate analysis indicates that the intraoperative steroid was a protective factor against acute respiratory failure (P = 0.046, OR = 0.206). Intraoperative corticosteroid administration was associated with a decreased risk of acute respiratory failure following an oesophagectomy. The laboratory data suggest that corticosteroids may attenuate the stress-induced inflammatory responses after surgery.

  1. Recruitment and retention of participants for an international type 1 diabetes prevention trial: a coordinators' perspective.

    PubMed

    Franciscus, Margaret; Nucci, Anita; Bradley, Brenda; Suomalainen, Heli; Greenberg, Ellen; Laforte, Diane; Kleemola, Paivi; Hyytinen, Mila; Salonen, Marja; Martin, Mary Jean; Catte, Daniel; Catteau, Jacki

    2014-04-01

    The Trial to Reduce Insulin Dependent Diabetes Mellitus in the Genetically at Risk (TRIGR) is the first multicenter international type 1 diabetes (T1D) prevention trial to be undertaken. A unique feature of TRIGR has been recruitment of eligible pregnant women and enrollment of newborns for long-term follow-up assessments. Our purpose is to summarize the recruitment and retention strategies used to conduct TRIGR from the perspective of the study coordinators. TRIGR was designed to test whether weaning to formula containing hydrolyzed versus intact cow's milk protein would be efficacious in decreasing risk for development of T1D-associated autoantibodies and T1D among infants identified to be at increased risk for T1D based on their human leukocyte antigen (HLA) profile and family history. Multiple strategies tailored to local issues were required to enroll and follow the target number of infants. This study was conducted in the United States, Canada, Australia, and 12 countries in Europe. Of the 5606 mothers registered worldwide, 5000 of their infants were randomized. Of these, 2159 were HLA eligible and enrolled in the 8-month intervention and 10-year follow-up phases of this study. The TRIGR study met the accrual goal after 4.7 years of recruitment, 2.7 years longer than projected initially. Challenges included difficulty in finding fathers with T1D, a higher than expected rate of premature delivery among T1D mothers, and implementation of new privacy regulations mid-trial. The majority of participants were recruited from primary care antenatal clinics located near the study centers and from a general hospital or pediatric center that was affiliated with a TRIGR Study center. Internet and magazine advertisements were found to be useful for recruitment of families. Alternative follow-up strategies are offered to families who wish to reduce or discontinue participation. Our experience is limited to a single international multicenter trial. TRIGR coordinators played

  2. Recruitment and Retention of Participants for an International Type 1 Diabetes Prevention Trial: A Coordinators’ Perspective

    PubMed Central

    Franciscus, Margaret; Nucci, Anita; Bradley, Brenda; Suomalainen, Heli; Greenberg, Ellen; LaForte, Diane; Kleemola, Paivi; Hyytinen, Mila; Salonen, Marja; Martin, Mary Jean; Catte, Daniel; Catteau, Jacki

    2013-01-01

    Background The Trial to Reduce Insulin Dependent Diabetes Mellitus in the Genetically at Risk (TRIGR) is the first multicenter international type 1 diabetes (T1D) prevention trial to be undertaken. A unique feature of TRIGR has been recruitment of eligible pregnant women and enrollment of newborns for long-term follow-up assessments. Purpose Our purpose is to summarize the recruitment and retention strategies used to conduct TRIGR from the perspective of the study coordinators. Methods TRIGR was designed to test whether weaning to formula containing hydrolyzed vs. intact cow’s milk protein would be efficacious in decreasing risk for development of T1D-associated autoantibodies and T1D among infants identified to be at increased risk for T1D based on their human leukocyte antigen (HLA) profile and family history. Multiple strategies tailored to local issues were required to enroll and follow the target number of infants. Results The study was conducted in the United States, Canada, Australia and 12 countries in Europe. Of the 5,606 mothers registered world-wide, 5,000 of their infants were randomized. Of these, 2,159 were HLA eligible and enrolled in the 8-month intervention and 10-year follow-up phases of the study. The TRIGR study met the accrual goal after 4.7 years of recruitment, 2.7 years longer than projected initially. Challenges included difficulty in finding fathers with T1D, a higher than expected rate of premature delivery amongst T1D mothers, and implementation of new privacy regulations mid-trial. The majority of participants were recruited from primary care antenatal clinics located near the study centers and from a general hospital or pediatric center that was affiliated with a TRIGR Study center. Internet and magazine advertisements were found to be useful for recruitment of families. Alternative follow-up strategies are offered to families who wish to reduce or discontinue participation. Limitations Our experience is limited to a single

  3. Prevention of mental disorders, substance abuse, and problem behaviors: a developmental perspective.

    PubMed

    Beardslee, William R; Chien, Peter L; Bell, Carl C

    2011-03-01

    Robust scientific evidence shows that mental, emotional, and behavioral disorders can be prevented before they begin. This article highlights and expands points from a 2009 Institute of Medicine report to provide a concise summary of the literature on preventing mental illness. Because prevention requires intervention before the onset of illness, effective preventive approaches are often interdisciplinary and developmental. Evidence-based preventive strategies are discussed for the different phases of a young person's life. Specific recommendations to focus on parenting, child development, and the prevention of depression are made for a target audience of practicing psychiatrists and mental health professionals. Further systemic recommendations are to prioritize prevention and to coordinate and facilitate research on preventive practices in order to reduce suffering, create healthier families, and save money.

  4. Theoretical Perspectives on Learning for the Prevention of Fishing Vessel Accidents.

    ERIC Educational Resources Information Center

    Boshier, Roger

    2000-01-01

    Outlines a theoretical model for accident prevention education that includes four paradigms: humanism, radical humanism, functionalism, and radical functionalism. Applies the model to fishing boat accidents and derives implications for changing the content and processes of prevention education. (SK)

  5. Theoretical Perspectives on Learning for the Prevention of Fishing Vessel Accidents.

    ERIC Educational Resources Information Center

    Boshier, Roger

    2000-01-01

    Outlines a theoretical model for accident prevention education that includes four paradigms: humanism, radical humanism, functionalism, and radical functionalism. Applies the model to fishing boat accidents and derives implications for changing the content and processes of prevention education. (SK)

  6. Family Violence Prevention Programs in Immigrant Communities: Perspectives of Immigrant Men

    ERIC Educational Resources Information Center

    Simbandumwe, Louise; Bailey, Kim; Denetto, Shereen; Migliardi, Paula; Bacon, Brenda; Nighswander, Maggie

    2008-01-01

    The Strengthening Families in Canada Family Violence Prevention Project was aimed at engaging immigrant and refugee communities in family violence prevention. The project, which received support from the Community Mobilization Program, National Crime Prevention Strategy, involved a partnership of four community health and education organizations.…

  7. The Role of Teachers in School-Based Suicide Prevention: A Qualitative Study of School Staff Perspectives

    PubMed Central

    Kataoka, Sheryl H.; Chang, Vickie Y.; Vona, Pamela; Wong, Marleen; Stein, Bradley D.

    2016-01-01

    In response to concerns over youth suicide, there has been an increase in school-based suicide prevention programs. However, we know little about teacher perspectives on school-based suicide prevention and mental health programs. This study examined teacher roles in the implementation of a district-wide suicide prevention program through focus groups and interviews with middle school teachers, administrators, and other school personnel. Study results highlighted teachers’ critical role in detecting students at risk for suicide. Factors that appeared to facilitate teacher participation in the suicide prevention program included well-defined crisis policies and procedures, communication of these procedures, collaboration across staff, and the presence of on-campus mental health resources. Participants identified a need for direct teacher training on risk factors for suicide, crisis response, and classroom management. Other strategies for improving suicide prevention efforts included in-school trainings on mental health resources and procedures, regular updates to these trainings, and greater visibility of mental health staff. PMID:27042239

  8. Working-class Filipino women's perspectives on factors that facilitate or hinder prenatal micronutrients supplementation to prevent congenital anomalies.

    PubMed

    Daack-Hirsch, Sandra; Gamboa, Henrietta

    2012-11-01

    The study was conducted to plan for a community-health campaign to inform working-class Filipinos about the causes and prevention of orofacial clefting. Prenatal micronutrients may play a role in preventing orofacial clefting. Therefore, women's practices and perspectives on barriers to and facilitators of micronutrient supplementation were elicited. A total of 43 women and 22 health care workers were interviewed. Barriers to taking supplements included side effects, late prenatal care, the view that micronutrients are medications, inadequate supply, and health care workers who were unaware that prenatal vitamin supplements prevent congenital anomalies. The main facilitator was women's understanding that prenatal micronutrients improve the physical well-being of both mother and child. Given that women view having healthy babies as a reason to take micronutrients and that the health care workers lacked knowledge related to the use of micronutrients to prevent congenital anomalies, uptake of prenatal micronutrient supplementation programs may improve by specifically promoting the health benefit of preventing congenital anomalies.

  9. Posterior Arch Augmentation (Spinoplasty) before and after Single and Double Interspinous Spacer Introduction at the Same Level: Preventing and Treating the Failure?

    PubMed

    Manfré, Luigi

    2014-10-31

    Lumbar spinal canal stenosis (LSCS) is one of the most common degenerative diseases in elderly patients. Failure of he treatment can occur, generally related to bone remodelling/fracture of spinous processes. PMMA augmentation of the posterior arch (spinoplasty, SP) has recently been proposed in case of neoplastic involvement. This study evaluated the efficacy of SP as a prophylactic treatment before introducing an interspinous spacer (IS). Moreover, we consider the possibility to treat patients who previously underwent IS implants with subsequent failure of the device, by introducing a second spacer at the same level, performing accessory SP. From January 2009 to September 2011, 174 patients with LSCS underwent CT-guided percutaneous IS implant in our department. From January 2011, all patients with osteoporosis underwent prophylactic SP before introducing the spacer. Moreover, in patients with re-stenosis related to bone remodelling and/or fracture, after strengthening the spinous processes with PMMA introduction, a second similar device was introduced to re-open the stenotic spinal canal. In patients with prophylactic treatment before spacer introduction, no restenosis occurred at three to 12 month follow-up. Patients who underwent second spacer implant at the same level after posterior arch augmentation again obtained a resolution of symptoms, and no further bone remodelling had occurred at follow-up controls. In conclusion, prophylactic SP prevents single spacer failure for bone remodelling/fracture, and allows failure repair by introducing a second spacer at the same level.

  10. Prevention

    Treesearch

    Kerry Britton; Barbara Illman; Gary Man

    2010-01-01

    Prevention is considered the most cost-effective element of the Forest Service Invasive Species Strategy (USDA Forest Service 2004). What makes prevention difficult is the desire to maximize free trade and the resulting benefits to society while, at the same time, protecting natural resources. The role of science is to first identify which commodities pose an...

  11. Participatory workshops are not enough to prevent policy implementation failures: an example of a policy development process concerning the drug interferon-beta for multiple sclerosis.

    PubMed

    Moret-Hartman, Margriet; Reuzel, Rob; Grin, John; van der Wilt, Gert Jan

    2008-06-01

    A possible explanation for policy implementation failure is that the views of the policy's target groups are insufficiently taken into account during policy development. It has been argued that involving these groups in an interactive process of policy development could improve this. We analysed a project in which several target populations participated in workshops aimed to optimise the utilisation of an expensive novel drug (interferon beta) for patients with Multiple Sclerosis. All participants seemed to agree on the appropriateness of establishing a central registry of Multiple Sclerosis patients and developing guidelines. Nevertheless, these policy measures were not implemented. Possible explanations include (1) the subject no longer had high priority when the costs appeared lower than expected, (2) the organisers had paid insufficient attention to the perceived problems of parties involved, and (3) changes within the socio-political context. The workshops in which representatives of the policy's target populations participated did not provide enough interactivity to prevent policy implementation failure.

  12. Patient barriers to implantable cardioverter defibrillator implantation for the primary prevention of sudden cardiac death in patients with heart failure and reduced ejection fraction

    PubMed Central

    Chan, Laura Lihua; Lim, Choon Pin; Aung, Soe Tin; Quetua, Paul; Ho, Kah Leng; Chong, Daniel; Teo, Wee Siong; Sim, David; Ching, Chi Keong

    2016-01-01

    INTRODUCTION Device therapy is efficacious in preventing sudden cardiac death (SCD) in patients with reduced ejection fraction. However, few who need the device eventually opt to undergo implantation and even fewer reconsider their decisions after deliberation. This is due to many factors, including unresolved patient barriers. This study identified the factors that influenced patients’ decision to decline implantable cardioverter defibrillator (ICD) implantation, and those that influenced patients who initially declined an implant to reconsider having one. METHODS A single-centre survey was conducted among 240 patients who had heart failure with reduced ejection fraction and met the ICD implantation criteria, but had declined ICD implantation. RESULTS Participants who refused ICD implantation were mostly male (84%), Chinese (71%), married (72%), currently employed (54%), and had up to primary or secondary education (78%) and monthly income of < SGD 3,000 (51%). Those who were more likely to reconsider their decision were aware that SCD was a consequence of heart failure with reduced ejection fraction, knowledgeable of the preventive role of ICDs, currently employed and aware that their doctor strongly recommended the implant. Based on multivariate analysis, knowledge of the role of ICDs for primary prophylaxis was the most important factor influencing patient decision. CONCLUSION This study identified the demographic and social factors of patients who refused ICD therapy. Knowledge of the role of ICDs in preventing SCD was found to be the strongest marker for reconsidering ICD implantation. Measures to address this information gap may lead to higher rates of ICD implantation. PMID:27075476

  13. Early intervention of patients at risk for acute respiratory failure and prolonged mechanical ventilation with a checklist aimed at the prevention of organ failure: protocol for a pragmatic stepped-wedged cluster trial of PROOFCheck.

    PubMed

    Gong, M N; Schenk, L; Gajic, O; Mirhaji, P; Sloan, J; Dong, Y; Festic, E; Herasevich, V

    2016-06-10

    Acute respiratory failure (ARF) often presents and progresses outside of the intensive care unit. However, recognition and treatment of acute critical illness is often delayed with inconsistent adherence to evidence-based care known to decrease the duration of mechanical ventilation (MV) and complications of critical illness. The goal of this trial is to determine whether the implementation of an electronic medical record-based early alert for progressive respiratory failure coupled with a checklist to promote early compliance to best practice in respiratory failure can improve the outcomes of patients at risk for prolonged respiratory failure and death. A pragmatic stepped-wedged cluster clinical trial involving 6 hospitals is planned. The study will include adult hospitalised patients identified as high risk for MV >48 hours or death because they were mechanically ventilated outside of the operating room or they were identified as high risk for ARF on the Accurate Prediction of PROlonged VEntilation (APPROVE) score. Patients with advanced directives limiting intubation will be excluded. The intervention will consist of (1) automated identification and notification of clinician of high-risk patients by APPROVE or by invasive MV and (2) checklist of evidence-based practices in ARF (Prevention of Organ Failure Checklist-PROOFCheck). APPROVE and PROOFCheck will be developed in the pretrial period. Primary outcome is hospital mortality. Secondary outcomes include length of stay, ventilator and organ failure-free days and 6-month and 12-month mortality. Predefined subgroup analysis of patients with limitation of aggressive care after study entry is planned. Generalised estimating equations will be used to compare patients in the intervention phase with the control phase, adjusting for clustering within hospitals and time. The study was approved by the institutional review boards. Results will be published in peer-reviewed journals and presented at international

  14. Important differences in mode of death between men and women with heart failure who would qualify for a primary prevention implantable cardioverter-defibrillator.

    PubMed

    Rho, Robert W; Patton, Kristen K; Poole, Jeanne E; Cleland, John G; Shadman, Ramin; Anand, Inder; Maggioni, Aldo Pietro; Carson, Peter E; Swedberg, Karl; Levy, Wayne C

    2012-11-13

    Whether sex differences in implantable cardioverter-defibrillator (ICD) benefit exist remains unanswered. We evaluated sex differences in mode of death among a large cohort of ambulatory heart failure patients who meet criteria for a primary prevention ICD. Patients from 5 trials or registries were included if they met American College of Cardiology/American Heart Association/Heart Rhythm Society guideline criteria for implantation of a primary prevention ICD. We investigated the potential sex differences in total deaths and total deaths by mode of death. The relationship between the estimated total mortality and mode of death by percentage of total mortality was also analyzed by sex. The Seattle Heart Failure Model was used to estimate total mortality in this analysis. A total of 8337 patients (1685 [20%] women) met inclusion criteria. One-year mortality was 10.8±0.3%. In women, the age-adjusted all-cause mortality was 24% lower (hazard ratio [HR], 0.76; confidence interval [CI], 0.68-0.85; P<0.0001), the risk of sudden death was 31% lower (HR, 0.69; CI, 0.58-0.83; P<0.0001), but no significant difference in pump failure death was observed. Throughout a range of total mortality risk, women had a 20% lower all-cause mortality (HR, 0.80; CI, 0.71-0.89; P<0.001) and 29% fewer deaths that were sudden (HR, 0.71; CI, 0.59-0.86;P<0.001) compared with men. Women with heart failure have a lower mortality than men, and fewer of those deaths are sudden throughout a spectrum of all-cause mortality risk. These data provide a plausible reason for and thus support the possibility that sex differences in ICD benefit may exist.

  15. An economic appraisal of the Australian Medical Sheepskin for the prevention of sacral pressure ulcers from a nursing home perspective

    PubMed Central

    2010-01-01

    Background Many devices are in use to prevent pressure ulcers, but from most little is known about their effects and costs. One such preventive device is the Australian Medical Sheepskin that has been proven effective in three randomized trials. In this study the costs and savings from the use of the Australian Medical Sheepskin were investigated from the perspective of a nursing home. Methods An economic model was developed in which monetary costs and monetary savings in respect of the sheepskin were balanced against each other. The model was applied to a fictional (Dutch) nursing home with 100 beds for rehabilitation patients and a time horizon of one year. Input variables for the model consisted of investment costs for using the sheepskin (purchase and laundry), and savings through the prevented cases of pressure ulcers. The input values for the investment costs and for the effectiveness were empirically based on a trial with newly admitted rehabilitation patients from eight nursing homes. The input values for the costs of pressure ulcer treatment were estimated by means of four different approaches. Results Investment costs for using the Australian Medical Sheepskin were larger than the monetary savings obtained by preventing pressure ulcers. Use of the Australian Medical Sheepskin involves an additional cost of approximately €2 per patient per day. Preventing one case of a sacral pressure ulcer by means of the Australian Medical Sheepskin involves an investment of €2,974 when the sheepskin is given to all patients. When the sheepskin is selectively used for more critical patients only, the investment to prevent one case of sacral pressure ulcers decreases to €2,479 (pressure ulcer risk patients) or €1,847 (ADL-severely impaired patients). The factors with the strongest influence on the balance are the frequency of changing the sheepskin and the costs of washing related to this. The economic model was hampered by considerable uncertainty in the

  16. The costs of heart failure in Poland from the public payer's perspective. Polish programme assessing diagnostic procedures, treatment and costs in patients with heart failure in randomly selected outpatient clinics and hospitals at different levels of care: POLKARD.

    PubMed

    Czech, Marcin; Opolski, Grzegorz; Zdrojewski, Tomasz; Dubiel, Jacek S; Wizner, Barbara; Bolisęga, Dorota; Fedyk-Łukasik, Małgorzata; Grodzicki, Tomasz

    2013-01-01

    Heart failure (HF) is a chronic disease of great clinical and economic significance for both the healthcare system and patients themselves. To determine the consumption of medical resources for treatment and care of HF patients and to estimate the related costs. The study involved 400 primary care practices and 396 specialist outpatient clinics, as well as 259 hospitals at all reference levels. The sample was representative and supplemented with patient interview data. Based on the consumption of particular resources and the unit costs of services in 2011, costs of care for HF patients in Poland were estimated. Separate analyses were conducted depending on the stage of the disease (according to NYHA classification I-IV). The public payer's perspective and a one year time horizon were adopted. Direct annual costs of an HF patient's treatment in Poland may range between PLN 3,373.23 and 7,739.49 (2011), the main cost item being hospitalisation. The total costs for the healthcare system could be as high as PLN 1,703 million, which is 3.16% of the National Health Fund's budget (Ex. rate from 05.03.2012: 1 EUR = 4.14 PLN). The costs of treating heart failure in Poland are high; proper allocation of resources to diagnostic procedures and treatment may contribute to rationalisation of the relevant expenditure.

  17. Preventable Failure: Improvements in Long-Term Outcomes When High Schools Focused on the Ninth Grade Year. Research Summary

    ERIC Educational Resources Information Center

    Roderick, Melissa; Kelley-Kemple, Thomas; Johnson, David W.; Beechum, Nicole O.

    2014-01-01

    In 2007, spurred by University of Chicago Consortium on Chicago School Research (UChicago CCSR) research reports, leadership at the Chicago Public Schools (CPS) began a new targeted approach to reducing course failure in the ninth grade. The research suggested that the transition between eighth and ninth grade played a critical role in shaping…

  18. Evaluation of Alternative Control for Prevention and or Mitigation of HEPA Filter Failure Accidents at Tank Farm Facilities

    SciTech Connect

    GUSTAVSON, R.D.

    2000-01-28

    This study evaluates the adequacy and benefit of use of HEPA filter differential pressure limiting setpoints to initiate exhauster shut down as an alternative safety control for postulated accidents that might result in filtration failure and subsequent unfiltered release from Tank Farm primary tank ventilators.

  19. A feminist perspective on risk factor research and on the prevention of eating disorders.

    PubMed

    Piran, Niva

    2010-01-01

    This review utilizes a feminist lens to discuss risk factor research and prevention work in the field of eating disorders. The article suggests that feminist informed risk factor research needs to consider gender as it intersects with other social variables as a relevant higher level risk factor and examine its relationship to individual level risk factors such as the internalization of thinness or negative body image. The article also highlights the key elements of participatory approaches and systemic changes to feminist informed prevention work. Prevention work conducted to date suggests the relevance of these elements to achieving behavioral changes in prevention work.

  20. Can oral vitamin D prevent the cardiovascular diseases among migrants in Australia? Provider perspective using Markov modelling.

    PubMed

    Ruwanpathirana, Thilanga; Owen, Alice; Renzaho, Andre M N; Zomer, Ella; Gambhir, Manoj; Reid, Christopher M

    2015-06-01

    The study was designed to model the effectiveness and cost effectiveness of oral Vitamin D supplementation as a primary prevention strategy for cardiovascular disease among a migrant population in Australia. It was carried out in the Community Health Service, Kensington, Melbourne. Best-case scenario analysis using a Markov model was employed to look at the health care providers' perspective. Adult migrants who were vitamin D deficient and free from cardiovascular disease visiting the medical centre at least once during the period from 1 January 2010 to 31 December 2012 were included in the study. The blood pressure-lowering effect of vitamin D was taken from a published meta-analysis and applied in the Framingham 10 year cardiovascular risk algorithm (with and without oral vitamin D supplements) to generate the probabilities of cardiovascular events. A Markov decision model was used to estimate the provider costs associated with the events and treatments. Uncertainties were derived by Monte Carlo simulation. Vitamin D oral supplementation (1000 IU/day) for 10 years could potentially prevent 31 (interquartile range (IQR) 26 to 37) non-fatal and 11 (IQR 10 to 15) fatal cardiovascular events in a migrant population of 10,000 assuming 100% compliance. The provider perspective incremental cost effectiveness per year of life saved was AU$3,992 (IQR 583 to 8558). This study suggests subsidised supplementation of oral vitamin D may be a cost effective intervention to reduce non-fatal and fatal cardiovascular outcomes in high-risk migrant populations.

  1. Intravenous Versus Oral Antibiotics for the Prevention of Treatment Failure in Children With Complicated Appendicitis: Has the Abandonment of Peripherally Inserted Catheters Been Justified?

    PubMed

    Rangel, Shawn J; Anderson, Brett R; Srivastava, Rajendu; Shah, Samir S; Ishimine, Paul; Srinivasan, Mythili; Bryan, Matthew; Gong, Wu; Hall, Matt; Localio, Russell; Luan, Xianqun; Anandalwar, Seema; Keren, Ron

    2017-08-01

    To compare treatment failure leading to hospital readmission in children with complicated appendicitis who received oral versus intravenous antibiotics after discharge. Antibiotics are often employed after discharge to prevent treatment failure in children with complicated appendicitis, although existing studies comparing intravenous and oral antibiotics for this purpose are limited. We identified all patients aged 3 to 18 years undergoing appendectomy for complicated appendicitis, who received postdischarge antibiotics at 35 childrens hospitals from 2009 to 2012. Discharge codes were used to identify study subjects from the Pediatric Health Information System database, and chart review confirmed eligibility, treatment assignment, and outcomes. Exposure status was based on outpatient antibiotic therapy, and analysis used optimal and full matching methods to adjust for demographic and clinical characteristics. Treatment failure (defined as an organ-space infection) requiring inpatient readmission was the primary outcome. Secondary outcomes included revisits from any cause to either the inpatient or emergency department setting. In all, 4579 patients were included (median: 99/hospital), and utilization of intravenous antibiotics after discharge ranged from 0% to 91.7% across hospitals. In the matched analysis, the rate of treatment failure was significantly higher for the intravenous group than the oral group [odds ratio (OR) 1.74, 95% confidence interval (CI) 1.05-2.88; risk difference: 4.0%, 95% CI 0.4-7.6%], as was the rate of all-cause revisits (OR 2.11, 95% CI 1.44-3.11; risk difference: 9.4%, 95% CI 4.7-14.2%). The rate of peripherally inserted central catheter line complications was 3.2% in the intravenous group, and drug reactions were rare in both groups (intravenous: 0.7%, oral: 0.5%). Compared with oral antibiotics, use of intravenous antibiotics after discharge in children with complicated appendicitis was associated with higher rates of both treatment

  2. Integrating the Perspective of Vulnerable Heterosexual Male Adolescents to Prevent Premature Paternity and Sexually Transmitted Infection

    ERIC Educational Resources Information Center

    Manseau, Helene; Blais, Martin; Engler, Kim; Bosse, Marie-Andre

    2008-01-01

    This study presents the perspective of vulnerable Canadian (Quebecker) adolescents defined as such on account of their numerous experiences with potential or actual fatherhood or exposure to sexually transmitted infection. The interviews allowed youth to talk about their experiences with paternity, their sex lives and their views on sex education.…

  3. Integrating the Perspective of Vulnerable Heterosexual Male Adolescents to Prevent Premature Paternity and Sexually Transmitted Infection

    ERIC Educational Resources Information Center

    Manseau, Helene; Blais, Martin; Engler, Kim; Bosse, Marie-Andre

    2008-01-01

    This study presents the perspective of vulnerable Canadian (Quebecker) adolescents defined as such on account of their numerous experiences with potential or actual fatherhood or exposure to sexually transmitted infection. The interviews allowed youth to talk about their experiences with paternity, their sex lives and their views on sex education.…

  4. Effective heart disease prevention: lessons from a qualitative study of user perspectives in Bangladeshi, Indian and Pakistani communities.

    PubMed

    Netto, G; McCloughan, L; Bhatnagar, A

    2007-03-01

    Coronary heart disease (CHD) has a high mortality, incidence and prevalence among Indian, Pakistani and Bangladeshi communities in the UK, indicating the need for effective heart disease prevention initiatives for these communities. This paper considers how service user perspectives can be used to develop effective, culturally focused CHD prevention interventions for these target groups by addressing identified barriers, including deeply held cultural beliefs. A qualitative research study, using a longitudinal action research approach. This was a community-based study in Edinburgh. Six focus group discussions--two for each community--were organized with participants from these communities at the beginning of the project. A further six focus group discussions for the same communities were organized six months later. Over the period examined, participants reported varying changes in levels of knowledge relating to the nature, causes and symptoms of CHD. Some participants reported taking slight to significant steps to reduce or prevent heart disease, while others did not. The project was viewed as helpful in increasing knowledge about CHD and preventive measures and encouraging healthier lifestyles. However, persistent barriers to change were also identified, requiring changes to the project that involved not only matching intervention materials and messages to observable, superficial characteristics of the target population, but more fundamental changes that address the cultural, social, historical, environmental and psychological forces that influence health behaviour. CHD prevention initiatives need to identify and respond to deep-rooted influences on health-behaviour in 'at-risk' groups, in addition to superficial characteristics of the target populations. It is important for specific prevention initiatives to be linked into wider CHD frameworks to ensure transferability of learning and integration within wider service provision.

  5. Public Health and Church-Based Constructions of HIV Prevention: Black Baptist Perspective

    ERIC Educational Resources Information Center

    Roman Isler, Malika; Eng, Eugenia; Maman, Susanne; Adimora, Adaora; Weiner, Bryan

    2014-01-01

    The black church is influential in shaping health behaviors within African-American communities, yet few use evidence-based strategies for HIV prevention (abstinence, monogamy, condoms, voluntary counseling and testing, and prevention with positives). Using principles of grounded theory and interpretive description, we explored the social…

  6. Practitioners' Perspectives on Cultural Sensitivity in Latina/o Teen Pregnancy Prevention

    ERIC Educational Resources Information Center

    Wilkinson-Lee, Ada M.; Russell, Stephen T.; Lee, Faye C. H.

    2006-01-01

    This study examined practitioners' understandings of cultural sensitivity in the context of pregnancy prevention programs for Latina teens. Fifty-eight practitioners from teen pregnancy prevention programs in California were interviewed in a guided conversation format. Three themes emerged in our analysis. First, practitioners' definitions of…

  7. Public Health and Church-Based Constructions of HIV Prevention: Black Baptist Perspective

    ERIC Educational Resources Information Center

    Roman Isler, Malika; Eng, Eugenia; Maman, Susanne; Adimora, Adaora; Weiner, Bryan

    2014-01-01

    The black church is influential in shaping health behaviors within African-American communities, yet few use evidence-based strategies for HIV prevention (abstinence, monogamy, condoms, voluntary counseling and testing, and prevention with positives). Using principles of grounded theory and interpretive description, we explored the social…

  8. Practitioners' Perspectives on Cultural Sensitivity in Latina/o Teen Pregnancy Prevention

    ERIC Educational Resources Information Center

    Wilkinson-Lee, Ada M.; Russell, Stephen T.; Lee, Faye C. H.

    2006-01-01

    This study examined practitioners' understandings of cultural sensitivity in the context of pregnancy prevention programs for Latina teens. Fifty-eight practitioners from teen pregnancy prevention programs in California were interviewed in a guided conversation format. Three themes emerged in our analysis. First, practitioners' definitions of…

  9. Public health and church-based constructions of HIV prevention: black Baptist perspective

    PubMed Central

    Roman Isler, Malika; Eng, Eugenia; Maman, Susanne; Adimora, Adaora; Weiner, Bryan

    2014-01-01

    The black church is influential in shaping health behaviors within African-American communities, yet few use evidence-based strategies for HIV prevention (abstinence, monogamy, condoms, voluntary counseling and testing, and prevention with positives). Using principles of grounded theory and interpretive description, we explored the social construction of HIV prevention within black Baptist churches in North Carolina. Data collection included interviews with church leaders (n = 12) and focus groups with congregants (n = 7; 36 participants). Analytic tools included open coding and case-level comparisons. Social constructions of HIV/AIDS prevention were influenced by two worldviews: public health and church-based. Areas of compatibility and incompatibility exist between the two worldviews that inform acceptability and adaptability of current evidence-based strategies. These findings offer insight into ways to increase the compatibility of evidence-based HIV prevention strategies within the black Baptist church context. PMID:24643141

  10. Providers' perspectives on the best practices for HIV prevention for men who have sex with men in Berlin, Germany: lessons for policy and prevention.

    PubMed

    Grov, Christian; Restar, Arjee; Gussmann, Philip; Schlemmer, Kurt; Rodríguez-Díaz, Carlos E

    2014-12-01

    Using qualitative data via providers' perspectives, the goal of this study was to identify strengths and weaknesses in the current approaches being used to prevent onward transmission of HIV among men who have sex with men (MSM) in Berlin, Germany. In 2013, 18 participants from 10 organizations who provide direct outreach or services to MSM were interviewed (30-75 minutes). With regard to strategies and services that individuals believed contributed to the organization's success, we identified five themes: (1) Having staff and volunteers to "match" the target population, (2) Embracing homosexuality and gay identity, (3) Being invested in the cause, (4) Coordination of services to avoid overlap and duplication, and (5) Seeing eye-to-eye with the target population. Finally, with regard to areas in which organizations felt they could use improvement (i.e., continuing challenges), we identified three themes: (1) Insufficient funding and resources, (2) Insufficient services, and (3) HIV stigma, homophobia, and shifting attitudes about HIV. This study informs HIV prevention approaches in Berlin, Germany as well as other urban centers where MSM are disproportionally affected by the HIV epidemic.

  11. The EARLY ALLIANCE prevention trial: an integrated set of interventions to promote competence and reduce risk for conduct disorder, substance abuse, and school failure.

    PubMed

    Dumas, J E; Prinz, R J; Smith, E P; Laughlin, J

    1999-03-01

    Describes the EARLY ALLIANCE interventions, an integrated set of four programs designed to promote competence and reduce risk for early-onset conduct disorder, substance abuse, and school failure. These interventions are evaluated as part of a prevention trial that begins at school entry and targets child functioning and socializing practices across multiple contexts (school, peer group, family) and multiple domains (affective, social, and achievement coping-competence). The paper presents the conceptual foundation of the four interventions, including a synopsis of the risk and protective factors associated with conduct disorder and related outcomes, and of the coping-competence model driving EARLY ALLIANCE. The developmental rationale, intended impact, and procedures are described for each intervention: a universally administered classroom program and indicated, peer, reading-mentoring, and family programs. Interventions are currently being tested in a prevention trial, which is briefly summarized.

  12. Magnesium sulfate after transient hypoxia-ischemia fails to prevent delayed cerebral energy failure in the newborn piglet.

    PubMed

    Penrice, J; Amess, P N; Punwani, S; Wylezinska, M; Tyszczuk, L; D'Souza, P; Edwards, A D; Cady, E B; Wyatt, J S; Reynolds, E O

    1997-03-01

    Severely birth-asphyxiated human infants develop delayed ("secondary") cerebral energy failure, which carries a poor prognosis, during the first few days of life. This study tested the hypothesis that i.v. magnesium sulfate (MgSO4) after severe transient cerebral hypoxia-ischemia decreases the severity of delayed energy failure in the newborn piglet. Twelve piglets underwent temporary occlusion of the common carotid arteries and hypoxemia. Resuscitation was started when cerebral [phosphocreatine (PCr)]/[inorganic phosphate (Pi)], as determined by phosphorus magnetic resonance spectroscopy, had fallen virtually to zero, and nucleotide triphosphate (NTP) had fallen below a third of baseline. The piglets were randomized to receive, blind, either: 1) three i.v. infusions of 12.5% MgSO4 heptahydrate solution: 400 mg.kg-1 MgSO4.7H2O starting 1 h after resuscitation, and 200 mg.kg-1 12 and 24 h later (n = 6); or 2) three infusions of placebo, 0.9% NaCl (n = 6). Phosphorus and proton spectroscopy were continued until 48 h after resuscitation, and values were compared between the two groups. Mean plasma magnesium levels, 1 h after each of the three doses of MgSO4, were 2.1, 2.0, and 1.9 mmol.L-1, respectively. The severity of the primary insult, determined by the time-integral of depletion of cerebral [NTP]/[exchangeable phosphate pool (EPP)], was similar in the MgSO4-treated and placebo groups. After resuscitation, there was no difference in the progression or severity of delayed energy failure between the two groups, as judged by cerebral [PCr]/[Pi], [NTP]/[EPP], or lactate/creatine and N-acetylaspartate/creatine peak-area ratios. We conclude that MgSO4 did not decrease the severity of delayed cerebral energy failure.

  13. Gender perspectives on views and preferences of older people on exercise to prevent falls: a systematic mixed studies review.

    PubMed

    Sandlund, Marlene; Skelton, Dawn A; Pohl, Petra; Ahlgren, Christina; Melander-Wikman, Anita; Lundin-Olsson, Lillemor

    2017-02-17

    To offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both women's and men's views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people's views or preferences regarding uptake and adherence to exercise to prevent falls. A review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach. Nine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of men's and women's views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies. Although there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older women

  14. β-Blockers for the prevention of sudden cardiac death in heart failure patients: a meta-analysis of randomized controlled trials.

    PubMed

    Al-Gobari, Muaamar; El Khatib, Chadia; Pillon, François; Gueyffier, François

    2013-07-13

    In many studies, beta-blockers have been shown to decrease sudden cardiac death (SCD) in heart failure patients; other studies reported mixed results. Recently, several large randomized control trials of beta blockers have been carried out. It became necessary to conduct a systematic review to provide an up-to-date synthesis of available data. We conducted a meta-analysis of all randomized controlled trials examining the use of beta-blockers vs. placebo/control for the prevention of SCD in heart failure patients. We identified 30 trials, which randomized 24,779 patients to beta-blocker or placebo/control. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Eligible studies had to be randomized controlled trials and provide information on the incidence of sudden cardiac death in heart failure patients. Additional inclusion criteria included: treatment for >30 days and follow-up≥3 months. Studies of patients<18 years, randomization to beta-blocker vs. an angiotensin converting enzyme (without placebo) and/or beta-blocker in both arms were excluded from the analysis. Pre-specified outcomes of interest included SCD, cardiovascular death (CVD), and all-cause mortality and were analyzed according to intention-to-treat. We found that beta-blockers are effective in the prevention of SCD [OR 0.69; 95% CI, 0.62-0.77, P<0.00001], cardiovascular death (CVD) [OR 0.71; 95% CI, 0.64-0.79, P<0.00001], and all-cause mortality [OR 0.67; 95% CI, 0.59-0.76, P<0.00001]. Based on the study analysis, 43 patients must be treated with a beta-blocker to prevent one SCD, 26 patients to prevent one CVD and 21 patients to prevent all-cause mortality in one year. Beta-blockers reduce the risk of sudden cardiac death (SCD) by 31%, cardiovascular death (CVD) by 29% and all-cause mortality by 33%. These results confirm the mortality benefits of these drugs and they should be recommended to all patients similar to those included in the trials.

  15. Developmental issues in school-based aggression prevention from a social-cognitive perspective.

    PubMed

    Boxer, Paul; Goldstein, Sara E; Musher-Eizenman, Dara; Dubow, Eric F; Heretick, Donna

    2005-09-01

    Contemporary research on the development and prevention of aggressive behavior in childhood and adolescence emphasizes the importance of social-cognitive factors such as perceptual biases, problem-solving skills, and social-moral beliefs in the maintenance of aggression. Indeed, school-based social-cognitive intervention approaches have been identified as best practices by the Centers for Disease Control and Prevention. However, because child age is an important covariate of both intervention effectiveness and social-cognitive ability, school-based prevention program designers should keep in mind a number of issues identified through developmental research. In this paper, we review the social-cognitive model of aggressive behavior development as applied to prevention programming. We then discuss some of the ways in which the broader developmental research base can inform the design of aggression prevention programs. EDITORS' STRATEGIC IMPLICATIONS: Educational administrators and policy makers will find evidence in this review that school-based programs that employ a social-cognitive model represent a strategy that works for preventing violence. Prevention researchers will also benefit from the authors' insights regarding theoretical mediating processes and the importance of a developmental view.

  16. Assessment of the Broader Economic Consequences of HPV Prevention from a Government-Perspective: A Fiscal Analytic Approach

    PubMed Central

    Setiawan, Didik; Kotsopoulos, Nikolaos; Wilschut, Jan C.; Postma, Maarten J.; Connolly, Mark P.

    2016-01-01

    Background Cervical cancer poses a substantial burden in terms of morbidity, mortality, and economic losses, especially in low/middle-income countries. HPV vaccination and/or cervical cancer screening among females may reduce the burden of HPV-related diseases, including cervical cancer. However, limited funds may impede the implementation of population-based programmes. Governmental investments in the prevention of infectious disease may have broader economic and fiscal benefits, which are not accounted in conventional economic analyses. This study estimates the broader economic and fiscal impacts of implementing HPV vaccination and/or cervical cancer screening in Indonesia from the perspective of the government. Methods A government-perspective quantitative analytic framework was applied to assess the Net Present Value (NPV) of investment on cervical cancer prevention strategies including HPV vaccination, cervical screening and its combination in Indonesia. All monetary values were presented in International Dollars (I$). Results Based on a cohort of 10,000,000 Indonesian 12-year-old females, it was estimated that HPV vaccination and/or cervical cancer screening result in a positive NPV for the Indonesian government. The combination of cervical screening and HPV vaccination generated a substantial reduction of cervical cancer incidence and HPV-related mortality of 87,862 and 19,359, respectively. It was estimated that HPV vaccination in combination with cervical screening is the most favorable option for cervical cancer prevention (NPV I$2.031.786.000), followed by HPV vaccination alone (NPV I$1.860.783.000) and cervical screening alone (NPV I$375.244.000). Conclusion In addition to clinical benefits, investing in HPV vaccination and cervical screening may yield considerable fiscal benefits for the Indonesian governments due to lifelong benefits resulting from reduction of cervical cancer-related morbidity and mortality. PMID:27490258

  17. What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective.

    PubMed

    Filby, Alex; McConville, Fran; Portela, Anayda

    2016-01-01

    Quality of care is essential for further progress in reducing maternal and newborn deaths. The integration of educated, trained, regulated and licensed midwives into the health system is associated with improved quality of care and sustained decreases in maternal and newborn mortality. To date, research on barriers to quality of care for women and newborns has not given due attention to the care provider's perspective. This paper addresses this gap by presenting the findings of a systematic mapping of the literature of the social, economic and professional barriers preventing midwifery personnel in low and middle income countries (LMICs) from providing quality of care. A systematic search of five electronic databases for literature published between January 1990 and August 2013. Eligible items included published and unpublished items in all languages. Items were screened against inclusion and exclusion criteria, yielding 82 items from 34 countries. 44% discussed countries or regions in Africa, 38% in Asia, and 5% in the Americas. Nearly half the articles were published since 2011. Data was extracted and presented in a narrative synthesis and tables. Items were organized into three categories; social; economic and professional barriers, based on an analytical framework. Barriers connected to the socially and culturally constructed context of childbirth, although least reported, appear instrumental in preventing quality midwifery care. Significant social and cultural, economic and professional barriers can prevent the provision of quality midwifery care in LMICs. An analytical framework is proposed to show how the overlaps between the barriers reinforce each other, and that they arise from gender inequality. Links are made between burn out and moral distress, caused by the barriers, and poor quality care. Ongoing mechanisms to improve quality care will need to address the barriers from the midwifery provider perspective, as well as the underlying gender inequality.

  18. Assessment of the Broader Economic Consequences of HPV Prevention from a Government-Perspective: A Fiscal Analytic Approach.

    PubMed

    Setiawan, Didik; Kotsopoulos, Nikolaos; Wilschut, Jan C; Postma, Maarten J; Connolly, Mark P

    2016-01-01

    Cervical cancer poses a substantial burden in terms of morbidity, mortality, and economic losses, especially in low/middle-income countries. HPV vaccination and/or cervical cancer screening among females may reduce the burden of HPV-related diseases, including cervical cancer. However, limited funds may impede the implementation of population-based programmes. Governmental investments in the prevention of infectious disease may have broader economic and fiscal benefits, which are not accounted in conventional economic analyses. This study estimates the broader economic and fiscal impacts of implementing HPV vaccination and/or cervical cancer screening in Indonesia from the perspective of the government. A government-perspective quantitative analytic framework was applied to assess the Net Present Value (NPV) of investment on cervical cancer prevention strategies including HPV vaccination, cervical screening and its combination in Indonesia. All monetary values were presented in International Dollars (I$). Based on a cohort of 10,000,000 Indonesian 12-year-old females, it was estimated that HPV vaccination and/or cervical cancer screening result in a positive NPV for the Indonesian government. The combination of cervical screening and HPV vaccination generated a substantial reduction of cervical cancer incidence and HPV-related mortality of 87,862 and 19,359, respectively. It was estimated that HPV vaccination in combination with cervical screening is the most favorable option for cervical cancer prevention (NPV I$2.031.786.000), followed by HPV vaccination alone (NPV I$1.860.783.000) and cervical screening alone (NPV I$375.244.000). In addition to clinical benefits, investing in HPV vaccination and cervical screening may yield considerable fiscal benefits for the Indonesian governments due to lifelong benefits resulting from reduction of cervical cancer-related morbidity and mortality.

  19. What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective

    PubMed Central

    McConville, Fran; Portela, Anayda

    2016-01-01

    Background Quality of care is essential for further progress in reducing maternal and newborn deaths. The integration of educated, trained, regulated and licensed midwives into the health system is associated with improved quality of care and sustained decreases in maternal and newborn mortality. To date, research on barriers to quality of care for women and newborns has not given due attention to the care provider’s perspective. This paper addresses this gap by presenting the findings of a systematic mapping of the literature of the social, economic and professional barriers preventing midwifery personnel in low and middle income countries (LMICs) from providing quality of care. Methods and Findings A systematic search of five electronic databases for literature published between January 1990 and August 2013. Eligible items included published and unpublished items in all languages. Items were screened against inclusion and exclusion criteria, yielding 82 items from 34 countries. 44% discussed countries or regions in Africa, 38% in Asia, and 5% in the Americas. Nearly half the articles were published since 2011. Data was extracted and presented in a narrative synthesis and tables. Items were organized into three categories; social; economic and professional barriers, based on an analytical framework. Barriers connected to the socially and culturally constructed context of childbirth, although least reported, appear instrumental in preventing quality midwifery care. Conclusions Significant social and cultural, economic and professional barriers can prevent the provision of quality midwifery care in LMICs. An analytical framework is proposed to show how the overlaps between the barriers reinforce each other, and that they arise from gender inequality. Links are made between burn out and moral distress, caused by the barriers, and poor quality care. Ongoing mechanisms to improve quality care will need to address the barriers from the midwifery provider perspective

  20. Prevention of postpartum hemorrhage in low-resource settings: current perspectives

    PubMed Central

    Prata, Ndola; Bell, Suzanne; Weidert, Karen

    2013-01-01

    Background Postpartum hemorrhage (PPH) is the leading cause of maternal death in low-income countries and is the primary cause of approximately one-quarter of global maternal deaths. The purpose of this paper is to provide a review of PPH prevention interventions, with a particular focus on misoprostol, and the challenges and opportunities that preventing PPH in low-resource settings presents. Methods Using PubMed, we conducted a review of the literature on the randomized controlled trials of interventions to prevent PPH. We then searched PubMed and Google Scholar for nonrandomized field trials of interventions to prevent PPH. We limited our review to interventions that are discussed in the current World Health Organization (WHO) recommendations for PPH prevention and present evidence regarding the use of these interventions. We focused our review on nondrug PPH prevention interventions compared with no intervention and uterotonics versus placebo; this review does not decipher the relative effectiveness of uterotonic drugs. We describe challenges to and opportunities for scaling up PPH prevention interventions. Results Active management of the third stage of labor is considered the “gold standard” strategy for reducing the incidence of PPH. It combines nondrug interventions (controlled cord traction and cord clamping) with the administration of an uterotonic drug, the preferred uterotonic being oxytocin. Unfortunately, oxytocin has limited application in resource-poor countries, due to its heat instability and required administration by a skilled provider. New heat-stable drugs and drug formulations are currently in development that may improve the prevention of PPH; however, misoprostol is a viable option for provision at home by a lay health care worker or the woman herself, in the interim. Conclusion As the main cause of maternal mortality worldwide, PPH prevention interventions need to be prioritized. Increased access to prophylactic uterotonics, regardless

  1. Exploring Service Providers' Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia.

    PubMed

    Cyril, Sheila; Green, Julie; Nicholson, Jan M; Agho, Kingsley; Renzaho, Andre M N

    2016-01-01

    Childhood obesity rates have been increasing disproportionately among disadvantaged communities including culturally and linguistically diverse (CALD) migrant groups in Australia due to their poor participation in the available obesity prevention initiatives. We sought to explore service providers' perceptions of the key factors influencing the participation of CALD communities in the existing obesity prevention services and the service requirements needed to improve CALD communities' participation in these services. We conducted a qualitative study using focus group discussions involving fifty-nine service providers from a range of services, who are involved in the health and wellbeing of children from CALD groups living in four socioeconomically disadvantaged areas in Victoria, Australia. Thematic analysis of the data showed three major themes including community-level barriers to CALD engagement in childhood obesity prevention services; service-level barriers to the delivery of these services; and proposed changes to current childhood obesity prevention approaches. Integrating obesity prevention messages within existing programs, better coordination between prevention and treatment services and the establishment of a childhood obesity surveillance system, were some of the important changes suggested by service providers. This study has found that low CALD health literacy, lack of knowledge of cultural barriers among service providers and co-existing deficiencies in the structure and delivery of obesity prevention services negatively impacted the participation of CALD communities in obesity prevention services. Cultural competency training of service providers would improve their understanding of the cultural influences of childhood obesity and incorporate them into the design and development of obesity prevention initiatives. Service providers need to be educated on the pre-migratory health service experiences and health conditions of CALD communities to ensure

  2. Exploring Service Providers' Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia

    PubMed Central

    Cyril, Sheila; Green, Julie; Nicholson, Jan M.; Agho, Kingsley; Renzaho, Andre M. N.

    2016-01-01

    Background Childhood obesity rates have been increasing disproportionately among disadvantaged communities including culturally and linguistically diverse (CALD) migrant groups in Australia due to their poor participation in the available obesity prevention initiatives. We sought to explore service providers’ perceptions of the key factors influencing the participation of CALD communities in the existing obesity prevention services and the service requirements needed to improve CALD communities’ participation in these services. Methods We conducted a qualitative study using focus group discussions involving fifty-nine service providers from a range of services, who are involved in the health and wellbeing of children from CALD groups living in four socioeconomically disadvantaged areas in Victoria, Australia. Results Thematic analysis of the data showed three major themes including community-level barriers to CALD engagement in childhood obesity prevention services; service-level barriers to the delivery of these services; and proposed changes to current childhood obesity prevention approaches. Integrating obesity prevention messages within existing programs, better coordination between prevention and treatment services and the establishment of a childhood obesity surveillance system, were some of the important changes suggested by service providers. Conclusion This study has found that low CALD health literacy, lack of knowledge of cultural barriers among service providers and co-existing deficiencies in the structure and delivery of obesity prevention services negatively impacted the participation of CALD communities in obesity prevention services. Cultural competency training of service providers would improve their understanding of the cultural influences of childhood obesity and incorporate them into the design and development of obesity prevention initiatives. Service providers need to be educated on the pre-migratory health service experiences and health

  3. A translational neuroscience perspective on mindfulness meditation as a prevention strategy.

    PubMed

    Tang, Yi-Yuan; Leve, Leslie D

    2016-03-01

    Mindfulness meditation research mainly focuses on psychological outcomes such as behavioral, cognitive, and emotional functioning. However, the neuroscience literature on mindfulness meditation has grown in recent years. This paper provides an overview of relevant neuroscience and psychological research on the effects of mindfulness meditation. We propose a translational prevention framework of mindfulness and its effects. Drawing upon the principles of prevention science, this framework integrates neuroscience and prevention research and postulates underlying brain regulatory mechanisms that explain the impact of mindfulness on psychological outcomes via self-regulation mechanisms linked to underlying brain systems. We conclude by discussing potential clinical and practice implications of this model and directions for future research.

  4. Alternatives to Antibiotics to Prevent Necrotic Enteritis in Broiler Chickens: A Microbiologist's Perspective

    PubMed Central

    Caly, Delphine L.; D'Inca, Romain; Auclair, Eric; Drider, Djamel

    2015-01-01

    Since the 2006 European ban on the use of antibiotics as growth promoters in animal feed, numerous studies have been published describing alternative strategies to prevent diseases in animals. A particular focus has been on prevention of necrotic enteritis in poultry caused by Clostridium perfringens by the use of microbes or microbe-derived products. Microbes produce a plethora of molecules with antimicrobial properties and they can also have beneficial effects through interactions with their host. Here we review recent developments in novel preventive treatments against C. perfringens-induced necrotic enteritis in broiler chickens that employ yeasts, bacteria and bacteriophages or secondary metabolites and other microbial products in disease control. PMID:26648920

  5. [Safety and health in work from the perspective of the Prevention of Occupational Hazards Act].

    PubMed

    Gómez-Hortigüela Amillo, J

    1996-01-01

    The passing of the Prevention of Occupational Hazards Act, (Ley 31/1995), constituted a change in direction in the development of occupational safety and health in Spain. This article describes the most salient points of this new legislation, from the criteria and principles that have to govern preventive activities, to the obligations and rights of both employers and workers, together with the co-operation and co-ordination of the activities of the various Administrations which have jurisdiction and the participation of employers' and workers' organisations, as the backbone of policy in matters concerning the prevention of occupational hazards.

  6. [Aspects of prevention of obesity in children and adolescents - a European perspective].

    PubMed

    Kühne, G

    2011-08-01

    The prevalence of overweight in childhood and adolescence in Europe is still growing. This development could not yet be stopped despite numerous intervention and prevention measures. Due to the lack of longitudinal data, so far no reliable evaluation of incidence rates or long-term health effects of overweight and obesity can be made. Overweight and adiposity are caused by multiple factors. Beside genetic predisposition and individual lifestyle, effective prevention measures should e. g. also take account of psycho-social, context and environmental factors. The prevention of obesity is an issue that clinical medicine and public health should tackle together. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Perspectives.

    ERIC Educational Resources Information Center

    Robertson, Shari; Camerini, Michael

    2001-01-01

    Provides background information on the U.S. Immigration and Naturalization Service Asylum office. Uses the perspective of two movie producers as they filmed a documentary film, "Well-founded Fear", about asylum and refugee protection. Includes information on how to order a classroom aid and the film. (CMK)

  8. Perspectives

    ERIC Educational Resources Information Center

    Tarone, Elaine

    2013-01-01

    The topic of this "Perspectives" column is "Requiring a Proficiency Level as a Requirement for U.S. K-12 Teacher Licensure." In 1998, the American Council of Teachers of Foreign Languages (ACTFL) began to work with the National Council for Accreditation of Teacher Education (NCATE), which accredits teacher education programs…

  9. Perspectives

    ERIC Educational Resources Information Center

    Tarone, Elaine

    2013-01-01

    The topic of this "Perspectives" column is "Requiring a Proficiency Level as a Requirement for U.S. K-12 Teacher Licensure." In 1998, the American Council of Teachers of Foreign Languages (ACTFL) began to work with the National Council for Accreditation of Teacher Education (NCATE), which accredits teacher education programs…

  10. Ammonia tank failure

    SciTech Connect

    Sweat, M.E.

    1983-04-01

    An ammonia tank failure at Hawkeye Chemical of Clinton, Iowa is discussed. The tank was a double-wall, 27,000 metric-ton tank built in 1968 and commissioned in December 1969. The paper presented covers the cause of the failure, repair, and procedural changes made to prevent recurrence of the failure. (JMT)

  11. Heart Failure

    MedlinePlus

    ... version of this page please turn Javascript on. Heart Failure What is Heart Failure? In heart failure, the heart cannot pump enough ... failure often experience tiredness and shortness of breath. Heart Failure is Serious Heart failure is a serious and ...

  12. Role of the Renin–Angiotensin System in the Pathogenesis of Intimal Hyperplasia: Therapeutic Potential for Prevention of Vein Graft Failure?

    PubMed Central

    Osgood, Michael J.; Harrison, David G.; Sexton, Kevin W.; Hocking, Kyle M.; Voskresensky, Igor V.; Komalavilas, Padmini; Cheung-Flynn, Joyce; Guzman, Raul J.; Brophy, Colleen M.

    2014-01-01

    The saphenous vein remains the most widely used conduit for peripheral and coronary revascularization despite a high rate of vein graft failure. The most common cause of vein graft failure is intimal hyperplasia. No agents have been proven to be successful for the prevention of intimal hyperplasia in human subjects. The rennin–angiotensin system is essential in the regulation of vascular tone and blood pressure in physiologic conditions. However, this system mediates cardiovascular remodeling in pathophysiologic states. Angiotensin II is becoming increasingly recognized as a potential mediator of intimal hyperplasia. Drugs modulating the renin–angiotensin system include angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. These drugs are powerful inhibitors of atherosclerosis and cardiovascular remodeling, and they are first-line agents for management of several medical conditions based on class I evidence that they delay progression of cardiovascular disease and improve survival. Several experimental models have demonstrated that these agents are capable of inhibiting intimal hyperplasia. However, there are no data supporting their role in prevention of intimal hyperplasia in patients with vein grafts. This review summarizes the physiology of the rennin–angiotensin system, the role of angiotensin II in the pathogenesis of cardiovascular remodeling, the medical indications for these agents, and the experimental data supporting an important role of the rennin–angiotensin system in the pathogenesis of intimal hyperplasia. PMID:22445245

  13. Barriers and facilitators to preventive cancer screening in Limited English Proficient (LEP) patients: Physicians’ perspectives

    PubMed Central

    Bruce, Kelly H.; Schwei, Rebecca J.; Park, Linda S.; Jacobs, Elizabeth A.

    2016-01-01

    Background Limited English proficient (LEP) patients receive fewer recommended preventive screenings than English-speaking patients. Studies have explored patients’ perceptions of the factors that contribute to this disparity, but little research has focused on physicians’ perceptions. Objective To describe physicians’ perceptions of the barriers and facilitators to preventive cancer screening in LEP patients. Design Qualitative interview study using a semi-structured interview guide. Participants Eight primary care physicians from Wisconsin. Approach Each interview was systematically coded to illuminate important themes. Key Results A variety of barriers specifically hinder LEP patients’ receipt of cancer screening, including poor language proficiency, lack of transportation, unfamiliarity with the concept of prevention, complex scheduling systems, poor interpretation, and limited physician time to discuss preventive care. While physicians identified many factors that facilitate preventive screening in general, they mentioned few that are perceived as specific to LEP patients. Conclusion We found that primary care physicians attribute the low rates of preventive cancer screening among LEP populations to a variety of patient, provider, interpreter, and system factors, most of which go beyond simple language barriers. Interventions designed to reduce these barriers and enhance the impact of identified facilitators should be multifactorial and designed to engage primary care physicians. PMID:27499725

  14. Real-Time Smart Grids Control for Preventing Cascading Failures and Blackout using Neural Networks: Experimental Approach for N-1-1 Contingency

    NASA Astrophysics Data System (ADS)

    Zarrabian, Sina; Belkacemi, Rabie; Babalola, Adeniyi A.

    2016-12-01

    In this paper, a novel intelligent control is proposed based on Artificial Neural Networks (ANN) to mitigate cascading failure (CF) and prevent blackout in smart grid systems after N-1-1 contingency condition in real-time. The fundamental contribution of this research is to deploy the machine learning concept for preventing blackout at early stages of its occurrence and to make smart grids more resilient, reliable, and robust. The proposed method provides the best action selection strategy for adaptive adjustment of generators' output power through frequency control. This method is able to relieve congestion of transmission lines and prevent consecutive transmission line outage after N-1-1 contingency condition. The proposed ANN-based control approach is tested on an experimental 100 kW test system developed by the authors to test intelligent systems. Additionally, the proposed approach is validated on the large-scale IEEE 118-bus power system by simulation studies. Experimental results show that the ANN approach is very promising and provides accurate and robust control by preventing blackout. The technique is compared to a heuristic multi-agent system (MAS) approach based on communication interchanges. The ANN approach showed more accurate and robust response than the MAS algorithm.

  15. Preventing a Leak: Two Perspectives on Creating Supportive Environment for Graduate Student Colleagues

    NASA Astrophysics Data System (ADS)

    Wohl, Ellen; Lininger, Katherine

    2017-04-01

    Debate continues about whether there exists a leaky pipeline for women in STEM fields within academia, as well as the causes of leaks - points in an individual's career where women are more likely than men to choose a non-academic pathway. Statistics on MS and PhD degrees awarded in STEM fields indicate that one of these leaks occurs during and immediately following graduate school. Here, we present two perspectives, that of a full professor and a graduate student, on how to create an environment in which geosciences graduate students can thrive psychologically and professionally. We recognize the challenges faced by many underrepresented groups, but here we focus specifically on gender diversity from the perspective of white women. From the perspective of a faculty advisor overseeing a research group, the goal is to treat each member of the group as an individual and to develop a mentoring relationship that most effectively fosters that individual's development as a scientist, while maintaining a cohesive, collegial group dynamic. Among the recommended ways to achieve this are: maintaining flexibility in the work schedule, with success evaluated by outcomes; consideration of work-life balance; respect for diverse approaches to problem solving; recognition that individuals can be most productive, satisfied, and engaged when their individual contributions are acknowledged and valued; and respect for different choices for a career path and for changes in those choices during graduate studies. From the perspective of a graduate student, it is important that an advisor demonstrates a clear commitment to treating each member of a research group as a valued individual with differing needs. In addition to the recommendations above for achieving a positive and supportive research group, as a graduate student it is useful to have multiple mentors and role models who have had different career tracks and can provide diverse perspectives and advice. Graduate students can also

  16. Correlates of isoniazid preventive therapy failure in child household contacts with infectious tuberculosis in high burden settings in Nairobi, Kenya - a cohort study.

    PubMed

    Okwara, Florence Nafula; Oyore, John Paul; Were, Fred Nabwire; Gwer, Samson

    2017-09-16

    Sub-Saharan Africa continues to document high pediatric tuberculosis (TB) burden, especially among the urban poor. One recommended preventive strategy involves tracking and isoniazid preventive therapy (IPT) for children under 5 years in close contact with infectious TB. However, sub-optimal effectiveness has been documented in diverse settings. We conducted a study to elucidate correlates to IPT strategy failure in children below 5 years in high burden settings. A prospective longitudinal cohort study was done in informal settlings in Nairobi, where children under 5 years in household contact with recently diagnosed smear positive TB adults were enrolled. Consent was sought. Structured questionnaires administered sought information on index case treatment, socio-demographics and TB knowledge. Contacts underwent baseline clinical screening exclude TB and/or pre-existing chronic conditions. Contacts were then put on daily isoniazid for 6 months and monitored for new TB disease, compliance and side effects. Follow-up continued for another 6 months. At baseline, 428 contacts were screened, and 14(3.2%) had evidence of TB disease, hence excluded. Of 414 contacts put on IPT, 368 (88.8%) completed the 1 year follow-up. Operational challenges were reported by 258(70%) households, while 82(22%) reported side effects. Good compliance was documented in 89% (CI:80.2-96.2). By endpoint, 6(1.6%) contacts developed evidence of new TB disease and required definitive anti-tuberculosis therapy. The main factor associated with IPT failure was under-nutrition of contacts (p = 0.023). Under-nutrition was associated with IPT failure for child contacts below 5 years in high burden, resource limited settings. IPT effectiveness could be optimized through nutrition support of contacts.

  17. Failure of impedance monitoring to prevent adverse clinical events caused by fracture of a recalled high-voltage implantable cardioverter-defibrillator lead.

    PubMed

    Kallinen, Linda M; Hauser, Robert G; Lee, Ken W; Almquist, Adrian K; Katsiyiannis, William T; Tang, Chuen Y; Melby, Daniel P; Gornick, Charles C

    2008-06-01

    The Medtronic Sprint Fidelis implantable cardioverter-defibrillator high-voltage lead is prone to fracture. The October 2007 safety advisory recommended lead impedance monitoring to aid in identifying lead fractures. The aim of this single-center study was to examine the effectiveness of impedance monitoring for detecting Sprint Fidelis lead failures before they caused adverse clinical events such as inappropriate shocks. Impedance and sensing information were acquired during routine clinic and CareLink follow-up and at the time of lead failure using the Patient Alert, sensing integrity counter, nonsustained episode, and electrogram features in Medtronic pulse generators. Between September 2004 and February 2008, 17 of 514 Sprint Fidelis leads (3.3%) followed up at our center failed between 11 and 35 months after implantation (mean 23.0 +/- 8.0 months). Fifteen of these failures (88%) were caused by pace-sense conductor fractures, and 2 (12%) were caused by high-voltage conductor defects. Twelve of 15 patients (80%) with pace-sense conductor fractures received inappropriate shocks; of these, 4 had no significant increase in lead impedance before they were shocked, 2 were shocked <3 hours after their lead impedances exceeded the 1,000 Omega audible alert threshold, and 2 patients did not hear the alarm. All pace-sense conductor failures whose sensing function could be evaluated (13 of 15) had oversensing based on stored data, and oversensing usually (11 of 13) preceded impedances changes. Impedance monitoring did not prevent inappropriate shocks in two-thirds of our patients. Thus, pace-sense conductor impedance monitoring as currently implemented does not reliably forewarn patients of a lead malfunction. Consequently, patients who have Sprint Fidelis leads remain at risk for adverse clinical events associated with pace-sense conductor fracture.

  18. [Failure to Attend Child Preventive Examination as a Possible Indication of Risk to Children's Welfare: Retrospective Analysis of 605 Cases Reported to the Child Protection Services].

    PubMed

    Hock, S; Graul, C; Herb, S; Nötzel, G; Kieslich, M

    2017-04-01

    Objective: The extent to which childrens's welfare is compromised when they do not attend compulsory prevention medical check-ups is yet to be determined. Together with the Hessen Prevention Center for Children (Hessisches Kindervorsorgezentrum), the Child Protection Services in the Main-Taunus district have conducted a study to investigate failure to attend child preventive examinations as a possible indication of risk to the welfare of such children. Method: 605 notifications of child preventive examinations that were not carried out, sent in 2012 to the Child Protection Services by the Hessen Prevention Center for Children, were analyzed retrospectively. Each case was recorded using a standardized questionnaire and, cases that were passed on to General Social Services within Child Protection Services were investigated with an additional interview with the employee responsible. Results: In 60 (10%) cases there was no certificate to show that the check-up had been conducted, while in 165 (27%) cases the check-up was conducted late, i. e. only after being contacted by the Child Protection Services. In 9 of the 605 cases (1.5%), the families involved were already known to Child Protection Services due to previous proceedings against them under endangering children's welfare act (known as § 8a cases). No new case of a risk to children's welfare was detected. In 58 cases, families gave reasons for the missed or late check-up. Reasons included being abroad and moving house (20 cases), forgetting (14 cases) and illness (11 cases), as well as lack of knowledge of the law (6 cases), lack of health insurance (4 cases), lack of language skills (2 cases) and objection to the law in principle (1 case). It was notable that, in 57% of the cases notified, documentary evidence could be provided by the end of the case work that the check-up had taken place within the recommended period (including additional discretionary period). The majority of these notifications of failure

  19. The immigrant Haitian mother: transcultural nursing perspective on preventive health care for children.

    PubMed

    DeSantis, L; Thomas, J T

    1990-01-01

    Thirty immigrant Haitian mothers in Southeast Florida were interviewed regarding their beliefs and practices about preventive health care (illness prevention and health maintenance measures) for infants and preschool children (up to age 5). All mothers used preventive health care measures from both the Western biomedical and traditional Haitian ethnomedical (folk) systems. Ninety-seven percent used magico-religious measures; 47% administered home remedies; 47% gave children over-the-counter drugs; and 35% utilized a variety of measures to ensure cold air did not enter neonates and cause illness or pain. The Haitian mothers considered the preventive health care measures effective because the children remained healthy and will likely use them again. They sought consultation from a variety of individuals who formed their health management groups and child caretaker networks. Infants and toddlers were considered at higher risk than newborns for illness due to "evil harm" inflicted by other people and/or voodoo spirits. Implications for transcultural nursing practice include developing community outreach programs, implementing nursing interventions that combine biomedical and ethnomedical preventive health care measures, and functioning as part of the health management group. The authors wish to thank Maude Vincent, R.N., for her assistance in data gathering and analysis.

  20. Primary prevention of beta-cell autoimmunity and type 1 diabetes – The Global Platform for the Prevention of Autoimmune Diabetes (GPPAD) perspectives

    PubMed Central

    Ziegler, A.G.; Danne, T.; Dunger, D.B.; Berner, R.; Puff, R.; Kiess, W.; Agiostratidou, G.; Todd, J.A.; Bonifacio, E.

    2016-01-01

    Objective Type 1 diabetes can be identified by the presence of beta-cell autoantibodies that often arise in the first few years of life. The purpose of this perspective is to present the case for primary prevention of beta-cell autoimmunity and to provide a study design for its implementation in Europe. Methods We examined and summarized recruitment strategies, enrollment rates, and outcomes in published TRIGR, FINDIA and BABYDIET primary prevention trials, and the TEDDY intensive observational study. A proposal for a recruitment and implementation strategy to perform a phase II/III primary prevention randomized controlled trial in infants with genetic risk for developing beta-cell autoimmunity is outlined. Results Infants with a family history of type 1 diabetes (TRIGR, BABYDIET, TEDDY) and infants younger than age 3 months from the general population (FINDIA, TEDDY) were enrolled into these studies. All studies used HLA genotyping as part of their eligibility criteria. Predicted beta-cell autoimmunity risk in the eligible infants ranged from 3% (FINDIA, TEDDY general population) up to 12% (TRIGR, BABYDIET). Amongst eligible infants, participation was between 38% (TEDDY general population) and 97% (FINDIA). Outcomes, defined as multiple beta-cell autoantibodies, were consistent with predicted risks. We subsequently modeled recruitment into a randomized controlled trial (RCT) that could assess the efficacy of oral insulin treatment as adapted from the Pre-POINT pilot trial. The RCT would recruit infants with and without a first-degree family history of type 1 diabetes and be based on general population genetic risk testing. HLA genotyping and, for the general population, genotyping at additional type 1 diabetes susceptibility SNPs would be used to identify children with around 10% risk of beta-cell autoimmunity. The proposed RCT would have 80% power to detect a 50% reduction in multiple beta-cell autoantibodies by age 4 years at a two-tailed alpha of 0.05, and

  1. Primary prevention of beta-cell autoimmunity and type 1 diabetes - The Global Platform for the Prevention of Autoimmune Diabetes (GPPAD) perspectives.

    PubMed

    Ziegler, A G; Danne, T; Dunger, D B; Berner, R; Puff, R; Kiess, W; Agiostratidou, G; Todd, J A; Bonifacio, E

    2016-04-01

    Type 1 diabetes can be identified by the presence of beta-cell autoantibodies that often arise in the first few years of life. The purpose of this perspective is to present the case for primary prevention of beta-cell autoimmunity and to provide a study design for its implementation in Europe. We examined and summarized recruitment strategies, enrollment rates, and outcomes in published TRIGR, FINDIA and BABYDIET primary prevention trials, and the TEDDY intensive observational study. A proposal for a recruitment and implementation strategy to perform a phase II/III primary prevention randomized controlled trial in infants with genetic risk for developing beta-cell autoimmunity is outlined. Infants with a family history of type 1 diabetes (TRIGR, BABYDIET, TEDDY) and infants younger than age 3 months from the general population (FINDIA, TEDDY) were enrolled into these studies. All studies used HLA genotyping as part of their eligibility criteria. Predicted beta-cell autoimmunity risk in the eligible infants ranged from 3% (FINDIA, TEDDY general population) up to 12% (TRIGR, BABYDIET). Amongst eligible infants, participation was between 38% (TEDDY general population) and 97% (FINDIA). Outcomes, defined as multiple beta-cell autoantibodies, were consistent with predicted risks. We subsequently modeled recruitment into a randomized controlled trial (RCT) that could assess the efficacy of oral insulin treatment as adapted from the Pre-POINT pilot trial. The RCT would recruit infants with and without a first-degree family history of type 1 diabetes and be based on general population genetic risk testing. HLA genotyping and, for the general population, genotyping at additional type 1 diabetes susceptibility SNPs would be used to identify children with around 10% risk of beta-cell autoimmunity. The proposed RCT would have 80% power to detect a 50% reduction in multiple beta-cell autoantibodies by age 4 years at a two-tailed alpha of 0.05, and would randomize around 1160

  2. Creating social norm change to prevent VAW and HIV: a programmatic perspective from Uganda.

    PubMed

    Chadwick, Katy

    2016-05-01

    There has been an increased emphasis on evidence based programming for violence prevention in recent years, although research on what works to prevent violence is still an emerging field. There are also important lessons emerging from practice. The experience of Raising Voices in Uganda is that using community mobilization programming can help to shift entrenched norms, attitudes and behaviours. A recent randomised control trial evidenced some of these changes and whilst this research has been key to developing the approach, it is also essential that we continue to be informed by the voices of community members and activists. As we continue to build the evidence base on what works to prevent violence, the field needs to ensure that we place the experiences and ideas of the community at the center of our interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Uterine prolapse prevention in Eastern Nepal: the perspectives of women and health care professionals

    PubMed Central

    Radl, Christina M; Rajwar, Ranjita; Aro, Arja R

    2012-01-01

    Uterine prolapse is a major reproductive health issue in Nepal. There is a wide range of literature available on the causes and risk factors of uterine prolapse and on the ways to prevent and treat it. There is still a lack of published evidence on what prevention and treatment services are working well or the attitudes toward them. This paper presents the findings of a qualitative study on primary and secondary prevention of uterine prolapse in Eastern Nepal. Method The study involved eight focus group discussions with 71 women in six villages of the eastern districts of Siraha and Saptari and 14 qualitative interviews with health professionals from the local to central level. The group discussions and interviews covered the awareness levels of uterine prolapse and its prevention and treatment, as well as participants’ opinions on and experiences with the services offered. Results It was found that patriarchy, gender discrimination, and cultural traditions such as early marriage and pregnancy make it difficult for people to discontinue uterine prolapse risk behaviors. Women are aware of risk factors, prevention, and treatment, but are powerless to change their situations. Health professionals and women are fond of surgery as treatment, but opinions on the use of ring pessaries and pelvic floor muscle training are split. Conclusion The main recommendation that can be drawn from this study is that research on the effectiveness of early treatments, such as ring pessaries and exercise, should be conducted. Furthermore, the involvement of other target groups (husbands, adolescents, and mothers-in-law) needs to be increased in order to make it easier for women to adapt low-risk behaviors. Finally, uterine prolapse prevention should be better integrated in national reproductive health services. Enforcing transparency, monitoring systems, and collaborations are important factors that should be considered as well. PMID:22927768

  4. A fresh perspective from immunologists and vaccine researchers: Active vaccination strategies to prevent and reverse Alzheimer’s disease

    PubMed Central

    Agadjanyan, M.G.; Petrovsky, N.; Ghochikyan, A.

    2015-01-01

    Traditional vaccination against infectious diseases relies on generation of cellular and humoral immune responses that act to protect the host from overt disease even although they do not induce sterilizing immunity. More recently, attempts have been made with mixed success to generate therapeutic vaccines against a wide range of non-infectious diseases including neurodegenerative disorders. Following the exciting first report of successful vaccine prevention of progression of an AD animal model in 1999, various epitope-based vaccines targeting beta-amyloid (Aβ) have proceeded to human clinical trials, with varied results. More recently, AD vaccines based on tau protein have advanced into clinical testing too. This review seeks to put perspective to the mixed results obtained so far in clinical trials of AD vaccines, and discuss the many pitfalls and misconceptions encountered on the path to a successful AD vaccine, including better standardization of immunological efficacy measures of antibodies, immunogenicity of platform/carrier and adjuvants. PMID:26192465

  5. Towards a shared understanding: Perspectives from Toronto's first media forum for suicide prevention.

    PubMed

    Sinyor, Mark; Pirkis, Jane; Picard, André; McKeown, David; Vincent, Margaret; Cheung, Christian; Schaffer, Ayal; Fordham, Jan; Mishaiel, Rosie; Heisel, Marnin

    2016-10-20

    Media reporting on suicide may have harmful and/or protective effects on deaths by suicide, depending on the nature of the coverage. Canada's first forum on this important issue was held in Toronto on November 6, 2015. Participating in the forum were public health policy-makers, mental health and suicide prevention experts and senior media representatives. This commentary summarizes the content of the forum and highlights the need for ongoing collaboration between suicide prevention experts and media professionals aimed at safe and respectful reporting that maintains the public's need to be informed.

  6. No-reflow phenomenon: pathophysiology, diagnosis, prevention, and treatment. A review of the current literature and future perspectives.

    PubMed

    Galasso, Gennaro; Schiekofer, Stephan; D'Anna, Carolina; Gioia, Giuseppe Di; Piccolo, Raffaele; Niglio, Tullio; Rosa, Roberta De; Strisciuglio, Teresa; Cirillo, Plinio; Piscione, Federico; Trimarco, Bruno

    2014-03-01

    No-reflow is responsible for 40% of the primary percutaneous coronary intervention without complete myocardial reperfusion despite successful reopening of the infarct-related artery. This review describes the main pathophysiological mechanisms of no-reflow, its clinical manifestation, including the strong association with increased in-hospital mortality, malignant arrhythmias, and cardiac failure as well as the diagnostic methods. The latter ranges from simple angiographic thrombolysis in myocardial infarction grade score to more complex angiographic indexes, imaging techniques such as myocardial contrast echo or cardiac magnetic resonance, and surrogate clinical end points such as ST-segment resolution. This review also summarizes the strategies of prevention and treatment of no-reflow, considering the most recent studies results regarding medical therapy and devices.

  7. Lifestyle Determinants on Prevention and Improvement of Dry Eye Disease from the Perspective of Iranian Traditional Medicine.

    PubMed

    Haji-Ali-Nili, Neda; Khoshzaban, Fariba; Karimi, Mehrdad

    2016-05-01

    Dry eye disease is one of the most common public health problems in the field of ophthalmology that causes decreased physical, psychological, social and occupational functioning, and interferes with daily activities like reading, driving, computer work and watching TV. The effect of this disease on quality of life is similar to severe migraine and angina. In addition, the severity of the disease is closely related to depression. Outbreaks are increasing with the use of contact lenses and refractive surgery such as LASIK. The purpose of this paper is to assess the causes of dry eye and its prevention by the principles of hygiene. In this review study, traditional medicine resources like Al canon fil tibb, Sharh-al-Al Asbab and Exir-e-azam have been studied with engine motors such as Google Scholar and PubMed. From the perspective of Iranian traditional medicine, the principles of maintaining health include air, food and drink, exercise and rest, sleep and wakefulness, mental state, retention of essential materials and depletion of wastes from the body. Proper performance of each principle is useful for the prevention of disease in different organs, including the eyes. Recommendations for the prevention or treatment of dry eye disease include the prevention of dryness in the eye or the entire body. In addition, the stomach and brain are important to eye health. Accordingly, one of the most effective managements of dry eye disease is avoiding foods that affect the eye in this way; for example garlic and onion. Maintaining eye health is related to aspects of physical and mental health of the whole body. Therefore, codification of an integrated plan that contains eating and sleeping patterns, exercise, general clearing, eye clearing, and mental health is essential for treating dry eye disease.

  8. Facilitators and Barriers to Discussing HIV Prevention With Adolescents: Perspectives of HIV-Infected Parents

    PubMed Central

    Reis, Janet S.; Weber, Kathleen M.

    2013-01-01

    Objectives. We examined HIV-infected parents’ conversations about HIV prevention with their uninfected children, including what facilitated or hindered communication. Methods. Parents with HIV/AIDS (n = 90) who had children aged 10 to 18 years were recruited for a mixed method study from 2009 to 2010. Interviews assessed facilitators and barriers to discussing HIV prevention. A questionnaire identified the frequency and content of conversations, parental confidence level, and perceived importance of discussing preventive topics. Results. Eighty-one percent of parents reported “sometimes” or “often” communicating about HIV prevention. A subset of parents found these conversations difficult; 44% indicated their desire for support. Facilitators to communication included utilizing support, focusing on the benefits of talking, and having a previous relationship with one’s child. Barriers to discussions included fear of negative consequences, living in denial, and lacking a parental role model who discussed safer sex. Parents varied as to how they believed their HIV status affected communication. Those who did not disclose their HIV status to their children reported less frequent communication; self-efficacy partially mediated this relationship. Conclusions. Findings highlighted the need for communication skills training that support HIV-infected parents in their efforts to discuss HIV-related information with adolescents. PMID:23763390

  9. Bystander Education: Bringing a Broader Community Perspective to Sexual Violence Prevention

    ERIC Educational Resources Information Center

    Banyard, Victoria L.; Plante, Elizabethe G.; Moynihan, Mary M.

    2004-01-01

    Recent research documents the problem of sexual violence across communities, often finding its causes to be embedded in community and cultural norms, thus demonstrating the need for community-focused solutions. In this article we synthesize research from community psychology on community change and prevention with more individually focused studies…

  10. Indian students' perspectives on obesity and school-based obesity prevention: a qualitative examination.

    PubMed

    Riggs, Nathaniel; Tewari, Abha; Stigler, Melissa; Rodrigues, Lindsay; Arora, Monika; Khubchandani, Jagdish; Simmons, Rob; Pentz, Mary Ann

    2013-11-01

    Childhood obesity has recently been reported as a growing problem in low- and middle-income countries. One potential prevention strategy is to apply effective obesity prevention approaches from the United States and/or other Western countries into programs that can be implemented in developing countries such as India. The purpose of this study was to explore Indian students' perceptions of social-contextual factors related to obesity and whether they perceived a role for school-based obesity prevention. This study was conducted as a first step in a model to translate interventions from one culture to another. A total of 183 fourth- and fifth-grade students of middle socioeconomic status participated in focus group discussions. Analyses were guided by the essential principles of qualitative research and informed by social cognitive and social ecological theories. Results yielded five relevant themes: (a) student health behavior knowledge, (b) parental influence on health behavior, (c) school influence on health behavior, (d) media influence on health behavior, and (e) contexts for health promotion intervention. We found that students had moderate knowledge related to health behaviors (i.e., food intake and physical activity); that parents, schools, and the media are all important contributors to healthy and unhealthy behavior; and that schools can play an important role in the prevention of obesity. Results suggest that Indian middle socioeconomic status students are already moderately aware of the health benefits to nutritious food intake and physical activity, but parents, schools, and the media can influence unhealthy behaviors.

  11. First-Year Students' Perspectives on Reasons for and Prevention of Their Own Alcohol Overdose

    ERIC Educational Resources Information Center

    Reis, Janet

    2014-01-01

    Two hundred twenty-six first-year students enrolled at a large, public Midwest university and deemed to require an emergency transport for a potential alcohol overdose completed a brief questionnaire on the student's perceptions of why the event occurred, what might have happened to prevent the overdose situation, and personal assessment of…

  12. Cross-National Perspectives on Early Adolescence: Implications and Strategies for Public Health Prevention and Interventions

    ERIC Educational Resources Information Center

    Swahn, Monica H.

    2012-01-01

    The current special issue brings together intriguing and important cross-country comparisons of issues pertinent to early adolescence that can inform the design and implementation of broader and relevant public health prevention strategies. The findings illustrate the importance of cross-country analyses for better understanding a range of…

  13. First-Year Students' Perspectives on Reasons for and Prevention of Their Own Alcohol Overdose

    ERIC Educational Resources Information Center

    Reis, Janet

    2014-01-01

    Two hundred twenty-six first-year students enrolled at a large, public Midwest university and deemed to require an emergency transport for a potential alcohol overdose completed a brief questionnaire on the student's perceptions of why the event occurred, what might have happened to prevent the overdose situation, and personal assessment of…

  14. Substance abuse prevention in Cape Town's peri-urban settlements: local health trainers' perspectives

    PubMed Central

    Puljević, Cheneal; Learmonth, Despina

    2014-01-01

    South Africa currently experiences high levels of alcohol and other drug (AOD) abuse. As a result there is a need for the initiation of regional AOD abuse prevention programmes with a specific focus on youth prevention strategies. The Medical Knowledge Institute (MKI) is a non-profit organisation which develops and facilitates health information workshops to members of disadvantaged peri-urban communities in South Africa. This research investigated the views of eight local MKI health trainers on factors contributing to AOD abuse in their communities. Although the expected focus of the discussion was on prevention strategies and effective interventions, the trainers placed more emphasis on the individual and community factors influencing AOD abuse. The themes which emerged through the research included: status, government, (di)stress, gender, recreation, consequences and community. This research holds significance as it has the potential to assist further development of community-based AOD prevention workshops and to guide public health policy and service development for AOD abuse. PMID:25750776

  15. A Preventative Model of School Consultation: Incorporating Perspectives from Positive Psychology

    ERIC Educational Resources Information Center

    Akin-Little, K. Angeleque; Little, Steven G.; Delligatti, Nina

    2004-01-01

    Using the principles of mental health and behavioral consultation, combined with concepts from positive psychology, this paper generates a new preventative model of school consultation. This model has two steps: (1) the school psychologist aids the teacher in the development and use of his/her personal positive psychology (e.g., optimism,…

  16. Prevention of type 2 diabetes in young people: a theoretical perspective.

    PubMed

    Huang, Terry T; Goran, Michael I

    2003-03-01

    Type 2 diabetes in youth is an increasing public health concern, especially in certain minority populations. The current paper consists of four sections. First, we establish the significance of the problem by presenting an overview of epidemiological and physiological evidence. Second, we discuss behavioral issues relevant to the prevention of type 2 diabetes in youth. Third, a qualitative review of existing prevention interventions specific to type 2 diabetes in youth is presented. Results suggest that modest improvements in social cognitive, dietary, and exercise outcomes are possible with diabetes intervention studies, although beneficial changes are difficult to sustain over the long term. Although theoretical frameworks are not always explicit, most studies have utilized elements of the social cognitive theory. Less attention has been paid to sociocultural and community organization variables. Finally, the paper discusses issues of risk definition and intervention sustainability, and presents a comprehensive, theoretically diverse model for the prevention of type 2 diabetes in youth. In summary, we suggest that theories of the natural history and pathophysiology of type 2 diabetes are important to identify modifiable risk factors, while theories of behavioral change are essential to modify the risk factors identified. The combination of sound physiological and behavioral theories should form the basis of prevention intervention design. In addition, an ecologic approach that takes into consideration the dynamic interactions of personal, social, and environmental factors would best promote the long-term adoption of healthful behaviors in a supportive, meaningful, and personally enjoyable context.

  17. A Preventative Model of School Consultation: Incorporating Perspectives from Positive Psychology

    ERIC Educational Resources Information Center

    Akin-Little, K. Angeleque; Little, Steven G.; Delligatti, Nina

    2004-01-01

    Using the principles of mental health and behavioral consultation, combined with concepts from positive psychology, this paper generates a new preventative model of school consultation. This model has two steps: (1) the school psychologist aids the teacher in the development and use of his/her personal positive psychology (e.g., optimism,…

  18. [The planning of prevention in Italy: the perspective of the university].

    PubMed

    Villari, Paolo; Rosso, Annalisa; De Vito, Corrado; Marzuillo, Carolina

    2014-01-01

    The Department of Public Health and Infectious Diseases of Sapienza University of Rome conducted a critical appraisal of Regional Prevention Plans (RPPs) 2010-2012 aimed at exploring different quality elements of the RPPs, including the coherence with the epidemiological context and with regional health planning, the degree of attention to specific public health issues, the adherence to the principles of Project Cycle Management (PCM) and Evidence-Based Prevention (EBP), as well as at analyzing possible determinants of the quality of RPPs, such as the influence of Recovery Plans. A grid analysis evidence-based was use to conduct, for the two RPPs areas (i.e. strategic and operative planning): 1. the descriptive analysis of RPPs; 2. the analysis of the projects included in RPPs. The analysis showed some strengths and weaknesses in the prevention planning process, including a low adherence to the principles of EBP and a low degree of attention towards the reduction of health inequalities. Furthermore, projects developed by Regions with recovery plans showed a lower quality. The role of the University in the ongoing evaluation of the planning process, but also in monitoring the health status of the population, with particular attention to regional differences, can be crucial to support regional capacity building in prevention planning.

  19. A Media Campaign Prevention Program for Child Sexual Abuse: Community Members' Perspectives

    ERIC Educational Resources Information Center

    Self-Brown, Shannon; Rheingold, Alyssa A.; Campbell, Carole; de Arellano, Michael A.

    2008-01-01

    This study examines the face validity and feasibility of materials included in a multimedia child sexual abuse (CSA) prevention campaign. A quantitative survey method assessed participants' comfort level, knowledge gain, and likelihood of behavioral change in response to the media campaign. Furthermore, a focus group method explored participants'…

  20. Prevalence, consequences and prevention of childhood nutritional iron deficiency: a child public health perspective.

    PubMed

    Moy, R J D

    2006-10-01

    The true extent of nutritional iron deficiency (ID) in childhood is unclear because of uncertainty over its definition and the insensitivity of markers of ID. The major cause is likely to be the excessive and early use of cow's milk. Recent neurophysiological observations support the many field studies correlating ID with cognitive developmental delays. Prevention is best sought through supplementation of essential foods.

  1. Animal Models and “Omics” Technologies for Identification of Novel Biomarkers and Drug Targets to Prevent Heart Failure

    PubMed Central

    Hou, Yunlong; Adrian-Segarra, Juan M.; Richter, Manfred; Kubin, Natalia; Shin, Jaeyoung; Werner, Isabella; Walther, Thomas; Schönburg, Markus; Pöling, Jochen; Warnecke, Henning; Braun, Thomas; Kostin, Sawa; Kubin, Thomas

    2015-01-01

    It is now accepted that heart failure (HF) is a complex multifunctional disease rather than simply a hemodynamic dysfunction. Despite its complexity, stressed cardiomyocytes often follow conserved patterns of structural remodelling in order to adapt, survive, and regenerate. When cardiac adaptations cannot cope with mechanical, ischemic, and metabolic loads efficiently or become chronically activated, as, for example, after infection, then the ongoing structural remodelling and dedifferentiation often lead to compromised pump function and patient death. It is, therefore, of major importance to understand key events in the progression from a compensatory left ventricular (LV) systolic dysfunction to a decompensatory LV systolic dysfunction and HF. To achieve this, various animal models in combination with an “omics” toolbox can be used. These approaches will ultimately lead to the identification of an arsenal of biomarkers and therapeutic targets which have the potential to shape the medicine of the future. PMID:26236717

  2. Lack of current implantable cardioverter defibrillator guidelines application for primary prevention of sudden cardiac death in Latin American patients with heart failure: a cross-sectional study.

    PubMed

    Gonzalez-Zuelgaray, Jorge; Pellizon, Oscar; Muratore, Claudio A; Oropeza, Elsa Silva; Rabinovich, Rafael; Ramos, José Luis; Tentori, Maria Cristina; Reyes, Nicolás; Aguayo, Rubén; Marin, Jorge; Peterson, Brett J

    2013-02-01

    This cross-sectional study evaluated the application of accepted international implantable cardioverter defibrillator (ICD) guidelines for primary prevention of sudden cardiac death in patients with heart failure. The PLASMA (Probabilidad de Sufrir Muerte Arritmica) study was designed to characterize management of cardiac patients in Latin America. Twelve centres included 1958 consecutively admitted patients in cardiology units in 2008 and 2009. Discharged patients were evaluated for primary prevention, ICD indication and prescription by general cardiologists. Of 1711 discharged patients, 1525 (89%) had data available for evaluating indication status. Class I indications for ICD therapy were met for 153 (10%) patients based on collected data. Only 20 (13%, 95% confidence interval: 7.7-18.4%) patients with indication were prescribed an ICD. Patients prescribed an ICD were younger than patients who were not prescribed an ICD (62 vs. 68 years, P < 0.01). The reasons given by cardiologists for not prescribing an ICD for 133 patients with an indication were: indication criteria not met (75%), life expectancy <1 year (9.7%), rejection by the patient (5.2%), no medical coverage paying for the device (3.7%), psychiatric patient (2.2%), and other reasons (4.2%). In Latin America, international guidelines for primary prevention ICD implantation are not well followed. The main reason is that cardiologists believe that patients do not meet indication criteria, even though study data confirm that criteria are met. This poses a significant challenge and underlines the importance of continuous and improved medical education.

  3. Predicting outflow induced by moraine failure in glacial lakes: the Lake Palcacocha case from an uncertainty perspective

    NASA Astrophysics Data System (ADS)

    Rivas, D. S.; Somos-Valenzuela, M. A.; Hodges, B. R.; McKinney, D. C.

    2015-06-01

    Moraine dam collapse is one of the causes of glacial lake outburst floods. Available models seek to predict both moraine breach formation and lake outflow. The models depend on hydraulic, erosion, and geotechnical parameters that are mostly unknown or uncertain. This paper estimates the outflow hydrograph caused by a potential erosive collapse of the moraine dam of Lake Palcacocha in Peru and quantifies the uncertainty of the results. The overall aim is to provide a simple yet hydraulically robust approach for calculating the expected outflow hydrographs that is useful for risk assessment studies. To estimate the peak outflow and failure time of the hydrograph, we assessed several available empirical equations based on lake and moraine geometries; each equation has defined confidence intervals for peak flow predictions. Complete outflow hydrographs for each peak flow condition were modeled using a hydraulic simulation model calibrated to match the peak flows estimated with the empirical equations. Failure time and peak flow differences between the simulations, and the corresponding empirical equations were used as error parameters. Along with an expected hydrograph, lower and upper bound hydrographs were calculated for Lake Palcacocha, representing the confidence interval of the results. The approach has several advantages: first, it is simple and robust. Second, it evaluates the capability of empirical equations to reproduce the conditions of the lake and moraine dam. Third, this approach accounts for uncertainty in the hydrographs estimations, which makes it appropriate for risk management studies.

  4. Predicting outflow induced by moraine failure in glacial lakes: the Lake Palcacocha case from an uncertainty perspective

    NASA Astrophysics Data System (ADS)

    Rivas, D. S.; Somos-Valenzuela, M. A.; McKinney, D. C.; Hodges, B. R.

    2014-09-01

    Moraine dam collapse is one of the causes of Glacier Lake Outburst Floods. Available models seek to predict both moraine breach formation and lake outflow. The models depend on hydraulic, erosion, and geotechnical parameters that are mostly unknown or uncertain. This paper estimates the outflow hydrograph caused by a potential collapse of the moraine dam of Lake Palcacocha in Peru and quantifies the uncertainty of the results. The overall aim is to provide a simple and robust method of calculation of the expected outflow hydrographs that is useful for risk assessment studies. To estimate the peak outflow and failure time of the hydrograph, we assessed several available empirical equations based on lake and moraine geometries; each equation has defined confidence intervals for peak flow predictions. Complete outflow hydrographs for each peak flow condition were modeled using a~hydraulic simulation model calibrated to meet the peak flows estimated with the empirical equations. Failure time and peak flow differences between the simulations and the corresponding empirical equations were used as error parameters. Along with an expected hydrograph, lower and upper bound hydrographs were calculated for Lake Palcacocha, representing the confidence interval of the results. The method has several advantages: first, it is simple and robust. Second, it evaluates the capability of empirical equations to reproduce the conditions of the lake and moraine dam. Third, this method accounts for uncertainty in the hydrographs estimations, which makes it appropriate for risk management studies.

  5. The Prevention of the Workplace Harassment at Japanese Universities:The Perspective of the Research and the Findings from the Complete Count Survey

    ERIC Educational Resources Information Center

    Kawabata, Tomoko

    2014-01-01

    This article shows the perspective of this research and the result of the complete count survey performed from October to November in 2013 to examine the attitude toward the prevention and the resolution of the workplace harassment at the Japanese universities. The questionnaire was distributed to 1131 universities, two years colleges, and…

  6. The Prevention of the Workplace Harassment at Japanese Universities:The Perspective of the Research and the Findings from the Complete Count Survey

    ERIC Educational Resources Information Center

    Kawabata, Tomoko

    2014-01-01

    This article shows the perspective of this research and the result of the complete count survey performed from October to November in 2013 to examine the attitude toward the prevention and the resolution of the workplace harassment at the Japanese universities. The questionnaire was distributed to 1131 universities, two years colleges, and…

  7. Use of Q Methodology to Analyze Divergent Perspectives on Participatory Action Research as a Strategy for HIV/AIDS Prevention Among Caribbean Youth

    ERIC Educational Resources Information Center

    Goto, Keiko; Tiffany, Jennifer; Pelto, Gretel; Pelletier, David

    2008-01-01

    This study used Q methodology to examine perspectives regarding participatory action research (PAR) among participants in a UNICEF initiative aimed at enhancing HIV/AIDS prevention among youth in the Caribbean. We interviewed 20 youth PAR researchers and 12 project managers from youth organizations about their attitudes and experiences. Statements…

  8. Germ-line gene modification and disease prevention: some medical and ethical perspectives.

    PubMed

    Wivel, N A; Walters, L

    1993-10-22

    There has been considerable debate about the ethics of human germ-line gene modification. As a result of recent advances in the micromanipulation of embryos and the laboratory development of transgenic mice, a lively discussion has begun concerning both the technical feasibility and the ethical acceptability of human germ-line modification for the prevention of serious disease. This article summarizes some of the recent research on germ-line gene modification in animal models. Certain monogenic deficiency diseases that ultimately might be candidates for correction by germ-line intervention are identified. Several of the most frequently considered ethical issues relative to human germ-line gene modification are considered in the context of professional ethics, parental responsibility, and public policy. Finally, it is suggested that there is merit in continuing the discussion about human germ-line intervention, so that this technique can be carefully compared with alternative strategies for preventing genetic disease.

  9. Parents as health promoters: a theory of planned behavior perspective on the prevention of childhood obesity.

    PubMed

    Andrews, Kyle R; Silk, Kami S; Eneli, Ihuoma U

    2010-01-01

    Childhood obesity is a significant problem in the United States. A number of communication campaigns and interventions have been conducted to combat the problem, with parents being recognized as an important target audience. A critical aspect of involving parents in such campaigns is formative research on parents' perceptions of their role in preventing childhood obesity. To facilitate this process, a study was conducted in which parents (N = 201) responded to Theory of Planned Behavior (TPB) survey items as they relate to providing healthy foods and limiting unhealthy foods for their children. Results indicated support for TPB predictions. Additionally, the degree to which parents viewed providing healthy foods and limiting unhealthy foods as effective in preventing obesity (response efficacy) was predictive of parent tracking of children's unhealthy eating behavior. Finally, parent TV viewing behavior was related to perceived response efficacy of limiting children's TV viewing hours. Practical implications for communication practitioners are discussed.

  10. [Perspectives of prevention of postoperative neuropathic pain syndrome in cancer patients].

    PubMed

    Osipova, N A; Petrova, V V; Abuzarova, G R; Edeleva, N V; Belov, A V

    2005-01-01

    The paper deals with the anesthesiological problems in the prevention and therapy of neuropathic pain syndrome (NPS), including phantom pain syndrome (PPS) at different stages of surgical treatment in a cancer patient. A prospective study has been conducted; a protocol has been elaborated for the management of patients with preoperative chronic pain syndrome and those at a high risk for NPS after cancer operations associated with damage to nerve structures. A clinical case of successful therapy for severe NPS in a female patient after 4 surgical interventions, including exarticulation of the upper limb, is described. The undertaken prevention of NPS and its treatment policy that is based on the current views of the mechanisms responsible for this type of pain and included, in addition to opioid analgesics, different types of antineuropathic agents, including the recent generation anticonvulsant gabapentin (neurontin), are analyzed and investigated in detail.

  11. The role of public schools in HIV prevention: perspectives from African Americans in the rural South.

    PubMed

    Lloyd, Stacey W; Ferguson, Yvonne Owens; Corbie-Smith, Giselle; Ellison, Arlinda; Blumenthal, Connie; Council, Barbara J; Youmans, Selena; Muhammad, Melvin R; Wynn, Mysha; Adimora, Adaora; Akers, Aletha

    2012-02-01

    Though African-American youth in the South are at high risk for HIV infection, abstinence until marriage education continues to be the only option in some public schools. Using community-based participatory research methods, we conducted 11 focus groups with African-American adults and youth in a rural community in North Carolina with high rates of HIV infection with marked racial disparities. Focus group discussions explored participant views on contributors to the elevated rates of HIV and resources available to reduce transmission. Participants consistently identified the public schools' sex education policies and practices as major barriers toward preventing HIV infection among youth in their community. Ideas for decreasing youth's risk of HIV included public schools providing access to health services and sex education. Policymakers, school administrators, and other stakeholders should consider the public school setting as a place to provide HIV prevention education for youth in rural areas.

  12. Violent and aggressive behaviors in youth: a mental health and prevention perspective.

    PubMed

    Osofsky, H J; Osofsky, J D

    2001-01-01

    Aggressive behavior and violence leading to disciplinary and legal difficulties have reached epidemic proportions among our youth. The severity of problems and social and economic costs to society have increased markedly. In this article, the authors review the risk factors, situational concerns, and warning signs that are important in predicting school violence and in designing effective prevention and early intervention efforts. They then describe programs with which they are involved as mental health professionals that appear to be extremely promising and applicable to other communities. The prevention and intervention programs are distinctive in that they involve collaborations with law enforcement, including the police and criminal sheriff, and the juvenile court as well as parents and schools in their efforts to promote positive development. These clinical, educational, and public policy approaches offer mental health professionals increased opportunities to be of help in this critical area.

  13. Strategies for the prevention of stigma in psychiatry: Perspectives on local Psychiatric Rehabilitation.

    PubMed

    Amorosi, Marilisa

    2014-11-01

    The author, along the many years of her experience about psychiatric clinical cases on the community work, has acquired expertise in the field psychiatric rehabilitation and prevention of psychological discomfort or psychiatric disorder. Particular attention she and har team have always put the issue ok killing of the stigma and prejudice about mental illness, also through an invilment of the general populazion, school and etc. Her Experiences has shown that all of the strategies, as well as drug therapies and psycoterapies, improve recovery.

  14. Using social networks to understand and prevent substance use: a transdisciplinary perspective.

    PubMed

    Valente, Thomas W; Gallaher, Peggy; Mouttapa, Michele

    2004-01-01

    We review findings from research on smoking, alcohol, and other drug use, which show that the network approaCh is instructive for understanding social influences on substance use. A hypothetical network is used throughout to illustrate different network findings and provide a short glossary of terms. We then describe how network analysis can be used to design more effective prevention programs and to monitor and evaluate these programs. The article closes with a discussion of the inherent transdisciplinarity of social network analysis.

  15. Risk factors for miscarriage from a prevention perspective: a nationwide follow-up study.

    PubMed

    Feodor Nilsson, S; Andersen, P K; Strandberg-Larsen, K; Nybo Andersen, A-M

    2014-10-01

    To identify modifiable risk factors for miscarriage and to estimate the preventable proportion of miscarriages that could be attributed to these. Nationwide observational follow-up study. Denmark. Ninety-one thousand four hundred and twenty seven pregnancies included in the Danish National Birth Cohort between 1996 and 2002. Information on potentially modifiable risk factors before and during pregnancy was collected by means of computer-assisted telephone interviews and linkage with Danish registers, ensuring almost complete follow-up of pregnancy outcome. Modifiable risk factors for miscarriage were identified by multiple Cox regression analysis, which provided the background for our estimations of population attributable fractions. In all, 88,373 pregnancies had full information on all covariates and were included in this analysis. Miscarriage before 22 completed weeks of gestation. The potentially modifiable pre-pregnant risk factors associated with increased miscarriage risk were: age of 30 years or more at conception, underweight, and obesity. During pregnancy the modifiable risk factors were: alcohol consumption, lifting of >20 kg daily, and night work. We estimated that 25.2% of the miscarriages might be prevented by reduction of all these risk factors to low risk levels. Modification of risk factors acting before and during pregnancy could lead to prevention of 14.7 and 12.5%, respectively, of the miscarriages. Maternal age at conception and alcohol consumption were the most important risk factors. Miscarriage risk is increased by multiple potentially modifiable risk factors and a considerable proportion of miscarriages may be preventable. © 2014 Royal College of Obstetricians and Gynaecologists.

  16. Prevention and Treatment of Flatulence From a Traditional Persian Medicine Perspective

    PubMed Central

    Larijani, Bagher; Esfahani, Mohammad Medhi; Moghimi, Maryam; Shams Ardakani, Mohammad Reza; Keshavarz, Mansoor; Kordafshari, Gholamreza; Nazem, Esmaiel; Hasani Ranjbar, Shirin; Mohammadi Kenari, Hoorieh; Zargaran, Arman

    2016-01-01

    Context The feeling of abdominal fullness, bloating, and movement of gas in the abdomen is a very uncomfortable sensation termed flatulence. Since flatulence is one of the most common gastrointestinal symptoms that is bothersome to patients, it is important to identify effective methods to resolve this issue. In modern medicine, management of flatulence is often not satisfactory. On the other hand, traditional systems of medicine can be considered good potential sources to find new approaches for preventing and treating flatulence. The aim of this study is to review flatulence treatments from a traditional Persian medicine (TPM) viewpoint. Evidence Acquisition In this study, the reasons for flatulence and methods for its prevention and treatment are reviewed in traditional Persian medicine (TPM) texts and then related with evidence from modern medicine by searching in databases, including PubMed, Scopus, Google Scholar, and IranMedex. Results From a traditional Persian scholar viewpoint, one of the most important causes of flatulence is an incorrect manner of eating; valuable advice to correct bad eating habits will be illustrated. In addition, traditional practitioners describe some herbs and vegetables as well as herbal compounds that are effective food additives to relieve flatulence. The anti-flatulent effect of most of these herbs has been experimentally verified using modern medicine. Conclusions Attention to TPM can lead to the identification of new preventive and curative approaches to avoid and treat flatulence. In addition, Persian viewpoints from the medieval era regarding flatulence are historically important. PMID:27275398

  17. [Prevention and control of infectious diseases from a disciplinary-law perspective].

    PubMed

    van Dijk, E Ivar; Dute, Jos C J; ten Ham, Peter B G

    2015-01-01

    To gain insight into the importance for medical disciplinary courts of the collective health interest in the prevention and control of infectious diseases. Descriptive retrospective study. The electronic databases of the Dutch government gazette (Staatscourant) and the Netherlands' medical disciplinary courts were searched for disciplinary court rulings on actions and negligence in the prevention and control of infectious diseases. We found 67 verdicts relevant to our subject in the period 1995-2013. Of these 67 disciplinary hearings, 12 were filed by the Netherlands' health inspectorate, 29 by the patient and 26 by a representative or next of kin. The defendants included 31 medical specialists, 12 dentists and 11 general practitioners. The disciplinary tribunal imposed measures in 23 cases, including 5 suspensions. In the case of serious infectious diseases the disciplinary courts decide that the caregiver also has to take into account the interests of other parties than caregiver and the patient. Medical microbiologists in hospitals should even go so far as to surrender their responsibility for general patient safety, if they are unable to comply with the applicable medical guideline. It is also striking that in questions of vaccination the disciplinary court judge is inclined to put a child's health interests before parental authority. One final striking point is that the health inspectorate plays an important role as complainant in disciplinary cases concerning prevention of infection.

  18. Perspectives on HIV/AIDS epidemiology and prevention from the Eighth International Conference on AIDS.

    PubMed Central

    Castro, K G; Valdiserri, R O; Curran, J W

    1992-01-01

    The Eighth International AIDS Symposium in Amsterdam, the Netherlands, provided updated scientific and programmatic information on the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) to thousands of interested participants. As in the other scientific areas, the amount of information presented in epidemiology and prevention was overwhelming; however, the scientific progress described was steady but incremental. This commentary summarizes progress made in three selected areas that were highlighted during the meeting's scientific session and a fourth that received widespread media attention: (1) the epidemiology of HIV/AIDS in heterosexual women; (2) tuberculosis as an increasing opportunistic pathogen in HIV-infected persons; (3) prevention research, practice, and policy; and (4) preliminary reports of severe immunodeficiency in persons without evident HIV infection. In order to stem HIV transmission worldwide, a safe and effective vaccine is urgently needed. Currently, in the absence of such a vaccine, it is crucial for all of the world's communities to apply the best science-based prevention methods available. PMID:1443293

  19. Current Perspectives on Prevention of Mother-to-Child Transmission of Syphilis

    PubMed Central

    2016-01-01

    This article aims to provide an update on the prevention of mother-to-child transmission of syphilis by drawing upon some important basic concepts and reviewing the most recent literature on the diagnosis and treatment of syphilis in pregnancy. New technologies, such as automated and point-of-care immunologic tests, are shifting some paradigms, which will certainly be further investigated in the forthcoming years. This is the time to carefully evaluate traditional as well as new strategies to prevent congenital syphilis. Adverse outcomes of mother-to-child transmission of syphilis can be prevented with antenatal screening and penicillin therapy, which proved to have an excellent cost-benefit ratio even in populations with a low prevalence of syphilis. However, syphilis epidemiology is influenced by socioeconomic and cultural factors, and major challenges are faced by poor and developing countries in which the severity of the problem is extremely alarming. On the other hand, the emergence of new technologies has raised doubts about the best algorithm to be used when proper laboratory resources are available. Conditions are quite heterogeneous across populations, and some procedures should not be generalized while there is no evidence that supports some changes and while in-depth studies about local conditions are not conducted. Official organizations need to be alert in order to avoid isolated decisions and ensure that evidence-based guidelines be used in the management of syphilis in pregnancy. PMID:27081586

  20. Prevention and Treatment of Flatulence From a Traditional Persian Medicine Perspective.

    PubMed

    Larijani, Bagher; Esfahani, Mohammad Medhi; Moghimi, Maryam; Shams Ardakani, Mohammad Reza; Keshavarz, Mansoor; Kordafshari, Gholamreza; Nazem, Esmaiel; Hasani Ranjbar, Shirin; Mohammadi Kenari, Hoorieh; Zargaran, Arman

    2016-04-01

    The feeling of abdominal fullness, bloating, and movement of gas in the abdomen is a very uncomfortable sensation termed flatulence. Since flatulence is one of the most common gastrointestinal symptoms that is bothersome to patients, it is important to identify effective methods to resolve this issue. In modern medicine, management of flatulence is often not satisfactory. On the other hand, traditional systems of medicine can be considered good potential sources to find new approaches for preventing and treating flatulence. The aim of this study is to review flatulence treatments from a traditional Persian medicine (TPM) viewpoint. In this study, the reasons for flatulence and methods for its prevention and treatment are reviewed in traditional Persian medicine (TPM) texts and then related with evidence from modern medicine by searching in databases, including PubMed, Scopus, Google Scholar, and IranMedex. From a traditional Persian scholar viewpoint, one of the most important causes of flatulence is an incorrect manner of eating; valuable advice to correct bad eating habits will be illustrated. In addition, traditional practitioners describe some herbs and vegetables as well as herbal compounds that are effective food additives to relieve flatulence. The anti-flatulent effect of most of these herbs has been experimentally verified using modern medicine. Attention to TPM can lead to the identification of new preventive and curative approaches to avoid and treat flatulence. In addition, Persian viewpoints from the medieval era regarding flatulence are historically important.

  1. Application of environmental sensitivity theories in personalized prevention for youth substance abuse: a transdisciplinary translational perspective.

    PubMed

    Thibodeau, Eric L; August, Gerald J; Cicchetti, Dante; Symons, Frank J

    2016-03-01

    Preventive interventions that target high-risk youth, via one-size-fits-all approaches, have demonstrated modest effects in reducing rates of substance use. Recently, substance use researchers have recommended personalized intervention strategies. Central to these approaches is matching preventatives to characteristics of an individual that have been shown to predict outcomes. One compelling body of literature on person × environment interactions is that of environmental sensitivity theories, including differential susceptibility theory and vantage sensitivity. Recent experimental evidence has demonstrated that environmental sensitivity (ES) factors moderate substance abuse outcomes. We propose that ES factors may augment current personalization strategies such as matching based on risk factors/severity of problem behaviors (risk severity (RS)). Specifically, individuals most sensitive to environmental influence may be those most responsive to intervention in general and thus need only a brief-type or lower-intensity program to show gains, while those least sensitive may require more comprehensive or intensive programming for optimal responsiveness. We provide an example from ongoing research to illustrate how ES factors can be incorporated into prevention trials aimed at high-risk adolescents.

  2. Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure.

    PubMed

    Giordano, A; Scalvini, S; Zanelli, E; Corrà, U; Longobardi, G L; Ricci, V A; Baiardi, P; Glisenti, F

    2009-01-09

    Chronic heart failure (CHF) remains a common cause of disability, death and hospital admission. Several investigations support the usefulness of programs of disease management for improving clinical outcomes. However, the effect of home-based telemanagement programs on the rate of hospital readmission is still unclear and the cost-effectiveness ratio of such programs is unknown. The aim of the study was to determine whether a home-based telemanagement (HBT) programme in CHF patients decreased hospital readmissions and hospital costs in comparison with the usual care (UC) follow-up programme over a one-year period. Four hundred-sixty CHF patients (pts), aged 57+/-10 years were randomised to two management strategies: 230 pts to HBT programme and 230 pts to UC programme. The HBT pts received a portable device, transferring, by telephone, a one-lead trace to a receiving station where a nurse was available for interactive teleconsultation. The UC pts were referred to their primary care physicians and cardiologists. The primary objective of the study was one-year hospital readmission for cardiovascular reasons. During one-year follow-up 55 pts (24%) in HBT group and 83 pts (36%) in UC group had at least one readmission (RR=0.56; 95% CI: 0.38-0.82; p=0.01). After adjusting for clinical and demographic characteristics, the HBT group had a significantly lower risk of readmission compared with the UC group (HR=0.50, 95% CI: 0.34-0.73; p=0.01). The intervention was associated with a 36% decrease in the total number of hospital readmissions (HBT group: 91 readmissions; UC group: 142 readmissions) and a 31% decrease in the total number of episodes of hemodynamic instability (101 in HBT group vs 147 in UC group). The rate of hearth failure-related readmission was 19% (43 pts) in HBT group and 32% (73 pts) in UC group (RR=0.49, 95% [CI]: 0.31-0.76; p=0.0001). No significant difference was found on cardiovascular mortality between groups. Mean cost for hospital readmission was

  3. Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective.

    PubMed

    Finocchario-Kessler, Sarah; Wexler, Catherine; Maloba, May; Mabachi, Natabhona; Ndikum-Moffor, Florence; Bukusi, Elizabeth

    2016-06-04

    Women living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. We systematically reviewed and characterized recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa. We searched online databases a